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Surgical Reconstruction Of The Lost Interdental Papilla Using Roll Technique - A Case Reportdisplacement of the interproximal palatal tissue in thebuccal direction. 5The present case report describes a case ofreconstruction of the interdental papilla using rolltechnique (involving displacement of the interproximalpalatal tissue in the buccal direction).CASE REPORTA 24 years old male patient reported to theDepartment of Periodontics with the chief complaint ofan unpleasant smile. On examination there was partialloss of the interdental papilla in the midline betweenthe maxillary central incisors (Fig. 3). The interdentalpapilla occupied one-third of the interproximalembrasure space. The soft tissues presented a healthyclinical aspect with minimal sulcus depth and theinitial therapy consisted of oral prophylaxis. Patientwas instructed on the significance and maintenanceof good oral hygiene. The surgical procedure wascarried out under an adequate antibiotic coverage[Doxycycline 100mg (twice on the first day and oncedaily for the next 5days)] and anti-inflammatorycoverage [Ibuprofen 400mg thrice daily for 4days}starting one day prior to the surgery. 2% Lignocainehydrochloride with 1:80,000 adrenalin was used as thelocal anaesthetic agent.Surgical ProcedureAfter adequate local anaesthesia was obtained,a William’s graduated periodontal probe was used tomeasure the distance between the alveolar bony crest(abc) to the desired height of the papilla reconstruction(pr). A partial thickness incision was made using aNo.15 blade mounted on a Bard Parker handle. Thisincision was made such that it started from the mesiofacialline angle of right central incisor, extended alongits mesial surface upto its mesio-palatal line angle.From here the incision was continued onto the palateextending upto a distance of twice abc-pr. The secondincision was started on the mesio-facial line angle ofthe adjacent left central incisor, extended in the samemanner along its mesial surface upto its mesio-palatalline angle. Then extending onto the palatal upto adistance of twice abc-pr. Then the two incisions wereconnected by a horizontal incision (Fig. 1). A partialthickness flap was then dissected using a periostealelevator and the flap was pushed with gentle pressurethrough the embrasure space onto the labial side (Fig.2, 4, 5). The unhealthy granulation tissue, if present,was curetted and the root surfaces of the adjacentteeth thoroughly planed. The elongated papilla wasthen folded upon itself to approximate the connectivetissue sides in a manner similar to the roll techniquefor ridge augmentation. The lateral aspects of thepapilla were contoured using a scissor to create thedesired pyramidal form. Then Ethicon suture material(3-0 black silk swaged onto the needle) was used tobind the laminated papilla together and suspend itbetween the two central incisors with a sling suturearound adjacent tooth (Fig. 6). The same procedurewas repeated on the left lateral incisior.Periodontal dressing was applied to the palatalaspect to act as a scaffold for the reconstructed papillaand on the labial aspect to position the papilla properlyand immobilise it (Fig. 7).Figure 1: Partial thickness incision made on palatalgingivaFigure 2: Cross-sectional view of roll techniqueprocedureFigure 3: Pre-operative view of the unesthetic openembrasure between central incisorsMalaysian Dental Journal Jan-Jun 2011 Vol 32 No 142