{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T12:49:31Z","timestamp":1791809371870,"version":"4.3.4"},"reference-count":32,"publisher":"Wiley","issue":"S1","license":[{"start":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T00:00:00Z","timestamp":1769385600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T00:00:00Z","timestamp":1769385600000},"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":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Interdental papilla is key to gingival health and esthetics. Its loss leads to black triangles, which affects the smile's appearance and increases periodontal risks. Various treatments have been proposed, but papilla reconstruction remains challenging due to anatomical and vascular limitations. This case report aims to describe the vertex technique (VT), a novel approach combining tunneling with connective tissue and bone grafts for papilla reconstruction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>VT was performed on patients with papilla presence index (PPI) 3 and 4 defects and a thick gingival phenotype in the esthetic zone. A microsurgical approach was employed to create an interproximal tunnel, thereby minimizing tissue trauma and preserving the vascular supply. Custom\u2010shaped connective tissue grafts were inserted to enhance soft tissue volume, while bone grafts targeted interproximal bone loss for additional support. The procedure emphasized careful flap management to optimize healing and graft stability. All patients were periodontally treated prior to surgery and were healthy at the time of the procedure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>VT achieved significant papilla augmentation, reducing the visibility of the black triangles, and improving gingival esthetics, from PPI 3 or 4 to PPI 2 after treatment. The integration of connective tissue and bone grafts resulted in enhanced soft tissue volume and long\u2010term stability observed over follow\u2010up periods of 1\u20125 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The VT offers a promising solution for interdental papilla defects PPI 3\u20124, addressing both soft tissue and bone deficiencies. Its combination of microsurgical tunneling with grafting provides esthetic and stable results, expanding treatment options in periodontal plastic microsurgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key points<\/jats:title>\n                    <jats:p>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>Vertex technique (VT) combines microsurgical tunneling with connective tissue and bone grafts to reconstruct interdental papillae with high precision and minimal trauma.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Significant esthetic improvement and stable papilla height were achieved in papilla presence index 3\u20124 defects, with outcomes maintained over 1\u20125 years.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>VT is indicated for healthy, periodontally treated patients with thick phenotypes, although it requires advanced skills and resources for proper execution.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Plain language summary<\/jats:title>\n                    <jats:p>This study introduces the vertex technique, a new method to fix gaps (black triangles) between teeth caused by the loss of the interdental papilla. These gaps not only affect the look of a smile but can also harm gums\u2019 health. The technique uses a microsurgical approach to insert connective tissue and bone grafts, improving both soft tissue volume and bone support. It was used on patients with severe defects in the esthetic zone. Results showed a significant improvement in appearance and long\u2010term stability, with no complications. The vertex technique offers a promising solution for these periodontal issues.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cap.70028","type":"journal-article","created":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T10:16:21Z","timestamp":1769422581000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Vertex technique: A novel microsurgical technique for papilla reconstruction\u2014Case study"],"prefix":"10.1002","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1557-4846","authenticated-orcid":false,"given":"Fernando","family":"Solanes","sequence":"first","affiliation":[{"name":"Private Practice  Santiago Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8837-2540","authenticated-orcid":false,"given":"Juan Carlos","family":"Dur\u00e1n","sequence":"additional","affiliation":[{"name":"Private Practice  Santiago 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