Reconstructive surgery for periodontal soft tissues requires a precise sequence of surgical maneuvers to achieve optimal aesthetic and functional integration. Treating gingival recession in patients with a history of orthodontic therapy presents significant challenges, creating a multifaceted scenario where factors such as exposed root conditions, root prominences, the amount of residual soft tissue, and potential interproximal attachment loss can greatly complicate clinical decision-making regarding reconstruction. Similarly, the preventive treatment of soft tissue deficiencies requires a careful cost-benefit analysis to determine the appropriate course of action. In this context, reconstructive procedures utilizing connective tissue grafts are considered the most predictable in terms of medium- and long-term clinical efficacy. However, these procedures are associated with increased postoperative morbidity, a factor that must be carefully weighed, particularly in growing patients. The aim of this conference is to focus on key clinical scenarios and surgical procedures, examining the predictability of outcomes based on scientific evidence.