Soft Tissue Grafting Procedures Research Articles

Papilla Access Tunnel Combined With the Laterally Closed Tunnel: A Technique for Treatment of Deep Gingival Recession in the Anterior Mandible.

Treatment of gingival recession in the anterior mandible is more complex due to unique anatomic features including excessive tension due to frenal and muscle attachments, thin tissue, shallow vestibule, and narrow interdental space. These features are particularly limiting in the presence of deep recession and negatively impact the success most routine soft tissue grafting procedures. The recently proposed laterally closed tunnel combined the benefit of tension management from tunneling rather than incising papillae with lateral closure of deep recession to minimize the need for coronal advancement. This is an effective, although technically demanding procedure. This report presents a method of facilitating tunnel preparation by utilizing superficial papillary access incisions bilaterally in the papilla between the lateral incisor and canine. This papilla has the least tension and most robust interdental volume and blood supply. This incision creates a mini flap that facilitates tunnel dissection and graft placement. Because the mini flap is used for graft insertion, the suturing for lateral closure can be performed before graft insertion. The result is reduced technical difficulty.

Advancements, applications, and safety of negative pressure wound therapy: a comprehensive review of its impact on wound outcomes

The increasing adoption and widespread acceptance of negative pressure wound therapy (NPWT) have paralleled the expansion of its indications in clinical practice. The spectrum of indications for NPWT now extends to encompass soft tissue defects arising from trauma, infection, surgical wound care, and soft tissue grafting procedures. Recent advancements in NPWT devices have introduced various adjuncts, such as instillation of fluids or antibiotics into the wound. These additions empower surgeons to enhance the wound healing environment and contribute to combatting infections more effectively. This review delves into the latest literature addressing the proposed mechanisms underlying NPWT's action, its cost-effectiveness, its impact on patient quality of life, and the essential components necessary for its safe use. The review examines the evidence supporting NPWT's application in managing traumatic extremity injuries, controlling infections, and wound care. While NPWT generally exhibits a low complication rate, surgeons must remain aware of the potential risks linked to its utilization. Moreover, the review explores the widening scope of indications for NPWT, shedding light on prospective avenues for innovation and research in this field.

Assessment of palatal mucosal thickness and location of the greater palatine foramen using cone-beam computed tomography: a retrospective study.

This study aimed to measure the palatal mucosal thickness and examine the location of the greater palatine foramen using cone-beam computerized tomography (CBCT). In this study, cone-beam computed tomography (CBCT) images of the maxillary posterior region of 120 subjects were evaluated. The palatal mucosal thickness (PMT), palatal width and depth, and location of the greater palatine foramen (GPF) were determined on CBCT. The differences in the palatal mucosal thickness according to gender and palatal width/palatal depth were analyzed. The location of the GPF related to the maxillary molars was noted. The mean palatal mucosal thicknesses from the canine to the second molar teeth were 3.66, 3.90, 4.06, 3.76, and 3.92mm, respectively. The mean PMT at the second premolar was statistically thicker than at other regions (p < 0,001). There was no relationship between PMT and gender. However, the palatal depth and width of the males were greater than females. (p = 0.004 and p = 0.014, respectively) PMT in the low palatal vault group had statistically higher compared to the high palatal vault group. (p = 0.023) Greater palatine foramen was mostly observed between second and third molar teeth. (48%). According to our results, first and second premolar regions can be preferable in soft tissue grafting procedures for safe and successful treatment outcomes. The measurement of the thickness of the palatal mucosa and the evaluation of the greater palatine foramen location before the surgical procedures are essential steps to harvest from the ideal donor site and to achieve optimal surgical outcomes.

Negative pressure wound therapy: Where are we in 2022?

Summary: The use of negative pressure wound therapy (NPWT) continues to be an important tool for surgeons. As the use and general acceptance of NPWT have grown, so have the indications for its use. These indications have expanded to include soft tissue defects in trauma, infection, surgical wound management, and soft tissue grafting procedures. Many adjuvants have been engineered into newer generations of NPWT devices such as wound instillation of fluid or antibiotics allowing surgeons to further optimize the wound healing environment or aid in the eradication of infection. This review discusses the recent relevant literature on the proposed mechanisms of action, available adjuvants, and the required components needed to safely apply NPWT. The supporting evidence for the use of NPWT in traumatic extremity injuries, infection control, and wound care is also reviewed. Although NPWT has a low rate of complication, the surgeon should be aware of the potential risks associated with its use. Furthermore, the expanding indications for the use of NPWT are explored, and areas for future innovation and research are discussed.

Combination of A-PRF and A Strip Free Keratinized Mucosal Graft for Increasing the Width of Keratinized Tissue Around Dental Implants: A Case Series

&lt;p&gt;Abstract: Background: Insufficient width of keratinized tissue (KT) around dental implants is a potential contributing factor of peri-implant diseases, and soft tissue grafting procedures are recommended for long-term maintenance of dental implants. A bulk free keratinized mucosal graft (FKMG) from the hard palate in conjunction with an apically positioned flap (APF) is the gold standard for KT augmentation. However, the major shortcomings are limited sources of the grafts and risks of donor wound morbidity. This case series proposed an alternative approach for KT augmentation by the combination of advanced platelet-rich fibrin (A-PRF) with a strip FKMG. Material and methods: Two patients with insufficient peri-implant KT width (&lt; 2mm) bilaterally were enrolled for the split-mouth observation. Two different surgical methods were utilized to augment KT in the same patient. The recipient bed was fully covered by a bulk FKMG on one side, and topical hemostatic agents were applied to the donor wound. A strip FKMG was placed at the apical border on the other side with the remaining recipient bed being covered by an A-PRF membrane, and the donor wound was protected by another A-PRF membrane. Results: All four treated sites exhibited 4-5 mm significant gain in KT width, and the width was maintained for 12 months. Compared with the surgeries using a bulk FKMG, patients reported lower postoperative pain scores with a strip FKMG and A-PRF combination. Conclusion: The combination of an A-PRF membrane and a FKMG strip demonstrated satisfactory short-term outcomes for peri-implant KT augmentation, and donor wound morbidity was reduced.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

A Multidisciplinary Approach for the Management of Iatrogenic Severe Periodontitis Following Orthodontic Treatment with a 12-Year Follow-up.

Orthodontic treatment aims to realign teeth in a functional and esthetic manner. When applied on an unhealthy periodontium, this may lead to advanced periodontal tissue breakdown. The present 12-year follow-up report describes the multidisciplinary management of a severe, iatrogenic, generalized periodontitis case that was caused/aggravated by orthodontic therapy on unhealthy periodontal tissues. Prompt therapy was applied through nonsurgical and surgical approaches, including soft and hard tissue grafting procedures combined with corrective orthodontic treatment on healthy tissues. This report is a clear demonstration that early disease detection and proper diagnosis combined with appropriate therapeutic approaches concomitant with strict supportive periodontal therapy could lead to long-term successful and maintainable outcomes, even in hopeless cases.

Poor Biointegration of Porcine Acellular Dermal Matrix Associated with Unfavorable Gingival Healing: A Report of Three Cases

The aim of the present work was to explain the poor biointegration of acellular dermal xenogeneic matrix, leading to an unfavorable gingival healing following a grafting procedure for the treatment of soft tissue deficiencies. Numerous works have demonstrated the successful use of acellular dermal matrix (ADM) in soft tissue augmentation procedures. However, spare human investigations reported adverse healing outcomes at microscopic level. Three patients showing various soft tissue deficiencies (recession, gingival thickening) requiring a gingival augmentation were grafted using an ADM porcine acellular dermal matrices (pADM) as a soft tissue substitute. For this purpose, appropriate soft tissue augmentation surgeries were performed and the grafted pADM was left for proper healing. Biopsies were harvested from two out of the three patients, respectively, at 11 and 27 weeks in order to conduct a histological evaluation of the pADM's doubtful biointegration. Moreover, the ultrastructural analysis of pADM was performed using scanning electron microscopy, and additional histological procedures were used to assess its ability to support human gingival fibroblast cultures. Signs of gingival inflammation persisted several months postoperatively. Histologically, numerous inflammatory cells characterized the grafted site. Indeed, the high number of foreign body giant cell granulomas and the very densified newly formed collagen fibers highlighted a fibrotic process within gingival connective tissue. The ultrastructural and histological analysis showed that pADM was characterized by very thick and dense collagen bundles demonstrating a nonphysiological collagen network organization. Cell culture experiments showed fibroblasts proliferating on the matrix surface, sparing its deeper part, even though the collagen matrix degradation seemed to occur following a gradient from the pADM surface inward. The unfavorable clinical results may be caused by the poor colonization of matrix cells and poor angiogenesis leading to the inadequate biointegration of pADM. Hence, the pADM structure in terms of porosity and degradability should be further investigated. The present cases highlighted a poor integration of pADM following soft tissue grafting procedures, which was caused by the inadequate ultrastructure of the used pADM. Therefore, despite the utility of such tissue substitutes, their manufacturing improvement could be required to obtain a better biointegration.

An in vivo comparison of wound healing characteristics of two commercial acellular dermal matrices

ObjectivesMany acellular dermal matrices (ADMs) are available for use in periodontal surgical procedures. However, few studies exist evaluating their in vivo healing properties. The objectives of this study were to compare the wound healing and remodeling of two ADMs used for gingival augmentation procedures in the rat model.Materials and methodsThis was a nonrandomized controlled split‐mouth study. Envelope flaps were surgically created in the maxillary quadrants of 24 Sprague Dawley rats. Each received either (a) AlloDerm Regenerative Tissue Matrix, or (b) OrACELL. Gingival tissue from one mandibular quadrant served as the untreated control. Six male and six female rats were treated for 7 or 21 days. Biopsies were processed for histologic analysis (H&E, Picro‐sirius red, Verhoeff's solution) or RNA analysis (RT‐PCR) to analyze the expression of type I collagen (Col1a1), fibronectin (Fn‐1) and VEGF‐A (Vegf‐A).ResultsThere was a greater density of fibroblasts in OrACELL compared to AlloDerm at both timepoints. There was a greater density of elastin present in AlloDerm compared to OrACELL at 7 days but no differences at 21 days. There were no differences between test groups in the percentage of birefringent collagen or in the expression of Vegf‐A or Fn‐1. At 7 days, there were significantly more fibroblasts for males in the OrACELL group compared to females. At 21 days, there was a significantly greater expression of Col1a1 for males in the OrACELL group compared to females.ConclusionsEarly wound healing and remodeling of OrACELL appeared to occur more rapidly than AlloDerm and was accelerated in male rats. Whether these results have clinical implications for soft tissue grafting procedures in humans remains to be determined.

Patient experience of autogenous soft tissue grafting has an implication for future treatment: A 10- to 15-year cross-sectional study.

Patient-reported outcomes have received a great deal of interest in periodontal plastic procedures. However, their evaluation has mainly been short-term. Thus, the aim of this study was to evaluate the impact of soft tissue grafting procedures conducted over a decade ago on the willingness of a patients to undergo the surgery again. Subjects that received an autogenous soft tissue graft over 10 years ago were screened and invited for a survey. Their response was only analyzed if they were able to correctly identify the sites of the surgical procedures. Dichotomous questions and visual analogue scales (VASs) were used to assess self-reported pain, willingness to retreat and satisfaction. Fifty-two patients were included in the analyses. Higher pain was reported for mandibular sites, and treated areas including ≥ 3 teeth (P<0.01). Willingness to retreatment was 84.6% and it was negatively associated with self-reported pain measures, the arch location (mandible), and number of treated sites (≥3 teeth) (P<0.01). Mean satisfaction rate was 86.9 ± 13.65 (VAS) and showed a positive correlation with willingness to retreat (P<0.01). Having a complete root coverage at the recall visit was also significantly associated with higher patient satisfaction scores (P<0.01). Patient experience of previous autogenous soft tissue grafting has an influence on their decision to undergo future treatment. Willingness to retreat was negatively affected by mandibular sites, larger treated areas and the perceived pain, while presenting with complete root coverage was significantly associated with patient satisfaction.

ARE YOUR GUMS IN THE PINK OF HEALTH?

Introduction The presence of healthy attached tissue at the tooth and implant soft tissue interface correlates with long-term success and stability in function and esthetics and requires conversion of unfavorable soft tissue traits to more favorable ones. Several soft tissue grafting procedures have been developed to improve both the volume of keratinized tissue and the soft tissue contour around implants and the tooth. Objectives This study therefore aims at determining the knowledge , attitude , and perception of Periodontists and implantologists in private practice towards soft tissue grafting around implants and teeth . Methodology Approximately 100 periodontists and dental practioners from Mumbai were provided with a questionnaire to evaluate their knowledge about soft tissue grafting around implants and teeth .The questionnaire consists questions regarding different techniques involved in soft tissue grafting , the materials used for it , the complications faced during the procedure and the preferred method . Results: The results show that very few practioners are practicing soft tissue grafting around natural teeth and implants in their private practice. Conclusion : Thus, keeping in mind the results of the study it is essential to create more awareness about soft tissue augmentation and its importance and also conduct programmes to train dentists for the same. Key Words : Teeth Replacement, awareness, attitude, patients, missing teeth, socioeconomic status.

Effects of soft tissue augmentation procedures on peri-implant health or disease: A systematic review and meta-analysis.

To review the dental literature in terms of soft tissue augmentation procedures and their influence on peri-implant health or disease in partially and fully edentulous patients. A MEDLINE search from 1966 to 2016 was performed to identify controlled clinical studies comparing soft tissue grafting versus no soft tissue grafting (maintenance) or two types of soft tissue grafting procedures at implant sites. The soft tissue grafting procedures included either an increase of keratinized tissue or an increase of the thickness of the peri-implant mucosa. Studies reporting on the peri-implant tissue health, as assessed by bleeding or gingival indices, were included in the review. The search was complemented by an additional hand search of all selected full-text articles and reviews published between 2011 and 2016. The initial search yielded a total number of 2,823 studies. Eligible studies were selected based on the inclusion criteria (finally included: four studies on gain of keratinized tissue; six studies on gain of mucosal thickness) and quality assessments conducted. Meta-analyses were applied whenever possible. Soft tissue grafting procedures for gain of keratinized tissue resulted in a significantly greater improvement of gingival index values compared to maintenance groups (with or without keratinized tissue) [n=2; WMD=0.863; 95% CI (0.658; 1.067); p<.001]. For final marginal bone levels, statistically significant differences were calculated in favor of an apically positioned flap (APF) plus autogenous grafts versus all control treatments (APF alone; APF plus a collagen matrix; maintenance without intervention [with or without residual keratinized tissue]) [n=4; WMD=-0.175mm; 95% CI: (-0.313; -0.037); p=.013]. Soft tissue grafting procedures for gain of mucosal thickness did not result in significant improvements in bleeding indices over time, but in significantly less marginal bone loss over time [WMD=0.110; 95% CI: 0.067; 0.154; p<.001] and a borderline significance for marginal bone levels at the study endpoints compared to sites without grafting. Within the limitations of this review, it was concluded that soft tissue grafting procedures result in more favorable peri-implant health: (i) for gain of keratinized mucosa using autogenous grafts with a greater improvement of bleeding indices and higher marginal bone levels; (ii) for gain of mucosal thickness using autogenous grafts with significantly less marginal bone loss.

The efficacy of a porcine collagen matrix in keratinized tissue augmentation: a 5-year follow-up study

BackgroundWhen keratinized tissue width around dental implants is poorly represented, the clinician could resort to autogenous soft tissue grafting. Autogenous soft tissue grafting procedures are usually associated with a certain degree of morbidity. Collagen matrices could be used as an alternative to reduce morbidity and intra-operatory times. The aim of this study was to assess the efficacy of a xenogeneic collagen matrix as a substitute for soft tissue grafting around dental implants.MethodsFifteen consecutive patients underwent a vestibuloplasty and keratinized tissue reconstruction around dental implants, both in the mandible and the maxilla, with a porcine collagen matrix. The so obtained keratinized tissues were measured and evaluated after 6 months and 1, 4, and 5 years.ResultsThe average gain of keratinized tissue was 5.7 mm. After 6 months, it was observed a resorption of 37%, after 1 year 48%, and after 5 years 59%. The mean gain of keratinized tissue after 5 years was 2.4 mm. Hemostatic effect and post-operative pain were evaluated too. All subjects referred minimal pain with no bleeding. No adverse reaction nor infection was noted.ConclusionsThe present study showed the efficacy of a porcine collagen matrix in keratinized tissue augmentation. The possibility to use a soft tissue substitute is a great achievement as morbidity decreases and bigger areas can be treated in a single surgery.

Single tooth osteotomy and distraction in the treatment of an ankylosed central incisor — a case report

Abstract Introduction Clinical practice encounters the unfortunate consequences of dental trauma. The avulsion of permanent teeth is seen in 0.5–3% of all dental traumatic injuries, and when re-implanted, a tooth can undergo ankylosis in the form of replacement resorption. When ankylosis of a maxillary incisor occurs in a pre-adolescent, the affected tooth gradually becomes infra-occluded with time, which results in severe local dentoalveolar disturbances in normal growth and development, along with aesthetic concerns that challenge orthodontic management. To achieve an ideal dental outcome, an interdisciplinary approach is often required. Aim To detail a case report of an infra-occluded ankylosed central incisor successfully treated with a single tooth osteotomy and distraction osteogenesis in conjunction with mechanotherapy to correct the osseous and gingival margins. Methods This combined orthodontic/surgical case report was completed in stages by (1) pre-surgical orthodontics to diverge the roots of the adjacent teeth from the surgical site, (2) a single tooth osteotomy followed by distraction osteogenesis, (3) postsurgery orthodontics, and (4) retention. Consent and complete records were obtained, including pre-treatment photographs, radiographs and cephalometric superimpositions over an eight-year period from initial presentation until retention. Results Distraction osteogenesis in combination with orthodontics successfully managed the dentoalveolar and soft tissue defect. If tooth replacement is eventually needed, donor site morbidity associated with conventional bone and soft tissue grafting procedures may be eliminated. Conclusion This combined interdisciplinary treatment is an effective alternative to bony and soft tissue augmentation procedures that may not be as predictable in restoring vertical and horizontal osseous and soft tissue defects resulting from severe infraocclusion of anterior teeth.

Use of a Collagen Matrix as a Substitute for Free Mucosal Grafts in Pre-Prosthetic Surgery: 1 Year Results From a Clinical Prospective Study on 15 Patients.

Background:The presence of keratinized tissue around dental implants is more than desirable either from a functional and aesthetic point of view, making soft tissue grafting a common practice in implant rehabilitation. Autogenous soft tissue grafting procedures are usually associated with high morbidity. Aim of this study was to assess the efficacy of a xenogeneic collagen matrix as a substitute for soft tissue grafting around dental implants.Methods:15 consecutive patients underwent a vestibuloplasty and grafting, both in the mandible and the maxilla, with a collagen matrix.Results:The primary endpoint was to evaluate the resorption of the graft along with the re-epithelization grafted area. The percentage of the resorption was 44,4%, with a mean gain in vestibular height of 3 mm. Secondary endpoints evaluated the clinical appearance, the hemostatic effect and the post-operative pain. All subjects referred minimal pain with no bleeding. No adverse reaction nor infection were noted.Conclusion:This study showed that the used collagen matrix can find major interest in those patients who need a greater aesthetic outcome as the matrix has a perfect integration with the surrounding tissues. Furthermore it is strongly recommended for those patients who can bear little pain.Clinical Significance:Post-operative morbidity of autologous grafts is the biggest concern of this type of surgery. The possibility to use a soft tissue substitute is a great achievement as morbidity decreases and bigger areas can be treated in a single surgery.The present study showed the efficacy of a collagen matrix as this kind of substitute.

Soft Tissue Augmentation Techniques and Materials Used in the Oral Cavity: An Overview.

Oral soft tissue augmentation or grafting procedures are often necessary to achieve proper wound closure after deficits resulting from tumor excision, clefts, trauma, dental implants, and tooth recessions. Autologous soft tissue grafts still remain the gold standard to acquire a functionally adequate zone of keratinized attached gingiva. However, soft tissue substitutes are more commonly used because they minimize morbidity and shorten surgical time. This review aimed to assess soft tissue grafting techniques and materials used in the oral cavity from existing literature. There are a large variety of materials and techniques, including grafts, local flaps, allogenic derived matrices such as acellular dermal allograft, xenogenic tissue matrices from animal origin, and synthetic materials. Tissue engineering of oral mucosa represents an interesting alternative to obtain sufficient autologous tissue for reconstructing oral wounds using biodegradable scaffolds, and may improve vascularization and epithelialization, which are critical for successful outcomes.

RhPDGF Mediated Root Coverage Procedure Using Coronally Advanced Flap in Treatment of Multiple Recession Defects: A Case Report

AbstractGingival recession has been defined as the term used to characterize the apical shift of the marginal gingiva from its normal position on the crown of the tooth to levels on the root surface beyond the cemento-enamel junction (CEJ). Numerous techniques have been developed for treatment of these defects including rotational and advanced gingival flaps, soft-tissue grafting procedures with autogenous and allograft materials. This paper illustrates a case report of 42-years-old male patient with a chief complaint of thermal root sensitivity in relation with front teeth of lower jaw and describes a technique to coronally advance the flap in combination with recombinant human platelet-derived growth factor-BB (rhPDGF-BB) (GEM 21S®) to treat multiple gingival recession defects. Patient was followed postoperatively, and healing was evaluated at 1, 3 and 6 months, with recession depth as the primary outcome measure. This case report revealed a favourable tissue response to GEM 21S® from both clinical and aesthetic points of view showing excellent plastic surgery results for gingiva.

A Guided Surgical Technique for the Use of Small Diameter Implants in the Anterior Mandible: Report of a Case

Introduction: Over the last five years 3,276 implants have been placed at the University of Nevada Las Vegas School Of Dental Medicine. Of those, 55 have been small diameter implants (SDI), accounting for less than 2% of all dental implants. Nine SDI’s were placed for fixed restorations. This case report demonstrates the use of SDI’s for a fixed, splinted restoration, utilizing a surgical guide for both the osteotomies and implant placement. Methods: Two 2.0 mm × 15 mm SDI’s (Shatkin F.I.R.S.T.) were placed in the location of teeth #23 and #24. A surgical guide (Shatkin F.I.R.S.T Laboratory) was used for initial osteotomies to ensure proper angulation and for final placement of the SDI’s. A laboratory fabricated splinted acrylic temporary (Shatkin F.I.R.S.T.) was placed during the healing phase. Results: Both SDI’s displayed successful integration, based on the Health Scale for Dental Implants. The SDI’s displayed no mobility, no pain or tenderness upon function, <2 mm of radiographic bone loss from initial surgery, and no exudates. The final splinted Porcelain-Fused-to-Metal (PFM) restoration was fabricated using conventional crown and bridge techniques and was cemented using FujiCEM. Conclusion: SDI’s are indicated in cases where bucco-lingual bone width is limited and bone and soft tissue grafting are not possible. A surgical guide can be used to ensure proper placement and angulation of SDI’s. Placement of a single traditional implant with cantilever prosthesis has an increased chance of prosthesis failure in five years. SDI’s, in this application, have a success rate comparable to traditional implants. This case demonstrated a guided surgical technique for SDI’s without extensive bone or soft tissue grafting procedures.

Soft Tissue Grafting Around Teeth and Implants.

The presence of healthy attached tissue at the tooth and implant soft tissue interface correlates with long-term success and stability in function and esthetics. There are several soft tissue grafting procedures that increase the volume of keratinized tissue and provide coverage on both teeth and implants. Many of these techniques can be used in conjunction with implant placement, or after placement as a means of salvage. This article describes the techniques for augmentation of keratinized tissue as well as root and implant coverage. These tools should be in the armamentarium of oral and maxillofacial surgeons providing implant services.

Palatal pedicle flap-varied applications

Implant restorations, a boon to dentistry, often suffer from ridge and soft tissue deficiencies because of the postextraction tissue remodeling. This hindrance could be overcome through soft and hard tissue augmentation as future implant site development. A good pink carpet is one of the prerequisite for esthetics around implant restoration, which could be achieved adequately through hard and soft tissue grafting procedures. In this regard, many techniques have been advocated, wherein the pedicle grafts gained popularity owing to the ability to maintain intact vascularity. Palatal tissue is desirable graft of choice for its thick biotype. Thus a combination of palatal tissue with pedicle grafts are said to be novel in this application. In this article, we discussed the applications of different palatal pedicle grafts along with elaborating their varied applications in three patients.

Gingival augmentation procedure prior to fixed orthodontic treatment

Patients seek orthodontic treatment for correction of malocclusion and aesthetic improvement. A strong correlation between labially placed teeth and gingival recession has been found. If such cases are left untreated with or without orthodontic therapy, it may lead to an increase in the severity of the disease. A similar case of a 21-year-old male patient with gingival recession in the mandibular anterior region is reported. The patient was successfully treated using a free gingival graft technique. This technique not only improves the aesthetic aspect but also avoids future attachment loss and thus makes the patient more stable for further orthodontic treatment. The aim behind the treatment of gingival recession is not only to cover the exposed root surface, but also to improve aesthetics and reduce dentinal hypersensitivity. Different soft tissue-grafting procedures have been proposed for the treatment of gingival recession, of which free gingival graft is the most reliable one. The purpose of this case report is to illustrate the importance of root coverage prior to orthodontic treatment and to describe the planning for successful treatment which will improve the overall periodontal status of the patient.