
 crestal incision placed about 1.5 mm palatal to the greatest bony height with an angulation of 45 with no .
15 bard parker blade [ figure 1 ] 
 a vertical releasing incision placed mesially and distally to the crestal incision without disturbing the adjacent teeth papilla and extending about 3 mm labially [ figure 2 ] 
 soft tissue reflected to expose the cover screw [ figure 3 ] 
 palatal extension of the incision followed closer to the adjacent teeth on both sides , and a release incision made around the palatal portion of the exposed cover screw [ figure 4 ] 
 then healing abutment is placed after thoroughly cleaning the soft tissue around internal hex of the implant [ figure 5 ] 
 soft tissue approximated with 40 suture material ( vicryl)sutures removal has to be done after 10 daysafter 2 weeks , second stage prosthetic procedure should be carried out . 
 
crestal incision placed about 1.5 mm palatal to the greatest bony height with an angulation of 45 with no .
15 bard parker blade [ figure 1 ] 
  a vertical releasing incision placed mesially and distally to the crestal incision without disturbing the adjacent teeth papilla and extending about 3 mm labially [ figure 2 ] 
  soft tissue reflected to expose the cover screw [ figure 3 ] 
  palatal extension of the incision followed closer to the adjacent teeth on both sides , and a release incision made around the palatal portion of the exposed cover screw [ figure 4 ] 
  then healing abutment is placed after thoroughly cleaning the soft tissue around internal hex of the implant [ figure 5 ] 
  soft tissue approximated with 40 suture material ( vicryl ) sutures removal has to be done after 10 days after 2 weeks , second stage prosthetic procedure should be carried out . incision and flap outlined ( after reflection )
more importantly it plays an important and crucial role in an esthetic component of a natural dentition .
hence , it is very vital to maintain the integrity of the papilla during second stage implant surgery .
several methods with unique incisions and suturing designs have been proposed to regenerate interdental papilla around implants .
palacci suggested that a full thickness flap be raised from the buccal and palatal side of the implant on the ridge and rotated 90 to accommodate the interproximal space of the implant .
palatal sliding strip flap  to form papilla between implants and natural dentition in the anterior maxilla .
nemcovsky et al . suggested an u- shaped incision , with opening toward the buccal aspect of the implant site with divergent incisions .
tinti and benfenati reported a ramp mattress suture design , which pulled the buccal flap coronally , to obtain a papilla between two implants .
suggested a split finger surgical method in which three interlacing finger like incisions were made and each of the fingers was sutured over the desired interdental papillary position .
proposed a method for papilla regeneration wherein the healing abutment is buried beneath the gingival flap to produce a dead space with expectation of the space being filled by the soft tissue . even though these procedures provided papillary height , the results were not predictable .
various factors were involved in the success of any papilla regeneration procedures , such as preservation of blood supply , prevention of scar formation , and more importantly ideal placement of the implant into the bone .
this new and innovative surgical technique provided significantly excellent results compared to the conventional mid - crestal technique [ figures 6 and 7 ] . in this case report , in order to overcome the limitations of above - mentioned techniques a novel window technique was followed to regenerate papilla around implants during second stage surgery prior to prosthetic restoration . unlike most other procedures mentioned above , this technique avoided the labial papilla on the adjacent teeth and involved wholly the palatal papilla , which is considered to be the key element in the success of this technique .
moreover , there is no cross incisions on to the papilla , which may lead to , disturbed wound healing and scar formation .
above all avoiding more invasive surgery is considered one of the best methods of soft tissue regeneration , which is being incorporated in this technique .
the major advantages of this technique , when compared with earlier ones , are minimal invasive incision , less postoperative discomfort , and excellent esthetic and emergence profile obtained
. the aim of any soft tissue procedure should be to obtain a resilient and scar less soft tissue .
this can be obtained with atraumatic tissue handling , minimal tension during approximation , adequate vascularity , adequate hydration , and expedient surgical procedures that do not compromise blood supply .
this case report shows the excellent results following the above requisites to obtain esthetic soft tissue profile .
the patients were followed for 2 years at regular intervals and still the esthetic results obtained during the surgery and after 2 years were the same [ figure 8 ] . with above considerations with respect to follow - up and esthetic component , this technique provided the required and desired results .
in order to obtain esthetic papillary height and tissue integrity around implants proper and meticulous implant positioning is needed .
being a long term follow - up report this technique can be considered as a simple , minimal invasive procedure , which can be followed during 2 stage surgery .
 reconstructing predictable and esthetic papilla is the most complex and challenging aspect of implant dentistry . to obtain an esthetic and predictable gingival architecture and implant restoration , 
 interdental papilla plays an important role . 
 the main objective of the surgeon during the second stage of implant treatment should be the creation of interdental papilla prior to prosthetic restoration . 
 the aim of this case report was to demonstrate a novel window technique for developing predictable and esthetic papilla around dental implants , which was followed for 2 years with excellent esthetic results . 