Laterally positioned flap to treat deep isolated gingival recession in a rotated tooth. A case report.

Background: Complete root coverage (CRC) is the primary goal in the treatment of gingival recession defects. However, anatomical factors such as thin periodontal phenotype, limited keratinized tissue width, mucosal thickness, and tooth position can influence treatment prognosis. The laterally moved flap technique is recommended when keratinized tissue is absent apical to the recession defect, especially in malpositioned teeth. Methods: A 36-year-old woman presented with a Miller Class II (Cairo Recession Type 2) gingival recession defect on the buccal surface of a rotated tooth #24, characterized by absence of keratinized tissue and a thin gingival phenotype. A laterally moved coronally advanced flap combined with a connective tissue graft was performed to increase keratinized tissue and mucosal thickness prior to orthodontic treatment. Results: At 6 months post-surgery, the patient showed stable clinical conditions with 60% root coverage, significant gain of keratinized tissue (3 mm), and increased gingival thickness. Both donor and recipient sites demonstrated satisfactory healing without signs of inflammation. Conclusion: The combined use of a laterally moved coronally advanced flap with connective tissue graft is an effective mucogingival approach for managing deep gingival recession in rotated teeth with thin phenotypes. This technique enhances tissue thickness and keratinized tissue width, improving periodontal stability prior to orthodontic intervention.