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Papilla-Preserving Gingival Fiber Retention Osseous Surgery in the Anterior Maxilla: A Novel Clinical Technique
Abdusalam E Alrmali1,2, Hom-Lay Wang1
1Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA.
Objective:
To describe papilla-preserving gingival fiber retention osseous surgery (PP-FibReOS), a biologically driven resective approach intended to eliminate periodontal pockets while maintaining interproximal connective tissue and papillary stability in esthetically demanding maxillary anterior sites.
Clinical Technique:
PP-FibReOS was implemented in two challenging anterior maxillary scenarios: functional crown lengthening and surgical pocket elimination in a stage IV, grade C periodontitis case. The key feature of this protocol uses a split-full-split buccal flap with selective coronal tissue removal, combined with deliberate preservation of a de-epithelialized interproximal supracrestal fiber complex attached to the palatal flap, which is designed to support papillary volume during healing. Osseous recontouring is performed conservatively, with the flap repositioned in a double-layered papillary complex closure just coronal to the bone crest. At 36-month follow-up, both cases showed shallow probing pocket depths (PPD) of 1-3 mm and absence of bleeding on probing, together with stable interdental papilla positions, high clinician-reported esthetic scores (pink esthetic score [PES] 11-12), and patient satisfaction ratings of 10/10.
Conclusion:
Within the limits of this two-case proof-of-concept report, PP-FibReOS may offer a promising alternative for maxillary resective surgery when preservation of papillary architecture is a primary objective. Larger controlled studies are needed to clarify its indications, limitations, and long-term predictability.
Clinical Significance:
PP-FibReOS provides a possible approach for selected anterior maxillary defects in which pocket elimination or functional crown lengthening must be balanced against preservation of interdental soft-tissue dimensions. In patients with a thick periodontal phenotype, adequate supracrestal connective tissue, and predominantly horizontal or shallow angular defects, a fiber-retentive palatal flap combined with conservative osseous reshaping may help maintain stable, shallow probing pocket depths while limiting increases in clinical crown length and visible loss of papillary fill.