Treatment of isolated gingival recession by tunneled coronally advanced flap and orthodontics: A case report

Abstract

Gingival recession (GR) in malpositioned teeth with a thin periodontal phenotype poses a high risk during orthodontic movement. Phenotype modification before orthodontic treatment may reduce complications and improve clinical outcomes. A 27-year-old woman presented with a 3-mm RT2 gingival recession and<1 mm of keratinized tissue (KT) in tooth 31, which was labially displaced. Cone-beam computed tomography (CBCT) revealed the absence of the vestibular bone, and clinical evaluation confirmed a thin periodontal phenotype. To prevent GR progression during orthodontic movement, a tunneled coronally advanced flap (TCAF) combined with a subepithelial connective tissue graft (SCTG) was performed. Three months later, orthodontic treatment was initiated to lingualize the incisor. At 3-, 6-, and 10-month follow-ups, clinical improvements included an increase in KT width from<1 mm to 5 mm and greater gingival thickness. Complete root coverage was achieved and remained stable after orthodontic therapy. Esthetic results were rated as excellent using the root coverage esthetic score (RES=10/10). The patient reported minimal postoperative discomfort and no complications. This case highlights the successful use of TCAF with SCTG to modify the phenotype before orthodontic treatment in a high-risk GR case. The interdisciplinary approach led to favorable soft tissue augmentation, complete root coverage, and esthetic stability, supporting its use in similar clinical scenarios.

Keywords: Connective tissue graft, Gingival phenotype, Gingival recession, Orthodontic treatment, Periodontal plastic surgery