Connective tissue grafts (CTGs) are generally viewed as the most successful technique for root coverage. The aim of this retrospective study was to assess the longterm clinical and patient-centered esthetic results of the envelope technique for CTG. Thirty-nine defects in 20 patients (22 to 57 years of age; mean 37.8 ± 11.5 years) had received CTG that had been harvested from the palate and grafted according to the envelope technique of Raetzke. Factors influencing root coverage were identified by multilevel analysis. The patients were also asked to judge the results of treatment. Follow-up examinations were performed 6 to 22 years (mean, 11.4 ± 5.4 years) after surgery. Mean baseline recession was 3.1 ± 1.3 mm (range, 1 to 6 mm). Clinical re-examination revealed mean root coverage of 89.7% ± 25.1%. In 32 of 39 defects (82%), complete root coverage was achieved. Recessions were statistically significantly reduced by a mean of 2.7 ± 1.2 mm (P .001), to a postsurgical mean of 0.4 ± 0.94 mm. Higher baseline Miller classes resulted in less favorable prognoses for complete and relative root coverage. Baseline recession height had a negative influence and location at a canine had a positive influence on the percentage of relative root coverage. All patients judged the situation at the respective teeth as improved.