Periodontal plastic surgery for cases with fixed “hygienic” lingual retainer: Case study

This study aimed to describe the clinical outcomes of a combined periodontal treatment and periodontal plastic surgical approach for the treatment of gingival recession (GR) in patients using a fixed "hygienic" lingual retainer (FHLiR). It is bonded to the lingual (back) surface of the lower front teeth after orthodontic treatment. While these retainers are meant to keep teeth straight/aligned, their design often makes them challenging to clean and may reduce passivity. Over time, poor hygiene and possible minor movements might contribute to undesirable tooth shifts, bone loss, and, most notably, GR on the outer/facial tooth surfaces. This report details the treatment of three healthy patients who developed localized GR around their lower front teeth, possibly associated with FHLiR. The treatment involved removing the problematic retainer and replacing it with a simpler, straight design, followed by specialized gingival (periodontal plastic) surgery, using techniques such as connective tissue grafts to cover the exposed roots. The results showed consistent improvement in gingival thickness and successful root coverage. The study concludes that combining basic periodontal therapy with specific surgical procedures for the treatment of GRs in mandibular incisors associated with FHLiR is a practical approach for restoring both the function and appearance of the gingival tissue.