Evidence-based rationale for the management of mucogingival deformities before or after orthodontic treatment

Objective: this review aims to explore key aspects related to the treatment of gingival recession defects (GRD) and sites lacking keratinized gingiva in orthodontic patients. It focuses on five crucial core aspects: 1) risk assessment for GRD development; 2) diagnosis, characteristics, and the dilemma surrounding GRD treatment necessity; 3) the evolution of root coverage procedures and the significance of modifying soft tissue phenotype for gingival margin stability; 4) the development and progression of gingival recessions in orthodontic patients; and 5) the staging of orthodontic and periodontal therapies; specifically, the consideration of preemptive soft tissue phenotype modification (STPM) or treatment of GRD. Overview and Conclusions: the management of GRD and sites lacking gingiva or with a thin mucosal phenotype, as well as the staging of periodontal and orthodontic treatment, should be guided by the positioning of the tooth within the alveolar bone envelope and the periodontal phenotype. In cases where the gingival phenotype is thin (< 1 mm), with or without GRD, it is advisable to perform preemptive soft tissue augmentation (PMT) prior to orthodontic treatment if the tooth is located within the alveolar bone envelope. Conversely, if the tooth is positioned outside the alveolar bone housing, orthodontic tooth movement should be employed to reposition the tooth within the bone housing before any soft tissue augmentation procedure is performed. Research has demonstrated a negative correlation between tooth position and periodontal root coverage, whereas tooth repositioning has shown a two-fold positive effect: 1) improving the surrounding soft tissues by reducing or eliminating the defect, and 2) enhancing the implementation and wound healing dynamics of root coverage procedures.