The Ramp Mattress Suture: A New Suturing Technique Combined with a Surgical Procedure to Obtain Papillae Between Implants in the Buccal Area

This article has been written to show the opportunity and eventually the predictability to obtain new papillae between implants and a better esthetic result by the use of a new suturing technique. After raising a full-thickness flap from the palatal to the vestibular side, it can be stabilized in such a position using a new suturing technique (ramp mattress suture) to apply pressure and tearing forces on the flap in an apicocoronal direction at the vestibular site and an opposite traction in a coronoapical direction at the palatal site. The ramp mattress suture seems to be capable of pulling the flap in an apicocoronal direction in the vestibular site, as well as in a coronoapical direction in the palatal site. Thanks to such a mattress suture, it will be possible to obtain a more coronal gingival margin. After an adequate healing period of approximately 5 weeks, a vestibular scalloped gingivectomy is performed around the vestibular surface of the abutment to create either a scalloped gingival margin or interproximal papillae only in the vestibular area, forming a gingival ramp in a palatovestibular direction to reasonably reduce the residual increased vestibular depth and optimize the esthetic result. Eight patients, for a total of 56 papillae, were treated with this new suturing technique. The esthetic results satisfied both clinician and patient expectations.