Does the Papilla Preservation Flap Technique Induce Soft Tissue Modifications over Time in Endodontic Surgery Procedures? Silvio Taschieri, MD, DDS,* † Massimo Del Fabbro, BSc, PhD,* † Luca Francetti, MD, DDS,* † Isabella Perondi, DDS,* † and Stefano Corbella, DDS, PhD* † Abstract Introduction: The aim of the present controlled clinical trial was to compare 2 incision techniques, papilla base incision (PBI) and sulcular incision (IS), evaluating changes in papilla and recession height over a 12- month period. Methods: A total of 24 subjects requiring endodontic surgery on a single tooth were enrolled. PBI was used in 1 group and IS in the other group. The pri- mary outcomes were changes in gingival recession of the tooth affected by periapical lesions and the mesial and distal teeth and the mesial and distal papilla height using the treated tooth as the reference. Outcome vari- ables were assessed at baseline and 12 months after the surgical intervention. Statistical analysis was performed by a blinded operator through appropriate tests, with significance set at a P value equal to .05. Results: In the PBI group, the papilla height at the 12-month follow-up in the mesial and distal aspect decreased 0.10 Æ 0.32 mm and 0.10 Æ 0.32 mm, respectively, and 0.23 Æ 0.68 mm and 0.25 Æ 0.40 mm, respectively, in the IS group without any significant differences. There were no differences found for recession change values between groups. Conclusions: The PBI and IS ap- proaches in endodontic surgery showed similar results in terms of papilla height preservation and recession changes. (J Endod 2016;42:1191–1195) Key Words Apicoectomy, interdental papilla, oral surgical proce- dure, periodontal indexes T he aim of endodontic treatment is to obtain the resolution of pulp pa- thosis through the eradication of pathologic microbiota by proper root canal shaping in order to perform effi- cient cleaning and an adequate 3-dimensional filling (1). Endodontic surgery is recommended in all cases of apical periodontitis in which orthograde retreatment failed or is not feasible (2). A modern endodontic surgery approach was first described in 2006 (3, 4) as a change to the standard protocol and implies a microsurgical approach in flap management, resulting in a mean weighted success rate of 89% 1 year after treatment (5). Adequate management of soft tissue during endodontic surgery should be considered mandatory to obtain satisfactory healing, without impairing esthetics and function (6). The attempt to preserve interdental papillary tissue through a papilla base incision (PBI) flap was described in the literature as favoring soft tissue healing (7–9) 6 and 12 months after surgery as well as postoperative quality of life (10) compared with a sulcular flap. How- ever, 1 short-term comparative study found better soft tissue preservation in the early post- operative period (first 2 weeks) using a PBI approach compared with an intrasulcular flap although it did not find a significant beneficial effect of PBI for soft tissue healing after 6 months at the level of the tooth with a lesion (11). This particular flap design could be considered a modification of the papilla preservation flaps proposed in periodontal conservative (12) and regenerative surgery (13, 14). In detail, the purpose of PBI is to obtain access to the periapical lesion without mobilizing the interdental papilla, thus preserving that tissue for flap repositioning and suturing in order to achieve a satisfying esthetic outcome. This aim was similar to those proposed in studies about periodontal surgery without papilla mobilization (15, 16). One recent article even reported an improvement in the height of gingival buccal and interdental recession in teeth treated with the so-called single-flap approach (17), which is comparable with the PBI flap. This was explained by the observation that flaps created with the papilla preservation tech- nique were less prone to cause gingival tissue recession on the involved teeth than sulcular flaps (18) when evaluated 12 months after the surgical intervention. The purpose of the present 12-month study was to evaluate gingival recession height (on the treated teeth and on adjacent ones) and papilla height after endodontic surgery, comparing PBI flaps and sulcular ones. The null hypothesis was that both treat- ments are equally effective when evaluated 12 months after surgery. From the *Department of Biomedical, Surgical and Dental Sciences, Universit a degli Studi di Milano, Milan, Italy; and † IRCCS Istituto Ortopedico Galeazzi, Milan, Italy. Address requests for reprints to Dr Stefano Corbella, IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi, 4, 20161 Milan, Italy. E-mail address: stefano.corbella@ gmail.com 0099-2399/$ - see front matter Copyright ª 2016 American Association of Endodontists. http://dx.doi.org/10.1016/j.joen.2016.05.003 Significance Papilla preservation flaps could safely be applied to endodontic surgery procedures. The results ob- tained (12 months after surgery) with this approach in terms of papilla height changes and gingival recession are expected to be similar to cases treated with intrasulcular flaps. Clinical Research JOE — Volume 42, Number 8, August 2016 Papilla Preservation Flap Technique 1191