Surgical reconstruction of interdental papilla using subepithelial connective tissue graft (SCTG) with a coronally advanced flap: a clinical evaluation of five cases.

AIM The aim of these case reports was to evaluate the effectiveness of a subepithelial connective tissue graft with a coronally advanced flap to reconstruct an interdental papilla. BACKGROUND In the last decade, esthetics has become a major concern in periodontal therapy. One of the most difficult and elusive goals for the periodontist in the esthetic aspect of periodontal therapy is the reconstruction of the interdental papilla. Consequently, the absence or loss of the interdental papilla for a variety of reasons may create significant esthetic, functional, and phonetic challenges for the patient. CASE DESCRIPTION Five systemically healthy patients between the ages of 23 and 52 years with absence of the periodontal pocket were selected. Loss of interdental papillary height was classified using the Nordland and Tarnow classification system as class 1 to 4. All five patients received a subepithelial connective tissue graft (SCTG) with a coronally advanced flap (CAF). Four parameters were measured at baseline and at six months post-surgery: (1) vertical distance from contact point to gingival margin, (2) soft tissue (papilla) height in the interdental area, (3) horizontal distance at the gingival margin, and (4) width of keratinized gingiva. The changes noted at six months post-surgery were (1) the vertical distance decreased from 3.2±0.44 mm to 0.4±0.54 mm, (2) the mean gain in soft tissue (papilla) height increased from 3.2±0.44 mm to 5.8±0.44 mm, (3) the horizontal distance at the gingival margin was reduced from 2.6±0.54 mm to 0.4±0.54 mm and the width of the keratinized gingiva increased 1.4±0.89 mm. CONCLUSION The periodontal surgical technique used for the five reported cases successfully reconstructed the interdental papilla in just one type of papilla loss, the class I situation. Therefore, it should not be concluded that the technique shown would be equally as successful for every type of papilla loss. Furthermore, the postoperative time interval was short, at only six months. CLINICAL SIGNIFICANCE A subepithelial connective tissue graft supported by a coronally advanced flap should be considered to surgically correct the loss of an interdental papilla in class I cases.