Background. Biologic adjuncts such as platelet-rich fibrin (PRF), enamel-matrix derivative (EMD), and recombinant platelet-derived growth factor-BB (PDGF) are widely used to enhance soft-tissue outcomes in mucogingival surgery, yet comparative real-world evidence on postoperative morbidity and early regenerative performance remains limited. Objectives. This thesis retrospectively compared postoperative pain, swelling, root-/implant-coverage success, and three-month gingival-thickness gain among PRF-, EMD-, and PDGF-treated recession sites, and explored adjusted predictors of pain. Methods. Chart notes for 1,358 consecutive surgeries (2015-2022) were abstracted. Outcomes—binary pain (VAS > 0 cm), swelling (days), coverage (complete yes/no) and thickness gain (> 1 mm)—were analyzed via chi-square tests, pairwise odds ratios (OR) with 95 % confidence intervals, and multivariable logistic regression controlling for co-outcomes. Results. PRF yielded the lowest morbidity: 83.6 % of PRF sites reported no pain versus 51.6 % for EMD and 24.3 % for PDGF (χ² = 327.2, p < 0.001; PRF vs PDGF OR = 13.2, 95 % CI 9.8–17.8). Swelling followed a similar gradient (PRF 79.2 % no-swelling; EMD 73.4 %; PDGF 20.6 %; χ² = 363.9, p < 0.001). PDGF achieved the highest complete-coverage rate (99.2 %) versus EMD (92.4 %) and PRF (91.7 %) (χ² = 25.3, p < 0.001). Gingival-thickness gain exceeded 96 % in all groups with no significant difference (χ² = 0.28, p = 0.871). Logistic regression confirmed intervention type as the dominant pain predictor (PDGF vs EMD adjusted OR = 3.24, p < 0.001; PRF vs EMD OR = 0.21, p < 0.001); swelling, coverage, and thickness were not independent pain drivers. Conclusions. PRF offers the most favorable morbidity profile with comparable regenerative efficacy, making it the biologic of choice when patient comfort is paramount. PDGF maximizes early coverage but at the cost of greater pain and edema, warranting robust peri-operative analgesia when cosmetic demands justify its use. EMD provides a balanced middle ground. These real-world data inform a tiered clinical algorithm that aligns adjunct selection with patient priorities, surgical objectives, and economic considerations, while highlighting the need for prospective, long-term, cost-utility trials to validate durability and value.