{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T13:59:00Z","timestamp":1790258340936,"version":"4.1.0"},"reference-count":35,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T00:00:00Z","timestamp":1771459200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T00:00:00Z","timestamp":1771459200000},"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":[[2026,9]]},"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Single flap approach (SFA) is a validated procedure for obtaining clinical attachment gain and pocket closure when applied to deep intraosseous defects. However, the presence of an interdental crater as well as the tooth location were associated with a lower rate of primary intention closure, possibly jeopardizing the outcome of the procedure. In order to favor primary closure, the use a periosteum pedicle flap (PPF) was proposed. The present case report showed the effect of a combination of SFA with PPF for the treatment of a severe, isolated intrabony defect at a molar site associated with a deep interproximal crater.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A patient presenting two 6\u2010mm deep bleeding periodontal pockets, in association with an intrabony defect, at the mesio\u2010buccal and mesio\u2010lingual aspect of #19 was treated with the combination of SFA and PPF. Intrabony component of the defect was filled with a combination of deproteinized bovine bone mineral mixed with a gel composed by polynucleotides and hyaluronic acid.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n A dehiscence of the primary flap was observed at the interproximal area. Primary closure was still present due to the presence of the underlying periosteal pedicle flap. At the 12\u2010months follow up, pocket closure was observed at both mesio\u2010buccal and mesio\u2010lingual aspects. The radiographical examination showed a substantial remineralization of the infrabony component<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n The combination of SFA with PPF may be a promising approach for the treatment of intrabony defects associated with unfavorable conditions of soft tissues located at molar sites.<\/jats:p>\n <\/jats:sec>\n \n Key points<\/jats:title>\n \n \n \n \n Why is this case new information?<\/jats:bold>\n <\/jats:p>\n <\/jats:list-item>\n \n The present case reports that single flap approach may be successfully combined with a periosteal pedicle flap to correct intrabony defects associated with unfavorable conditions of soft tissues located at molar sites.<\/jats:p>\n <\/jats:list-item>\n \n \n What are the keys to successful management of this case?<\/jats:bold>\n <\/jats:p>\n <\/jats:list-item>\n \n Careful dissection of the flap to isolate and maintain the integrity pf the periosteal pedicle flap<\/jats:p>\n <\/jats:list-item>\n \n Complete debridement of both the intrabony defects and of the root<\/jats:p>\n <\/jats:list-item>\n \n Stabilization of the periosteal pedicle flap above the defect in order to contribute to the primary intention healing<\/jats:p>\n <\/jats:list-item>\n \n \n What are the primary limitations to success in this case?<\/jats:bold>\n <\/jats:p>\n <\/jats:list-item>\n \n Absence of unfavorable anatomical conditions possibly jeopardizing the primary closure of the surgical wound<\/jats:p>\n <\/jats:list-item>\n \n Proximity with mental nerve due to possible lesions during the partial thickness dissection<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>\n \n Plain language summary<\/jats:title>\n The present paper explored the use of a surgical technique combining a buccal single flap elevation and a periosteal pedicle to treat a periodontal pocket associated with a deep intrabony defect. A buccal split\u2010thickness incision was performed to both visualize the osseous defect and isolate a periosteal pedicle. The defect was debrided and filled with a combination of a xenograft and gel composed of polynucleotides and hyaluronic acid. The periosteal pedicle was rotated and sutured above the filled defect. The primary split\u2010thickness flap was sutured, covering both the defect and periosteal pedicle. Twelve months after surgery, no periodontal pocket was present. At the radiographic examination, substantial remineralization of the defect was observed.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/cap.70052","type":"journal-article","created":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T09:56:33Z","timestamp":1771494993000},"page":"676-681","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Single flap approach combined with periosteal pedicle flap as a regenerative procedure: A case report"],"prefix":"10.1002","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0204-3816","authenticated-orcid":false,"given":"Mattia","family":"Severi","sequence":"first","affiliation":[{"name":"Research Centre for the Study of Periodontal and Peri\u2010Implant Diseases University of Ferrara Ferrara Italy"},{"name":"Operative Unity of Dentistry of Ferrara Ferrara Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Viola","sequence":"additional","affiliation":[{"name":"Private Practice Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1147-2199","authenticated-orcid":false,"given":"Leonardo","family":"Trombelli","sequence":"additional","affiliation":[{"name":"Research Centre for the Study of Periodontal and Peri\u2010Implant Diseases University of Ferrara Ferrara Italy"},{"name":"Operative Unity of Dentistry of Ferrara Ferrara Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,2,19]]},"reference":[{"key":"e_1_2_10_2_1","first-page":"15","article-title":"Single flap approach in periodontal reconstructive surgery (article in Italian)","volume":"8","author":"Trombelli L","year":"2007","journal-title":"Dental Cadmos"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/JPER.19\u20100127"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00784\u2010025\u201006396\u20100"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2011.110045"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.12409"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2009.080420"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00784\u2010012\u20100838\u20106"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2010.100113"},{"issue":"4","key":"e_1_2_10_10_1","first-page":"106","article-title":"A novel marginal periosteal pedicle graft as an autogenous guided tissue membrane for the treatment of intrabony periodontal defects","volume":"10","author":"Gamal YA","year":"2008","journal-title":"J Int Acad Periodontol"},{"issue":"3","key":"e_1_2_10_11_1","first-page":"76","article-title":"Clinical re\u2010entry and histologic evaluation of periodontal intrabony defects following the use of marginal periosteal pedicle graft as an autogenous guided tissue membrane","volume":"12","author":"Gamal AY","year":"2010","journal-title":"J Int Acad Periodontol"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2012.110734"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/JPER.18\u20100006"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.13290"},{"issue":"6","key":"e_1_2_10_15_1","first-page":"589","article-title":"The simplified papilla preservation flap. 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