Combined EPP and CTG Wall Approach for Distal Papilla Reconstruction in a Noncontained Intrabony Defect: A 24-Month Follow-Up Case Report.

Background: Management of noncontained intrabony defects remains challenging because limited defect containment compromises clot stability, flap support, and regenerative outcomes. This case report describes a combined surgical approach using the entire papilla preservation (EPP) technique with connective tissue graft (CTG) wall augmentation, enamel matrix derivative (EMD), and a xenogeneic bone substitute for the management of a combined intrabony defect with distal papilla deficiency. Methods: A patient presented with a 9-mm probing depth associated with a combined intrabony defect with a noncontained two-wall coronal component and a three-wall apical component. Following initial periodontal therapy, regenerative surgery was performed using the EPP technique with CTG wall augmentation, xenogeneic bone substitute, and EMD. Clinical and radiographic outcomes were evaluated over 24 months. Results: Probing depth was reduced from 9 mm at baseline to 3 mm at 24 months, accompanied by a substantial clinical attachment gain and radiographic evidence of defect fill. Distal papilla deficiency decreased from 4 to 2 mm, corresponding to an improvement from Class II to Class I, indicating partial soft-tissue reconstruction and improved tissue stability. Radiographic evaluation demonstrated progressive defect fill and stable radiopacity throughout the follow-up period. No postoperative complications, flap dehiscence, or biomaterial exposure were observed. Conclusion: The combined use of EPP and CTG wall with xenograft-EMD may provide favorable clinical and radiographic outcomes in challenging noncontained intrabony defects. This approach may contribute to improved soft-tissue stability and partial reconstruction of papillary deficiencies.