Maxillary anterior esthetics. Preservation of the interdental papilla

Periodontal therapy for the maxillary anterior area requires careful consideration as to the choice of therapy, as esthetic results are just as important as eradication of disease. The extensive shrinkage or loss of the interdental papilla, especially between the two central incisors as a result of periodontal therapy, should be minimized by the proper selection of therapy. Thorough subgingival scaling and root planing without surgical flaps is the treatment of choice as the maxillary anterior area is compatible for this type of therapy from the anatomic and access standpoints. In the posterior dentition, the surgical, conventional flap approach is encouraged after initial scaling, because of the anatomy of the roots (concavities, furcations) and difficulty with access makes thorough root therapy difficult. Fortunately, esthetics is not a major concern in the posterior areas. If surgical therapy is necessary for the maxillary anterior area, the papilla preservation flap technique better preserves the papilla for esthetic purposes but allows good access to the roots for root planing and, if necessary, the placement of graft material.