{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T12:48:38Z","timestamp":1791809318632,"version":"4.3.4"},"reference-count":21,"publisher":"Wiley","issue":"S1","license":[{"start":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T00:00:00Z","timestamp":1776211200000},"content-version":"vor","delay-in-days":45,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"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":[[2026,3]]},"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n While the simplified papilla preservation flap is commonly recommended in the molar region, it may not be optimal when blood flow and microsurgical visibility are considered. This case study aimed to evaluate the relationship between surgical visibility and interdental incision designs in the molar region and to propose a decision\u2010making framework for interdental papilla incision design based on the extent of flap elevation and blood supply.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Three cases of periodontal regenerative therapy in the molar regions were performed using different flap designs: extended flap with circumferential defect (3\u00a0mm depth) and minimally invasive surgical technique (MIST) and modified MIST (M\u2010MIST) with combination defects (4\u00a0mm depth), both incorporating interdental incision designs with a buccal or palatal shift. Clinical parameters and radiographic outcomes were assessed at baseline and 6 months postoperatively.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The initial probing pocket depths of 10, 9, and 8\u00a0mm were reduced to 4, 4, and 3\u00a0mm, respectively, with radiographic evidence of bone\u2010filling in all cases. Cases using MIST and M\u2010MIST demonstrated superior primary healing compared with the extended flap case. Interdental incision designs with a buccal or palatal shift improved visibility and operability during microsurgery in molar regions.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n This case study showed that buccal\u2010 or palatal\u2010shifted interdental incision designs were effective for molar periodontal regenerative therapy under operating microscopes. The decision\u2010making process for interdental incision designs should consider the inter\u2010root distance as well as the extent of flap elevation and its impact on blood supply.<\/jats:p>\n <\/jats:sec>\n \n Key points<\/jats:title>\n \n \n \n Buccal\u2010 or palatal\u2010shifted interdental incision designs using an appropriate flap design can be successfully applied to molar regions.<\/jats:p>\n <\/jats:list-item>\n \n Microscope\u2010enhanced visibility with buccal\u2010 or palatal\u2010shifted interdental incision designs improves surgical precision and accessibility.<\/jats:p>\n <\/jats:list-item>\n \n Preservation of the blood supply is crucial for optimal wound healing.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>\n \n Plain language summary<\/jats:title>\n Successful periodontal regenerative therapy in molar regions requires adequate surgical access and preservation of the interdental papilla. Although various minimally invasive techniques are available, accessing deep bone defects in molar regions while maintaining blood supply to the papilla remains challenging. In this context, interdental papilla incision designs that shift the incision line to the buccal or palatal aspect\u2014such as the papilla preservation technique, modified papilla preservation technique, and triangle papilla access approach\u2014are considered to contribute to improved visibility in periodontal regenerative therapy in the molar region using the operating microscope (OM). Building on this, the present case study proposes a new decision\u2010making framework for interdental papilla incision design, with an emphasis on enhancing visibility under the OM and considering the anatomical relationship between flap design and blood supply.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/cap.70011","type":"journal-article","created":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T08:03:49Z","timestamp":1776240229000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Optimizing papillary incision design in molar periodontal regenerative therapy: A case study"],"prefix":"10.1002","volume":"16","author":[{"given":"Shunichi","family":"Shibazaki","sequence":"first","affiliation":[{"name":"Department of Dentistry and Oral Surgery Keio University School of Medicine Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoru","family":"Morikawa","sequence":"additional","affiliation":[{"name":"Department of Dentistry and Oral Surgery Keio University School of Medicine Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuichiro","family":"Ihara","sequence":"additional","affiliation":[{"name":"Department of Dentistry and Oral Surgery Keio University School of Medicine Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taneaki","family":"Nakagawa","sequence":"additional","affiliation":[{"name":"Department of Dentistry and Oral Surgery Keio University School of Medicine Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,15]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600\u2010051x.1991.tb00435.x"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.12756"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600\u2010051x.1982.tb02099.x"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2015.130685"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/prd.12048"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600\u20100757.2006.00157.x"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600\u2010051X.2006.01020.x"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1985.56.4.204"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1995.66.4.261"},{"issue":"6","key":"e_1_2_9_11_1","first-page":"589","article-title":"The simplified papilla preservation flap. 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