Nakata, Kotaro

The reconstruction of interproximal papilla around implants is considered challenging with limited predictability due to the anatomical constraints and reduced blood supply to the interproximal area. This report introduces a minimally invasive tunneling approach, assisted by an operating microscope, to augment interproximal papillae and improve soft tissue contours. Four cases are included: Cases 1 and 2 demonstrate soft tissue grafting around adjacent implants, performed either during the second stage or after provisionalization, while Cases 3 and 4 address implant-pontic scenarios. After conditioning the peri-implant tissues using provisionals, all cases achieved satisfactory outcomes, maintaining stability over a period of six to nine years. The described microsurgical tunnel technique, with the combination of buccal and interproximal subepithelial connective tissue graft, appears to be a promising approach for reconstructing peri-implant papillae with reliable long-term stability. Keywords: dental implants, interproximal papilla reconstruction, connective tissue graft, tunnel technique, soft tissue graft, periodontal plastic surgery, restoration

As microscope penetration has grown significantly in recent years, the number of clinicians working on microsurgery has also increased steadily. During surgi-cal management in daily practice, the thickness of periodontal tissue we are handling is sometimes very thin, thus careful and delicate handling is required. In areas such as periodontal surgery, the handling of flaps greatly affects the re-sults, which has become a topic recently, microsurgery is the most effective. But the instrument will change from macrosurgery, the thickness of the thread used, the length of the needle, etc. Therefore, in this paper, I will focus on the micro instruments used for microsurgery and introduce the usage of typical ones. Keywords: microsurgical instrument, micro suturing