Long-term outcomes of microsurgical interdental papilla reconstruction: 13-year and 18-year case follow-ups.

Abstract

Background: Loss of the interdental papilla compromises esthetics, speech, and hygiene, significantly affecting quality of life and psychological well-being. Reconstruction has long been considered unpredictable, particularly in Cairo RT3 cases with advanced interproximal bone loss. With advances in microsurgical techniques using the operating microscope, the feasibility of papilla reconstruction has improved; however, long-term evidence beyond 5 years remains rare. The author developed the Patch Technique from 2005 to 2007, which places a subepithelial connective tissue patch beneath a flap advanced coronally, and first reported it in 2009.

Methods: Two Cairo recession type 3 (RT3) cases were treated with the Patch Technique: One in 2007 (18-year follow-up) and one in 2012 (13-year follow-up). The procedure included flap elevation under a microscope, grafting with alloplast or xenograft, and connective tissue patch anchored coronally with sutures and resin. Outcomes assessed were radiographic bone height, papilla morphology, the papilla presence index (PPI), and patient satisfaction (esthetics) on the visual analog scale (VAS).

Results: In the 18-year case, PPI improved from 4 to 2 and clinical attachment loss (CAL) from 9 to 2.5 mm, while in the 13-year case, PPI went from 3 to 2 and CAL from 4 to 1 mm. Stable radiographic bone height and papilla morphology were maintained over the follow-up period. Patient satisfaction was 10/10 on the VAS for both cases.

Conclusion: The Patch Technique can achieve predictable, long-term esthetic and functional stability even in cases of advanced papilla loss (RT3) when combined with careful case selection and precise microsurgical execution.

Key points: This report presents some of the longest follow-up periods for interdental papilla reconstruction using microsurgery, demonstrating stable results over the 13- and 18-year follow-up periods. Good outcomes were achieved through microscope-assisted surgery, the use of connective tissue patches to maintain adequate blood flow and mechanical support, and controlled placement of graft materials stabilized coronally using resin-based coronal tensile support. In these cases, major limiting factors included high adjacent interproximal contacts, the thin gingival phenotype, and the technical difficulty associated with precise microsurgical procedures.

Plain language summary: Loss of tissue between teeth can affect appearance, speech, and the ability to keep the mouth clean. This problem may reduce a person's quality of life and confidence. In cases where the bone between teeth is severely reduced, rebuilding this tissue has been difficult, and long-term outcomes have not often been reported. This report describes two patients with advanced loss of tissue between teeth who were treated using a surgical method developed by the author. The procedures were performed using a surgical microscope to improve precision. One patient was followed for 18 years and the other for 13 years after treatment. In both patients, the shape and height of the tissue between the teeth were maintained over time. X-ray images showed stable bone levels, and the appearance of the treated area remained consistent during the follow-up period. Both patients reported high satisfaction with the esthetic outcome. These observations suggest that, in carefully selected cases, this surgical approach may help maintain long-term appearance and function in areas where tissue between teeth has been severely reduced.