This article presents a case report of papilla reconstruction in a patient with severe periodontal disease. Papilla reconstruction is a difficult procedure when performed with the naked eye; however, it becomes much easier when carried out using the dental operating microscope. The technique presented here—the so-called patch technique—is composed of the following operations under the dental microscope: (1) debridement, desquamation, and tension-releasing incisions through the sulcus; (2) harvest of connective tissue from the palate; (3) support of an epithelial flap with the harvested connective tissue patch; and (4) lifting of this combined flap in the coronal direction using a composite resin anchor on the tooth surface. The patch technique is an effective method for papilla reconstruction when used in conjunction with the operating microscope. Int J Microdent 2009;1:25–29