Use of orthodontic therapy to improve the esthetic and periodontal prognosis of root coverage surgery

Improvement by orthodontic therapy in the esthetic and periodontal prognosis of root coverage surgical procedure A healthy 11-year-old boy of Caucasian origin initially presented for orthodontic consultation. The patient was in the late mixed dentition with an occlusal sagittal molar relationship of Angle Class I; cross-bite of teeth #21 and #22; severe maxillary anterior crowding, with no space available for the permanent maxillary right and left canines, both labially erupting and in close proximity to the adjacent lateral incisors; moderate mandibular anterior crowding (Fig. 1). After 2 years of fixed orthodontic treatment in the upper and lower jaws, the permanent maxillary canines were successfully aligned within the dental arch, both the arches were correctly leveled and aligned, normal overjet and overbite were obtained. At that time, after fixed appliances removal, retention was achieved with a removable maxillary Hawley plate and a mandibular lingual bonded retainer from canine to canine (Fig. 2,3). Following 2 years, the patient presented with a gingival recession at the labial aspect of tooth # 41 (Fig. 4). The patient reported that he first noticed the recession about 12 months before and that it was getting progressively bigger and sensitive to tooth-brushing and cold drinks. No bleeding, spontaneous or during brushing was reported by the patient. The patient also referred that no mayor improvement was observed despite he attended 3 professional oral hygiene recalls during the last year. The patient was referred to a periodontist for a periodontal evaluation.