This study assessed the use of orthodontic extrusion (OE) for biologic width reestablishment (BWR) and compared two protocols for BWR: periodontal flap surgery (FS) performed either before (FS + OE) or after (OE + FS) extrusion. Databases were screened up to March 2013 for studies on OE, and outcomes from 13 patients treated by OE + FS or FS + OE were assessed. The results of the literature showed that OE + fiberotomy led to a greater amount of root extrusion than OE alone. The clinical/radiographic assessment demonstrated no significant differences between groups (P > .05). Within groups, there was an improvement in the keratinized tissue (P = .034) and in probing depth (P = .025) for OE + FS.