Interdental Papilla Height Research Articles

Dental and periodontal dimensions stability after esthetic clinical crown lengthening surgery: a 12‐month clinical study

ObjectivesTo evaluate the stability of periodontal tissues 3 (T3), 6 (T6), and 12 (T12) months after esthetic crown lengthening (ACL) and the possible correlations between changes in those structures.Materials and methodsTwenty individuals were evaluated through clinical assessment, photography, and tomography. Measurements included gingival margin (GM), clinical crown length (CCL), interdental papilla height (PH) and width (PW), gingival thickness (GT), bone thickness (BT), probing depth (PD), distance between alveolar crest and GM, distance between alveolar crest and cementoenamel junction. Nonparametric and correlation statistics were performed (p < 0.05).ResultsCCL at T0 was 7.42 ± 0.70 mm and increased to 9.48 ± 0.49 mm immediately after ACL, but it decreased to 8.93 ± 0.65 mm at T12. PD decreased 0.60 mm from T0 to T6, and it increased 0.39 mm from T6 to T12. BT decreased 0.20 mm, while GT increased 0.29 mm from T0 to T12. Both PW and PH showed enlargement in T12. A positive moderate correlation was found between CCL/T0 and CCL/T12, GT/T0 and AC-GM/T12, BT/T0 and GT/T12. A few negative moderate correlations were PD/T0 and CCL/T12, PD/T0 and PH/T0, PD/T0 and BT/T12.ConclusionsACL procedure was effective. Although some rebound occurred, that was not clinically important. PD tended to reestablish its original length, partially due to a migration of GM during the healing period. Besides, a thickening of supracrestal soft tissues was observed.Clinical relevanceThe present study centers on the factors influencing the stability of periodontal tissues after esthetic crown lengthening, underscoring the procedure’s influence on esthetics and biology and the need for careful treatment planning.

Post-extraction volumetric analysis of alveolar ridge contour using subepithelial connective tissue graft in esthetic zone: a randomized controlled clinical trial

ObjectivesThe aim of this randomized clinical trial was to assess the alveolar ridge contour after soft tissue augmentation using subepithelial connective tissue graft (SCTG) buccal to fresh extraction sockets in patients with thin buccal bone, versus minimally-traumatic extraction followed by spontaneous healing solely.Materials and methodsForty non-restorable maxillary teeth in the esthetic zone were randomly assigned into two groups: minimally-traumatic extraction with SCTG (test) and minimally-traumatic extraction followed by spontaneous healing (control). The outcomes assessed included linear volumetric change of buccal soft tissue contour, vertical tissue loss, gingival thickness (GT), and interdental papilla (IDP) height after 6 months.ResultsThe SCTG group showed a significant improvement (P < 0.001) in all outcomes after 6 months. The SCTG group showed a statistically significant (P < 0.001) gain in the buccal soft tissue volumetric change compared to the control group. The SCTG group showed a statistically significant increase in GT (P < 0.001) and IDP height (P < 0.05) after 6 months compared to the control group.ConclusionsThe use of SCTG buccal to extraction sockets in the anterior maxilla might be considered as a predictable approach for preserving the alveolar ridge contour.Clinical relevanceSCTG buccal to extraction sockets might counteract post-extraction hard and soft tissue alterations in the esthetic zone.

Influence of miniscrew-assisted rapid palatal expansion (MARPE) on the interdental papilla height of maxillary central incisors

ObjectivesTo evaluate the influence of miniscrew-assisted rapid palatal expansion (MARPE) on the interdental papilla height of maxillary central incisors.Materials and methodsPatients who completed MARPE treatment at the Radboud University Medical Center between 2018 and 2021 were included in this retrospective study. The papilla height between the maxillary central incisors was evaluated on frontal intraoral photographs taken before expansion (T0) and 1.5 years after MARPE treatment (T1) using the Jemt classification. The difference in Jemt score at T0 and T1 was the primary outcome variable. In addition, gender, age, Angle classification, MARPE duration, midpalatal suture maturation stage, maximal central diastema (MCD) immediately after expansion, crown width to length ratio (W/L), pretreatment overlap of maxillary central incisors, and the distance between the approximal contact point of the central incisors and the bone crest (CP-B) were also record.ResultsTwenty-two patients were included (2 men, 20 women, mean age 27.3 ± 8.8 years) and 4 patients (18%) showed a significant reduction in the Jemt score following MARPE (p = 0.04), indicating papilla recession. Interdental papilla recession was significantly associated with the increase of CP-B (p = 0.02), smaller W/L (p < 0.01), overlapping of maxillary central incisors (p < 0.01), and smaller MCD immediately after expansion (p = 0.02).ConclusionsOne and a half years after MARPE, 18% of patients exhibited mild recession of papilla height of the maxillary central incisors. Overlapping and smaller W/L of maxillary central incisors were prognostic factors for interdental papilla recession.Clinical relevanceClinicians have to be aware of and inform the patients about the occurrence of papilla recession following MARPE.

Go Micro Aesthetics: A Cross-Sectional Study to Assess Anterior Hard and Soft Tissue Parameters in Young Adults of Bhopal City.

Background In the maxillary aesthetic zone, the symmetry and proportions of hard and soft dental tissue play a crucial role. A dental practitioner should have a thorough knowledge of parameters such as crown length (CL), crown width (CW), zenith point, and gingival angle (GA) to perform teeth restorations. This study aims to assess the anterior hard and soft tissue parameters and determine the crown shape and its correlation with the gingival parameters of young adults' anterior teeth. Methods In the study, 110 patients were assessed and divided into two groups: Group I with 55 females and Group II with 55 males. Using a calibrated vernier caliper, the following parameters were calculated: crown width (CW)/crown length (CL) ratio, gingival angle (GA), distance from the lateral incisor (LI) to the gingival aesthetic line (GAL), interdental papilla height (PH) between the two central incisors (CI), distance between the central incisor (CI) and the lateral incisor (LI), and distance between LI and canine. Results Statistical analysis of data was performed using the independent samples t-test (P<0.05). The mean value of CW, CL, CW/CL ratio, and GA, along with the distance from LIs to GALs and PHs of the anterior teeth, were lower in females than in males. The correlation between the GA and the CW/CL ratio indicated that higher GAs and CW/CL ratios give teeth a square appearance. Moreover, a lower GA and CW/CL ratio will make teeth appear round ornarrow. Conclusion The present study concluded that the mean values of hard and soft dental tissue parameters are higher in males than in females. These values can be used to restore functional aesthetics in accordance with the results of a local population and could help form restorative, aesthetic, and cosmetic procedures while maintaining focus on the size and shape of teeth and the level of gingiva at various significant treatment stages.

Morphological features of smile attractiveness and related factors influence perception and gingival aesthetic parameters

IntroductionIn addition to understanding the basic standards of a smile and patient's opinion, dentists should take into account smile aesthetics, an essential factor for optimal outcomes. This study aimed to evaluate the factors that affect the perception of an aesthetic smile and determine its morphological characteristics and measure the gingival aesthetic parameters. MethodsIn all, 200 Vietnamese aged 18-35 years were recruited to have their spontaneous smiles captured. These smile images were assessed by 50 laypersons and 50 dentists using a visual analogue scale measurement. The images were analysed to evaluate perceptions of evaluators, determine smile attractiveness, and measure gingival aesthetics. ResultsThe difference in the judgements of laypersons and dentists, males and females, and laypersons aged 18-25 and 26-35 years were nonsignificant. High or average anterior smile line, parallel smile arc, upward upper lip curvature, second premolars as the posterior-most teeth displayed, smile index of 5.23-5.63, and dynamic smile symmetry of 1 were scored highly on smile attractiveness. The following maxillary gingival aesthetic parameters were preferred: gingival zenith (GZ) of the canine 0.72-0.75 mm apical to the GZ of the central incisor; GZ of the lateral incisor 0.66 mm coronal to the gingival line; gingival line angle of ∼87°; for the central incisor, lateral incisor, and canines, distance from the GZ to the long axis of 1, 0.4, and 0 mm, respectively; interdental papilla height of 4.25, 3.60, and 3.85 mm, respectively; ratio of the distance from the GZ and the interdental papilla tip to the incisal edge of ∼1.74-1.77 mm. ConclusionsFactors including profession, gender, and age of evaluators had almost no impact on their perception of aesthetics. Smile attractiveness characteristics and gingival aesthetic parameters have clinical applicability for patient care.

Influence of surgically assisted rapid maxillary expansion on the interdental papilla height of maxillary central incisors.

PurposeTo evaluate the influence of orthodontic treatment with surgically assisted rapid maxillary expansion (SARME) on the interdental papilla height of maxillary central incisors.MethodsIn this retrospective study, patients who completed orthodontic treatment including SARME at the Radboud University Medical Center Orthodontic Department before December 2019 were included. Frontal intraoral photographs taken before (T1) and after completion of treatment (T2) were examined to determine the papilla height between the maxillary central incisors using the Jemt classification. The difference between the Jemt classification at T1 and T2 (∆Jemt) was defined as the primary outcome variable. Secondary outcome variables were gender, age, treatment duration, type of expansion appliance, maximal central diastema during expansion, pretreatment overlapping between the central incisors, gingival biotype, crown morphology and the distance between the bone crest and incisal contact point. Kappa statistics and paired t‑tests were used to determine reliability of the measurements. Pearson’s Χ2 test and independent t‑tests were used to compare the variables between the groups of patients with and without papillary recession. Finally, multiple logistic regression analysis was performed.ResultsIn all, 93 patients fulfilled the inclusion criteria and were included in the study. The Jemt score worsened for 30 patients (32%) between T1 and T2, indicating the occurrence of papillary recession. Incisal overlapping, crown morphology, small width to length ratio, increasing age and an increasing distance between crestal bone and the incisal contact point were factors associated with papillary recession.ConclusionAfter orthodontic treatment including SARME, one third of patients exhibited recession of papilla height of the maxillary central incisors.

The influence of gingival phenotype on the morphology of the maxillary central papilla

BackgroundPreservation of the interdental papilla is an essential part of the functional and esthetic rehabilitation of dental treatment. It has been described that thicker gingival tissues are more resistant to recession. The main objective of this investigation was to analyze whether a thin gingival phenotype represents a potential risk indicator affecting interdental papilla fill, height, or width in an esthetic region between maxillary central incisors. The secondary goals were: (1) to analyze parameters describing the papilla—fill, height, width, and effect of papilla base width on the vertical papillary dimension; (2) to determine correlation between different non-invasive measurements of gingival thickness; (3) to compare both sexes.MethodsA total of 54 periodontally healthy students (20–30 years old) were included in the study. Gingival thickness was measured using Pirop Ultrasonic Biometer. Gingival phenotype was also assessed by gingival probe transparency. Papilla height and width were measured, and the degree of papilla recession was classified.ResultsNo significant relationship between papilla fill, height, width and gingival probe transparency or gingival thickness was found. Gingival thickness and gingival probe transparency showed a significant relationship (P < 0.001). There was a significant relationship between papilla height and papilla fill (P = 0.028). A papilla which filled the interdental space completely seemed to be shorter. A strong positive correlation between papilla height and papilla width was found (P < 0.0001). The papilla between maxillary central incisors was significantly higher in males (P = 0.01).ConclusionThe appearance of the interdental papilla may be influenced by various factors. Within the limitations of this study, the results showed that the thin gingival phenotype alone is no potential risk indicator affecting interdental papilla fill, height, or width. It seems that there may be some effect of papilla base width on its vertical dimension. Gingival probe transparency is a simple reliable method of assessment of gingival thickness with a threshold value of 1-mm gingival thickness between the thick and thin phenotypes.

Ultrasonography for chairside evaluation of periodontal structures: A pilot study.

The crestal bone level and soft tissue dimension are essential for periodontal diagnosis and phenotype determination; yet, existing measurement methods have limitations. The aim of this clinical study was to evaluate the correlation and accuracy of ultrasound in measuring periodontal dimensions, compared to direct clinical and cone-beam computed tomography (CBCT) methods. A 24-MHz ultrasound probe prototype, specifically designed for intraoral use, was employed. Periodontal soft tissue dimensions and crestal bone levels were measured at 40 teeth and 20 single missing tooth gaps from 20 patients scheduled to receive a dental implant surgery. The ultrasound images were interpreted by two calibrated examiners. Inter-rater agreement was calculated by using inter-rater correlation coefficient (ICC). Ultrasound readings were compared with direct clinical and CBCT readings by using ICC and Bland-Altman analysis. The following six parameters were measured: 1) interdental papilla height (tooth), 2) mid-facial soft tissue height (tooth), 3) mucosal thickness (tooth), 4) soft tissue height (edentulous ridge), 5) mucosal thickness (edentulous ridge), and 6) crestal bone level (tooth). Intra-examiner calibrations were exercised to achieve an agreement of at least 0.8. ICC between the two readers ranged from 0.482 to 0.881. ICC between ultrasound and direct readings ranged from 0.667 to 0.957. The mean difference in mucosal thickness (tooth) between the ultrasound and direct readings was -0.015mm (95% CI: -0.655 to 0.624mm) without statistical significance. ICC between ultrasound and CBCT ranged from 0.654 to 0.849 among the measured parameters. The mean differences between ultrasound and CBCT range from -0.213 to 0.455mm, without statistical significance. Ultrasonic imaging can be valuable for accurate and real-time periodontal diagnosis without concerns about ionizing radiation.

Pink Esthetics: A Study on Significant Gingival Parameters

The aim of the study was to quantify the specific spatial displacement of gingival zenith (GZ) and determine a representative value for the interdental papilla height as a percentage ratio of clinical crown length (CL), as measured from GZ in the maxillary anterior dentition. A total of 100 subjects and 1,200 interdental papillae were included. Eighty percent of the population presented with the gingival margin of lateral incisor (LI) teeth positioned coronally to the GZ of the ipsilateral canine (C) and central incisor (CI). No significant difference was found between mesial and distal papilla proportion (DPP) of maxillary incisor groups. In the C group, numerical values showed higher DPP. The data achieved provide the ideal numerical values for prosthetic, restorative, periodontal, implant, postorthodontic, and esthetic treatment outcomes. The study describes the importance of quantifying the ideal numerical values for prosthetic, restorative, periodontal, implant, postorthodontic, and esthetic treatment outcomes. The readers should understand to quantify the specific spatial displacement of GZ and determine a representative value for the interdental papilla height as a percentage ratio of clinical CL, as measured from GZ in the maxillary anterior dentition.

A Clinical Study of Early Intervention with Coralline Hydroxyapatite on Fresh Extraction Sockets.

To clinically, histologically and radiologically evaluate the effects of early intervention on fresh extraction sockets, 30 patients were selected and assigned evenly into group A (blood clot) and group B (coralline hydroxyapatite). All participants underwent clinical examination. Oral plaster casts and panoramic radiographs were undertaken before tooth extraction and at 3-4 months after socket grafting. A 6-8 mm sample of longitudinal bone core was obtained using a 2 mm diameter trephine 3-4 month's post-operatively. Group A had a greater decrease in interdental papilla height, which was about 2-3 times more than that of group B (P >0.001). The buccal-lingual alveolar ridge width also absorbed more in group A (P >0.001). Radiological findings were similar. Group B had less new bone formation (P >0.001), and the residual rate was a little high. There was no statistical difference between the two groups in terms of new bone formation rating grade. Clinical, histological and radiological tissue differences were observed between sockets with and without biomaterial grafts 3-4 months after surgery. This indicates that early intervention of extraction sockets is clinically advantageous.

Orthodontic treatment with removal of one mandibular incisor: Outcome data and the importance of extraction site preparation

Extraction of one mandibular incisor in adolescents and adults can simplify orthodontic treatment in 2 major circumstances: (1) severe crowding of the mandibular but not the maxillary incisors, and (2) mild anterior crossbite with good alignment in both arches. Despite its potential advantages, this method has had limited use in most practices. There have been 3 major objections: (1) the possibility of unsightly black triangles because of loss of interdental papilla height, (2) a possible tooth size discrepancy that would affect occlusal relationships, and (3) patient concerns about a visible extraction site. All 3 objections now can be overcome. For 37 consecutively treated single-incisor-extraction patients, preparation of the extraction site for the tooth to be extracted was done by tipping it lingually while simultaneously closing the space in front of it. Treatment outcomes and the effect of age at the time of treatment were evaluated. In patients below age 20, this approach eliminated post-treatment black triangles and almost eliminated partial loss of the interdental papilla. It reduced the previously reported prevalence of these problems in patients aged 20-40years and did not seem to be helpful in those aged over 40years. This positive effect was achieved because of maintenance of alveolar crest height that supports the interdental papillae. Tooth size discrepancy caused by incisor extraction was largely compensated by the different labio-lingual orientation of maxillary and mandibular anterior teeth. The extraction space quickly disappeared during extraction site preparation. The new procedure of extraction site preparation described in this paper offers more favorable outcomes for post-treatment prevalence of black triangles in younger patients but shows limited efficacy in older patients. Camouflage of a mild skeletal Class III problem is the major indication for this extraction pattern. About 3% of Icelandic orthodontic patients appear to be good candidates for this treatment, and this finding should be reasonably generalizable to other populations of European descent.

Maxillary central incisor gingival papilla and zenith heights with and without periodontally accelerated osteogenic orthodontics

Objectives: The objective of the study is to compare maxillary central incisor gingival papilla and zenith heights photogrammetically in orthodontically treatment patients with and without periodontally accelerated osteogenic orthodontics (PAOOs). Materials and Methods: Samples of 29 participants were matched for pre-treatment age and five gingival height dimensions supporting the four maxillary incisors. PAOO active orthodontic treatment time (9.29 vs. 20.47 months) and control post-treatment observation time (10.7 vs. 20.1 months) were significantly shorter (P &lt; 0.05). Linear gingival heights were measured photogrametrically on standardized intraoral frontal photographs perpendicular to a horizontal line constructed parallel to the maxillary central incisal edges. Results: (1) The three papillae and two zenith gingival margins moved incisally as a consequence of conventional orthodontic therapy (P &lt; 0.05) but not in PAOO therapy. (2) At least 6-month post-orthodontic treatment, PAOO gingival dimensions were longer for both central incisor zenith heights, and the interdental papilla height between maxillary central incisors was shorter. Conclusions: Based on the conditions of the study, orthodontic treatment with and without PAOO results in similar maxillary incisor papilla and zenith heights if viewed from a clinical perspective.

Local Injection of Hyaluronic Acid Filler Improves Open Gingival Embrasure: Validation Through a Rat Model.

The open gingival embrasure, the so-called black triangle, is one of the unsolved dilemmas in adult dentistry. Although various techniques have been introduced to improve black triangles, the lack of reproducible experimental models has prevented development of successful protocols to regenerate or to compensate loss of the interdental papilla. Therefore, the objective of this study is first to develop a reliable animal model of open gingival embrasure and then to validate a minimally invasive injection technique using hyaluronic acid (HA) filler to augment the interdental papilla. To reproduce open gingival embrasure in rats, rapid space opening was induced between the mandibular incisors by attachment of a compression spring. Loss of interdental papilla height was morphologically evaluated and calculated using standardized serial photographs, microcomputed tomography, and histologic sections. Afterward, HA fillers or phosphate-buffered saline (PBS) was locally injected, and changes in the interdental papilla were evaluated. After 7 days of space opening, the margin of the interdental papilla between the mandibular incisors gradually became irregular and flat, indicating a condition similar to the open gingival embrasure (P <0.05). Local injection of HA filler induced an augmentation effect of the interdental papilla compared with injection of PBS (P <0.05). Interdental papilla became convex, and inner granules containing HA were detected within the submucosal layer after its injection. Open gingival embrasure was reproduced reliably in vivo. Local injection of HA filler was validated as a meaningful minimally invasive procedure to improve open gingival embrasure.

CLINICAL APPLICATION OF RADIESSE AND HYALURONIC ACID GEL FOR TREATMENT OF PAPILLAE DEFICIENCIES IN THE ESTHETIC ZONE

Background: A black triangle or an open gingival embrasure is one of the main problems that compromise esthetics. Different surgical techniques have been utilized to resolve this problem. Consequently, minimally invasive techniques using filler injections have been recommended. Hyaluronic acid (HA), a naturally occurring polysaccharide; was widely used in treatment of deficient interdental papillae. On the other hand, Radiesse is calcium hydroxide dermal filler used in facial rejuvenation. This study was performed to compare the effect of Radiesse and hyaluronic acid gel in treatment of deficient interdental papillae. Materials and Methods: A total of 30 female patients with 40 deficient interdental papillae were assigned into two groups A and B. Group A received hyaluronic acid gel injection while group B received Radiesse gel injection. Clinical data included papillary marginal gingival index, probing depth, clinical attachment loss, papilla presence index and height of interdental papilla. Data were taken at baseline, after three weeks, three and six months. Results: Significant improvement occurred in both groups but this improvement was more prevalent in Radiesse group compared with HA group. There was a decline in the papillary height in the HA group after three and six months while in Radiesse group more long-lasting effect was denoted. Conclusion: It was concluded that both fillers were biocompatible and safe for treatment of interdental papilla deficiency. Though, Radiesse gel was more effective and long-lasting compared with hyaluronic acid.

Prevalência de biótipos gengivais numa população peruana

ObjetiveTo determine the prevalence of gingival biotypes in patients with permanent dentition in the city of Trujillo, Peru. MethodsDescriptive, observational and cross‐sectional study was carried out at the dental clinic of the Unit of Second Specialization in Stomatology (USEE) of the National University of Trujillo, during the months of January to June 2015. Information was collected on the gingival biotype, interdental papilla height and shape of the teeth using an OMS periodontal probe. Data was obtained from three calibrated observers. Analysis of binary logistic regression (α=0.05) was used to compare the gingival biotype to the interdental papilla height, the shape of the teeth, age and gender. ResultsThe sample consisted of 286 patients. The prevalence of thick gingival biotype was 61.2% and thin gingival biotype was 38.8%. In addition, it was found that the gingival biotype is closely related to gender, the interdental papilla height, tooth shape and age. ConclusionsThe people in the city of Trujillo, Peru, have a thick gingival biotype and this is closely related to gender, the interdental papilla height, tooth shape and age. The thin gingival biotype is more common in women and young people.

Papillary Height and its Relation with Interproximal Distances and Cementoenamel Junction in Subjects with Chronic Periodontitis. A Cross-Sectional Study.

Presence of intact interdental papilla is considered as an essential component of aesthetic dentistry. Loss or absence of interdental papilla creates black triangles which are unpleasing. The purpose of the present study was to determine relation of interproximal distances and cementoenamel junction with the classification of interdental papilla recession after surgical exposure in chronic periodontitis patients. This cross-sectional, single masked study group involved 198 interdental papillae in 50 chronic periodontitis patients subjected to open flap debridement. The subjects were divided into three groups according to loss of height of interdental papillae: Class I papilla, Class II papilla, Class III papilla. The interproximal distances included vertical and horizontal distance. The vertical distance was measured from apical point of the contact area to alveolar crest; horizontal distance was measured between roots at the alveolar crest. Distance from mid buccal cementoenamel junction to apical point of the contact area was also measured. The vertical distance was found to be significantly affecting all the classes of loss of papillary height (p<0.05). Significantly positive correlation was found between vertical distance and buccal cementoenamel junction (p<0.05). On applying multiple linear regressions vertical distance was found to be strongest determinant of loss of papillary height. Although interproximal distances and cementoenamel junction affect the height of interdental papilla, other factors influencing the existence of interdental papilla should also be taken into consideration for treatment planning to achieve better aesthetics.

Prediction of root coverage for single recessions in anterior teeth: a 6-month study.

The aim of this study was to evaluate the predictive values of baseline inter-dental papilla height (IPH), loss of inter-dental papilla height (LPH), avascular exposed root surface area (AERSA) and inter-dental clinical attachment level (ICAL) measurements on complete root coverage (CRC) of single recession defects treated with coronally advanced flap and connective tissue graft technique (CAF+CTG). A total of 122 patients with one isolated gingival recession were enrolled. All recession defects without loss of ICAL (ID-CAL) (RT1) and with an amount of ID-CAL equal or smaller to the buccal attachment loss (RT2), located at upper and lower anterior teeth were treated with CAF+CTG. IPH, LPH, AERSA and ICAL parameters were analysed for possible correlation with CRC after 6 months. The CRC was 86.7% for RT1, 74.2% for RT2 groups. The ROC analyses revealed acceptable cut-off points for baseline AERSA, IPH and LPH for achieving CRC. The results of logistic regression analyses showed that having baseline AERSA≥19 mm(2) (OR:23.7), IPH lower ≤1 mm (OR:97.3) and belonging to RT2 group (OR:15.0) were found to be independent risk factors related with not achieving final CRC. This study indicates that AERSA and IPH may be used to predict the final CRC outcomes in RT1 and RT2 defects treated with CAF+CTG.

Preliminary study on measuring interdental papilla height and thickness of the maxillary anterior teeth based on cone-beam computed tomography

To investigate the features of the fill of interdental spaces by gingival papillae and the associated factors. Fifteen volunteers with healthy gingiva were involved in this study. The height and thickness on the alveolar crest level of 62 maxillary anterior papilla were measured radiographically with cone-beam computed tomography (CBCT) scans. A standardized periodontal probe with Williams markings was used for measurements of the papilla width on the alveolar crest level. When the papilla was complete fill interdentally, the mean height of papillary tissue on the alveolar crest level (equal to contact point-bone crest) was (3.67 ± 0.51) mm. The mean thickness of papilla on the alveolar crest level was (8.38 ± 0.75) mm. The papilla height had a positive correlation with papilla thickness (r = 0.433, P < 0.001). The cone-beam computed tomography can be used for clear visualization of the papilla profile and the measurements of papilla height and thickness. Thicker and wider tissue was associated with an increased likelihood of having a complete papilla fill.

Three different surgical techniques of crown lengthening: A comparative study

Introduction:A short clinical crown may lead to poor retention form thereby leading to improper tooth preparation. Surgical crown lengthening procedure is done to increase the clinical crown length without violating the biologic width. Several techniques have been proposed for clinical crown lengthening which includes gingivectomy, apically displaced flap with or without resective osseous surgery, and surgical extrusion using periotome.Objective:The aim of this paper is to compare clinically the three different surgical techniques of crown lengthening procedures.Materials and Methods:Fifteen patients who reported to the department of Periodontology, were included in the study. Patients were randomly divided into three groups, which include patients who underwent gingivectomy (Group A), apically repositioned flap (Group B) and surgical extrusion using periotome (Group C). Clinical measurements such as clinical crown length, gingival zenith, interdental papilla height were taken at baseline and at 3rd month post-operatively.Results:Clinical and radiographic evaluation at 3rd month suggest that surgical extrusion technique offers several advantages over the other conventional surgical techniques such as preservation of the interproximal papilla, gingival margin position and no marginal bone loss.Conclusions:This technique can be used to successfully treat a grossly damaged crown structure as a result of tooth fracture, dental caries and iatrogenic factors especially in the anterior region, where esthetics is of great concern.

Factors Associated With the Interdental Papilla Height Between Two Maxillary Central Incisors: A Radiographic Study

Various factors affect the central maxillary incisor papilla height (PH) and central clinically observable PH (COPH) such that a study of these factors and their interactions is needed. This study reports on an investigation of the factors associated with PH and COPH in patients with and without papilla recession. The central papilla was visually assessed in 450 adults using standardized periapical radiographs of maxillary central incisors. Various vertical and horizontal distances were measured including the lengths from the proximal cemento-enamel junction (pCEJ) to apical contact point (CP), bone crest (BC) to CP (BC-CP), BC to pCEJ (BC-pCEJ), and papilla tip (PT) to CP (PT-CP) and the interdental width at the pCEJ level (IW), width at the BC level (crest width [CW]), and width at the PT level (PTW). PH was defined as the length from the PT to BC, and COPH was defined as the length from the PT to pCEJ. Simple analyses for PH and COPH were performed, and significant variables were entered into multiple linear regression models. Among all study patients, papilla recession status and PT-CP were significant independent predictors of PH (both P <0.001). Age, papilla recession status, PT-CP, and BC-pCEJ were significant independent predictors of COPH (all P <0.001). Among patients with papilla recession, CW and PT-CP independently predicted PH (both P <0.001). All variables tested (except sex and CW) were significantly associated with COPH in patients with papilla recession, especially IW, PTW, PT-CP, and BC-pCEJ (P <0.001 for these variables). The effects of age and BC-pCEJ on COPH change differed in patients without and with recession, suggesting that the initial change in COPH was large but later slowed after recession occurred while there was no severe interdental bone loss progression. However, additional clinical study is needed to find out other variables that may decrease or ameliorate the severity of central papilla recession by restorative/prosthetic or orthodontic intervention and to confirm this possibility.