Nonsurgical therapy to recapture the interproximal papilla
Nonsurgical therapy can be useful to recapture the esthetic aspect of periodontal tissues even in the most difficult cases, where the interproximal papilla has been lost because of the inflammatory process.
An 18 years old girl, with no systemic risk factors (non-diabetic, non-smoker) presented with grade 1-2 tooth mobility, spontaneous bleeding, halitosis and diastemas.
Img. 1 – Nonsurgical therapy: Recovery of papilla. The young patient showed multiple abscesses with altered gingival profiles. Note the creation of diastemas.
Img. 2 – Considerable contraction of interproximal tissues followed nonsurgical therapy.
Img. 3 – Clinical case compared before and after one year of nonsurgical therapy: recovery of the height of the papilla following optimal oral hygiene, control of inflammation, and tissue maturation.
Nonsurgical therapy if properly and carefully performed, may improve the esthetic of the patients even in the most challenging cases, namely those who have lost the interproximal papilla.
Reiser GM, Bruno JF, Mahan PE, Larkin LH. The subepithelial connective tissue graft palatal donor site: anatomic considerations for surgeons. Int J Periodontics Restorative Dent. 1996 Apr;16(2):130-7.
Proceedings of the World Workshop in Periodontics. Consensus report of mucogingival therapy. Annals of Periodontology. 1996 Nov; 1(1): 702-6.
Agudio G, Nieri M, Rotundo R, Cortellini P, Pini Prato GP. Free gingival grafts to increase keratinized tissue: a retrospective long term evaluation (10 to 25 years) of outcomes. J Periodontol 2008 Apr; 79(4): 587-94.
Charruel S, Perez C, Foti B, Camps J, Monnet-Corti V. Gingival contour assessment: clinical parameters useful for esthetic diagnosis and treatment. J Periodontol. 2008 May; 79(5): 795-801.
Carolina ML, Mattos, Ronaldo B. Santana. Quantitative evaluation of the spatial displacement of the gingival Zenith in the maxillary anterior dentition. J Periodontol. 2008 Oct; 79(10): 1880-1885.
Pini Prato GP, Baldi C, Nieri M, Franseschi D, Cortellini P, Clauser C, Rotundo R, Muzzi L. Coronally Advanced Flap: The Post-Surgical Position of the Gingival Margin Is an Important Factor for Achieving Complete Root Coverage. J Periodontol. 2005 May; 76(5):713-722.
Rotundo R, Mori M, Bonaccini D, Baldi C. Intra-and inter-rater agreement of a new classi?cation system of gingival recession defects. Eur J Oral Implantol. 2011 Summer; 4(2):127-33.
Zabalegui I, Sicilia A, Cambra J, Gil J, Sanz M. Treatment of multiple adjacent gingival recessions with the tunnelsubepithelial connective tissue graft: a clinical report. Int J Periodontics Restorative Dent. 1999; 19: 199-206.
Kois J. The restorative-periodontal interface: biological parameters. Periodontol 2000. 1996 Jun; 11: 29-38.