Salvaging the Lost Pink Triangle: A Case of Papilla Reconstr
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The interdental papilla may be lost or reduced in height, forming black triangles due to various reasons, which gives an unaesthetic appearance when the patient smiles. Various noninvasive and invasive techniques have been used to augment/reconstruct the interdental papilla, to reclaim the pink triangle. The most satisfactory and natural appearance can be obtained by augmenting or reconstructing the lost papilla as the pink esthetics is as important as the white esthetics.

A 45-year-old adult female patient reported with complaint of deposits in the lower anterior teeth and a black space between the upper front teeth and the gum region for 6 months. On examination, the patient presented with class 1 papilla (Nordland and Tarnow's ). The patient was diagnosed with chronic papillary gingivitis with papillary gingival recession type 1. As the interdental bone was within 5 mm from the contact point, the roll technique was used for reconstruction of the papilla. Scaling and root planning was performed for the patient on the first visit and brushing technique was corrected. After 1 week, the surgical procedure was carried out using the roll technique. The interdental area was anesthetised.

Next, two parallel vertical incisions were placed in the interdental gingiva starting from the coronal end of the papilla near the proximal contact points and was extended apically and joined by a horizontal incision to create a pouch. A partial thickness flap was raised from the apical end and was gently advanced apically towards the contact point. The partial thickness was then rolled and folded on itself and sutured using 3-0 silk suture to keep it in the designated position. While suturing, the suture was circumferentially wound around adjacent teeth to avoid any displacement . Periodontal dressing was given to provide mechanical protection, and the patient was instructed to take analgesics twice a day to avoid postoperative pain. Suture removal was done after 10 days , and there was a complete fill of the interdental papilla which was maintained even after 3 weeks and after 2 years.

Postoperatively and after 1-month follow-up, there was a complete fill of the interdental area by the interdental papilla normal (Nordland and Tarnow's). As a result, the black triangle was successfully converted into a natural pink triangle.