A New Surgical Biopsy Technique to Preserve Esthetic and Function in Case of Interdental Soft Lesions

Background: Oral biopsy is a crucial procedure but when periodontal soft tissues in frontal areas are involved aesthetic and functional issues arise, becoming particularly critical when the interdental papilla is entailed. An innovative surgical approach to overcome the aforementioned concerns is hereafter described. Description of the procedure: Buccally not bevelled scalloped incisions into keratinised tissue 1 mm apical to the lesion are made at the midline between the adjacent teeth. A parabolic incision reaches the gingival margin at distal line angle, a second parabolic incision connects the starting point with mesial line angle, creating a surgical papilla. To coronally reposition and rotate the flap the parabolic incisions are eccentric to the respective long axis tooth. The lesion extension bring to two options. If the line that connects gingival margin zeniths of the teeth is apical to the coronally confined lesion, oblique linear incisions to the gingival margin zenith of the adjacent teeth are done. If the lesion extends beyond this line 2 parabolic incisions are made on reaching the mesial and distal line angles of both teeth. Biopsies on palatal side follow traditional rules. Intrasulcular incision is made and soft tissue is collected for examination. Outcomes: The de-epithelised anatomic papillae resulted in connective tissue beds for coronal flap advancement. Slings sutures for the coronal repositioning of the surgical papillae and single sutures for the rest are performed. Eventual connective graft can be used. Conclusions: Overall satisfying results without any relevant complication have been achieved in all cases treated to date.