Staged Tissue Augmentation In Orthodontic-Related Recession, 4-Year Follow up

A patient with severe orthodontic-related gingival recession and apical bone dehiscence in the mandibular anterior teeth underwent a two-stage tissue augmentation protocol, achieving stable hard and soft tissue regeneration at 4-year follow-up. A 25-year-old female presented with progressive gingival recession and chronic pain in the mandibular anterior region 4 years post-orthodontic treatment. Clinical evaluation revealed RT2 recession (5-9mm for teeth 32-41), absent keratinized tissue, vestibular collapse, and bone dehiscence to tooth apices. Stage I employed free gingival grafting to restore keratinized tissue and vestibular depth. Five months later, Stage II utilized a collagen membrane sutured apically (periosteal fixation) and coronally (sling suture) to create a stabilized "pocket" filled with bone graft. Four-year outcomes demonstrated sustained horizontal (2.4-5.2mm) and vertical (5.4-5.7mm) bone gain, recession reduction to 1mm, and retained tooth 41 despite initial mobility. The protocol prioritizes soft tissue stabilization (FGG) before bone regeneration, countering graft displacement risks through apical-coronal membrane fixation. This "pocket" design enhances vertical and horizontal bone regeneration, a limitation of conventional GTR. Reestablishing hard and soft tissue resolved pathological mobility, emphasizing the role of sequential tissue reconstruction in complex defects. Combining FGG and "pocket" GBR achieved long-term dual-tissue regeneration, offering a conservative solution for severe orthodontic sequelae in young patients.