Non-Incised Papilla Flap in Deep Supraossous Defects

Non-Incised Papilla Flap With and Without Connective Tissue Graft for Management of Deep Supraossous Defects

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.