Novel triangle papilla access approach for interdental bone defect regeneration: A case study
Authors: Ihara Yuichiro , Shibazaki Shunichi , Morikawa Satoru , Nakagawa Taneaki 
Published: January 2025

Background

Successful periodontal regeneration depends on primary wound closure and interdental papilla preservation. In this case study, we introduce a novel triangle papilla access approach (T‐PAA) performed under a surgical microscope for treating interdental bone defects. In this novel approach, buccal incisions were used to access root surfaces and bone defects, avoiding interdental papilla incisions and preventing papillary collapse and necrosis.

Methods

Nine patients with a mean age of 56 years were enrolled in this study. Incisions were made to create a triangular flap, which was reflected using a micro‐periosteal elevator to expose the bone defect and granulation tissue. Subsequently, the granulation tissue was removed from the bone defect using a microsurgical blade, followed by root debridement using ultrasonic and micro‐hand scalers and root conditioning. Thereafter, a mixture of fibroblast growth factor‐2 and carbonated apatite granules was applied to the bone defect. The triangular flap was repositioned to ensure that the apex was not lifted by the graft material, and from the flap apex, 7‐0 nylon sutures were used, followed by the addition of mesial and distal sutures. Adjacent teeth were splinted using wire and resin cement.

Results

Postoperatively, clinical and radiographic evaluations at 6 months and 1 year showed significant improvements in periodontal parameters and bone filling. All patients achieved primary wound closure with no postoperative complications.

Conclusions

T‐PAA is a promising approach for periodontal regeneration, providing adequate surgical access under a surgical microscope while preserving the papilla and potentially improving clinical outcomes in patients with interdental bone defects.

Key points

Triangle papilla access approach (T‐PAA) provides adequate surgical access, preserves the interdental papillae, and improves clinical outcomes in cases of interdental bone defects.

Triangular incisions made in areas with abundant blood flow and thicker gingiva at the base of the papilla are less likely to impair blood supply to the interdental papillae.

T‐PAA facilitates effective debridement, precise placement of regenerative materials, and accurate flap repositioning regardless of the defect morphology in localized interdental areas.

Plain language summary

Successful periodontal treatment often requires surgical procedures for bone regeneration in patients with bone defects. However, traditional surgical approaches may damage the interdental papillae, leading to esthetic concerns and compromised healing. In this study, we introduced a new surgical technique called the triangle papilla access approach, which uses a specially designed triangular incision to access and treat bone defects under a surgical microscope while preserving the interdental papillae. Our results from nine patients demonstrated that this technique effectively maintained tissue health and promoted bone regeneration. Therefore, it could become a more efficient approach for treating interdental bone defects.