The Papilla Amplification Flap: A Surgical Approach to Narrow Interproximal Spaces in Regenerative Procedures

A modified surgical approach to interproximal guided tissue regeneration procedures (GTR) was used when anatomic conditions at the defect-associated interdental area rendered papilla preservation techniques very difficult. The main goal of this study was to evaluate the effectiveness of the papilla amplification flap (PAF) in obtaining and maintaining primary soft tissue closure of the interdental space above nonresorbable, titanium-reinforced, expanded polytetrafluoroethylene (e-PTFE) membranes and to quantify the regenerative outcomes obtained using this procedure. Seventeen patients with one deep intrabony defect associated with a narrow interproximal space were selected for this case-series clinical study. The application of the PAF in combination with e-PTFE membranes resulted in clinically and statistically highly significant gains in clinical attachment levels (4.7 ± 1.4 mm) and reductions in probing pocket depth (6.3 ± 1.3 mm) after 1 year. Primary soft tissue closure of the interdental space was obtained in 100% of cases after completion of the surgery and maintained in 65% of cases during the initial healing period (6 weeks). Results from the present study indicate that the PAF can be considered a suitable soft tissue surgical approach for GTR treatment of intrabony defects when papilla preservation techniques are not recommended because of unfavorable local anatomic conditions interproximally.