(a) Pretreatment view. The gingival tissues were distorted from previous attempts at esthetic reconstruction. The patient wished to have a papilla between the right maxillary lateral and central incisorand a natural looking bridge.
(b) The pontic area, including the papilla on the mesial of the right lateral incisor, was de -epithelialized and
a thick (5 mm) onlay graft was sutured into position.
(c) The pontic was shortened at the time of surgery to accommodate the thick graft. At 3 months post- surgery the graft had undergone maximum
shrinkage and gingivoplasty could now be done.
(d) Incisal view at 3 months post-surgery. Note the "papilla" that has been created. The indentation in the ridge was naturally created by the tissue swelling against the pontic tooth.
Rotary diamond point gingivoplasty was done to reshape the bulky graft to normal contours, deepen the receptacle site for the ovate pontic and level the gingival margins.
(f) This view shows the esthetic harmony that was obtained in the soft tissues and tooth form at 2 years post-treatment.