Entire papilla preservation technique in the regenerative treatment of deep intrabony defects: 1-Year results

Aim: This study evaluates the clinical outcomes of a novel tunnel-like surgical technique in the treatment of isolated deep intrabony defects. Material and Methods: Twelve patients presenting with at least one isolated deep intrabony defect received regenerative periodontal treatment with "entire papilla preservation (EPP)" technique. Access to the intrabony defect for debridement was provided by a bevelled vertical releasing incision positioned in the buccal gingiva of the neighbouring inter-dental space. Following the elevation of a buccal flap, an inter-dental tunnel was prepared undermining the defect-associated papilla. Granulation tissue was removed, root surfaces were carefully debrided and bone substitutes and enamel matrix derivative were applied. Microsurgical suturing technique was used for optimal wound closure. Results: Early healing was uneventful in all cases, and 100% wound closure was maintained during the entire healing period. At 1-year, there was significant attachment gain of 6.83 +/- 2.51 mm (p<0.001). The 7 2.8 mm reduction in probing depth was also significant (p<0.001), which was associated with minimal increase in gingival recession (0.16 +/- 0.38 mm, p=0.166). Conclusions: Tunnel-like "EPP" technique may limit the risk of wound failure particularly in the early healing phase, thereby preventing exposure of regenerative biomaterials, possibly enhancing stabilization of blood clot in deep intrabony defects and leading to optimal clinical outcomes.