Background: In the United States, orthodontic therapy has become a common phase in people's lives. Patients seek treatment for esthetic and functional reasons. As with most treatment modalities, it has its own risks and benefits. Anatomic variations can predispose certain patients to problems. Presenting with a thin gingival tissue biotype, where arch expansion is needed, can predispose the patients for mucogingival defects and bony dehiscences. The purpose of this case report is to present a surgical approach to augment both hard and soft tissue, post orthodontic treatment to manage the resulting dehiscence and prevent potential future recession. Methods: An eighteen year old patient presented to the University of Illinois, College of Dentistry six years after completion of active orthodontics. The lower anterior segment was characterized by a thin gingival tissue biotype, prominent roots and a minimal zone of keratinized tissue. A surgical procedure was performed by placing an allogenic bone graft with subepithelial connective tissue graft and enamel matrix protein. Results: Surgical procedure augmenting hard and soft tissue was completed with uneventful post-operative healing. The goals of increased tissue thickness and prevention of recession were accomplished through this technique and the results were stable after a one year follow up.

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