Coronally advanced flap-assisted surgically facilitated orthodontics: A technical note

In situations where orthodontic tooth movement is expected to exceed the preexisting alveolar envelope, surgically facilitated orthodontic therapy (SFOT) has been advocated to expand the alveolar housing and reduce periodontal risks. However, detailed descriptions of soft-tissue management during SFOT remain limited.

This technical note describes a surgical protocol incorporating a coronally advanced flap (CAF) within a segmental SFOT approach and illustrates its clinical application in patients undergoing orthodontic treatment requiring simultaneous periodontal phenotype modification.

The proposed CAF-assisted SFOT protocol is based on three main principles: limiting the surgical intervention to the orthodontically involved segment, applying established mucogingival surgical principles to ensure predictable flap management, and using an acellular dermal matrix to contribute to both graft containment and soft-tissue thickening.

The described technique provides a structured approach for integrating soft-tissue management into SFOT procedures and may facilitate simultaneous hard- and soft-tissue augmentation in orthodontic patients requiring phenotype modification.

This case provides new information as it is, to the best of our knowledge, the first technical report describing the application of coronally advanced flap principles within a segmental surgically facilitated orthodontic therapy protocol. Successful management of this case relies on accurate interdisciplinary orthodontic-periodontal diagnosis, careful treatment planning, and appropriate flap management to ensure tension-free coronal advancement and graft stabilization. The primary limitation of this report is the absence of prospective clinical studies evaluating the long-term outcomes of this technique.

Orthodontic treatment sometimes requires moving teeth beyond the natural limits of the surrounding bone, which can increase the risk of gum recession and other periodontal problems. Surgically facilitated orthodontic therapy (SFOT) has been introduced to expand the supporting bone and make such movements safer, but there is limited information on how to manage the gums during these procedures. This report describes a surgical approach that combines SFOT with a commonly used gum surgery technique called a coronally advanced flap. The procedure focuses only on the area where teeth are being moved, applies well-established principles of gum surgery to ensure stable healing, and uses a soft-tissue substitute to help protect the graft and thicken the gums. This technique offers a structured way to address both bone and gum deficiencies at the same time during orthodontic treatment. While promising, further clinical studies are needed to confirm its long-term effectiveness.