If thickening of gingival soft tissue and root coverage are indicated, these two procedures should be performed prior to starting orthodontic treatment. The decision to initiate these treatments can be made only based on a clinically exact and reproducible diagnosis. The case described in this article is that of a 53-year-old woman presenting Miller Class III gingival recessions from 13 to 23 and 32 to 42. Because of this impairment, she needs orthodontic treatment. The patient’s periodontal biotype is thin.

The objective of the surgery discussed in this article is both to thicken the periodontium of the patient and to promote coverage of the recessions. To achieve these two objectives, we have chosen the modified “envelope” technique with insertion of connective tissue.

The 18 month post-operative results show an excellent rate of root coverage and a significant esthetic improvement of the gingiva.