Patient RW was referred by her general dentist for evaluation and management of advanced gingival recession prior to planned restorative treatment.

Initial Condition & Life Before Treatment

At the time of presentation, RW was in her early 60s and expressed significant concern and embarrassment regarding the appearance of her smile.

Clinical examination revealed gingival recession with exposed, worn, and discolored root surfaces, most notably on the upper and lower anterior teeth. 

The maxillary anterior teeth were additionally compromised by chipping, cracks, and discoloration. These changes were consistent with years of cumulative wear and periodontal tissue loss.

The exposed root surfaces not only affected the appearance of her smile but also made it impossible to achieve an optimal esthetic result with restorative work alone. 

Without proper soft tissue coverage, even expertly crafted veneers would fail to achieve a natural, seamless appearance.

Initial presentation showing exposed, worn, and discolored root surfaces with chipping and discoloration of maxillary anterior teeth.

First Appointment & Discovery

During the initial consultation, treatment options were discussed in detail. 

Dr. Lofthus explained that significant aesthetic improvement could be achieved by first rebuilding a healthy periodontal foundation through connective tissue grafting.

An aesthetic mock-up was created to demonstrate the potential outcome following periodontal and restorative therapy. This visual preview helped RW understand the comprehensive approach needed to achieve her desired results.

Misunderstandings or Clinical Oversights

A common misconception in cosmetic dentistry is that veneers alone can solve all esthetic concerns. 

However, when gum recession and exposed roots are present, placing veneers without first addressing the soft-tissue foundation can lead to compromised results.

Veneers cannot effectively cover root surfaces, and attempting to do so often results in visible dark lines at the gumline, poor tissue integration, and an artificial appearance. 

By addressing the periodontal health and esthetics first, the final restorative work can achieve truly seamless, natural results.

Additionally, allowing adequate healing time for soft tissue maturation before proceeding with final restorations ensures optimal stability and long-term success, a critical step that cannot be rushed.

Treatment Plan & Approach

The comprehensive treatment plan consisted of:

Connective Tissue Grafting: Soft tissue grafting was performed around eight maxillary anterior teeth and eight mandibular anterior teeth. 

The objectives were to improve root coverage, increase tissue thickness, and enhance gingival symmetry and color.

Healing Phase: Adequate healing time was allowed to ensure full maturation and stability of the soft tissues prior to proceeding with final restorations.

Final Restorative Work: Once the periodontal foundation was established, carefully planned crowns and veneers were placed to achieve a harmonious and rejuvenated smile.

The entire case was completed over approximately four months, ensuring each phase received proper attention and time to heal.

Post connective tissue grafting showing dramatic improvement in root coverage, tissue color, and gingival contour prior to final restorative work.

Case Progression & Key Milestones

Periodontal Grafting: Connective tissue grafting was performed on 16 anterior teeth (8 maxillary, 8 mandibular) to address extensive recession and create an ideal foundation.

Soft Tissue Maturation: The grafted tissue was allowed adequate time to heal, integrate, and mature before restorative work began.

Dramatic Intermediate Improvement: The gingival grafting alone resulted in a dramatic improvement in smile aesthetics by reducing root exposure and improving tissue color and contour.

Final Restoration: With the periodontal foundation optimally prepared, crowns and veneers were placed, resulting in a harmonious and rejuvenated smile.

Final post-treatment results demonstrating seamless integration of restored gums and custom restorations following four-month comprehensive treatment.

Outcome

Connective tissue grafting successfully achieved significant root coverage across all 16 anterior teeth, with improved tissue thickness, color, and symmetry. 

The grafted tissue matured beautifully, providing the ideal foundation for restorative work.

Final aesthetic refinement was achieved with carefully planned crowns and veneers. The comprehensive approach, addressing periodontal health first, then restorative esthetics, delivered exceptional results.

RW was extremely pleased with the final outcome and reported renewed confidence in her smile. Her only regret was not pursuing treatment earlier.

Clinical Notes for Referring Doctors

This case demonstrates the critical importance of addressing advanced gingival recession prior to definitive cosmetic restorations. 

Connective tissue grafting to sixteen anterior teeth provided significant root coverage, improved tissue thickness, and established ideal gingival architecture.

The grafting alone produced dramatic aesthetic improvement before restorative work began. Allowing adequate soft-tissue maturation ensured optimal integration and stability for final crown and veneer placement.

The collaboration between periodontal and restorative teams, combined with proper treatment sequencing, resulted in predictable outcomes with excellent long-term esthetics and high patient satisfaction. 

Dr. Lofthus welcomes referrals for complex cases requiring extensive soft tissue augmentation in the esthetic zone.