Two-stage surgical plastic surgery of the lost interdental papilla in class III recession according to Tarnow and Nordland

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Abstract

This report presents a clinical case of elimination of the recession of the interdental papilla of class III according to Tarnow and Nordland with the help of mucogingival plastic surgery in two stages. Before the surgical intervention, orthopedic structures and braces were installed on teeth 1.1 and 2.1 to eliminate the diastema between the teeth and bring the roots of the teeth closer together 1.1, 2.1. The first surgical stage of eliminating the recession of the interdental papilla was the use of a coronal-displaced flap using a free gingival graft to increase soft tissues in the area of the lost interdental papilla. The second surgery for eliminating the recession of the interdental papilla and recreating its anatomical shape was tunnel plasty of the interdental gum using a free gingival transplant.

In this clinical case, the patient was fixed with an orthopedic structure with a space under the interdental papilla (5 mm), which is a criterion for complete restoration of the shape and volume of the interdental papilla. The full restoration of the volume, height, and anatomical contour of the interdental papilla is achieved thanks to the interdisciplinary work of dentists — periodontists, therapists, orthopedists, and orthodontists. A stable result was noted 1 year postoperatively.

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About the authors

Anastasia A. Babanina

Russian University of Medicine

Email: anastasiababanina@mail.ru
ORCID iD: 0000-0001-7378-9645
SPIN-code: 3848-0166
Russian Federation, Moscow

Galina S. Runova

Russian University of Medicine

Email: RunovaGal@mail.ru
ORCID iD: 0000-0002-3545-6353
SPIN-code: 9037-1928

MD, Cand. Sci. (Medicine), Professor

Russian Federation, Moscow

Fatima Yu. Daurova

Moscow University of Industry and Finance

Email: 5071098@mail.ru
ORCID iD: 0000-0003-0085-1051

MD, Dr. Sci. (Medicine), Professor

Russian Federation, Moscow

Diana I. Tomaeva

Moscow University of Industry and Finance

Author for correspondence.
Email: tomaevad@inbox.ru
ORCID iD: 0000-0001-8771-2438

MD, Cand. Sci. (Medicine), Associate Professor

Russian Federation, Moscow

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Supplementary files

Supplementary Files
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1. JATS XML
2. Fig. 1. Recession of the interdental papilla in the teeth area 1.1 and 2.1, Grade III according to Tarnow and Nordland.

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3. Fig. 2. Design of a coronal-displaced flap.

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4. Fig. 3. Gum condition after surgery: a — coronal-displaced flap, 5th day; b — view after removal of stitches, 14th day; c — 1 month; d — 6 month.

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5. Fig. 4. 7 months after surgery.

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6. Fig. 5. Free gingival transplant sampling from the keratinized gum area (a) and zone of keratinized gum after taking transplant (b).

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7. Fig. 6. De-epithelized free gingival transplant.

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8. Fig. 7. The second stage of surgery: a — performing intra-lumbar incisions using a microsurgical eye scalpel; b — apically, a horizontal incision was made between the teeth 1.1 and 2.1, in the area of the keratinized gum; c — using a microsurgical eye scalpel, the interdental papilla was exfoliated vestibularly; d — split flap; e — the de-epithelialized free gingival transplant is laid under a split flap in the area of the interdental papilla; f — the de-epithelialized free gingival transplant is fixed to the periosteum by a sail seam. The horizontal incision is sutured with nodular seams.

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9. Fig. 8. Gum condition after surgery: a — 1 week; b — 2 weeks; c — 1 month; d — 6 months; e — 1 year.

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