Progress in gingival papilla reconstruction

One of the most difficult and elusive goals for the periodontist in the reconstructive, regenerative and aesthetic aspect of periodontal therapy is the reconstruction of the interdental papilla that has been lost from either disease or previous pocket eradication periodontal therapy. The poor aesthetic appearance in the maxillary anterior as a result of the lost papilla has been a dilemma for both the patient and the therapist. Countless periodontists have attempted to reconstruct the papilla by numerous surgical methods, but the lack of blood supply for the donor tissue in a small, restricted recipient site has been one of the limiting factors for success. Most of the surgical procedures have emphasized gingival grafting (free grafting, ruga grafting, etc.). Others have attempted the coronal-buccal positioning of the papilla from the palatal side by folding the gingiva from the palatal side or reinforcing the buccally pushed papilla with connective tissue obtained from the palate (1). Periodic curettage of the papilla to stimulate regeneration was reported by Shapiro in 1985 (5).

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