This study aimed to examine the combination of mineral trioxide aggregate (MTA) and subepithelial connective tissue grafts to treat esthetic deficiencies caused by iatrogenic tooth perforations. Three patients were treated, and clinical and histologic documentation was obtained. Connective tissue grafts were performed following standard techniques after application of MTA to seal the root perforations. Complete root coverage was obtained, significantly improving the esthetic outcomes. Histologic analysis showed the long junctional epithelium in intimate contact with the root surface. It appeared to form coronal to the perforation and extended apical to the MTA. Based on the limitations of this clinical and histologic observation, it can be concluded that MTA in conjunction with connective tissue grafts could be considered for treatment of esthetic deficiencies associated with iatrogenic tooth perforations. (Int J Periodontics Restorative Dent 2014;34:71-77. doi: 10.11607/prd.1674)