Cul-de-Sac Technique - Coronally Advanced Double-Pedicle Flap with/ without Grafting for Papilla Reconstruction-Case Reports

Author(s): Hooshang Kashani, DMD, MS, MS, Ryutaro Kuraji, Jaclyn C

Background: Regeneration of the interproximal papilla remains a challenging, unpredictable aspect of periodontal surgery. This lack of predictability could be attributed to decreased blood supply, increased distance between the underlying bone and contact point, and limited surgical access that is inherently involved with the interdental space. This two case report series proposes a novel approach, the Cul-de-Sac technique, to reestablish the papilla, either with or without connective tissue grafting.

Methods: Following non-surgical therapy, two periodontally stable patients underwent the following surgical therapy to address class II interproximal recession defects between #7 and #8. Two divergent “butt-joint” incisions were made at mesiobuccal and distobuccal line angles of adjacent teeth, extending beyond the mucogingival junction. The flap and papilla were released then advanced coronally to the contact point, creating a dead-end space beneath the papilla. Based on soft tissue thickness and the defect’s interproximal recession classification, the space beneath the papilla was filled with a harvested connective tissue graft for Patient 2; Patient 1 did not receive a graft. Simple interrupted sutures at an oblique angle were used to secure the flap in this coronal position, filling the recession area.

Results: Both Case 1 and 2 achieved favorable, esthetic results at 6 weeks and 2 weeks, respectively.

Conclusions: This “Cul-de-Sac” technique offers an additional surgical method to rebuild a recessed interdental papilla. Additional research is needed to assess the long-term results and its use with other recession defects.