Modified nonincised papillae surgical approach: Minimally invasive technique for periodontal regeneration

Nonincised papillae surgical approach (NIPSA) preserves papillae by placing incision lines away from interdental areas, achieving good outcomes. However, these techniques may be unsuitable in cases with bone defect morphology or tissue anatomy. This case series introduces the modified nonincised papillae surgical approach (M-NIPSA), which preserves papillae while providing adequate access for periodontal defect debridement and regenerative material placement.

Ten intrabony defects were treated with M-NIPSA using recombinant human fibroblast growth factor-2 and carbonate apatite (CO3Ap) as regenerative materials. Clinical parameters were assessed at baseline and 6 and 12 months. Early wound healing index evaluated primary wound closure 7 days postoperatively.

All cases achieved complete flap closure without wound dehiscence, with significant probing pocket depth and clinical attachment level (CAL) improvements compared to baseline (mean CAL gain: 3.65 ± 1.20 mm). No significant changes in gingival recession or keratinized tissue were observed.

M-NIPSA overcomes anatomical limitations of conventional techniques, ensuring primary healing with minimal incision and flap reflection. Combined with effective growth factors, it significantly improves periodontal parameters.

Modified nonincised papillae surgical approach allows access to bone defects with a shorter incision range and reduced invasiveness by positioning the incision line more coronally compared to conventional nonincised papillae surgical approach. Ensuring an adequate width of keratinized gingiva (keratinized tissue width ≥3 mm) is essential. Incisions and flap elevation should minimize damage to the gingival tissue, and sutures with fine threads must be used to preserve blood flow. This incision technique is not suitable in cases with fragile gingiva due to inflammation or extensive bone defects spanning multiple teeth that could compromise blood flow.

This case series introduces a new surgical incision design for periodontal regeneration. Periodontitis, a disease that damages gum and bone, has long been treated with regeneration surgeries to restore lost tissues. Advances in materials and surgical methods have improved the predictability and effectiveness of these treatments. Recently, techniques have been developed to minimize surgical invasion and enhance healing. One innovation is avoiding incisions and tissue separating in the interdental area, preserving blood flow and keeping space for bone regeneration. In this study, the new incision design was applied to 10 patients undergoing periodontal regeneration therapy. After 12 months, evaluations showed improved soft and hard tissue healing. The results suggest that this new design addresses some anatomical limitations of traditional methods, offering effective healing with minimal surgical damage. Based on the results, this approach suggests the potential for faster recovery and better long-term outcomes by combining precision and reduced invasiveness.