Is interdental papilla filling using hyaluronic acid a stable approach to treat black triangles? A systematic review

Evaluation of Interdental Papilla Regeneration Using Injectable Hyaluronic Acid: A Clinical Study

AIM

This study aimed to assess the efficacy of hyaluronic acid (HA) gel injections in deficient papillae and record the effects for four weeks.

MATERIALS AND METHODS

Fifteen deficient class 1 papilla sites according to Nordland and Tarnow classification were included. After scaling and root planing, 0.5 ml HA gel was injected into the papillae. Measurements of black triangle height (BTH) and black triangle area (BTA) from the contact point to the most coronal level of the visible papilla tip were done on the clinical photographs using ImageJ software at baseline, one week, and four weeks postoperatively, and a comparison was made. Descriptive data were examined using the mean and standard deviation (SD). Paired t-test was used for intragroup comparisons, with p-values <0.05 considered significant. All the data analysis was done using SPSS software version 25.0.

RESULTS

There was a mean decrease in the BTA from baseline (0.54 mm2), one week (0.13 mm2), to four weeks (0.26 mm2) with a slight loss of papilla volume from the first week to the fourthweek, and this decrease in area was statistically significant. A mean decrease in the BTH throughout the follow-ups from baseline (1.36 mm) to the first week (0.30 mm) to the fourth week (0.73) was recorded with a slight loss of papilla volume from the first week to the fourthweek, and this decrease in height was also statistically significant (p < 0.05). However, the decrease in the BTA and BTH recorded was more from baseline to the first week as compared to baseline to the fourth week postoperatively.

CONCLUSION

HA gel is an effective treatment for minimally invasive papilla augmentation, particularly in class I Nordland and Tarnow papilla deficits.

The knowledge regarding the impacts and management of black triangles among dental professionals and laypeople

This study aimed to assess the knowledge regarding impacts, causes and management of black triangles (BT) among participants from different educational backgrounds including dental students, dentists and laypeople. This descriptive cross-sectional observational research included 435 participants who comprised 4 groups: pre-clinical (3rd year) dental students, clinical (4th and 5th year) dental students, dentists, and laypeople. A constructed self-reported questionnaire was utilized to assess participants' demographic data and their knowledge of the impacts, causes and management of BT. The VAS scale was used to assess participants' ratings for the impacts of BT on esthetics, with 0 meaning no impact and 10 meaning very severe negative impacts. The most reported treatments for BT were "cannot be treated" 99.3% and "non-surgical periodontal treatment" 67.1%. Meanwhile, the least reported was "modify the porcelain" 41.8%. The most reported cause of BT was "periodontal disease" 85.1%. However, the least reported were "parafunction" and "deep implants" 33.1% each. Dental professionals had better knowledge of the causes (t = 8.189, P < 0.001) and management (t = 8.289, P < 0.001) of BT than the non-dental participants. The dentists had the best knowledge, while the laypeople had the least knowledge of the causes (F = 62.056, P < 0.001) and treatment (F = 46.120, P < 0.001) of BT. The knowledge of the causes (t = 0.616, P = 0.538) and treatment (t = 1.113, P = 0.266) for BT was not significantly different between males and females. Age was not significantly related to the total knowledge about the causes (r = -0.034, P = 0.475) or treatment (r = -0.034, P = 0.482) for BT. Dental professionals had better knowledge of the impacts, causes and management of BT than the non-dental participants. The dentists were the best, while the laypeople were the worst in this regard. Age and gender had no relationships with the knowledge of causes or management of BT.

Effectiveness of Hyaluronic Acid Gel Injection with and without PRGF for Management of Interdental Papillary Loss: A Randomized Clinical Trial

BACKGROUND

To evaluate the effectiveness of hyaluronic acid (HA) gel injection with and without plasma rich in growth factors (PRGF) for the management of interdental papillary loss.

METHODS

A single blinded randomized clinical trial was carried out on 21 subjects with 34 sites. Patients within the age group 18-45 years who had Class I and II papillary recession in the maxillary anterior region were selected. The sites involved were randomly assigned to Group HA alone and Group HA + PRGF. The patients were recalled 4 weeks after receiving supragingival and subgingival instrumentation. HA or HA + PRGF was injected into the defective papilla at baseline and at 3 and 6 weeks. Image based measurements of Papillary Width (PW), Papillary Deficient Height (PDH), Deficient Area (DA), Deficient Volume (DV) were registered at baseline, 3 weeks, 6 weeks and 12 weeks. A vernier caliper was used to measure the papillary depth in the impression made using additional silicone impression material pre- and post-intervention.

RESULTS

There was a significant improvement in the within-group comparison of PW, PDH, DA and DV in both the groups. Group HA + PRGF showed significantly greater improvement in comparison to Group HA alone in terms of PDH, DA and DV at 6 and 12 weeks.

CONCLUSIONS

Even though HA gel has already been established as a promising injectable agent in the minimally invasive treatment of interdental papillary deficiency, PRGF may also have a significant adjuvant effect when used along with HA. Further clinical studies with longer follow up duration, larger sample size and standardization of the tooth shape are required for a better understanding of the adjuvant effect of PRGF when used along with HA.

Unilateral hard palate necrosis following gingival injections with hyaluronic acid

Hyaluronic acid (HA) injections into the oral mucosa have proven to be effective as a non-invasive method for the reconstruction of interproximal papillary defects in aesthetic areas. Despite being a minimally invasive and safe technique, certain side effects may occur after treatment.We report the first case of a patient with unilateral necrosis of the mucosa of the hard palate after HA filling in the maxillary anterior gingiva. Familiarity with these events and competent knowledge of the anatomy is essential to avoid complications, achieve and offer adequate treatment and good results to our patients.

Effects of psychological stress and cortisol on decision making and modulating factors: a systematic review

Evidence suggests that psychological stress has effects on decision making, but the results are inconsistent, and the influence of cortisol and other modulating factors remains unclear. Based on the PRISMA criteria, 18 studies carried out between 2015 and 2020 that examined the effects of psychological stress on decision making and measured cortisol levels were selected. Eight studies employed uncertainty-based economic tasks, five studies used decision-making tasks in hypothetical situations that can be encountered in real life or in a specific setting, and five studies employed prosocial decision tasks. Seventeen studies assessed acute stress, and two assessed chronic stress; eight evaluated the influence of sex. Most of the studies that explored the association between stress and decision making using uncertainty-based economic tasks found statistically significant differences as a function of stress exposure and the cortisol response to stress, whereas most of the studies that employed non-economic decision-making tasks in hypothetical situations did not find statistically significant differences. When prosocial decision making was evaluated, more altruistic decisions were found after acute stress, and these decisions were positively associated with cortisol. Half of the studies that assessed the role of sex observed a greater impact on decision making after stress in women. Results suggest that it is important to consider modulating factors - the type of decision-making task, the cortisol response to stress, the characteristics of the psychological stressor, or the subject's sex - when trying to understand psychosocial stress phenomena.

Hyaluronic acid injection to restore the lost interproximal papilla: a systematic review

OBJECTIVES

To assess the efficacy and safety of hyaluronic acid (HA) injections to restore the lost interproximal papilla.

MATERIALS AND METHODS

A systematic literature search was conducted in PubMed/MEDLINE, Scopus and Cochrane electronic databases with no time restriction up to September 2021. Any clinical study evaluating HA injection into the interproximal papilla loss Class I and II according to Norland & Tarnow, were included based on the following PICO questions (1) Are HA injections effective for the reconstruction of the interproximal papilla loss? (2) What are the side/adverse effects of using HA for the reconstruction of interproximal papilla loss? The risk of bias assessment was performed using the Cochrane Collaboration's the Newcastle Ottawa and Joanna Briggs institute tools.

RESULTS

A total of 1497 titles were retrieved. From these, eleven were included and underwent full data extraction. However, due to heterogeneity in the data among the included articles, a meta-analysis could not be performed. Three articles reported no-differences in term of papilla tip to contact point distance or the papilla fill reduction. Finally, five studies showed a reduction in the black triangle with a percentage range between 19 and 47%.

CONCLUSION

The non-surgical use of HA injection seems to have a positive effect on the re-establishment of interproximal papilla lost. However post-operative complications might develop.

The effect of family planning counselling on postpartum modern contraceptive uptake in sub-Saharan Africa: a systematic review

OBJECTIVE

Family planning counselling at different contact points of maternal health services has been recommended for increasing the uptake of modern contraceptive methods. However, studies from sub-Saharan Africa (SSA) demonstrated inconsistent findings. The aim of this systematic review was to synthesise the available current evidence for the association between family planning counselling and postpartum modern contraceptive uptake in SSA.

STUDY DESIGN

This is a systematic review of the SSA literature.

METHODS

On 11 February 2021, we searched six electronic databases for studies published in English. We included quantitative observational and interventional studies that assessed the effects of family planning counselling on contraceptive uptake among women who gave birth in the first 12 months. We used Joanna Briggs Institute critical appraisal tools to evaluate study quality. The protocol for this systematic review was registered in PROSPERO (CRD42021234785).

RESULTS

Twenty-seven studies with 26,814 participants comprising 18 observational and nine interventional studies were included. Family planning counselling during antenatal care, delivery, postnatal care, and antenatal and postnatal care was associated with postpartum contraceptive uptake. Moreover, the newly implemented family planning counselling interventions improved postpartum modern contraceptive uptake.

CONCLUSION

Overall, the evidence suggests that family planning counselling during the different maternal health service delivery points enhances contraceptive uptake among postpartum women. SSA countries should promote and strengthen family planning counselling integrated with maternal health services, which will play a significant role in combating unintended and closely spaced pregnancies.

A randomized controlled trial evaluating hyaluronic acid gel as wound healing agent in alveolar ridge preservation

AIM

To compare the results of administration of hyaluronic acid (HA) gel to no gel administration following alveolar ridge preservation (ARP) in terms of changes in wound dimensions over time.

MATERIALS AND METHODS

Systemically healthy patients scheduled for ARP at one or two sites in the incisor, cuspid, or premolar area with at least one neighbouring tooth and >50% buccal bone present following extraction were included. ARP consisted of socket grafting with collagen-enriched, deproteinized bovine bone mineral and socket sealing by means of a collagen matrix. Following surgical therapy, sites were randomly allocated to the control group (no gel application) or the test group (0.8% HA gel applied onto the collagen matrix three times per day for 7 days). Bucco-lingual and mesio-distal wound dimensions were registered at T0 (immediately post operation), T1 (1 week), and T2 (3 weeks). Patient-reported outcomes, clinical outcomes, and hard and soft tissue changes were recorded up to 4 months (T3).

RESULTS

In the control group, 20 patients (7 males, 13 females; mean age 53.30) with 23 sites, and in the test group 18 patients (9 males, 9 females; mean age 52.56) with 23 sites, were included. There were no significant differences between the groups in the changes in wound dimensions from T0 to T2 (bucco-lingual aspect: p = .340; mesio-distal aspect: p = .883). Three sites (13%) in the control group and six (26%) in the test group demonstrated complete wound resolution at T2 (p = .259). HA failed to show any effect on the number of analgesics taken (p = .175), patient-reported outcomes (p ≥ .263), alveolitis (p = .136), socket healing (p ≥ .424), soft tissue changes (p ≥ .064), or mucosal scarring (p = .548). However, significantly more horizontal bone loss at the coronal aspect was found in the test group (p ≤ .025).

CONCLUSION

HA failed to promote wound resolution on a collagen matrix. This study was registered in ClinicalTrials.gov (NCT04467736).