The enhanced visual perception and illumination of an operative microscope improve surgical techniques in terms of flap incision, quality of root debridement, and suturing. The aim of this study is to describe microsurgical flap access for the treatment of periodontal pockets associated with shallow to moderate bony defects in the esthetic zone of the mouth. This technique combines preservation of the still-attached gingival fibers and maintenance of the body of the interproximal papilla. The results in terms of attachment level gain and residual pocket depth show that the described microsurgical approach helps to minimize marginal tissue recession and improve esthetics in the treatment of shallow to moderate bony defects.