Management of Multiple Mandibular Gingival Recessions Following Orthodontic Treatment Using a Connective Tissue Graft and a Coronally Advanced Flap: A Case Report

Gingival recession is a common mucogingival condition that may develop following orthodontic treatment, particularly in patients with a thin periodontal phenotype and limited buccal bone support. This case report describes the management of multiple mandibular anterior gingival recessions in a 29-year-old female patient affecting teeth #22 through #27. Clinical examination revealed extensive root exposure and reduced gingival tissue thickness in the mandibular anterior region, resulting in esthetic concerns and increased risk of root sensitivity. Cone beam computed tomography (CBCT) was utilized to evaluate the periodontal anatomy and assist in surgical planning. A coronally advanced flap combined with an autogenous connective tissue graft harvested from the palate was performed to achieve root coverage and increase soft tissue thickness. The palatal donor site was closed with sutures following graft harvesting, and the connective tissue graft was stabilized at the recipient site before coronal repositioning of the flap and final closure with non-resorbable sutures. Healing progressed uneventfully, with favorable tissue integration and significant improvement in gingival margin position observed at the two-week follow-up. One month after surgery, the patient demonstrated increased gingival thickness, substantial root coverage, improved periodontal health, and satisfactory esthetic outcomes. This case highlights the effectiveness of a connective tissue graft combined with a coronally advanced flap for the treatment of orthodontically associated multiple gingival recessions and demonstrates predictable short-term clinical and esthetic results.