Two-stage surgical plastic surgery of the lost interdental papilla in class III recession according to Tarnow and Nordland

Abstract

This report presents a clinical case of elimination of the recession of the interdental papilla of class III according to Tarnow and Nordland with the help of mucogingival plastic surgery in two stages. Before the surgical intervention, orthopedic structures and braces were installed on teeth 1.1 and 2.1 to eliminate the diastema between the teeth and bring the roots of the teeth closer together 1.1, 2.1. The first surgical stage of eliminating the recession of the interdental papilla was the use of a coronal-displaced flap using a free gingival graft to increase soft tissues in the area of the lost interdental papilla. The second surgery for eliminating the recession of the interdental papilla and recreating its anatomical shape was tunnel plasty of the interdental gum using a free gingival transplant.
 In this clinical case, the patient was fixed with an orthopedic structure with a space under the interdental papilla (5 mm), which is a criterion for complete restoration of the shape and volume of the interdental papilla. The full restoration of the volume, height, and anatomical contour of the interdental papilla is achieved thanks to the interdisciplinary work of dentists — periodontists, therapists, orthopedists, and orthodontists. A stable result was noted 1 year postoperatively.