Laterally positioned interdental multiple papilla flap to augment the attached gingiva on a tooth with an abnormal root surface

This article is about the use of a laterally repositioned interdental multiple papilla flap to augment the attached gingiva on a tooth with an abnormal root surface.

A 35 years old male non diabetic, non smoker, presented with recurrent gingival inflammation on a lower cuspid. After several recall visits an enamel pearl was detected on the root surface and surgical treatment was planned.

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Diagram showing submarginal incision in the donor area and oblique incisions in the direction of the area to be treated with parallel incisions. The flap is pulled by the muscles that run in a mesiodistal direction until it is positioned in the area of the recipient teeth. The interproximal papillae are moved over the root surfaces of adjacent teeth. Sling sutures anchored to the periosteum are performed around individual teeth, and horizontal sutures help in maintaining flap adhesion to underlying surfaces.

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On the left, recurrent gingival inflammation of tooth 33, due to the presence of an enamel pearl on the root surface. Then a partial-thickness flap is performed in the area of tooth 32 with a submarginal internal beveled incision.

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Preparation of recipient bed with periosteum firmly adherent to the underlying bone in the area of teeth 33, 34 and 35. Then removal of the enamel pearl on tooth 33 with a carbide bur was performed.

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The flap is moved laterally from 32 and sutured on 33, with a sling horizontal suture to promote adaptation of the flap to the periosteum. The papillae between 33-34 and 34-35 are moved distally and similarly sutured. 2-years follow-up.

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The initial case and the 25-years follow-up.


After proper diagnosis and adequate surgical treatment, elimination of gingival inflammation, augmentation of attached gingiva and root coverage can be obtain long term.


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