Interdental Papillae Loss and Multiple RT2 and RT3 Gingival Recession Defects: A Case Report of a Combined Surgical Treatment Approach.

Modern dentistry is focused on patient needs, with the current trend shifting from merely restoring the loss of function to pursuing the esthetic satisfaction of patients and professional operators, as well as achieving optimal and stable results. Ideal smile esthetics depend on the balance between white and pink components, and therefore papilla reconstruction is one of the most challenging goals in periodontal plastic surgery and restorative procedures. The present case report proposes a surgical technique for the combined treatment of RT2 and RT3 recession defects and interdental papilla loss by means of a modified coronally advanced flap with an interdental subepithelial connective tissue graft.

Intrabony defects, open-flap debridement, and decortication: a randomized clinical trial.

BACKGROUND: Intramarrow penetration (IMP) is often incorporated in regenerative periodontal surgical procedures. However, the actual benefits of adding IMP to such a procedure remain undocumented. The purpose of this randomized controlled trial was to investigate the contribution of IMP to the outcomes of open-flap debridement (OFD) treatment of intrabony defects. METHODS: Forty-two chronic periodontitis patients, each contributing a 2-wall, 3-wall, or combined 2- to 3-wall intrabony defect, were treated. Sites were randomly assigned into one of two groups: control (OFD alone) or test (OFD + IMP). Papilla preservation flaps were raised, and defects were thoroughly debrided. In the control group, complete primary closure of flaps was ensured after debridement. In the test group, IMP was performed before flap closure, using a round bur to penetrate the cortical defect wall. Clinical and radiographic parameters were assessed at baseline and 12 months after treatment. RESULTS: At baseline, there were no statistically significant differences between groups. At 12 months, both groups experienced significant improvements, in terms of probing depth reduction, clinical attachment level (CAL) gain, and bone level (clinical and radiographic). The test group experienced significantly greater clinical bone gain (3.07 ± 1.74 mm) and prevalence of CAL gain ≥2 mm (93% of sites) compared with the control group (1.76 ± 2.71 mm, P <0.03; 62%, P = 0.024). The test treatment benefits were particularly evident in mandibular sites, in which OFD + IMP doubled the radiographic bone gain obtained by OFD alone. CONCLUSION: Addition of IMP to an OFD procedure used to treat intrabony defects results in statistically and clinically significant enhancement of both clinical and radiographic outcomes.