In the following operation, Prof. Wachtel (Munich) restores a deep three-walled periodontal defect of the lower right lateral incisor. First, an incision through the adjacent papillae and within the sulcus is conducted followed by an additional vertical releasing incision in the distal region of tooth 43. Then, a full thickness flap is prepared in the buccal and lingual area with the papilla elevator pushing the remaining papillae carefully towards lingual.

After debridement of the periodontal defect the root surfaces are cleaned. Then, an internal connective tissue flap is prepared in order to later cover the defect with a double flap procedure. The bone in the defect area is perforated in order to provoke bleeding. After further cleaning, EDTA is used to condition the root surfaces followed by the application of Straumann Emdogain (enamel matrix proteins). In order to fill the defect, autologous bone from the surrounding area is harvested. Wound closure is started with fixing the internal flap on top of the filled defect, followed by the repositioning and fixation of the “outer” flap using micro-sutures to ensure primary healing.