Title Using Papilla Base Flap Results in Significantly Less Recession of the Papilla than Sulcular Full-Thickness Flap After Endodontic Surgery for Apical Periodontitis
Clinical Question In adults with apical periodontitis who are in need of endodontic surgery, does a sulcular full-thickness flap result in greater papilla recession in comparison to a papilla base flap?
Clinical Bottom Line For patients with apical periodontitis who are in need of endodontic surgery, a papilla base flap is recommended over the standard sulcular full-thickness flap because it results in significantly less papilla recession (P < .001).
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
15347293Velvart/200412 patients with healthy, intact interdental papilla, lacking periodontal disease, and referred for endodontic surgery for apical periodontitisRandomized Controlled Trial
Key resultsThe author found that there were statistically significant differences in papilla recession between the papilla base flap and sulcular full-thickness flap at all (1-, 3-, and 12-month) recall visits. (P < .001) However, there were no statistical differences in papilla recession among recall intervals of the same technique.
Evidence Search papilla[All Fields] AND ("alkalies"[MeSH Terms] OR "alkalies"[All Fields] OR "base"[All Fields]) AND ("surgical flaps"[MeSH Terms] OR ("surgical"[All Fields] AND "flaps"[All Fields]) OR "surgical flaps"[All Fields] OR "flap"[All Fields]) AND endodontic[All Fields] AND ("surgery"[Subheading] OR "surgery"[All Fields] OR "surgical procedures, operative"[MeSH Terms] OR ("surgical"[All Fields] AND "procedures"[All Fields] AND "operative"[All Fields]) OR "operative surgical procedures"[All Fields] OR "surgery"[All Fields] OR "general surgery"[MeSH Terms] OR ("general"[All Fields] AND "surgery"[All Fields]) OR "general surgery"[All Fields]) AND ("wound healing"[MeSH Terms] OR ("wound"[All Fields] AND "healing"[All Fields]) OR "wound healing"[All Fields] OR "healing"[All Fields]) AND ("periapical periodontitis"[MeSH Terms] OR ("periapical"[All Fields] AND "periodontitis"[All Fields]) OR "periapical periodontitis"[All Fields] OR ("apical"[All Fields] AND "periodontitis"[All Fields]) OR "apical periodontitis"[All Fields])
Comments on
The Evidence
Validity: In spite of its relatively small sample (12 adults), this randomized controlled trial was able to obtain statistically significant differences in the papilla recession from these two techniques. This small sample size did not allow the investigators to assess the relationship between papilla size and papilla recession following endodontic surgery. One patient did not return for the 12-month follow-up and was not included in the 12-month results, leaving only 11 patients with full results for 1, 3, and 12 months after the endodontic procedure was performed. Perspective: Although there was a small patient sample, the postoperative information collected was consistent among all subjects, showing statistically significant differences between the papilla base flap technique and the sulcular full thickness flap technique.
Applicability During endodontic surgery, it is important to preserve the height of the papilla to achieve better aesthetic results and to prevent food accumulation in the interproximal area. The papilla base flap is a technique that allows the papilla to remain intact and reduces the probability of having an open interproximal space following surgery. For aesthetic reasons, papilla based flaps should especially be considered for the anterior regions of the mouth.
Specialty (Endodontics) (General Dentistry) (Oral Surgery) (Periodontics)
Keywords Apicoectomy, papilla recession, retrograde obturation, surgical flaps, apical periodontitis, papilla healing
ID# 2733
Date of submission 06/24/2014
E-mail ruxmohan@livemail.uthscsa.edu
Author Shreya Ruxmohan
Co-author(s) Mohamad Alhadlaq, Abdulaziz Alblaihess
Co-author(s) e-mail 429101462@Student.ksu.edu.sa, a.alblaihess@hotmail.com
Faculty mentor Edward F. Wright, DDS, MS
Faculty mentor e-mail WrightE2@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
Comments and Evidence-Based Updates on the CAT
None available