Surgical Reconstruction of Interdental Papilla Using Subepithelial Connective Tissue Graft (SCTG) with a Coronally Advanced Flap: A Clinical Evaluation of Five Cases
Citation Information :
Bhongade M, Jaiswal P, Tiwari I, Chavan R, Banode P. Surgical Reconstruction of Interdental Papilla Using Subepithelial Connective Tissue Graft (SCTG) with a Coronally Advanced Flap: A Clinical Evaluation of Five Cases. J Contemp Dent Pract 2010; 11 (6):49-57.
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.
Citation
Jaiswal P, Bhongade M, Tiwari I, Chavan R, Banode P. Surgical Reconstruction of Interdental Papilla Using Subepithelial Connective Tissue Graft (SCTG) with a Coronally Advanced Flap: A Clinical Evaluation of Five Cases. J Contemp Dent Pract [Internet]. 2010 December; 11(6):049-057. Available from: http://www.thejcdp. com/journal/view/volume11-issue6-jaiswal
Periodontal plastic surgery. Dent Clin North Am. 1998; 42(3):411-65.
The development of periodontal plastic surgery. Periodontol 2000. 1996; 11:7-17.
Esthetics: the orthodonticperiodontic restorative connection. Semin Orthod. 1996; 2(1):21-30.
Reconstruction of the lost interproximal papilla—presentation of surgical and nonsurgical approaches. Int J Periodontics Restorative Dent. 1999; 19(4):395-406.
Changes in interdental papillae heights following alignment of anterior teeth. Aust Orthod J. 2007; 23(1):16-23.
Progress in gingival papilla reconstruction. Periodontol 2000. 1996; 11:65-8.
Regeneration of interdental papillae using periodic curettage. Int J Periodontics Restorative Dent. 1985; 5(5): 27-33.
Surgical reconstruction of the interdental papilla: case report. Int J Periodontics Restorative Dent. 1992; 12(2):145-51.
Root coverage using a free soft tissue autograft following citric acid application. Part I: Technique. Int J Periodontics Restorative Dent. 1982; 2(1): 65-70.
Covering localized areas of root exposure employing the “envelope” technique. J Periodontol. 1985; 56(7):397-402.
The subepithelial connective tissue graft. J Prosthet Dent. 1980; 44(4):363-7.
Surgical reconstruction of the interdental papilla. Int J Periodontics Restorative Dent. 1998; 18:466-73.
Reduced plaque formation by the chloromethyl analogue of vitamine C. J Periodontol. 1970; 41(1):41-3.
HR. Psychological and chemical mediators of gingival health. J Prev Dent. 1977;4(4):6-17.
A classification system for loss of papillary height. J Periodontol. 1998; 69(10):1124-6.
Clinical response to local delivery of tetracycline in relation to overall and local periodontal conditions. J Clin Periodontol. 1997; 24(7):470-7.
The effect of the distance from the contact point to the crest of bone on the presence or absence of the interproximal dental papilla. J Periodontol. 1992; 63(12):995-1004.
Effect of bone crest to contact point distance on central papilla height using embrasure morphologies. Quintessence Int. 2009; 40(6):507-13.
Surgical reconstruction of interdental papilla using an interposed subepithelial connective tissue graft: a case report. Int J Periodontics Restorative Dent. 2004; 24(1): 31-7.
Root coverage and papilla reconstruction in Class IV recession: a case report. Int J Periodontics Restorative Dent. 1999; 19(5):449-55.
Interproximal papilla augmentation procedure: a novel surgical approach and clinical evaluation of 10 consecutive procedures. Int J Periodontics Restorative Dent. 2001; 21(6):553-9.
The subepithelial connective tissue pedicle graft combined with the coronally advanced flap for restoring missing papilla: a report of two cases. Quintessence Int. 2010; 41(3):213-20.