An evaluation of a periodontal plastic surgical procedure for the reconstruction of interdental papillae in maxillary anterior region: A clinical study

Abstract

Background: In today's world, people are very much aware about their looks and personality. They are getting more concerned about the esthetics and thus are not ready to compromise the appearance of black holes, especially in the anterior region of the mouth. Various techniques like orthodontic correction, prosthetic veneers and various periodontal surgical methods have been used to cover these unaesthetic open embrasures. In the present study, a variant technique given by Beagle in 1992 was used to cover these open gingival embrasures. The technique uses a gingival flap from the labial aspect to close the open gingival embrasures thus solving the problem of black holes.

Aims and objectives: This clinical study was aimed to reconstruct the lost or blunted interdental papillae with gingival tissue for esthetic purpose and for maintaining oral health with the objective to determine the extent to which the procedure can revert the maxillary esthetics.

Materials and methods: The patients selected were those who were having a complaint of at least one black hole in the maxillary anterior region with grade '0' or '1' type of contour of interdental tissues. A total of 39 open embrasures were surgically closed using this technique. Various indices were taken pre-surgically and then again post surgically.

Results: Plaque index and gingival index showed an initial increase in the scores at the end of 1 week. Later, there was a gradual fall till the end of the study. Bleeding index significantly increased at the end of 12 weeks (P<0.001) but reduced to insignificant levels at the end of 24 weeks (P<0.09). The sulcus depth increased by about 1.19 mm. There was improvement in the contour of interdental tissues in 51% of cases and in 38.46% the interdental papillae completely obliterated the open embrasures.

Conclusion: The surgical technique used here for reconstruction of interdental papilla was fairly successful. However, use of bone grafts or soft tissue grafts would have improved the results further.

Keywords: Black holes; gingival flap; open embrasures; periodontal plastic surgery; unaesthetic appearance.

Figure 1

Jemt's classification (1997)

Figure 2

Diagrammatic representation of surgical procedure

Figure 3

Missing interdental papilla grade “0”

Figure 4

Incision and raising of split thickness flap

Figure 5

Flap reconstructed in the desired position

Figure 6

Papilla stabilized by loop suture

Figure 7

Periodontal dressing in place

Figure 8

1 week post-operative view

Figure 9

24 week post-operative view