{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T03:54:51Z","timestamp":1781582091513,"version":"3.54.5"},"reference-count":40,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T00:00:00Z","timestamp":1760400000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T00:00:00Z","timestamp":1760400000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["aap.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clin Adv Periodontics"],"published-print":{"date-parts":[[2026,6]]},"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Prevention and treatment of interproximal recessions after periodontal therapy has been challenging and is important because the resulting black triangles are unesthetic. Traditional treatment options include orthodontic, restorative, surgical, and combined approaches. This case report aims to describe an approach using periodontal plastic surgery combined with prosthetic treatment for the management of a papillary deficiency in the esthetic zone.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A healthy, 64\u2010year\u2010old female presented with esthetic concerns related to a black triangle between the maxillary right canine and first premolar as a result of periodontal therapy. A Class III recession defect was present. A de\u2010epithelialized connective tissue graft harvested from the maxillary tuberosity was placed interproximally and combined with a coronally advanced flap and enamel matrix derivative. Following 6 months, the restorative phase was initiated including diagnostic wax\u2010up, direct composite restoration the mesial of the premolar, followed by facial veneer preparation on the canine using an incisal butt joint design. After the provisional phase, a lithium disilicate ceramic veneer was fabricated and cemented with adhesive technique.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Following 18 months of follow\u2010up, we observed a nearly complete closure of the embrasure space.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The successful closure of the interproximal tissue deficiency, as evidenced by this case report, demonstrates the potential of this approach utilizing an interproximal connective tissue graft along with prosthetic treatment to manage significant papillary defects; this report reinforces the role combined prosthodontic and periodontic approaches may have in treatment outcomes.<\/jats:p>\n <\/jats:sec>\n \n Key points<\/jats:title>\n \n \n \n The connective tissue cube technique showed potential for treatment of severe papillary deficiencies.<\/jats:p>\n <\/jats:list-item>\n \n Combined surgical\u2013restorative approaches might be needed for complete closure of black triangles.<\/jats:p>\n <\/jats:list-item>\n \n Further clinical studies with stronger level of evidence are needed.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>\n \n Plain language summary<\/jats:title>\n This case report discusses a treatment for a common issue after periodontal therapy: black triangles (open gingival embrasures) between teeth that can be unappealing. The patient, a 64\u2010year\u2010old woman, had a black triangle between her maxillary right canine and first premolar due to loss of interproximal periodontal support. The treatment combined surgery (tissue and bone grafting with biologic material) and restorative treatment. After 6 months, dental restorations were complete, with a provisional period prior to definitive restoration to evaluate tissue fill and esthetics. The restorative treatment involved the use of a single veneer and single interproximal composite restoration. Eighteen months postsurgical therapy, the gap was nearly closed and remained stable for an additional 6 months. The report highlights that combining gingival surgery and restorative treatment may effectively treat significant papillary deficiencies.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/cap.10371","type":"journal-article","created":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T13:07:00Z","timestamp":1760447220000},"page":"356-364","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The connective tissue cube for treatment of papillary deficiencies: A case report"],"prefix":"10.1002","volume":"16","author":[{"given":"Giuseppe","family":"Carvelli","sequence":"first","affiliation":[{"name":"Private Practice Mission Viejo California USA"},{"name":"Department of Periodontology, Eastman Institute for Oral Health University of Rochester Rochester New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elli Anna","family":"Kotsailidi","sequence":"additional","affiliation":[{"name":"Department of Periodontology, Eastman Institute for Oral Health University of Rochester Rochester New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Tsigarida","sequence":"additional","affiliation":[{"name":"Department of Periodontology, Eastman Institute for Oral Health University of Rochester Rochester New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shalom","family":"Benzaquen","sequence":"additional","affiliation":[{"name":"Department of Periodontology, Eastman Institute for Oral Health University of Rochester Rochester New York USA"},{"name":"Department of Prosthodontics, Eastman Institute for Oral Health University of Rochester Rochester New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos","family":"Chochlidakis","sequence":"additional","affiliation":[{"name":"Department of Prosthodontics, Eastman Institute for Oral Health University of Rochester Rochester New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo","family":"Ercoli","sequence":"additional","affiliation":[{"name":"Department of Prosthodontics, Eastman Institute for Oral Health University of Rochester Rochester New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jack G.","family":"Caton","sequence":"additional","affiliation":[{"name":"Department of Periodontology, Eastman Institute for Oral Health University of Rochester Rochester New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,10,14]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2008.070315"},{"issue":"3","key":"e_1_2_10_3_1","first-page":"246","article-title":"Interdental papilla management: a review and classification of the therapeutic approaches","volume":"24","author":"Prato GP","year":"2004","journal-title":"Int J Periodontics Restorative Dent"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1992.63.12.995"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/JPER.20\u20100587"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.9734\/BJAST\/2015\/11287"},{"issue":"3","key":"e_1_2_10_7_1","first-page":"296","article-title":"Black triangle dilemma and its management in esthetic dentistry","volume":"10","author":"Singh VP","year":"2013","journal-title":"Dent Res J (Isfahan)"},{"issue":"4","key":"e_1_2_10_8_1","first-page":"395","article-title":"Reconstruction of the lost interproximal papilla\u2014presentation of surgical and nonsurgical approaches","volume":"19","author":"Blatz MB","year":"1999","journal-title":"Int J Periodontics Restorative Dent"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600\u20100757.1996.tb00184.x"},{"issue":"11","key":"e_1_2_10_10_1","first-page":"1112","article-title":"\u201cRestoratively driven papilla regeneration: correcting the dreaded \u2018black triangle\u2019\u201d","volume":"125","author":"Clark D","year":"2008","journal-title":"Tex Dent J"},{"issue":"3","key":"e_1_2_10_11_1","first-page":"e1","article-title":"The role of emergence profile in papilla maintenance after diastema closure with direct composite resin restorations","volume":"64","author":"Sobrinho KN","year":"2016","journal-title":"Gen Dent"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1708\u20108240.2009.00267.x"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bdj.2011.2"},{"issue":"5","key":"e_1_2_10_14_1","first-page":"53","article-title":"Direct vs indirect restorations for diastema closure: determining the suitable approach","volume":"71","author":"Valente MSO","year":"2023","journal-title":"Gen Dent"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/s1073\u20108746(96)80036\u20103"},{"issue":"6","key":"e_1_2_10_16_1","doi-asserted-by":"crossref","first-page":"92","DOI":"10.5005\/jcdp-9-6-92","article-title":"The dilemma of the open gingival embrasure between maxillary central incisors","volume":"9","author":"Tanaka OM","year":"2008","journal-title":"J Contemp Dent Pract"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.11607\/prd.1628"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1998.69.10.1124"},{"issue":"2","key":"e_1_2_10_19_1","first-page":"8","article-title":"A classification of marginal tissue recession","volume":"5","author":"Miller PD","year":"1985","journal-title":"Int J Periodontics Restorative Dent"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600\u2010051X.2011.01732.x"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2007.070210"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2009.080420"},{"issue":"6","key":"e_1_2_10_23_1","first-page":"589","article-title":"The simplified papilla preservation flap. A novel surgical approach for the management of soft tissues in regenerative procedures","volume":"19","author":"Cortellini P","year":"1999","journal-title":"Int J Periodontics Restorative Dent"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2000.71.9.1506"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600\u2010051X.2010.01550.x"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1002\/term.1737"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00784\u2010015\u20101677\u2010z"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1089\/pho.2017.4349"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.4103\/0976\u2010237X.107443"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1111\/jerd.12411"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.11607\/prd.3549"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2016.160471"},{"issue":"1","key":"e_1_2_10_33_1","first-page":"55","article-title":"Papilla reconstruction using a vertical interproximal tunnel approach","volume":"16","author":"Saleh MHA","year":"2023","journal-title":"Int J Oral Implantol (Berl)"},{"issue":"7","key":"e_1_2_10_34_1","first-page":"351","article-title":"Deep rotated connective tissue flap for the reconstruction of the interdental papilla [article in Italian]","volume":"43","author":"Aubert H","year":"1994","journal-title":"Minerva Stomatol"},{"issue":"5","key":"e_1_2_10_35_1","first-page":"466","article-title":"Surgical reconstruction of the interdental papilla","volume":"18","author":"Azzi R","year":"1998","journal-title":"Int J Periodontics Restorative Dent"},{"issue":"2","key":"e_1_2_10_36_1","first-page":"141","article-title":"Root coverage and papilla reconstruction using autogenous osseous and connective tissue grafts","volume":"21","author":"Azzi R","year":"2001","journal-title":"Int J Periodontics Restorative Dent"},{"key":"e_1_2_10_37_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2007.060105"},{"key":"e_1_2_10_38_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00784\u2010023\u201005409\u20100"},{"key":"e_1_2_10_39_1","doi-asserted-by":"publisher","DOI":"10.31038\/JDMR.2019215"},{"key":"e_1_2_10_40_1","doi-asserted-by":"publisher","DOI":"10.1002\/cap.10047"},{"issue":"4","key":"e_1_2_10_41_1","first-page":"353","article-title":"Comparison of maxillary tuberosity and palatal donor sites for soft tissue augmentation at implant placement: a pilot controlled clinical study","volume":"15","author":"Kotsailidi EA","year":"2022","journal-title":"Int J Oral Implantol (Berl)"}],"container-title":["Clinical Advances in Periodontics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/aap.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cap.10371","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aap.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/cap.10371","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aap.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cap.10371","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T03:41:03Z","timestamp":1781581263000},"score":1,"resource":{"primary":{"URL":"https:\/\/aap.onlinelibrary.wiley.com\/doi\/10.1002\/cap.10371"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,14]]},"references-count":40,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1002\/cap.10371"],"URL":"https:\/\/doi.org\/10.1002\/cap.10371","archive":["Portico"],"relation":{},"ISSN":["2573-8046","2163-0097"],"issn-type":[{"value":"2573-8046","type":"print"},{"value":"2163-0097","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,14]]},"assertion":[{"value":"2024-08-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-05-26","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-14","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}