Reconstruction of the maxillary midline papilla following a combined orthodontic–periodontic treatment in adult periodontal patients

The aim of the present study was to evaluate the role of a combined orthodontic-periodontic treatment in determining the reconstruction of midline papilla lost following periodontitis.Twenty-eight patients, with infrabony defect and extrusion of one maxillary central incisor, were treated. At baseline, all patients presented opening of the interdental diastema and loss of the papilla. At 7-10 days after open-flap surgery, the intrusive movement started. For each patient, probing pocket depth (PPD), clinical attachment level (CAL) and papilla presence index (PI) were assessed at baseline, end of treatment and after 1 year. PI was also evaluated independently in patients with narrow or wide periodontal biotype (NPB-WPB).All parameters showed statistical improvement between the initial and final measurements, and showed no changes at follow-up time. The mean residual PPD was 2.50 mm, with a decrease of 4.29 mm, while the mean CAL gain was 5.93 mm. Twenty-three out of 28 patients improved the PI score at the end of therapy. No statistical difference was recorded in PI values between groups NPB and WPB.The presented clinical protocol resulted in the improvement of all parameters examined. At the end of orthodontic treatment, a predictable reconstruction of the interdental papilla was reported, both in patients with thin or wide gingiva.