Abstract
ABSTRACT
Background: Periodontitis Stage III associated with Cairo Type 3 (RT3) gingival recession represents a formidable clinical challenge. A carefully coordinated orthodontic-periodontal interdisciplinary approach is essential to restore structural stability and optimal aesthetics.
Case presentation: A 25-year-old female patient presented with Stage III periodontitis and severe RT3 gingival recessions at teeth 31 and 41, accompanied by misalignment and hypersensitivity (VAS=5). The comprehensive interdisciplinary treatment protocol comprised: (1) initial periodontal therapy via Scaling and Root Planing (SRP) for infection control; (2) a 3-year active orthodontic phase; and (3) subsequent periodontal plastic surgery utilizing a Vertically Coronally Advanced Flap (V-CAF) combined with a Subepithelial Connective Tissue Graft (SCTG). At the 6-month follow-up, hypersensitivity was completely resolved, the width of keratinized tissue increased by 3 mm, and the teeth achieved remarkable structural stability.
Conclusion: The "Orthodontics-First, Periodontal Surgery-Second" sequencing, aligned with the official European Federation of Periodontology (EFP) guidelines, provides an effective solution for complex RT3 defects. Repositioning the teeth into a physiological alignment prior to soft-tissue grafting alters the defect morphology favorably, thereby reaching periodontal sustainability.