Papilla reconstruction using a vertical interproximal tunnel approach.

Papilla reformation is one of the most difficult and elusive surgical techniques for clinicians. Although it involves similar tenets to those applied for soft tissue grafting at recession defects, crafting a small tissue in restricted space remains unpredictable. Numerous grafting techniques have been developed to correct interproximal and buccal recession, but so far, only a limited number of techniques have been prescribed for interproximal remediation.This report describes in detail a modern technique (the vertical interproximal tunnel approach) for reforming the interproximal papilla and treating interproximal recession. It also documents three challenging cases of papilla loss. The first case presented Class II papilla loss and a recession type 3 gingival defect adjacent to a dental implant, managed using the vertical interproximal tunnel approach through a short vertical incision. A 6-mm increase in attachment level and almost complete papilla fill were observed in this case with this surgical technique for papilla reconstruction. The second and third cases presented Class II papilla loss between two adjacent teeth, managed using the vertical interproximal tunnel approach through a semilunar incision and achieving full papilla reconstruction.Both described incision designs for the vertical interproximal tunnel approach require technical meticulousness. When executed carefully and using the most beneficial pattern of blood supply, predictable reconstruction of the interproximal papilla can be achieved. It also helps alleviate concerns associated with inadequate flap thickness, blood supply and flap retraction.