Management of Bone Defect in Anterior Teeth using Modified Whales Tail Technique - a Case Report

Special Article - Periodontology

Austin J Dent. 2019; 6(2): 1129.

Management of Bone Defect in Anterior Teeth using Modified Whales Tail Technique - a Case Report

Noble S* and Batra P

¹Department of Periodontics, Vydehi Institute of Dental Sciences and Research Centre, India

*Corresponding author: Sruthy Noble, Department of Periodontics, Vydehi Institute of Dental Sciences and Research Centre, Bangalore, Karnataka, India

Received: March 18, 2019; Accepted: April 10, 2019; Published: April 17, 2019


The Modified Whale’s tail technique was performed to obtain maximum interdental papilla fill in the anterior region after placement of Guided tissue regeneration barrier membrane. This study aims to assess the clinical efficacy of this new technique. This case report describes a case with a probing depth of 6-7 mm in the maxillary anterior teeth and their treatment with Modified Whale’s tail technique to obtain regeneration and maximum papilla preservation. The application of the “Whale’s tail” flap lead to significant improvement of hard and soft tissue conditions and improved the clinical attachment level involving the maxillary anterior teeth to recreate a functional and esthetic results.

Keywords: Bone Defect; Periodontics; Whale’s Tail Technique


Different surgical procedures have been proposed to preserve the interdental papillary structure during the early and late phases of wound healing to prevent contamination of the regenerating area and subsequent wound failure [1]. These procedures provided greater stability to the blood clot to enhance the regenerative potential [2]. To ensure predictable results in periodontal regeneration, primary closure of the osseous defect is essential to improve clinical attachment gain. To obtain complete coverage of the regenerative material placed in the osseous defect the flap design should be designed in such a way that maximum amount of gingival tissue is preserved [3-5].

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 [1]. Later Cortellini et al. gave modifications of the flap design - modified papilla preservation flap and simplified papilla preservation flap to be used in combination with regenerative procedures [3].

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 [5]. Authors described a significant improvement on clinical parameters and soft tissue healing with primary closure.

Guided Tissue Regeneration (GTR) comprises procedures attempting to regenerate lost periodontal structures through differential tissue responses.

The aim of this study is to describe a clinical case where the “modified whale’s tail” technique was employed to obtain periodontal regeneration and resulted in gain of clinical attachment level by using barrier membrane in the area of defect.

Case Presentation

A 35 years old woman presenting a diastema between central and lateral right incisors reported to our Department of Periodontics to treat periodontal defects (Figure 1). The patient did not have any systemic problems. There was a clinical and radiographic evidence of an intrabony defect associated with the maxillary right central and lateral incisor with a probing depth of 7 mm and attachment loss of 4mm.