Optimizing axial inclination with clear aligner orthodontic treatment to address recession defects: a case series

Proper alignment of the teeth not only aids in functional occlusion but also promotes harmonious gingival contours, potentially reducing the risk of inflammation and gingival recession. This case series aimed to evaluate the effectiveness of optimizing axial inclination through clear aligner orthodontic treatment in addressing gingival recession defects. This case series included nine patients, aged 20 to 36 years, who presented with varying degrees of gingival recession on 12 mandibular incisors. All patients had undergone orthodontic treatment during childhood and were maintained with a fixed stainless-steel canine-to-canine retainer. The exhibited gingival recessions were potentially caused by inadvertent torque discrepancies in the teeth induced by the retention wire. Prior to treatment, a comprehensive radiographic and periodontal evaluation was performed, and clear aligner orthodontic treatment was used to correct the axial inclination of the affected teeth. Following the completion of the orthodontic treatment, patients were reevaluated to assess changes in recession depth and width; those with remaining recession were considered for soft tissue grafting. The average treatment duration was 21.6 ± 3.7 months, ranging from 18 to 29 months. Root torque adjustments averaged 12 ± 9 degrees, ranging from a correction of 14 degrees lingually to 33 degrees labially, while buccolingual crown movement averaged 1.7 ± 1.2 mm, with a range from 3.4 mm lingually to 0.6 mm labially. All cases showed improvement in gingival recession, with complete recovery in one tooth and an average of 58% ± 21% reduction in recession depth and width for the remaining 11 teeth. Surgical intervention, consisting of soft tissue grafting, was required in four cases, while the remaining eight teeth showed sufficient improvement and were monitored with follow-up care. Correcting axial inclination with clear aligner orthodontic treatment positively impacts both tooth alignment and gingival recession. These findings propose a new approach: initiating orthodontic treatment before periodontal surgery to streamline treatment and reduce the need for invasive procedures. Orthodontists, general dental practitioners, and patients should be aware of the potential complications of fixed retainers and their possible orthodontic adjustments correction.