Understanding the relationship between orthodontic tooth movement and the mucogingival tissue response is of particular importance given the large number of patients undergoing orthodontic treatment every year. Active orthodontic tooth movement can induce gingival recession when teeth are moved outside the alveolar envelope. However, the available evidence does not give a definitive answer to the question whether orthodontic treatment is a major risk factor for the development of gingival recession in the long-term. The same is true regarding the role of individual patient-related or treatment-related contributing factors. Fixed orthodontic retention man also induce unwanted tooth movement of the retained teeth through the transmission of forces from an active retainer that remains bonded and is clinically intact. These movements typically manifest as progressive changes in tooth inclination and torque. Although orthodontic retreatment in these cases is generally feasible, severe root displacement beyond the alveolar bone envelop may result in irreversible complications, including bone dehiscence, gingival recession, and loss of tooth vitality, particularly when the changes are not detected at an early stage. This is an increasingly relevant topic in view of the growing trend toward lifelong retention. When treating gingival recession in orthodontic patients, special care must be given in the analysis of the specific topographic characteristics of the individual patient as this will dictate the need for orthodontic preparation before surgical intervention. This presentation will illustrate the above-mentioned topics using numerous clinical cases.