Partial-Full-Thickness Tunnel Technique with Palatal Vertical Incisions and Supracrestal Sling Sutures for Papilla Reconstruction and Root Coverage in the Esthetic Zone: A Technical Case Report

Interproximal attachment plays a crucial role in diagnosing periodontal conditions and predicting their prognosis due to its significant impact. The loss of interproximal attachment, often accompanied by papilla loss, can lead to phonetic, functional, and esthetic challenges. However, existing literature provides limited data on treatment outcomes for interdental papilla reconstruction and root coverage. This technical case report presents a novel surgical approach utilizing labial mucosal vertical incisions and palatal marginal vertical incisions to facilitate creation of a partial-full-thickness (PFT) tunnel. Then, connective tissue grafts (CTGs), stabilized by supra-crestal sling (SCS) sutures, are used to support and coronally advance the soft tissue overlying the graft to obtain root coverage and enhance papilla height and volume. This technique optimizes blood supply and maximizes wound stability, resulting in significant papilla augmentation and complete root coverage. It is suggested that PFT tunnel preparation via labial mucosal vertical incisions and palatal marginal vertical incisions, combined with CTG stabilization via the SCS suture, has the potential to treat gingival recessions with deficient papilla in the maxillary esthetic zone.