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Background and Aim: Reconstruction of interdental papillae (IDP) is among the most difficult periodontal therapy. Papillary recession is multifactorial, and several surgical, nonsurgical, and minimally invasive techniques have been suggested. The purpose of this study was to evaluate the clinical application of injectable hyaluronic acid (HA) gel for the reconstruction of IDP in Nordland and Tarnow's Class I and II papillary recession cases. Materials and Methods: In the present in vivo clinical trial, 7 patients (2 males, 5 females) with 25 defects were selected. A volume of 0.2 ml HA gel was injected at the respective areas and massaged for 2-3 min. Photographs were obtained, and the assessment of the data was performed clinically (CP-GM, interproximal width [IPW]) and by Image analysis software (black triangle height [BTH], black triangle width [BTW]). Comparison of mean values was performed using the analysis of variance, followed by Post hoc Bonferroni test. Value of P ≤ 0.05 was considered statistically significant. Results: Application of HA gel for the reconstruction of IDP was successful in 6 months. CP-GM, BTH, IPW, and BTW showed a statistically significant difference from baseline to 3 and 6 months interval (P = 0.01). Post hoc Bonferroni test for CP-GM, BTH, BTW, and IPW revealed a statistically significant difference from baseline to 3 months (P ≤ 0.05) and 6 months (P ≤ 0.05) and a nonsignificant difference at 3-6 months (P ≥ 0.05). Conclusion: Injectable HA gel is a promising minimally invasive therapy for enhancing papillary esthetics.

Objectives To assess treatment options for the reconstruction of the lost interdental papilla and to evaluate evidence for their efficacy. Methods An electronic search (Medline, Embase and the Cochrane Library Database and OpenGray) and a hand search were carried out to identify all types of studies investigating interdental papilla reconstruction (except for reviews) with a minimum of 3 months follow-up. Results Forty-five studies were included in the study including 7 RCTs, 2 cohort studies, 19 case series and 17 case reports. Fifteen studies reported on the use of hyaluronic acid, 6 studies on platelet-rich fibrin, 16 studies on soft tissue grafting, 4 studies on orthodontics and 4 on additional modalities. The most common outcome measures were black triangle dimensions and papillary fill percentage. Meta-analysis was not possible due to the high heterogeneity of the studies. Conclusion There are various options for interdental papilla reconstruction of which hyaluronic acid injections, PRF, surgical grafting and orthodontics seem to improve outcomes at a minimum 3 months. The use of soft tissue grafting with sub-epithelial connective tissue graft seems to be associated with the most robust evidence for the longer-term reduction of ‘black triangles’. There is insufficient evidence to make recommendations to clinicians. Further research is needed in the form of well conducted RCTs with longer follow ups and patient reported outcome measures. Clinical relevance Patients frequently complain about the appearance of black triangles and their management options seem unclear. This systematic review provides insight into the available reconstructive options.

In the anterior area of the mouth, the interdental papilla is important for dental hygiene and appearance. When it disappears, unpleasant “black triangles” form, which affects patients’ self-confidence in their smiles and makes oral hygiene more difficult. The loss of interdental papilla is caused by several variables such as tooth shape, periodontal disease, and aging. Although surgical treatments have been utilized to restore or retain missing papilla, their predictability remains unknown. In response, researchers have investigated non-invasive procedures, such as the use of fillers such as hyaluronic acid (HA). Owing to its capacity to increase tissue volume and bind water, HA, a naturally occurring polysaccharide with special rheological qualities, has become a popular choice for use as a dermal filler. It shows promise when used to cure interdental papilla loss; the effects usually last for six–12 months. This review article explores the development and history of papilla rebuilding methods, emphasizing hyaluronic acid as a cutting-edge and successful method for regaining both periodontal health and aesthetics.

Background Gingival papilla defects, which cause an unpleasant appearance and involve the upper anterior teeth, may be triggered by several factors. Several noninvasive and invasive techniques have been proposed for gingival papilla reconstruction. The combination of interproximal tunneling and customized connective tissue grafts (CTGs) has shown promise in papilla augmentation. However, due to the narrowness and limited blood supply of the gingival papilla, the long-term outcomes of these techniques remain unpredictable. Therefore, achieving tension-free coronal advancement of the interdental papilla and proper placement of the CTG is crucial for successful long-term outcomes and could provide widely applicable methods for papilla augmentation. Case report In this study, we enrolled three patients with gingival papilla defects in the maxillary anterior teeth. For reconstruction, we proposed a modified interproximal tunneling (MIPT) technique combined with a CTG. A crucial modification based on previous studies involved adding a cutback incision to the base of the palatal vertical incision, resulting in tension-free healing. Additionally, the CTG was sutured upright to further enhance the height of the gingiva papilla. To evaluate the efficacy of the MIPT technique, the clinical parameters—including the Jemt papilla index and the distance from the tip of the papilla to the interproximal contact point—were examined using a periodontal probe (UNC15, Hu-friedy) at baseline and 12 months after surgery. All three patients achieved satisfactory papilla reconstruction 12 months after the surgery. These three cases were used to evaluate the efficacy of the MIPT technique combined with the customized CTG. An average increase in the Jemt papilla score from 1.6 to 2.8 and a reduction in the distance from the papilla tip to the contact point of adjacent teeth from 2 mm to 0.08 mm were observed 12 months after surgery. Conclusion The preliminary results confirmed that this technique holds promise for gingival papilla augmentation between tooth/tooth or tooth/implant.

Background Interdental papilla deficiency is of high concern from the esthetic and functional perspectives. Several invasive approaches have been reported for interdental papilla reconstruction. However, the long-term success of invasive approaches is still controversial, therefore this study aimed to assess the minimally invasive Pouch technique using Leukocyte Platelet Rich Fibrin compared to non-invasive Hyaluronic acid gel injection in the reconstruction of Interdental papilla in esthetic zone. Methods The study was designed as a randomized, controlled, double-blinded, and phase (IV) clinical trial. The trial was registered retrospectively with the date (21/7/2023) and registration number (NCT05953896). A total sample size of 20 cases was planned to be recruited. i.e. (10 patients in each group). Patients with deficient interdental papilla class I or II in the esthetic zone were selected, then patients were randomized using computer-generated block randomization into two equal groups: group A (L-PRF) and group B (HA gel). Blinding was performed in selection of patient intervention, while blinding of the intervention wasn’t applicable since both interventions are completely different. The clinical and radiographic parameters were assessed at 3 and 6 months, As well as evaluation of patient satisfaction between the two tested groups. Results Both groups showed significant improvement in all clinical parameters at 3 months and 6 months postoperatively. Assessment of patient satisfaction showed overall improvement in both groups after 6 months, with successful reduction in the mean value of black triangle height of the PRF group: (0.9 ± 0.52), and HA group: (0.6 ± 0.46), with no significant difference ( P value : 0.178 ns ) between the two groups at 6 months. No significant difference was found in the primary outcomes, and secondary outcomes between the study groups at 6 months. Conclusions Both injectable HA and multilayered L-PRF gave successful results that can be comparable to the invasive surgical techniques.

Background and objectives: The study aimed to evaluate and compare the amount of papillary gain and black triangle height reduction after intervention with a microtunnelling technique with either Connective tissue graft (CTG) or Platelet-rich fibrin (PRF) as a biomatrix at 6 months using a microsurgical approach. Materials and Methods: Twenty-six patients with interdental papillary loss were included in the study. The patients were selected randomly for the study groups with thirteen patients in each group: a control group where CTG was utilised as a matrix, and a test group where PRF was utilised as a matrix, for interdental papillary reconstruction. A microtunnelling technique was performed for both the study groups under a surgical microscope. The primary parameters assessed were interdental Papillary height (PH) and Black triangle height (BTH) at baseline, with secondary parameters Visual analogue score by dentist (VAS-D) and patient (VAS-P) assessed at 6 months. Results: Both the control and test groups showed a significant reduction in BTH within their respective group at six months (p < 0.05). The gain in papillary height significantly improved only in the CTG group at 6 months. However, significant differences could not be demonstrated for any of the variables such as BTH (p value = 0.582) and PH (p-value = 0.892) between the study groups at 6 months. Conclusions: IDP reconstruction utilising a microtunnelling approach with CTG or PRF was successful without any significant differences between the groups for the parameters assessed at 6 months.

In the past, the common treatment of missing papillae was only mucogingival surgery.4 Among the surgical techniques, autogenous subepithelial connective tissue graft, the gold standard treatment, provided stable, predictable, and beautiful results with wounds and discomfort at the donor site.5 In 2010, Becker et al6 used hyaluronic acid (HA) injection to treat gingival recession for the first time and reported promising results. [...]HA was able to solve the problem of papilla degeneration and black triangle generation by stimulating fibroblastic migration and fibrogenesis.7,8 In several studies, the injection of HA into the interdental papilla has been investigated, and the favorable results have been maintained for at least six months.911 Today, most HA fillers are synthetic. Methods The present randomized clinical trial with a parallel design was conducted on 46 incomplete interdental papillae around natural teeth in the esthetic zone of 10 volunteers referred to the Specialty Department of Periodontics, Guilan University of Medical Sciences in 1400. [...]25 and 21 papillae (5 volunteers in each group) were placed in the Alb-PRF and HA groups, respectively.

Background: Platelet-rich fibrin (PRF) has emerged as one of the promising regenerative materials in the field of periodontics. Hence, this study evaluated the efficacy of subepithelial connective tissue graft (SCTG) and PRF in surgical reconstruction of interdental papillae using Han and Takei technique. Materials and Methods: A total of 20 sites with Class I and Class II interdental papilla defects were assigned to two groups (Group 1 - Han and Takie technique + SCTG and Group 2 - Han and Takie technique + PRF). Parameters such as papillary height (PH), distance from the contact point to the tip of papillae (CPTP), papilla presence index (PPI), pocket probing depth (PPD), relative clinical attachment level (RCAL), plaque index (PI), gingival index (GI), and distance from contact point to alveolar crest (CP-BC) were measured at baseline and after 3 months. The significance of difference within and between the groups was evaluated with paired and unpaired t-tests. Results: The mean PI, GI, PPD, RCAL, PPI, and CPTP distance decreased significantly, whereas the mean PH increased significantly in Group 1 as well as in Group 2. After 3 months, mean reduction in CPTP distance and mean gain in PH were statistically significant in Group 1 as compared to Group 2. However, there was no significant difference in mean CPBC distance between baseline and 3 months in Group 1 as well as in Group 2. Conclusion: Both the techniques were effective in the treatment of papillary recession defects; however, more significant clinical papillary enhancement was achieved after the surgical reconstruction with SCTG.

Tissue management is an integral and essential component of implant care. With the evolution of implant dentistry, the functional osteointegration of the implant to the recipient site is no longer considered an adequate measure of a successful outcome of therapy. The restoration of health, function, comfort, and aesthetics are parameters to be considered in the outcome of care. This becomes particularly significant in the anterior maxillary area where the expectation is that reconstructions must be indistinguishable from natural teeth. Different materials and surgical and restorative techniques are continuously being developed and tested to achieve this objective. Surgical tissue management, including soft tissue management, incision design, and suturing, and knowledge of anticipated healing outcomes are essential for a successful aesthetic outcome. This chapter describes flap design, papilla reconstruction techniques, management of soft tissue toward enhancement of attached gingiva, suturing materials, types of needles, types of knots, suturing techniques, and the various phases of soft tissue healing. A well thought-out surgical plan of flap design at every stage of implant surgery is critical to preserve and/or enhance the aesthetics and health of anterior implant restorations. Knowledge of the factors that affect flap design, suturing techniques, and the principles of healing are paramount in obtaining an ideal aesthetic result of an implant restoration that is indistinguishable from adjacent natural dentition.