Papilla‐Preserving Gingival Fiber Retention Osseous Surgery in the Anterior Maxilla: A Novel Clinical Technique
Abdusalam E. Alrmali, Hom‐Lay WangABSTRACT
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.