Deshpande Milind Mrunal, Jarde Samiksha Jaypal,

Rohan Srinivasan Wilson, Anirban Chatterjee

J Indian Soc Periodontol 2016;20:460-3.

Presented By
Dr.Vijeta Vyas
 INTRODUCTION
 The primary goal of periodontal treatment is the
maintenance of the natural dentition in health and
comfortable function.
 Key goal in periodontal regenerative procedures is to
obtain primary closure over the treated area and thus
ensure adequate protection for the healing events.
 To preserve the interdental soft tissue for maximum
soft tissue coverage following surgical intervention
involving the treatment of proximal osseous defects,
Takei et al., proposed a surgical approach called
papilla preservation technique.
 Later Cortellini et al. gave modifications of the flap
design – modified papilla preservation flap.

 In 2009, Bianchi and Bassetti described a new surgical

technique – the “Whale’s tail” technique, which was
designed for the treatment of wide intrabony defects
in the esthetic zone.

 This technique involved the elevation of a large flap

from the buccal to the palatal side to facilitate access
and visualization of the intrabony defect and was
created, especially to perform regeneration while
maintaining interdental tissue over grafting material.
 AIM

To assess the clinical efficacy of this new surgical

technique – the Whale’s tail technique in a series of
three cases.
 MATERIALS & METHOD
SUBJECT SELECTION:-
•Three systemically healthy subjects with probing depths 6–7
mm and radiographic evidence of bone loss in relation to the
maxillary anterior teeth were included in the study.

•Informed consent was taken from the subjects.

•Probing depths and attachment loss were recorded.

•Complete scaling and root planing were done for all the
subjects.
SURGICAL TECHNIQUE

After phase I therapy, Probing depths

were assessed .
Incision points marked
Two vertical and one horizontal –
Whale’s tail incision placed
Flap reflected from buccal to palatal aspect with intrabony defect
with relation to 11
Debridement done and bone graft
placed
Flap repositioned
perimeter sutures placed away
from incision lines
Periodontal dressing
• Postoperative instructions were given.
• Patients was asked to use 0.2% chlorhexidine mouth
rinse 48 h after the procedure for a period of 2 weeks.
• The patients were prescribed amoxicillin (500 mg –
TID for 5 days) and ibuprofen (400 mg – BID for 5
days).
• The subjects were recalled after 2 weeks for suture
removal and were recalled after the duration of 3
months and 6 months.
Six months postoperatively
INTRA ORAL PERIAPICAL RADIOGRAPH
Preoperative Postoperative
 SUBJECT 2
Preoperative probing Postoperative probing
depth = 7 mm depth = 3 mm
 SUBJECT 3
Preoperative probing Postoperative probing
depth = 7 mm depth = 3 mm with recession
 RESULTS
SUBJECT 1 SUBJECT 2 SUBJECT 3

Probing depth 3mm 4mm 4mm

reduction
Clinical 4mm 4mm 1mm
attachment level
gain
_ _ 3mm
Recession
 ADVANTAGES
 Good access to the defect area.

 Positioning of incisions away from the defect area and

placement of sutures distant from the regenerated
defects decreased the chances of bacterial colonization
and Flap dehiscence.

 Handling of the interdental papilla is easier and more

convenient than the conventional papilla preservation
technique.
INDICATIONS:-
 Therapies aimed at regeneration of periodontal defects
with bone grafts, membrane, or combination of these
materials.
 Surgical treatment of anterior tooth region with
diastema present.

CONTRAINDICATIONS:-
 High frenal attachment.
 Recession.
 Diastema <2 mm.
 MODIFIED WHALE’S TECHNIQUE
 Aid in regeneration of an interdental osseous defect
between maxillary central incisors complicated by an
aberrant frenal attachment.
 It is a case report of healthy 32-year-old female patient with
the complaint of spacing between her upper front teeth.
 Clinical Examination:-
Diastema of 4mm
Abberant Frenal attachment
Periodontal pocket of 6mm
IOPA shows Vertical bone loss in mesial aspect of left
maxillary central incisor
Clinical preoperative view of
maxillary anterior teeth
Initial two semilunar incisions
Intraoperative view of the defect
Alloplastic graft placed in the
defect
Flap sutured
Six months postoperative view
INTRAORAL PERIAPICAL RADIOGRAPH
Preoperative Postoperative
 DISCUSSION
• Whale’s tail technique allows regeneration of wide
intrabony defects involving the maxillary anterior
teeth with notable interdental diastemas.
• Maintaining interproximal tissue to recreate a
functional attachment with esthetic results.
• Elevation of large flap from buccal to palatal, allowed
the preservation of a large amount of soft tissue and
resulted in good primary closure.
• Positioning of incisions away from the defect area and
placement of sutures distant from the regenerated
defects decreased the chances of bacterial colonization
 In Modified Whale’s technique technique, two
semilunar incisions below the mucogingival line on
the buccal surface were used rather than using distinct
horizontal and vertical incisions, which helped in
better approximation of the flap margins.
 Soft tissue healing depend upon many factors such as
incision technique, flap design, soft tissues
management during surgery, root preparation, patient
compliance etc.
 The relocation of the frenum also reduced the chance
of flap dehiscence during healing.
THANK YOU