Purpose of this study is to evaluate the efficacy ofmodified vertical mattress suturing technique for flapapproximation after ramping – a modification ofresective osseous surgical procedure. Eighteen patientsrequiring periodontal surgery for pocket therapy wereincluded in the study. The preoperative gingival andperiodontal conditions were evaluated and intraoralradiographs were taken to identify the osseous defect.Shallow Craters present in the interdental regionstowards the palatal surface were treated by ramping.On completion of the procedure, flaps wereapproximated for the final suturing. Suturing is doneby a modification of vertical mattress suturing methodusing 4-0 silk sutures. The surgical sites wereevaluated at the conclusion of the surgery, duringsuture removal and one month post-operative. Theoutcomes were evaluated in terms of patient’s comfort,surgical flap approximation, complications and post–operativerecessions. Complete closure of wound andgood flap approximation was achieved in all casesimmediately after the surgery. Except for three patientswith delayed wound healing at suture removal, allother patients displayed rapid healing without anydiscomfort. No noticeable defect was seen in thehealing of the interdental papilla on the buccal aspect.Embrasure spaces on the buccal surface werecompletely filled by interdental papilla during the onemonth review period. In patients undergoing resectiveosseous surgery by ramping that result in two differentplanes for flap approximation, the modified verticalmattress suturing technique proves to be a reliable andan effective method of suturing.surgery