Reconstruction of interdental papilla using autogenous bone and connective tissue grafts

Abstract

Previous studies have reported the management of Class I and II papillary defects, but knowledge on Class III defects, estimated to have a poor periodontal prognosis, remains minimal. In this case report, a Class III papillary defect reconstruction was attempted mainly since the patient reported with difficulty in phonetics. In Stage I, autogenous bone graft from the maxillary tuberosity and subepithelial connective tissue graft was augmented to decrease the distance between the interdental bone crest and contact point, simultaneously achieving a switch in the periodontal biotype. In Stage II, subepithelial connective tissue graft was augmented to achieve papillary fill. To avoid manual errors associated with quantifying the posttreatment outcomes, image data processing ImageJ software was used to assess the length, perimeter, and surface area of papillary loss using the preoperative images.

Keywords: Autogenous bone graft; papillary reconstruction; subepithelial connective tissue graft.

Figure 1

Preoperative view of gingival papillary recession. (a) Frontal aspect; (b) Intraoral radiograph

Figure 2

(a) Intrasulcular incisions and vertical releasing incisions were made on the facial aspect including the adjacent mesial and distal papilla; (b) Autogenous bone graft was harvested form the maxillary tuberosity and stabilized using stainless steel screws; (c) Connective tissue graft harvested from the palate was placed in the interdental space and secured in place using 5-0 Vicryl sutures; (d) Suspensory sutures were used to advance the flap coronally ensuring closure of the interdental space

Figure 3

(a) Postoperative aspect of treated area 3 months after Stage I; (b) Intraoral radiograph after augmentation in papillary region after 3 months

Figure 4

Stage II (a) intrasulcular incisions and semilunar incision were made at the height of the mucogingival junction on the facial aspect; (b) Connective tissue graft harvested from the palate was tucked into the recipient site; (c) Gingivopapillary unit was coronally advanced and sutured using suspensory sutures to an orthodontic bracket that was bonded to the labial surface of the tooth; (d) Postoperative healing 1 year after surgery

Figure 5

Scale was set at 14.600 pixels/mm by comparing 1 mm calibrated UNC probe measurements and ImageJ software

Figure 6

ImageJ software used to calculate (a) surface area; (b) length; and (c) perimeter

Figure 7

Comparison of surface area of lost Interdental papilla graphically represented