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Luo C, Chen M. Do different incision techniques for implant surgery affect gingival papilla height around dental implants? A retrospective study of 115 cases. BMC Oral Health 2023; 23:128. [PMID: 36890532 PMCID: PMC9996942 DOI: 10.1186/s12903-023-02828-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 02/21/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Surgical incision designs are considered closely correlated to gingival papilla of dental implants. This study aims to explore whether different incision techniques for implant placement and second stage surgery affect gingival papilla height. METHODS Cases using different incision techniques (intrasulcular incisions or papilla sparing incisions) between November 2017 and December 2020 were selected and analyzed. A digital camera was used to capture images of gingival papilla at different time points. Ratio of papilla height to crown length using different incision techniques were measured and statistically compared. RESULTS A total of 115 papillae (68 patients) were eligible according to the inclusion/exclusion criteria. The average age was 39.6 years. Decreased postoperative papilla height were observed after implant placement surgery in all groups without statistical difference. However, for second stage surgery, intrasulcular incisions lead to more atrophy in gingival papilla compared to papilla sparing incisions. CONCLUSIONS Selection of incision techniques in implant placement surgery does not significantly affect papilla height. For second stage surgery, intrasulcular incisions significantly leads to more papilla atrophy compared with papilla sparing incisions. Trial registration KQCL2017003.
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Affiliation(s)
- Chenchen Luo
- Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, No.4, Tiantan Xili, Dongcheng District, Beijing, People's Republic of China.
| | - Ming Chen
- Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, No.4, Tiantan Xili, Dongcheng District, Beijing, People's Republic of China
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Chen M, Chen X, Sun L, Zhao B, Liu Y. Sequential soft- and hard-tissue augmentation after clear aligner-mediated adjustment of traumatic occlusion: A case report. J Am Dent Assoc 2022; 153:572-581.e1. [PMID: 35241272 DOI: 10.1016/j.adaj.2021.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 10/10/2021] [Accepted: 11/14/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Oral health and esthetic concerns have increasingly motivated adults with periodontitis to seek orthodontic care. Patients with periodontitis often have other dental complications that can make treatment more challenging or less likely to be successful. The predictability of multidisciplinary regenerative and orthodontic treatment approaches in a patient with periodontitis, thin periodontal phenotype, and anterior crossbite is described. CASE DESCRIPTION A 35-year-old man was designated as having a high risk of experiencing soft-tissue recession owing to his thin periodontal phenotype. After the initial periodontal therapy, clear aligners were used to eliminate the anterior crossbite that was causing traumatic occlusion. In addition, a subepithelial connective tissue graft was used to alter the thin periodontal phenotype. Three months later, guided bone regeneration with corticotomy was performed to increase bone mass, and orthodontic traction was used at 2 weeks after surgery. Orthodontic treatment was continued until all the spaces had been closed. Clinical and radiographic evaluations conducted at the 6-month follow-up revealed substantial improvements in both the soft- and hard-tissue phenotypes. PRACTICAL IMPLICATIONS Outcomes in this case indicate that sequential soft- and hard-tissue augmentation, after eliminating traumatic occlusion via using a clear aligner, may be a valuable approach for improving soft- and hard-tissue support in patients with periodontitis.
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Karmakar S, Kamath DSG, Shetty NJ, Natarajan S. Treatment of Multiple Adjacent Class I and Class II Gingival Recessions by Modified Microsurgical Tunnel Technique and Modified Coronally Advanced Flap Using Connective Tissue Graft: A Randomized Mono-center Clinical Trial. J Int Soc Prev Community Dent 2022; 12:38-48. [PMID: 35281688 PMCID: PMC8896580 DOI: 10.4103/jispcd.jispcd_117_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 08/25/2021] [Accepted: 09/16/2021] [Indexed: 11/04/2022] Open
Abstract
Background Complete and uneventful recession coverage should be the aim of gingival recession treatment. Systematic reviews have said that coronally advanced flap with connective tissue graft (CTG) is the gold standard for gingival recession treatment. Minimally invasive procedures with optical magnification allow minimal tissue manipulation and precise adaptation of wound edges helping in faster and uneventful healing, thus bringing about a satisfactory clinical and patient outcome. Thus, the following study compares the clinical- and patient-related outcomes of modified microsurgical tunnel technique (MMTT) and modified coronally advanced flap (MCAF) using CTG in the coverage of multiple adjacent Miller's class I and II gingival recessions. Materials and Methods Gingival recession patients were selected and were assigned randomly to either MMTT+CTG or MCAF+CTG. Clinical parameters were evaluated at 1, 3, and 6 months. Patient's satisfaction level was assessed by measuring root coverage esthetic score, hypersensitivity, and morbidity. The statistical analysis was performed using commercially available software SPSS version 14. Descriptive statistics were expressed as mean±standard deviation for each parameter. Intragroup comparison was done by using the paired T-test. Intergroup comparison was done using the independent Student's T-test. The significance level was set at P = 0.05. Results MMTT+CTG showed a statistically significant greater clinical- and patient-related outcome. Conclusion MMTT+CTG, being a closed procedure, preserves the blood supply, helps in faster healing, and does not compromise the esthetics. All these lead to decreased morbidity and increased patient satisfaction which makes MMTT a superior technique than the conventional procedure in gingival recession treatment.
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Affiliation(s)
- Sayantan Karmakar
- Department of Periodontology, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Deepa Sai Giridhar Kamath
- Department of Periodontology, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Neetha J Shetty
- Department of Periodontology, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Srikanth Natarajan
- Department of Oral Pathology and Microbiology, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Effect of Using a Plastic Stent with Apically Repositioned Flap in Peri-Implant Soft Tissue Augmentation: A Randomized Controlled Clinical Trial. Int J Dent 2021; 2021:5590400. [PMID: 34113381 PMCID: PMC8154274 DOI: 10.1155/2021/5590400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 05/11/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives This study aimed to clinically assess and compare the width of peri-implant keratinized mucosa following the use of a readymade plastic stent with apically repositioned flap versus conventional apically repositioned flap with papillary sparing incisions during single-stage implant placement protocol. Materials and Methods A total of 20 patients were enrolled in this study. In the test group, a prefabricated implant-retained stent was clipped on the healing abutment after implant surgery to reposition the keratinized tissue buccoapically. In the control group, simple interrupted sutures were applied instead of using a stent. After the surgical procedure, the width of the buccal keratinized mucosa was measured at the mesial, middle, and distal aspects of the healing abutment. The change in the width of the buccal keratinized mucosa was assessed at 3 months and 6 months. Results No statistically significant difference was found between the stent group and control group in 6 months' interval where p=0.840, where both groups showed the same mean value of 4.70 ± 0.35 and 4.70 ± 0.63, respectively. The percent of change in the width of KM was found to be higher in the stent group than in the control group with no statistical significance. Conclusion The use of a readymade plastic stent in combined full/partial-thickness apically repositioned flap shows to be effective in increasing the width of KM compared to the conventional technique. This trial is registered with NCT03754894.
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Zhang Y, Chen X, Zhou Z, Hao Y, Li H, Cheng Y, Ren X, Wang X. Effects of Impacted Lower Third Molar Extraction on Periodontal Tissue of the Adjacent Second Molar. Ther Clin Risk Manag 2021; 17:235-247. [PMID: 33790564 PMCID: PMC7997553 DOI: 10.2147/tcrm.s298147] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/05/2021] [Indexed: 12/19/2022] Open
Abstract
The extraction of impacted lower third molars (ILTM) is one of the most common procedures in oral-maxillofacial surgery. Being adjacent to lower second molars, most impacted lower third molars often lead to distal periodontal defects of adjacent second molars. Several symptoms may occur after extraction, such as periodontal pocket formation, loss of attachment, alveolar bone loss and even looseness of second molar resulting in extraction. The distal periodontal defects of second molars are affected by many factors, including periodontal conditions, age, impacted type of third molars, and intraoperative operations. At present, several studies have suggested that dentists can reduce the risk of periodontal defects of the second molar after ILTM extraction through preoperative evaluation, reasonable selection of flap design, extraction instruments and suture type, and necessary postoperative interventions. This review summarizes the research progress on the influence factors, interventions methods and some limitations of distal periodontal defects of adjacent second molar after extraction of impacted mandibular third molars, with the aim of opening up future directions for studying effects of ILTM extraction on periodontal tissue of the adjacent second molar.
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Affiliation(s)
- Yuan Zhang
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan, 030001, People’s Republic of China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, 030001, People’s Republic of China
| | - Xiaohang Chen
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan, 030001, People’s Republic of China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, 030001, People’s Republic of China
| | - Zilan Zhou
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan, 030001, People’s Republic of China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, 030001, People’s Republic of China
| | - Yujia Hao
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan, 030001, People’s Republic of China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, 030001, People’s Republic of China
| | - Huifei Li
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan, 030001, People’s Republic of China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, 030001, People’s Republic of China
| | - Yongfeng Cheng
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan, 030001, People’s Republic of China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, 030001, People’s Republic of China
| | - Xiuyun Ren
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan, 030001, People’s Republic of China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, 030001, People’s Republic of China
| | - Xing Wang
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan, 030001, People’s Republic of China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, 030001, People’s Republic of China
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Wessels R, Cosyn J, Eghbali A, De Bruyn H, Christiaens V. A 5 to 7-year case series on single angulated implants installed following papilla-sparing flap elevation. Clin Implant Dent Relat Res 2021; 23:400-407. [PMID: 33595178 DOI: 10.1111/cid.12988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/12/2021] [Accepted: 01/24/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Bony concavities at the buccal aspect may cause a distortion between the implant axis and ideal prosthetic axis. Angulated implants can overcome this problem, yet long-term data are lacking. In addition, papilla-sparing incisions have been proposed to reduce tissue loss, yet aesthetic outcomes have not been published. PURPOSE To evaluate the 5 to 7-year outcome of single angulated implants installed following papilla-sparing flap elevation. MATERIALS AND METHODS Patients who had been consecutively treated with a single angulated implant (Co-axis®, Southern Implants, Irene, South Africa) in the anterior maxilla were re-examined after 5 to 7 years. Available data at 1 year (T1) were compared to those obtained at 5 to 7 years (T2). RESULTS Twenty out of 22 treated patients (11 females, 9 males, mean age of 52) with 22 implants attended the 5 to 7-year reassessment. All implants survived and stable clinical conditions could be reached with mean marginal bone loss of 1.28 mm at T2. Papilla-sparing flap elevation resulted in Pink Esthetic Score of 9.83 at T1 and 8.23 at T2 (p = 0.072). Mucosal Scarring Index was 4.61 at T1 and 3.50 at T2 (p = 0.165). The overall appearance of scarring significantly improved over time (p = 0.032), yet 59% of the cases still demonstrated scarring at T2.c CONCLUSIONS: Within the limitations of the study, angulated implants (Co-axis®, Southern Implants) reached stable clinical conditions. Papilla-sparing incisions may not be recommended in aesthetically demanding patients due to high risk of scarring.
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Affiliation(s)
- Retief Wessels
- Faculty of Medicine and Health Sciences, Oral Health Sciences, Department of Periodontology and Oral Implantology, Ghent University, Ghent, Belgium
| | - Jan Cosyn
- Faculty of Medicine and Health Sciences, Oral Health Sciences, Department of Periodontology and Oral Implantology, Ghent University, Ghent, Belgium.,Faculty of Medicine and Pharmacy, Oral Health Research Group (ORHE), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Aryan Eghbali
- Faculty of Medicine and Health Sciences, Oral Health Sciences, Department of Periodontology and Oral Implantology, Ghent University, Ghent, Belgium.,Faculty of Medicine and Pharmacy, Oral Health Research Group (ORHE), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Hugo De Bruyn
- Faculty of Medicine and Health Sciences, Oral Health Sciences, Department of Periodontology and Oral Implantology, Ghent University, Ghent, Belgium
| | - Véronique Christiaens
- Faculty of Medicine and Health Sciences, Oral Health Sciences, Department of Periodontology and Oral Implantology, Ghent University, Ghent, Belgium
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Castro-Calderón A, Toledano-Serrabona J, Sánchez-Torres A, Camps-Font O, Sánchez-Garcés MÁ, Gay-Escoda C. Influence of incision on periodontal parameters after apical surgery: a meta-analysis. Clin Oral Investig 2021; 25:4495-4506. [PMID: 33387031 DOI: 10.1007/s00784-020-03761-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 12/21/2020] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The aim of the present meta-analysis was to determine the effect of the different incision designs used in apical surgery on periodontal parameters. METHODS An electronic search in Cochrane Library, Pubmed (MEDLINE), and Scopus was conducted on April 2020. Two independent investigators included clinical trials and prospective cohort studies comparing the influence of different incision designs used in apical surgery on gingival recession, periodontal probing depth, and clinical attachment level. A pairwise and network meta-analysis was performed in order to meta-analyze the direct and the indirect comparisons among the incision designs. RESULTS Six articles were included for the qualitative and the quantitative syntheses, involving a total of 401 teeth (372 patients). The pairwise meta-analysis did not reveal statistically significant differences between the incision designs in any of the outcomes evaluated. However, to reduce the amount of buccal gingival recession, the papilla base incision presented the highest probabilities of being ranked the most effective incision (85.7%), followed by submarginal incision (50.0%) and intrasulcular incision (14.3%). CONCLUSION Regardless of the incision design used, the periodontal parameters did not statistically differ after apical surgery. CLINICAL RELEVANCE Periodontal parameters did not significantly change despite the incision used in apical surgery. However, based on the results of the present review, the papilla base incision seems to be the best option to reduce the amount of buccal gingival recession.
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Affiliation(s)
- Adriana Castro-Calderón
- Faculty of Dentistry, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain
| | - Jorge Toledano-Serrabona
- School of Medicine and Health Sciences, Campus de Bellvitge, University of Barcelona, C/ Feixa Llarga, s/n; Pavelló Govern, 2ª planta, Despatx 2.9, 08907 L'Hospitalet de Llobregat, Barcelona, Spain. .,IDIBELL (Bellvitge Biomedical Research Institute), Barcelona, Spain. .,EFHRE International University/FUCSO, Belize City, Belize.
| | - Alba Sánchez-Torres
- School of Medicine and Health Sciences, Campus de Bellvitge, University of Barcelona, C/ Feixa Llarga, s/n; Pavelló Govern, 2ª planta, Despatx 2.9, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.,IDIBELL (Bellvitge Biomedical Research Institute), Barcelona, Spain
| | - Octavi Camps-Font
- School of Medicine and Health Sciences, Campus de Bellvitge, University of Barcelona, C/ Feixa Llarga, s/n; Pavelló Govern, 2ª planta, Despatx 2.9, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.,IDIBELL (Bellvitge Biomedical Research Institute), Barcelona, Spain
| | - Mª Ángeles Sánchez-Garcés
- School of Medicine and Health Sciences, Campus de Bellvitge, University of Barcelona, C/ Feixa Llarga, s/n; Pavelló Govern, 2ª planta, Despatx 2.9, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.,IDIBELL (Bellvitge Biomedical Research Institute), Barcelona, Spain
| | - Cosme Gay-Escoda
- School of Medicine and Health Sciences, Campus de Bellvitge, University of Barcelona, C/ Feixa Llarga, s/n; Pavelló Govern, 2ª planta, Despatx 2.9, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.,IDIBELL (Bellvitge Biomedical Research Institute), Barcelona, Spain.,EFHRE International University/FUCSO, Belize City, Belize.,Oral Surgery, Implantology and Maxillofacial Surgery Department, Teknon Medical Center, Barcelona, Spain
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Bin Mohsin AH, Sheethi KV, Priyanka M, Karre D, Ahmed MQ. Regenerative Surgical Flap to Maintain Interdental Papilla around Dental Implant. Int J Appl Basic Med Res 2019; 9:188-190. [PMID: 31392186 PMCID: PMC6652283 DOI: 10.4103/ijabmr.ijabmr_140_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The modified surgical flap technique for placement of implant in the anterior maxilla has been described. The flap design has been used to achieve optimal soft-tissue contour for implant restoration. A modification in the surgical technique has been employed with the intention to preserve the interdental papilla, which is the key to the maintenance of hygiene and esthetics around anterior implants. This, in turn, prevents black triangles and improves soft-tissue contours. The modified surgical flap method maintains both functional and esthetic values.
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Affiliation(s)
- Abdul Habeeb Bin Mohsin
- Department of Prosthodontics, Sri Sai College of Dental Surgery, Hyderabad, Telangana, India
| | - K V Sheethi
- Department of Periodontics, Sri Sai College of Dental Surgery, Hyderabad, Telangana, India
| | - M Priyanka
- Department of Periodontics, Sri Sai College of Dental Surgery, Hyderabad, Telangana, India
| | - Dhanalaxmi Karre
- Department of Pedodontics, Sri Sai College of Dental Surgery, Hyderabad, Telangana, India
| | - Mohammed Qusroo Ahmed
- Department of Oral Medicine, Sri Sai College of Dental Surgery, Hyderabad, Telangana, India
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Girbés-Ballester P, Viña-Almunia J, Balaguer-Martí JC, Peñarrocha-Diago M, Peñarrocha-Oltra D. Effect of incision design on interproximal bone loss of teeth adjacent to single implants. A randomized controlled clinical trial comparing intrasulcular vs paramarginal incision. Clin Oral Implants Res 2018; 29:367-374. [PMID: 29453772 DOI: 10.1111/clr.13131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2018] [Indexed: 12/14/2022]
Abstract
PURPOSE To evaluate the effect of incision design in implant surgery on interproximal bone loss of posterior teeth adjacent to interdental single implants, comparing intrasulcular and paramarginal incision. A further aim was to assess the influence of the incision technique on peri-implant bone remodeling. MATERIALS AND METHODS A controlled randomized clinical trial was carried out in a University Clinic. All the patients received an interdental posterior single implant. The incision type was randomly divided into two groups: (a) intrasulcular or (b) paramarginal. Standardized periapical digital radiographs were made with the parallel technique and a silicone index individualized in each patient. Radiographs were made immediately after implant placement, at abutment connection, 6 and 12 months post-loading. Two radiographic reference points were detected at the interproximal aspect of the adjacent teeth: (A) the cementoenamel junction and (B) the most coronal aspect of the bone crest. The interproximal bone loss of the adjacent teeth was calculated as the difference from A to B between the different follow-up periods and baseline. Two different examiners evaluated the radiographic measurements twice. RESULTS Sixty patients, each with one implant, were included, 30 in each group. A mean interproximal bone loss in teeth of 0.09 mm in the intrasulcular and 0.10 mm in the paramarginal group was found at 12 months post-loading. Mean peri-implant bone remodeling was 0.17 mm in the intrasulcular group and 0.15 mm in the paramarginal group. Differences between incision types were not statistically significant (p > .05). CONCLUSIONS Both incision designs used to place interdental single implants resulted in minimum bone loss at the interproximal aspect of adjacent teeth. The incision design did not significantly influence the radiographically assessed interproximal bone loss nor peri-implant bone remodeling.
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Affiliation(s)
- Paula Girbés-Ballester
- Faculty of Medicine and Dentistry, Master's program in Oral Surgery and Implant Dentistry, Stomatology Department, University of Valencia, Valencia, Spain
| | - Jose Viña-Almunia
- Faculty of Medicine and Dentistry, Master's program in Oral Surgery and Implant Dentistry, Stomatology Department, University of Valencia, Valencia, Spain
| | - Jose C Balaguer-Martí
- Faculty of Medicine and Dentistry, Master's program in Oral Surgery and Implant Dentistry, Stomatology Department, University of Valencia, Valencia, Spain
| | - Miguel Peñarrocha-Diago
- Faculty of Medicine and Dentistry, Master's program in Oral Surgery and Implant Dentistry, Stomatology Department, University of Valencia, Valencia, Spain
| | - David Peñarrocha-Oltra
- Faculty of Medicine and Dentistry, Master's program in Oral Surgery and Implant Dentistry, Stomatology Department, University of Valencia, Valencia, Spain
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Awartani FA, Tatakis DN. Interdental papilla loss: treatment by hyaluronic acid gel injection: a case series. Clin Oral Investig 2015; 20:1775-80. [PMID: 26613740 DOI: 10.1007/s00784-015-1677-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Accepted: 11/22/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The purpose of this prospective clinical trial was to examine the clinical and patient outcomes following esthetic reconstruction of interdental papilla loss in anterior teeth, using an injectable, non-animal-based, hyaluronic acid gel. MATERIALS AND METHODS Ten systemically healthy adults, with at least one anterior site with class I or II interdental papilla loss, were recruited. Following local anesthesia, ∼0.2 ml of hyaluronic acid gel was injected directly into the base of the papilla. The injection was repeated twice 21 days later. Patients were seen monthly for follow-up. Lost papilla surface area was calculated from digital clinical photographs taken at baseline and at 4 and 6 months postoperatively. Differences in lost papilla surface area between baseline and postoperative time points were statistically analyzed. Participants completed questionnaires (satisfaction surveys). RESULTS Seventeen sites (13 maxillary, 4 mandibular) were treated in 9 females who completed the study. The lost inderdental papilla area at baseline and at the 4- and 6-month postoperative visits was 1.2 ± 1.8 mm(2) (mean ± SD), 0.6 ± 0.9 mm(2), and 0.7 ± 0.7 mm(2), respectively. Differences between baseline and postoperative visits were statistically significant (p < 0.0001). Two thirds of the patients would choose to undergo the procedure again. CONCLUSIONS Use of hyaluronic acid gel to treat interdental papilla loss resulted in significant improvement at 6 months. Patients expressed satisfaction with the obtained improvement and dissatisfaction with the associated procedure discomfort. CLINICAL RELEVANCE Treatment of interdental papilla loss (black triangle) by hyaluronic acid gel injection appears a promising modality to address this esthetic patient concern.
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Affiliation(s)
- Fatin A Awartani
- Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Darraiyah Campus, P.O. Box 52500, Riyadh, 11563, Saudi Arabia.
| | - Dimitris N Tatakis
- Division of Periodontolgy, College of Dentistry, The Ohio State University, Columbus, OH, USA
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Flanagan D. Gingival Embrasure Fill In Fixed Implant-Supported Prosthetics: A Review. J ORAL IMPLANTOL 2014; 41:e297-300. [PMID: 25545968 DOI: 10.1563/aaid-joi-d-14-00185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
After provisional or definitive cementation of fixed implant-supported prostheses, spontaneous gingival proliferation may occur to fill the cervical embrasure areas of the prosthesis. Adequate oral hygiene, osseous spacing between the supporting implants and attached or immovable soft tissue may be the conditions that allow this phenomenon. This proliferation embrasure fill eliminates interproximal gingival voids, that is, black triangles, and makes the outcome more esthetically acceptable. Since interproximal prosthetic deign and implant positioning may be the primary factors for the fill, the gingival fill may be, in fact, an epulis.
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