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| Study | Technique | Key design features | Remarks |
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| Harrel [119] | Minimally invasive surgery (MIS) | Two separate intrasulcular incisions with a connecting single horizontal incision (at the palatal aspect for aesthetic areas) placed 2-3 mm from the papilla crest. | Performed with at least 3.5x magnification, a granulation tissue-removing instrument, and high-speed finishing bur for root surface smoothening. |
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| Cortellini and Tonetti [120] | Minimally invasive surgical technique (MIST) | Mesiodistal extensions kept to a minimum, avoid vertical releasing incisions, and elevate only the defect-associated papilla where possible. | Modified papilla preservation flap or simplified papilla preservation flap for the interdental incision, extended to buccal and lingual aspects. A microsurgical approach with ×4–16 magnification and enamel matrix derivative are used. |
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| Cortellini and Tonetti [121] | Modified minimally invasive surgical technique (M-MIST) | Mesiodistal extension extends only to the midbuccal area of involved teeth. | Modified papilla preservation flap or simplified papilla preservation flap for the interdental incision, only extended to the buccal aspect. A microsurgical approach with ×4–16 magnification and enamel matrix derivative are used. |
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| Trombelli et al. [127] | Single-flap approach (SFA) | Only an envelope flap on the buccal and oblique or horizontal incisions interproximally following the profile of the underlying bone crest. Interproximal supracrestal gingival tissues are left intact. | ×2.5 magnifying loupes are used. Limited to intraosseous defects requiring buccal access. May be more suitable with an enamel matrix derivative ± bone graft approach, rather than membrane + bone substitute due to wound dehiscence [128, 129]. |
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| Aslan et al. [130] | Entire papilla preservation flap (EPP) | Buccal intracrevicular and single short vertical releasing incision, followed by interdental tunnel preparation below the papilla to access the defect. | Microsurgical instruments, surgical loupes ×3.3, and a specifically designed angled tunnel elevator are required. Regenerative material consisted of enamel matrix derivative + bone substitute. |
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| Moreno Rodriguez and Caffesse [131] | Nonincised papilla surgical approach (NIPSA) | Buccal horizontal incision apical to the periodontal defect, followed by raising the flap coronally, allowing surgical access to the defect without disrupting marginal tissues. | Root surface debridement performed up to the first 2-3 mm of the pocket in question during the nonsurgical phase to preserve fibers attached to the root and to prevent postoperative shrinkage. ×2.8 magnifying loupes are used, and regenerative material consisted of enamel matrix derivative + bone substitute. |
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