A Breakthrough for Severe Malocclusion and Gum Recession

Severe malocclusion and gingival recession defects (GRDs) can significantly impact both the function and aesthetics of a smile. A 2025 case report published in Clinical Advances in Periodontics by Kotsailidi et al. introduces an innovative approach using surgically facilitated orthodontic treatment (SFOT) with clear aligners to address these issues in a 28-year-old male patient. This case marks a pioneering effort in managing complex dental conditions without traditional soft tissue grafting.

The patient presented with severe dental crowding, a Class III malocclusion, localized crossbites, and a tapered maxillary arch. Additionally, he had multiple type I gingival recessions up to 6 mm deep, with at least 2 mm of keratinized tissue and a thick scalloped gingival phenotype. These conditions posed both functional challenges, such as difficulty chewing, and aesthetic concerns, including an uneven smile and exposed tooth roots.

The treatment involved SFOT combined with clear aligners, a less invasive alternative to metal braces. The procedure began with buccal corticotomies—small cuts in the bone between the roots of the first molars on both arches—followed by bone augmentation using demineralized allograft. This surgical approach leveraged the regional acceleratory phenomenon, which speeds up bone remodeling and tooth movement. Orthodontic treatment included dental expansion, interproximal enamel reduction, and intermaxillary elastics to guide teeth into proper alignment. Aligners were changed every 3 days for the first 6 months, then every 5 days, with the entire treatment lasting 10.5 months.

The results were remarkable. The patient achieved tooth alignment, a Class I occlusion, and a significantly improved smile. Notably, 50% of the teeth with gingival recessions achieved complete root coverage, with an average root coverage of 81.6% (ranging from 1 to 6 mm). Residual recessions were minimal, between 1 and 2 mm. This outcome was achieved without soft tissue grafting, highlighting the potential of SFOT to address gingival recessions by optimizing tooth positioning within the alveolar bone.

This case is the first to demonstrate the successful use of clear aligner SFOT for severe malocclusion and multiple GRDs. The digital planning of orthodontic movements and surgical procedures ensured precision, while frequent aligner changes capitalized on accelerated bone remodeling. The approach not only corrected dental alignment but also enhanced gingival health, offering a less invasive and aesthetically pleasing alternative to traditional orthodontics.

For adults with complex dental issues, clear aligner SFOT represents a promising interdisciplinary solution. By combining surgery and orthodontics, it addresses both functional and cosmetic concerns, potentially transforming treatment protocols for severe malocclusion and gingival recession.