Research Information System
JOURNAL OF CLINICAL PERIODONTOLOGY, vol.52, no.s28, pp.378-580, 2025 (SCI-Expanded, Scopus)
A Novel Approach to Treatment of Intraosseous Defects: Two-Year Follow-Up With Entire Papilla Preservation Flap Design in Combination With CTG
guided tissue regeneration (GTR), grafting materials, enamel matrix derivatives (EMD), flap surgeries, and platelet-rich products, have been explored for
their effectiveness in treating intrabony defects.
Description of the procedure: This case report presents a 24-month follow-up of an intraosseous defect treated with enamel matrix derivative (EMD) and
a connective tissue graft (CTG) combined with an entire papilla preservation (EPP) flap. A 45-year-old male nonsmoker presented to the periodontology
clinic with a bleeding complaint. The patient had no systemic conditions or prior periodontal surgeries that would contraindicate treatment.
Clinical examination revealed a deep pocket and suppuration distal to the lower left canine (#33), with no tooth mobility. The interdental papilla and
keratinized tissue height were adequate. On the lingual side of the tooth, there were no signs of recession or deep pockets, and adjacent teeth were
periodontally healthy. Radiographic evaluation showed deep angular intrabony defects distal to the affected tooth.
The patient initially underwent cause-related therapy, including scaling and root planning (SRP), oral hygiene instructions, and motivation, with informed
consent obtained. Four weeks later, regenerative surgery was performed in the affected area.
During surgery, the EPP flap design was used, and the flap was elevated mesially. Granulation tissue was removed, and SRP was performed. A connective
tissue graft from the palate was applied to the buccal wall, and a xenograft was placed in the defect. The flap was then sutured.
Outcomes: After six months, probing depth was reduced to 3 mm. At the 24-month follow-up, a 5 mm pocket was detected, and SRP was re-applied with
continued monitoring.
Conclusions: The EPP flap design, when used with EMD and CTG, can offer promising outcomes in the regenerative treatment of intraosseous defects,
though long-term stability requires ongoing assessment.