Surgical Reconstruction of Interdental Papilla using Subepithelial Connective Tissue Graft by Microsurgical Technique: A Clinical Study

Abstract

Background: Loss of interdental papilla is one of the most concerning esthetic problem for the patient and equally challenging for the clinician. Management of papillary loss has shown limited success and is limited to case reports with lack of long-term follow-up.Method: Surgical microscope was used at 6X magnification in this study to enhance the visual acuity in the narrow interdental space. 13 cases with 20 sites in the maxillary anterior region were selected for surgical reconstruction. Tunnelling was performed under the deficient papillae and connective tissue graft used to fill the space created.Results: Among 20 sites, 5 sites showed complete papillary fill, while 3 sites were 1 mm deficient. The mean vertical gain achieved was 1.63 mm which was statistically significant at P value <0.01. A significant adverse surgical outcome was diastema formation within 4 weeks postoperatively.Conclusion: Microsurgery enhances the surgeon’s ability to handle delicate papillary tissue and hence more predictable. Splinting of teeth prior to papillary reconstruction may be considered to prevent diastema formation.