Objectives: This study was designed to evaluate and compare the papilla preservation technique (PPT) versus subgingival debridement in the treatment of periodontal pockets associated with shallow-moderate intrabony defects (IBDs) in the anterior esthetic zone of the mouth. The use of an optical microscope enhanced visual perception and illumination thus improving the surgical technique.Subjects and Methods: The study population included twelve patients suffering from chronic periodontitis with twenty four shallow-moderate IBDs (≤ 3 mm). All patients had received scaling and root planing (SRP). Selected interproximal sites were divided according to split-mouth design into PPT-treated sites (SRP followed by PPT) and SRP-treated sites (SRP alone). Minimally invasive surgical technique was performed according to the principles of PPT. Clinical parameters recorded at different time intervals of the study period (baseline, 3 months, 6 months, and 12 months) were: plaque index (PI), gingival index (GI), probing pocket depth (PPD), gingival recession (GR), clinical attachment level (CAL), IBD characteristics (the latter was recorded during surgical procedure in PPT-treated sites only).Results: Both treated-sites resulted in a statistically significant mean CAL gain of 2.5 ± 0.8mm in PPT-treated sites and 2.1 ± 0.9mm in SRP-treated sites at 12 months. When CAL gain was compared between both treated-sites, no statistically significant difference was revealed. In addition, the mean values of GR values at 12 months were 1.4 ± 0.5mm in PPT-treated sites and 1.1 ± 0.7mm in SRP-treated sites without statistically significant difference between both treated-sites. Two weeks after surgery, primary closure was maintained in ten IBDs of the PPT-treated sites.Conclusion: Both treated-sites using SRP alone or SRP followed by PPT resulted in PPD reduction and CAL gain with minimal increase in GR. In the treatment of shallow to moderate IBDs, SRP followed by PPT is the treatment of choice for deep pockets in the anterior esthetic region where SRP alone didn’t result in decrease in PPD < 5mm. The use of the optical microscope increased surgical acuity allowing atraumatic soft and hard tissue manipulation.