Connective Tissue Graft With Coronally Advanced Flap Successfully Treats Orthodontic-Related Gingival Recession: Case Report
USA: A case report published in the Cureus Journal of Medical Science highlights the successful management of multiple gingival recessions that developed after orthodontic treatment using a connective tissue graft combined with a coronally advanced flap. The authors report that the approach achieved substantial root coverage, improved gingival thickness, and favorable esthetic outcomes that were maintained for six months.
The report, authored by Keily J. Portillo Avila from Dental Loft, San Pedro Sula, Honduras, and colleagues, describes the treatment of a 29-year-old woman who sought periodontal care after noticing progressive gum recession affecting her lower front teeth following completion of orthodontic therapy.
The patient had no systemic illnesses, smoking history, or medication use known to affect periodontal health. Her primary concerns included the visible exposure of tooth roots, cosmetic appearance, and the possibility of developing dentin hypersensitivity. Clinical examination revealed multiple gingival recession defects involving teeth #22 to #27, along with a thin periodontal phenotype and reduced keratinized gingival tissue. There were no signs of active periodontal disease, and oral hygiene was satisfactory.
A panoramic radiograph showed no significant bone loss. However, because conventional radiographs provide only two-dimensional images, the clinicians performed cone beam computed tomography (CBCT) to obtain a more detailed assessment. The CBCT scan revealed a thin facial alveolar bone plate and localized facial alveolar dehiscence in the mandibular anterior region, findings that supported the decision to perform periodontal plastic surgery.
Following informed consent, the patient underwent a coronally advanced flap procedure combined with an autogenous connective tissue graft harvested from the palate. After administration of local anesthesia, a carefully designed split-full thickness flap was elevated while preserving the interdental papillae. The exposed root surfaces were cleaned and prepared before placement of the graft. The connective tissue graft was then secured over the recipient site, and the flap was repositioned coronally to completely cover the graft before being stabilized with non-resorbable sutures.
The patient was advised to follow standard postoperative care, including chlorhexidine mouth rinses twice daily for two weeks, appropriate pain management, and avoidance of mechanical trauma to the surgical area during healing.
Recovery was uneventful, with no evidence of infection, flap breakdown, or graft necrosis at the two-week review. Sutures were removed, and oral hygiene instructions were reinforced. At the six-month follow-up, the treated sites demonstrated stable root coverage, increased gingival thickness, a wider band of keratinized tissue, healthy periodontal tissues, and satisfactory esthetic integration of the graft.
The authors concluded that a connective tissue graft combined with a coronally advanced flap can be an effective option for managing multiple gingival recessions associated with orthodontic treatment. They also emphasized the value of selective CBCT imaging in identifying underlying periodontal anatomy and guiding surgical planning. Although larger studies with longer follow-up are needed, the case supports the predictability of this technique in appropriately selected patients.
Reference:
Portillo Avila K J, Ramirez C M, Esquea Rosa A R, et al. (July 30, 2026) Management of Multiple Mandibular Gingival Recessions Following Orthodontic Treatment Using a Connective Tissue Graft and a Coronally Advanced Flap: A Case Report. Cureus 18(7): e113687. doi:10.7759/cureus.113687
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