OBJECTIVE: This case report offers information on accurate diagnostic and soft- and hard-tissue reconstruction periodontal surgery deal with "black triangles" in the aesthetic zone of anterior teeth caused by submucous alveolar cleft, which is rare and easily overlooked. CLINICAL CONSIDERATIONS: Vertical and horizontal bone augmentation was conducted via guided tissue regeneration and alveolar bone grafting (ABG) at the cleft site where favorable bone grafting conditions were absent. A customized, vascularized interpositional periosteal-connective tissue (VIP-CT) flap was applied as the barrier membrane to maintain the stability of bone replacement graft and provide soft-tissue foundation for gingival papilla growth. Adjustment on the contact point position of the anterior teeth and the shapes of crowns induced growth of the gingival papillae with resin restoration. The radiological and clinical parameters, and smiling photographs demonstrated a satisfactory treatment outcome. CONCLUSIONS: When the inflammation and local alveolar bone destruction in the anterior area are disproportionate, submucous alveolar cleft should be considered a potential etiology. Surgical treatment combined with resin restoration substantially improved the affected area. CLINICAL SIGNIFICANCE: The hard- and soft-tissue defects can be improved through ABG and VIP-CT flap in a single surgery.