Application of Hyaluronic Acid as a Biopolymer Material in Reconstruction of Interdental Papilla in Rats

Applying hyaluronic acid, a biopolymer material, in the treatment of interdental papilla reconstruction has become a trend. The main objective of this research is to investigate the histologic effect of hyaluronic acid on interdental papilla over time. Deficient interdental papilla models were surgically created in sixty-two Sprague-Dawley (SD) rats and were randomly treated with the injection of hyaluronic acid (HA group) or phosphate-buffered saline (sham control group) or left untreated (control group). After 2, 4, and 8 weeks, the rats were sacrificed in batches to observe the histological changes. A fluorochrome label was used to monitor bone formation in 8 weeks. Immunohistochemical analyses were performed to evaluate the expression of potentially relevant cytokines, vascular endothelial growth factor (VEGF), bone morphogenetic protein-2 (BMP-2), and Wnt-induced secreted protein 1 (WISP1) in the gingival tissue in 8 weeks. A preliminary study of HA degradation after 24 weeks was performed in two rats. Following the HA injection, no inflammation or granulomatous foreign body reaction was observed. HA was able to promote collagen fiber and alveolar bone regular formation in the reconstruction site. HA also enhanced VEGF, BMP-2, and WISP-1 expression in gingival tissue (p＜0.05). After 24 weeks, there was no HA filler observed in the interdental papilla. In conclusion, our study suggested that HA is an effective way to reconstruct deficient interdental papilla.

Systematic Review and Meta-Analysis of the Use of Hyaluronic Acid Injections to Restore Interproximal Papillae

The absence of interdental papillae leads to the appearance of black triangles. For most patients, the appearance of these triangles is an important reason for concern and affects their social relationships. Multiple reconstruction techniques have been developed with different degrees of success and predictability. The main aim of this study was to evaluate the efficiency of hyaluronic acid (HA) injected into interproximal papillae 6 months after injection and to perform a systematic review and meta-analysis. After a systematic review, seven articles were selected: two clinical randomised controlled trials and five clinical trials. In total, 127 patients with a deficiency in upper papillae in the front of the maxilla and jaw were included in the study. The height variable was evaluated (mm) 6 months after HA injection. In total, 166 interproximal papillae were studied. Four articles showed an important difference in favour of intervention. The total result regarding in the injection of HA was favourable with an approximate average filling of 0.47 mm in the height of the interdental papilla. The injection of HA for the reconstruction of deficient papillae in the region of the upper and lower maxilla was a possible option treatment strategy in mild black triangles.

Idiopathic pigmented gingival fibromatosis: A case report

Gingival fibromatosis is a rare and heterogeneous group of disorders that develop as slowly progressive, local or diffuse enlargements within marginal and attached gingiva or interdental papilla. Gingival fibromatosis is a condition that can occur as an isolated disease or as a part of a syndrome or chromosomal abnormality. Here, we present the case of a 28-year-old male with pigmented gum enlargement in the maxilla and mandible. The clinical, radiographic, and histopathological features have been described in detail.

The effect of horizontal and vertical dimensions of the interproximal space on the existence of interdental papillae – A clinical study

The aim of the present study was to determine the existence of inter dental papilla according to the vertical dimension, horizontal dimension and the combined effects of the vertical and horizontal dimensions of the interproximal space on the existence of interdental papilla.182 interdental sites of 42 periodontitis patients undergoing open flap debridement were included in the study. The existence of interdental papilla was determined based on the Papilla Presence Index (PPI). The vertical dimension (VD) was measured from the alveolar crest to the contact point using UNC-15 probe. Horizontal dimension (HD) was measured from the mesial surface of the distal tooth and the distal surface of the mesial tooth at the level of the alveolar crest using castroviejocaliper. Statistical analysis was done by using independent ‘t’ test, Pearson’s Chi-square test and Trend Chi-square test. The existence of papilla was significantly higher in VD ≤ 5mm (91.5%) compared to VD > 5mm (9.8%) [p< 0.0001]. The existence of papilla was significantly higher in HD < 2mm (97%) compared to HD ≥ 2mm (1.2%) [p< 0.0001]. The contribution of both vertical dimension and horizontal dimension to the existence of papilla was about 61.6% and thus the existence of papilla may be influenced by various other factors (about 38.4%) which were not included in this study.The vertical and horizontal dimensions of the interproximal space gains significance in determining the existence of papilla and further research is needed to analyze the other factors influencing the papilla.

Systematic Review and Meta-Analysis of the Use of Hyaluronic Acid Injections to Restore Interproximal Papillae

The absence of interdental papillae leads to the appearance of black triangle. For most patients, the appearance of these triangles is an important reason for concern and affects their social relationships. Multiple reconstruction techniques have been developed with different degrees of success and predictability. The main aim of this study was to evaluate the efficiency of hyaluronic acid (HA) injected into interproximal papillae six months after injection and to perform a systematic review and meta-analysis. After a systematic review, five articles were selected: a clinical randomised controlled trial and four clinical trials. In total, eighty-five patients with a deficiency in upper papillae in the front of the maxilla and jaw were included in the study. The height variable was evaluated (mm) six months after HA injection. In total, one hundred and four interproximal papillae were studied. Three articles showed an important difference in favour of intervention. The total result regarding in the injection of AH was favourable with an approximate average filling of 0.7 mm in the height of the interdental papilla. The injection of HA for the reconstruction of deficient papillae in the region of the upper and lower maxilla was a possible option treatment strategy.

Clinical relevance of interdental papilla biopsy in chronic erosive gingivitis (desquamative gingivitis): retrospective bicentric study of 148 specimens

Background Chronic erosive gingivitis, also called desquamative gingivitis, defines a clinical picture that can be generated by several inflammatory and immune diseases. Pathology is therefore essential for the differential diagnosis. However, when the gingival lesion is initial, exclusive or predominant, selecting the biopsy site and protocol may be problematic due to tissue fragility. Especially since there are few studies on the subject, the aim of our study was to assess the protocol, diagnostic relevance and tolerance of an original protocol using interdental papilla biopsy. Methods We conducted a retrospective bicentric study, from October 2011 to July 2019, including all patients with a chronic erosive gingivitis who had received, for diagnostic purposes, a interdental papilla biopsy. Results The contribution levels for the two hospital departments were 94.7% and 97.1%, respectively. No postoperative complication was recorded in the short or long term. Conclusion The interdental papilla biopsy protocol is perfectly adapted to the anatomopathological examinations required to establish differential diagnosis of chronic erosive gingivitis. This surgical protocol is simple to perform, non iatrogenic with a very good tolerance and and accessible to all clinicians. It is highly efficient with an excellent contribution level. ClinicalTrials NCT04293718 (March 3, 2020). Health Data Hub N° F20201109083211 (November 9, 2020).

Comparative Clinical Evaluation of Platelet Rich Fibrin and Subepithelial Connective Tissue Graft in Interdental Papilla Reconstruction: A Randomized Controlled Clinical Trial

Background: Aesthetics has become a major concern nowadays. Loss of interdental papilla in the anterior region of the oral cavity accounts for a major compromise in aesthetics. Thus, techniques to correct this defect has emerged as a new area of research in dentistry. The present study aims to compare reconstruction of the interdental papilla using subepithelial connective tissue graft (SCTG)and platelet rich fibrin (PRF). Material and Methods: The present randomised clinical trial included 36 patients equally divided into test (platelet rich fibrin) and control groups (subepithelial connective tissue graft). Papilla reconstruction was done and clinical parameters- contact point to interdental papilla distance (CPID), width of keratinized gingiva (WKG), plaque index (PI), gingival index (GI), papillary bleeding index (PBI), pocket depth (PPD) were recorded at baseline, 3 and 6 months. Healing index (HI) was recorded at 1, 2 and 3 weeks. Results: At the end of 6 months, it was found that interdental papillae fill in terms of decrease in distance from the contact point to the interdental papilla tip and gain in WKG was statistically significant in both the groups (p value ≤0.05). On intergroup comparison, however, it was found that the improvement in the abovementioned parameters was significantly greater in the control group (39.32%) as compared to the test group (14.79%). The difference in other clinical parameters at various time intervals were found to be nonsignificant.

Three-dimensional (3D) facially driven workflow for anterior ridge defect evaluation: a treatment concept

The esthetic rehabilitation of anterior ridge defects and the achievement of patient satisfaction has become major clinical challenges for dentists and technicians. Poor diagnosis and treatment planning are frequently associated with multiple surgical procedures which fail to meet patient expectations. The loss of hard and soft tissues in esthetic compromised zone is commonly associated with anterior ridges and affects the rehabilitation prognosis. The presence of interdental papilla and papillary configuration play a decisive role in patient satisfaction. A treatment planning considering esthetic parameters, prosthetic needs, and morphological defects must be conducted to improve treatment outcomes. Therefore, this study aims to propose a treatment concept for anterior ridge defects focusing on digital evaluation systems and guided by an ideal facially driven smile design project. In addition, the relevance of the papilla for the esthetic outcomes and the treatment alternatives for anterior ridge defects are also addressed.