The destruction of the interdental papillae and formation of permanent gingival craters are common sequelae of acute necrotizing ulcerative gingivitis. These craters can be disfiguring, especially in the anterior gingiva, and can act as a nidus for recurrent episodes. Traditional therapy has emphasized a surgical approach for elimination of these defects, often increasing the esthetic problems. The purpose of this paper is to review the treatment modalities of acute necrotizing ulcerative gingivitis and illustrate an alternative treatment approach of periodic scaling, root planing, and antimicrobial rinses with 0.12% chlorhexidine. With this therapeutic regimen, the disease process can be reversed and damaged papillae may regenerate.