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Gingival recession identifies the location of marginal periodontal tissues apical to the cementoenamel junction. Causes of gingival recession include plaque-induced gingival inflammation, toothbrushing trauma, or malpositioning of teeth. Root coverage has become a common periodontal plastic surgery. However, periodontal plastic surgery is invasive for patients. A few case reports have demonstrated successful root coverage by nonsurgical therapy. The present study reports a case in which root flattening of malpositioned teeth was effective for achieving complete root coverage. A 38-year-old Japanese woman presented at a private practice setting. Her chief complaints were poor aesthetic appearance and hypersensitivity of teeth #23 and #44. Both teeth were malpositioned toward the buccal aspect. The plaque control record was 37%. She used a hard-bristled toothbrush. The mid-buccal aspect of tooth #23 exhibited the following baseline clinical parameters: 4 mm recession depth, 4 mm recession width, and 1 mm width of keratinized tissue (Miller’s Class I recession). Root caries were present near the cementoenamel junction. The mid-buccal aspect of tooth #44 exhibited the following baseline clinical parameters: 2 mm recession depth, 2 mm recession width, and 2 mm width of keratinized tissue (Miller’s Class I recession) (Fig. 1A1 and B1). The pocket depth was 2 mm, and there was no bleeding on probing. She was a nonsmoker and was systemically healthy. After local anesthesia, an intracrevicular, scalloped, partial-thickness incision was made. The minimal flap was raised with a partial-thickness flap, and thorough root debridement was performed with rotary and hand instruments to obtain a smooth, detoxified surface. The convex root surface was flattened within the bony housing of the adjunct tooth. Step shape of the root surface near the cementoenamel junction was corrected meticulously using hand instruments. Then the root was polished with a fluoride paste. The partial-thickness flap was not sutured (Fig. 1A2 and B2). A clinical examination was performed at the 4-month postoperative visit. Root

Root flattening of malpositioned teeth is effective for achieving complete root coverage