Loss Of Interdental Papilla Research Articles

The Papilla Base CTG: A Novel Approach for Interdental Soft Tissue Reconstruction.

Impairment or loss of interdental papilla is a common issue in patients with periodontal disease, leading to phonetic, functional, and aesthetic concerns. Numerous techniques have been explored to reconstruct and regenerate interdental papillae, but consistent success remains challenging. This article presents a novel surgical approach that applies the principles of the Connective Tissue Graft (CTG) wall technique to enhance papilla volume when interdental clinical attachment loss is present in the aesthetic zone. The case of a 35-year-old woman with an RT3 recession defect associated with loss of interdental hard and soft tissues is discussed. The patient underwent a procedure involving palatal incisions, application of amelogenins, and a trapezoidal shape CTG fixed at the base of the papilla under a coronally advanced flap. This approach aimed to stabilize the blood clot and prevent soft tissue collapse into the defect area, enhancing the position and volume of the interdental papilla. Results at 6- and 12-months follow-up indicated significant improvement in papilla appearance and complete root coverage. This case suggests that the modified CTG wall technique can effectively treat buccal and interdental gingival recessions associated with horizontal or infrabony defects. Further clinical trials are necessary to confirm these findings and establish the most effective approach for interdental papilla reconstruction.

Impact of long contact areas for the management of varying levels of interdental papilla loss on the perception of smile esthetics between dentists and laypersons in asymmetric and symmetric situations.

To determine the effect of restorations with long contact areas for the management of interdental papilla deficiencies, in smile attractiveness among laypersons and dentists. A full-portrait image was used to create a set of digitally modified images, simulating the management of various levels of interdental papilla loss. In a total of 48 modified images, single as well as multiple loss of interdental papilla among the anterior teeth, treated with a single or multiple restorations were simulated for unilateral and bilateral situations. Through a digital monitor 160 laypeople and dentists were asked to assess the attractiveness of each displayed image utilizing a visual-analog-scale. Multiple Wilcoxon-signed-rank tests followed by Mann-Whitney U tests were performed considering a significance level of 0.05. The management of an open gingival embrasure due to interdental papilla loss, by simulating the restoration of both central incisors led to a significantly higher mean smile attractiveness compared to the restoration of a single central incisor. Among the investigated regions, the management of open gingival embrasure in the area of central incisors using a restorative approach was perceived as the least esthetic (p<0.05). Despite the restorative management of interdental papilla loss, with the establishment of longer contact areas for the reduction of open gingival embrasures, as the level of the interdental papilla loss is increased, facial esthetics are compromised. When a longer contact area is accomplished through a single restoration, asymmetry among the teeth can be induced, especially in the region of the central incisors.

Cosmetic Makeover of Periodontally Compromised Patients using Flexible Gingival Mask and Porcelain Laminate Veneers: Report of Two Cases

Chronic periodontal disease can lead to advanced gingival tissue loss that can result in problems with esthetics, phonetics, food impaction and tooth sensitivity. One of the most difficult problem encountered in the management of periodontal disease is loss of interdental papillae which leaves unsightly “black triangles” between the teeth. The first step in the management of these problems is surgical correction of the defect. In cases where mucogingival surgery is unpredictable due to generalized recession and loss of large volume of gingival tissue, removable gingival prosthesis is an excellent alternative to correct the deformities remaining after the control of destructive periodontal disease specially in the maxillary anterior region. Gingival prostheses may be fixed or removable. It can be made from a range of materials like acrylic, silicones, porcelain- based materials and flexible resin denture material. This report describes two clinical situations in which combined periodontal/prosthodontic rehabilitation was done for patients with advanced periodontal disease. Accurately fitting flexible gingival prostheses and porcelain laminate veneers were fabricated to restore advanced gingival tissue loss in esthetic area following periodontal flap surgery. The flexible gingival masks not only help to achieve excellent cosmetic results but also reinstate the functional and psychological wellbeing of the patient.

Evolution of papilla preservation procedures - A Review

This review provides insights into the etiology and classification of the interdental papilla loss, along with treatment modalities for interdental papillary loss, emphasizing the significance of preserving papillary integrity for optimal smile aesthetics and patient satisfaction. This review article is intended to revisit the techniques that have been employed, till date, to preserve the interdental papilla while performing periodontal surgeries. Various surgical techniques have been introduced over the years for papilla preservation, including minimally invasive approaches. Recent meta-analysis suggests papilla preservation techniques prevent the post-surgery loss, with choice based on defect area and patient esthetics. Incision type is crucial for the healing process. Key Words: Esthetics, Gingiva, Interdental papilla, Papilla preservation, Periodontics, Soft tissue surgery

Demystifying the pink enigma: A succinct overview on the interdental papilla

Abstract Nowadays, the scope of dentistry has extended beyond the realm of functionality to include the elusive domain of esthetics as well. Gingival black triangle (GBT) is a cosmetic aberration caused by the absence of the papilla, resulting in black gaps or exposed embrasures. Loss of interdental papilla is significantly linked to advancing age, periodontal diseases, and orthodontic therapy. The lack of an interdental papilla raises the concerns about phonetics, food accumulation, and plaque deposition, all of which exacerbate the current situation and cause esthetic issues. In dental procedures, replacing the missing interdental papilla is a difficult and unpredictable process. Because of its complicated anatomy and numerous contributing elements, attaining a successful reconstruction is not always assured. This review article discusses the anatomy of interdental papilla, different classifications of interdental papillary loss, the etiology of the GBT, and the currently available nonsurgical and surgical treatment modalities recommended for preservation of interdental papilla and management of interdental papilla loss.

Effect of hyaluronic acid application on gingival black triangles– A systematic review

Interdental papilla loss, also known as “black triangles,” is a prevalent issue that both patients and dentists worry about. According to Singh and Vandana (2019a), the gingival black space is the loss of the papillary height. One of the most difficult periodontal issues to address is this one. According to V. P. Singh et al. (2013), tooth loss, incorrect restoration contouring, traumatizing oral hygiene practices, and dental spacing all play a role. Dentistry has paid a lot of attention to the use of hyaluronic acid (HA) injections for papilla regeneration in cases of interdental black triangles (BTs). The discussion here highlights the various strategies and results connected with employing HA injections for papilla regeneration.

Black Triangle and its Management in Dentistry: A Review Article

In today’s world demand for aesthetics amongst both clinicians and patients is increasing rapidly. The interdental papilla is one such aesthetic zone that is addressed as ‘pink triangle’ in dentistry. The loss of this interdental papilla due to several reasons leads to an unaesthetic zone known as ‘black triangle’. The black triangle is not only unaesthetic but also leads to various other problems including food impaction and lack of phonetics. Hence various surgical and non-surgical techniques are being introduced to restore the aesthetics by regenerating or reconstructing the lost interdental papilla. The aesthetics in maxillary anterior region after pocket elimination therapy is the most essential aspect of periodontal therapy. This review article includes interdental papilla loss and its various management techniques.

Frenectomy with laterally displaced flap: An aesthetic approach

Frenum is a mucous membrane fold that attaches the lip and the cheek to the alveolar mucosa, gingiva, and the underlying periosteum. The frena may endanger the gingival health when they are attached closely to the gingival margin. An aberrant frenum is presupposed to create functional and aesthetic problems. Archer’s ‘classical frenectomy’ is an extensive procedure including the excision of fibers, interdental papilla, and exposure of the alveolar bone up to the palatine papilla. The aftermath delayed healing, loss of interdental papilla, and unusual scar led toward the traditional approaches such as Edward’s frenectomy, frenum relocation by Z-plasty, and free gingival graft, with their practical and esthetic restriction. A superior approach to make a primary closure in midline and to bypass anaesthetic scar by creating a zone of attached gingiva, frenectomy is associated with lateral pedicle graft. Miller, in his study on 27 subjects, proposed that newly created zone of attached gingiva may have bracing effect inhibiting reopening of diastema. A case report of this approach with its well defined benefits is presented.

A NOVEL PERIODONTAL PLASTIC SURGICAL PROCEDURE FOR PAPILLA RECONSTRUCTION IN ANTERIOR AESTHETIC REGION WITH A VARIANT BEAGLE'S TECHNIQUE- A CASE REPORT

Black triangle, an open interproximal space between maxillary anterior teeth can create aesthetic concern among patients specially while smiling and during speech. There are several risk factors leading to the development of black triangle and the most common among them includes aging, periodontal disease, length of embrasure area, interproximal contact position, triangular- shaped crowns and root angulations. Various techniques like orthodontic correction, prosthetic veneers and various periodontal surgical methods have been used to cover these unesthetic open embrasures. Treating this black triangle can be best done by surgical techniques but it is challenging and very unpredictable. The purpose of this case report is to present a papilla regeneration technique with minimal surgical trauma in the reconstruction of papilla in the maxillary anterior region of a 36-year-old woman who presented with class II interdental papilla loss in 21 and 22 regions according to Nordland and Tarnow's classification. In the present study, a variant technique given by Beagle in 1992 was used to cover this open gingival embrasure. The technique uses a gingival flap from the labial aspect to close the open gingival embrasures thus improving the aesthetic as well as smile of the patient. The results obtained with this technique were satisfactory.

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).&#x0D; 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.&#x0D; 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.

Implant Placement with Palatal Access Flap (PAF) for Facial Tissue Preservation in the Esthetic Zone: A Retrospective Case Series.

Conventional crestal and intrasulcular incisions followed by full-thickness flap reflection may inevitably induce surgical trauma, resulting in facial contour reduction, mucosal recession, and interdental papilla loss. Flapless implant surgery is the most conservative approach; however, it might create undetectable bone fenestration/dehiscence and subsequent complications. The present clinical study introduces a modified and minimally invasive approach, the palatal access flap (PAF), for placing implants in the esthetic zone. Preliminary data of 15 consecutive cases demonstrated clinically negligible soft tissue contour changes when pre- and postoperative 3D model scans were compared. The PAF technique could be a surgical solution, especially for patients with a high esthetic risk, to maintain facial and interproximal tissue contours for the implant site and adjacent teeth.

“EVALUATION OF I-PRF INJECTION TECHNIQUE AS AN ALTERNATIVE FOR RECONSTRUCTION OF INTERDENTAL PAPILLAE - A PILOT STUDY

One of the most challenging and least predictable procedures in periodontal plastic surgery is the reconstruction of the lost interdental papilla. Preserving the integrity of the papillae is of utmost importance. Different variations of surgical procedures using connective tissue grafts have proved to be successful. Being less invasive in nature, non-surgical techniques such as hyaluronic acid injections have turned out to be a boon in this regard. Platelet concentrates like PRF &amp; PRP have shown promising results when used in surgical reconstruction of the lost papilla. One of the recent advancements in PRF formulations is the injectable PRF which is a liquid concentrate encompassing higher leuckocyte numbers, which resulted in higher total growth factor release, requiring slower and shorter centrifugation speeds for preparation. i-PRF was shown to be a potent inducer of cell proliferation, migration and angiogenesis, inducer of higher broblast migration and expression of PDGF, TGF-β, and collagen,thereby playing a vital role in tissue regeneration. With the current understanding, this study was designed to investigate the efciency of iPRF in achieving interdental papillary enhancement. We have noted that mutilple doses of this autologous formulation prove to be a non-invasive alternative for the treatment of minimal interdental papilla loss; primarily Norland &amp; Tarnow's Class I and to an extent Class II interdental papilla loss. Further validations of this technique are required

Frenectomy by millers technique: A case report

The Aberrant labial frenum results in diastema and gingival recession thereby compromising the esthetic and functional needs of the patient. There are various procedure for the treatment of the aberrant frenum. The classical frenctomy technique by Archer is an extensive procedure which results in Unesthetic scaring of the tissue, loss of interdental papilla. To overcome these drawbacks, Miller introduced a newer technique where he combined the frencetomy technique with laterally displaced flap. The main advantage of this technique is that the healing takes place by primary intention with no scaring of the tissue. This article is a case report on frenectomy with laterally displaced flap (Millers technique).

Interdental papilla reconstruction using injectable hyaluronic acid: A 6 month prospective longitudinal clinical study.

The objective of this study was to assess the efficacy of Hyaluronic Acid (HA) on interdental papilla (IDP) loss in the esthetic zone. Twenty one subjects (14 females and 7 males) from those referred for treatment of IDP loss at Periodontics postgraduate clinics at the Jordan University of Science and Technology. A total of 86 interdental sites (58 sites in the maxillary jaw and 28 sites in the mandibular jaw) were treated and followed up. A 0.2 ml of Hyaluronic acid was injected in each receded IDP site and injections were repeated after 21 days. Papilla sites were evaluated and statistically analyzed. At the 3 week interval the mean reduction of black triangle (BT) height was 0.17 mm (8% reduction) (P-value <0.001), at the 3 month interval there was a mean reduction of BT height of 0.83 mm (39% reduction) (P-value <0.001). At 6 months however, the reduction in BT height was 0.62 mm (29% reduction) (P-value <0.001). Within the limitations of this study, it can be concluded that the use of commercially available HA gel for the treatment of interdental papillae loss may have promising results over the first 6 months after injection. The maximum improvement in black triangles was at 3 months after injection with a reduction of improvement between 3 and 6 months. Clinical Relevance Helping clinician to take evidence based decision while considering Hyaluronic acid injection as a short term nonsurgical treatment modality for interdental papilla loss.

Interdental papilla and various preservation techniques: A review

Esthetics is an integral part of successful periodontal therapy. Interdental papilla plays a significant part in esthetics. Loss of interdental papilla leads to gingival black triangles. To prevent this, many surgical modifications in the flap designs have evolved over the years. This review focuses on anatomy of interdental papilla, different types of interdental papillary loss and its various preservation techniques.

Root submergence: An insight for alveolar bone preservation

Ridge resorption results in loss of interdental papillae and creation of unesthetic black triangles. Root submergence technique instead maintains the natural attachment apparatus of the tooth in the pontic site, which in turn allows for complete preservation of the alveolar bone frame and assists in the creation of an esthetic result in adjacent multiple tooth replacement cases. This study reports a case of fractured nonvital tooth where root submergence procedure was carried out, which represents intact bone aiding in the esthetics and function of the prosthesis.

Bilateral pedicle flap: A novel technique for functional and esthetic management of aberrant labial frenum

An aberrant maxillary labial frenum can lead to diastema and gingival recession creating functional and esthetic problems. Archer's classical frenectomy technique is an extensive procedure and has led to scarring and loss of interdental papilla. Conservative approaches such as Edward's frenectomy, frenum relocation by Z-plasty, and free gingival graft showed limitations in terms of esthetics. This case report describes a novel technique of bilateral pedicle flap for frenectomy which gives good esthetic results, color match, gain in attached gingiva, and no unaesthetic scar formation as healing takes place by primary intention.

Use of different concentrations of hyaluronic acid in interdental papillary deficiency treatment: A clinical study.

Background:In the present era, demand of beauty and esthetics has increased rapidly. Interdental papilla construction, especially in the esthetic zone, is one of the most challenging tasks. Interdental papilla loss might occur due to several reasons as a consequence of periodontal surgery, trauma, and others.Aim and Objective:The present study was aimed to prepare economically feasible injectable form of hyaluronic acid (HA) gel in three different concentrations – 1%, 2%, and 5% HA to evaluate its efficacy in the enhancement of deficient interdental papilla (IDP).Materials and Methods:A total of 42 sites (mean age range was 29.6–30.6 years) was categorized into three groups; 1% HA group (16 sites), 2% HA group (14 sites), and 5% HA group (12 sites). Total 35 sites were followed up out of 42 in which 2% HA group included only 7 sites. Both maxillary (17 sites) and mandibular (18 sites) sites were included in this study. HA was injected at 2 mm apical to papillary tip at weekly interval for 3 weeks. The IDP augmentation was measured using UNC-15 probe and modified stent at 1, 3, and 6 months. The photographic analysis was done using Image J software.Results:On clinical measurement, 5% of HA showed highly significant enhancement (P = 0.001) of 19.2%, 20.6% 18.2% at 1, 3, and 6 months, respectively. On photographic analysis, 5% of HA showed 41%, 42.9%, and 39.8% at 1, 3, and 6 months, respectively. However, intergroup comparison showed nonsignificant improvement.Conclusion:This study results suggest that the use of 5% of HA is effective for interdental deficiency treatment with minimal rebound at the end of 6 months. The modified stent for IDP measurement used in this study for the first time in the literature is highly recommended. The photographic analysis using image J Analyzer serves a useful and dependable tool. Further, long-term clinical studies would throw more insight in this regard.

Aesthetic complications of immediate implant placement of anterior teeth

In the anterior tooth zone, the criteria of successful implant restoration is not only to ensure a high survival rate of implant, but also to provide long-lasting and stable aesthetic outcomes. As for the rehabilitation of anterior teeth, immediate implant placement might achieve a survival rate similar to those of delayed implant placement and significantly reduce treatment time, whereas several aesthetic complications such as gingival recession, loss of interdental papilla, exposure of implant margin could also occur. Therefore, an important issue need to be solved is that how to avoid or handle the aesthetic complications of immediate implant placement of anterior teeth. This article mainly discusses the clinical features, possible etiologies and handling methods of aesthetics complications in rehabilitation of anterior teeth using immediate implant placement.

Papillary Reconstruction: A Case Report

The loss of the papilla can lead to cosmetic deformities, phonetic problems and lateral food impaction. Several reasons contribute to the loss of interdental papillae and the establishment of "black triangles" between teeth. In 1996, Han and Takei proposed a novel approach based on the use of a semi-lunar incision placed in the alveolar mucosa of the interdental area. The present case report, utilizing their approach, showed that within limits papillary reconstruction is achievable.