Background: One of the main objectives of periodontal reconstructive surgery is the coverage of exposed roots that occur due to gingival recession. On some occasions, where a caries, root resorption, or amalgam restoration exists on the exposed root surface, the treatment planning becomes more complex. This case report describes the use of a subepithelial connective tissue graft (SCTG) on a resin ionomer-restored root surface to treat gingival recession that is complicated with the above-mentioned handicaps.

Methods: An amalgam restoration and carious lesion were removed following full-thickness flap reflection, and the cavity was restored with glass ionomer cement. An SCTG was placed onto the restoration, and the flap was coronally positioned. A porcelain crown restoration was performed 9 months after surgery.

Results: At 3-, 6-, and 9-month follow-ups, probing depths were reduced and gain in attachment level was obtained with no clinical signs of inflammation in gingiva. Monthly periodontal controls revealed that creeping attachment had occurred on the restoration during the follow-up periods.

Conclusion: This single case report serves as a good example to show that SCTG can be successfully performed to treat gingival recession associated with a glass ionomer-restored root surface.