The objective of this study was to assess the effectiveness of NIPSA in periodontal lesions with deep supra-alveolar defects, measuring the clinical efficacy of this flap. The non-incised papilla surgical approach (NIPSA) is a novel technique that accesses the periodontal defect from apical direction and was established with the aim of creating clinical advances compared with marginal access techniques.

The defects with a supra-alveolar components are more frequent than intrabony defects, there is very little evidence about their treatment .

Inclusion Criteria:

• diagnosis of periodontal disease (periodontitis stage III and IV, grade A [12];
• non-smokers and former smokers who quit smoking at least 1 year previously
• previous treatment for periodontal disease using non-surgical periodontal treatment completion of step I and II of periodontal therapy
• compliance with periodontal maintenance and oral hygiene (FMPS at baseline ≤ 30%)
• active residual pockets (positive bleeding on probing; BoP) associated with intrabony defects that were not resolved with non-surgical treatment after 4-6 months of maintenance.
• periodontal lesions with probing depth (PD) > 6 mm and supraalveolar defect (pre-diagnosis clinically (periodontal probe)

Exclusion Criteria:

• systemic disease contraindicating periodontal surgery,
• smokers, and
• third molars or teeth with incorrect
• endodontic or restorative treatment.

Non-Incised Papilla Flap