{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T12:27:02Z","timestamp":1787401622662,"version":"build-2736575974"},"reference-count":34,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T00:00:00Z","timestamp":1787356800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T00:00:00Z","timestamp":1787356800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["aap.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clin Adv Periodontics"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Management of gingival recession type 3 (RT3) defects remains a clinical challenge due to interproximal attachment loss and soft tissue deficiency. This case report describes a regenerative strategy for a malpositioned anterior tooth presenting with severe recession.<\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n Following orthodontic alignment to correct the tooth position, a single\u2010stage regenerative surgery was performed using the entire papilla preservation technique (EPPT) combined with a modified connective tissue graft (m\u2010CTG) wall and adjunctive biologically active regenerative materials, including enamel matrix derivative, recombinant human basic fibroblast growth factor\u20102, plasma rich in growth factors, and deproteinized bovine bone mineral. This multidisciplinary approach resulted in successful root coverage, significant clinical attachment gain, and increased keratinized tissue width. Clinical and radiographic outcomes remained stable, with high esthetic satisfaction achieved over a 30\u2010month follow\u2010up period.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n A strategic combination of orthodontic therapy and periodontal regeneration using EPPT and m\u2010CTG wall technique may offer a clinically favorable treatment approach for managing complex RT3 recessions in the esthetic zone.<\/jats:p>\n <\/jats:sec>\n \n Key points<\/jats:title>\n \n \n \n This case presents an integrated approach with orthodontic alignment and the entire papilla preservation technique and a m\u2010CTG wall to treat severe recession type 3 gingival recession.<\/jats:p>\n <\/jats:list-item>\n \n Favorable outcomes were attributed to the synergistic effect of correcting the tooth position and the stability provided by the m\u2010CTG wall, which contained the regenerative materials within the non\u2010contained defect.<\/jats:p>\n <\/jats:list-item>\n \n Despite significant improvements in root coverage and attachment levels, complete regeneration of the interdental papilla remains biologically limited by the extent of underlying interproximal bone loss.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>\n \n Plain language summary<\/jats:title>\n Severe gum recession with interdental bone loss (recession type 3 [RT3]) is highly challenging to treat, particularly when the affected tooth is also malpositioned. This case report describes a 28\u2010year\u2010old woman with an upper front tooth presenting persistent RT3 recession following orthodontic correction of its position. A single\u2010stage surgery was performed to restore both gum and bone defects simultaneously. The surgeon used a minimally invasive tunneling technique to access the defect without cutting the delicate tissue between the teeth, preserving blood supply and wound stability. A palatal gum graft was inserted to cover the exposed root and thicken the surrounding tissue. To stimulate regeneration, three biological agents\u2014for attachment regeneration, bone formation, and wound stabilization\u2014were combined with a bone substitute to fill the defect. At 30 months, the root was successfully covered, gum width increased significantly, and the bone remained stable. This case demonstrates that combining orthodontic alignment with a tissue\u2010preserving surgical technique, a gum graft, and targeted biological agents can achieve lasting results in complex recession cases.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/cap.70088","type":"journal-article","created":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T12:11:50Z","timestamp":1787400710000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Single\u2010stage regenerative approach for persistent RT3 gingival recession following orthodontic improvement of tooth position"],"prefix":"10.1002","author":[{"given":"Takeshi","family":"Haga","sequence":"first","affiliation":[{"name":"Private Office Gakkentoshi Dental & Orthodontic Clinic Kitakyushu Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5150-2076","authenticated-orcid":false,"given":"Akira","family":"Hasuike","sequence":"additional","affiliation":[{"name":"Department of Periodontology Nihon University School of Dentistry Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taito","family":"Watanabe","sequence":"additional","affiliation":[{"name":"Department of Periodontology Nihon University School of Dentistry Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"So","family":"Higuchi","sequence":"additional","affiliation":[{"name":"Private Office Higuchi Dental Clinic Fukuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serhat","family":"Aslan","sequence":"additional","affiliation":[{"name":"Private Office, Dr. Aslan \u0130zmir Turkey"},{"name":"Department of Biomedical, Surgical and Dental Sciences University of Milan Milan Italy"},{"name":"Department of Oral Health Sciences Periodontology, KU Leuven Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,22]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1111\/j.1600-051X.2011.01732.x","article-title":"The interproximal clinical attachment level to classify gingival recessions and predict root coverage outcomes: an explorative and reliability study","volume":"38","author":"Cairo F","year":"2011","journal-title":"J Clin Periodontol"},{"key":"e_1_2_9_3_1","doi-asserted-by":"crossref","first-page":"849","DOI":"10.11607\/prd.2764","article-title":"Combined regenerative and mucogingival treatment of deep intrabony defects associated with buccal gingival recession: two case reports","volume":"36","author":"Santoro G","year":"2016","journal-title":"Int J Periodontics Restorative Dent"},{"key":"e_1_2_9_4_1","doi-asserted-by":"crossref","first-page":"1386","DOI":"10.1002\/JPER.19-0715","article-title":"Gingival phenotype modification therapies on natural teeth: a network meta\u2010analysis","volume":"91","author":"Barootchi S","year":"2020","journal-title":"J Periodontol"},{"key":"e_1_2_9_5_1","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1902\/jop.1985.56.4.204","article-title":"Flap technique for periodontal bone implants. 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