Remodelación de papila gingival interdental con ácido hialurónico. Una solución estética / Remodeling interdental gingival papilla with hyaluronic acid. An aesthetic solution

RESUMEN: El objetivo de este trabajo es evaluar el efecto de remodelación y relleno mediante aplicación de ácido hialurónico en papilas gingivales de sector estético con defectos de triángulo negro en un paciente tratado periodontalmente. Se inyectaron 0.15 ml de gel de ácido hialurónico dividido en 3 sesiones. Clínicamente se observó aumento de volumen y aumento de dimensiones verticales y horizontales en las papilas, mejorando así los parámetros estéticos. Como conclusión la aplicación de ácido hialurónico es efectiva en la remodelación y relleno en pérdidas de papila clase I de Nordland y Tarnow.

ABSTRACT: The objective of this work is to evaluate the effect of remodeling and filling through the application of hyaluronic acid in gingival papilla in the aesthetic sector with black triangle defects, in a periodontally- treated patient. In 3 portioned sessions, 0.15 ml of hyaluronic acid gel was injected. Clinically, an increase in volume was observed, and vertical and horizontal dimensions in the papilla increased too, thus improving aesthetic parameters. In conclusion, the application of hyaluronic acid is effective in the remodeling and filling in losses of class I papilla (Nordland and Tarnow classification).

Hyaluronic acid for repairing interdental papilla in esthetic area: case report

ABSTRACT: Background: Hyaluronic acid is a treatment option for this deficiency gingival papilla, since it aims to increase tissue volume in the region of loss of interdental papilla, minimally invasive. Aim this study was to describe the application of Hyaluronic acid in a deficient gingival papilla. Case report: Patient presented absence of interdental papilla in the maxillary arch around upper anterior teeth. A comprehensive exam was performed, plus 2D photographs taken with a professional camera coupled to a device for image standardization, and an intraoral scanning with the OMNICAM scanner. Three applications of Hyaluronic acid were performed to fill the black spaces, at an interval of four weeks. The patient was followed-up for three months, and the recovery of papilla was observed. Conclusion: The Hyaluronic acid as gingival filling material can be considered as a treatment option for augmenting interdental papilla in aesthetic area.

Uso de ácido hialurónico como alternativa para la reconstrucción de la papila interdental / Use of hyaluronic acid as an alternative for reconstruction of interdental papilla

RESUMEN: Introducción: El ácido hialurónico (AH) es un glucosaminoglicano esencial de la matriz extracelular de todos los tejidos, estando en una concentración media del 0.02%. Una persona de 60 kg de peso contiene aproximadamente 12 g de AH; las mayores concentraciones de este ácido se encuentran en los tejidos conectivos como la piel, la cual presenta hasta un 56% de éste. El AH tiene un papel importante en la migración celular, ya que está involucrado en procesos de crecimiento, inflamación y reparación, así como estimulación de diferentes células del tejido conectivo. Objetivo: Presentar un caso clínico de reconstrucción de la papila interdental infiltrando AH. Caso clínico: Paciente femenino de 24 años de edad que al interrogatorio refiere ser sistémicamente sana. Presenta pérdida de la papila interdental de la zona OD 11 y 21 a causa de una gingivitis y mala técnica de cepillado. Se valora de acuerdo con la clasificación de Nordland y Tarnow para saber el grado de predictibilidad del procedimiento y de acuerdo con la clasificación de Cardaropoli, con el fin de poder realizar comparaciones antes y después del tratamiento. La paciente presentaba 5 mm del punto de contacto a la cresta ósea, por lo que se realizó un infiltrado de AH en la papila durante cuatro semanas cada siete días. Conclusión: Existen muy pocas técnicas no quirúrgicas para la regeneración de la papila interdental, dentro de ellas encontramos el uso de AH. Las investigaciones sobre esta técnica no son nuevas, sin embargo, se deben continuar y ampliar los estudios considerando diversos factores: realizarlos en poblaciones mayores con personas de distintas razas, sexo y utilizando diferentes intervalos de infiltración.

ABSTRACT: Introduction: Hialuronic acid (HA) is an essential glucosaminoglycan of the extracellular matrix of all tissues; it is found at an average concentration of 0.02%. A subject weighing 60 kg contains approximately 12 g of HA. The greater concentrations of this acid are found in connective tissue such as the skin, which exhibits up to 56% percent of said acid. HA plays an important role in cell migration, since it is involved in processes of growth, inflammation and reparation as well as stimulation of different connective tissue cells. Objective: To present a clinical case involving interdental papilla reconstruction with HA infiltration. Clinical case: 24 year old female who reported being systemically healthy. The patient exhibited loss of interdental papilla in the area of tooth number 11 and 21 caused by presence of gingivitis and poor brushing techniques. The patient was assessed according to Nordland and Tarnow classification in order to ascertain the procedure's degree of predictability; she was additionally examined according to Cardaropoli classification in order to be able to establish pre- and post-treatment comparisons. The patient exhibited 5 mm of contact point to the bone crest, therefore, HA infiltration was undertaken into the papilla, every seven days for four weeks. Conclusion: There are very few non-surgical techniques to regenerate interdental papillae, one of them is HA use. Research conducted on this technique is not new, nevertheless, it would be suitable to further it taking into consideration different factors; conducting them in greater-sized populations with subjects of different ethnicities and gender, and using different infiltration intervals.

Strategic serial extractions and immediate implantation for interdental papilla preservation: A case report / 대한치과보철학회지

Maintaining the blood supply of the interdental alveolar bone is crucial for preserving the interdental papilla. Rebuilding the interimplant papilla between adjacent implants is more difficult than rebuilding the interdental papilla between the natural tooth and implant. Therefore, preserving the interimplant tissue is necessary when adjacent implants are closely placed. In this case report, three effective methods for maintaining the surrounding tissue, namely strategic serial extraction, immediate implantation, and provisionalization of adjacent maxillary central incisors, were performed. The marginal gingiva and interimplant papilla were well maintained for 24 months.

Absence of interdental papilla ­ Systematic review of available therapeutic modalities / Ausência de papila interdental ­ revisão sistemática sobre as modalidades terapêuticas disponíveis

The objective of the present study was to conduct a systematic review of the treatment alternatives for the absence of interdental papilla (AIP), a clinical situation that can have aesthetic and phonetic impacts. A search for original articles, in humans, reporting more than one case, without language restrictions, dealing with therapeutic alternatives for AIP, was conducted in the databases of MEDLINE and EMBASE. The strategy included [("interdental papilla" OR "black triangles" OR "open gingival embrasure") AND ("treatment" OR "therapy" OR "reconstruction")] up to the year of 2010, resulting in seven studies being included. One study was found upon checking the reference lists and was added, bringing the total to 8 studies. The sample size ranged from two to 19 participants. Six of the eight studies used periodontal surgical techniques and fi ve associated the subepithelial connective tissue graft. Two studies treated AIP with reticulated hyaluronic acid gel. The follow-up time ranged from four to 24 months. The results, in relation to the interdental space area, ranged from 43% to 100% of fi lling and the reduction of the distance between the contact point and the tip of the papilla ranged from 0.73 to 2.8 mm. Two studies did not describe the results numerically. It was concluded that the therapeutic results presented by the authors were positive. However, it is necessary to take into consideration that the designs of the studies included here have a weak capacity for generating scientifi c evidence. As studies with a randomized clinical trial design are not conducted to respond to this clinical question, the results of the present study should be used with caution.

O objetivo deste estudo foi realizar uma revisão sistemática sobre as alternativas de tratamento da ausência da papila interdental (API), situação clínica que pode trazer impactos estéticos e fonéticos. Uma busca por artigos originais, em humanos, apresentando mais de 1 caso, sem restrição de idiomas, que tratassem sobre alternativas terapêuticas para a API foi realizada nas bases de dados Pubmed e Embase. A estratégia incluiu: [("interdental papilla" OR "black triangles" OR "open gingival embrasure") AND ("treatment" OR "therapy" OR "reconstruction")] a partir do ano de 2010, resultando em sete estudos incluídos. Um estudo foi encontrado na verifi cação das listas de referências e adicionado, totalizando 8 estudos. O tamanho amostral variou de dois a 19 participantes. Seis dos oito estudos utilizaram técnicas cirúrgicas periodontais e cinco associaram o enxerto conjuntivo subepitelial. Dois estudos trataram a API com gel de ácido hialurônico reticulado. O tempo de acompanhamento variou de quatro a 24 meses. Os resultados em relação ao espaço/área interdental variaram de 43 a 100% de preenchimento e a redução da distância entre o ponto de contato e a ponta da papila variou de 0,73 a 2,8 mm. Dois estudos não descreveram numericamente os resultados. Conclui-se que os resultados terapêuticos apresentados pelos autores foram positivos. Entretanto, é preciso levar em consideração que o delineamento dos estudos incluídos tem fraca capacidade de gerar evidência científi ca. Enquanto estudos com delineamento do tipo ensaio clínico randomizado não sejam realizados para responder essa pergunta clínica, os resultados do presente estudo devem ser utilizados com cautela.

Interdental Papilla Management “Reality or A Myth” - A Review.

Interdental papillary recession has been esthetical as well as an oral hygiene maintenance problem for the patients. Abnormal tooth shape, improper contours of prosthetic restorations, and traumatic oral hygiene procedures may also negatively influence the outline of the interdental soft tissue. There are very fewer surgical techniques to create interdental papilla, which has been very technique sensitive and less predictive in treatment outcome; in this article, a review is attempted to illustrate various causes, classification, and management of interdental papilla.

Aesthetic Papillary Reconstruction – A Case Report of a New Technique Using Connective Tissue Graft.

Lost interdental papilla- commonly known as ‘black triangles’ are of great concern from the aesthetic as well as phonetics point of view when occurs in the anterior maxillary region. This causes an enormous effect on the self esteem of a person. The correction of lost interdental papillae is however one of the most challenging periodontal plastic surgical procedures as the interdental papilla is an end organ and does not have a blood supply of its own. Various techniques have been proposed with varied success rate for its management. We elicit a case report of papillary reconstruction in this article using connective tissue graft by undermining the gingiva-papillary unit to preserve the papillary blood supply.

The association between radiographic embrasure morphology and interdental papilla reconstruction using injectable hyaluronic acid gel

PURPOSE: The purpose of this study was to evaluate the clinical efficacy of enhancing deficient interdental papilla with hyaluronic acid gel injection by assessing the radiographic anatomical factors affecting the reconstruction of the interdental papilla. METHODS: Fifty-seven treated sites from 13 patients (6 males and 7 females) were included. Patients had papillary deficiency in the upper anterior area. Prior to treatment, photographic and periapical radiographic standardization devices were designed for each patient. A 30-gauge needle was used with an injection-assistance device to inject a hyaluronic acid gel to the involved papilla. This treatment was repeated up to 5 times every 3 weeks. Patients were followed up for 6 months after the initial gel application. Clinical photographic measurements of the black triangle area (BTA), height (BTH), and width (BTW) and periapical radiographic measurements of the contact point and the bone crest (CP-BC) and the interproximal distance between roots (IDR) were undertaken using computer software. The interdental papilla reconstruction rate (IPRR) was calculated to determine the percentage change of BTA between the initial and final examination and the association between radiographic factors and the reconstruction of the interdental papilla by means of injectable hyaluronic acid gel were evaluated. RESULTS: All sites showed improvement between treatment examinations. Thirty-six sites had complete interdental papilla reconstruction and 21 sites showed improvement ranging from 19% to 96%. The CP-BC correlated with the IPRR. More specifically, when the CP-BC reached 6 mm, virtually complete interdental papilla reconstruction via injectable hyaluronic acid gel was achieved. CONCLUSIONS: These results suggest that the CP-BC is closely related to the efficacy of hyaluronic acid gel injection for interdental papilla reconstruction.

Modified Root Submergence Technique for Pontic Site Development in Maxillary Anterior Region.

Extraction of tooth leads to alveolar ridge resorption, which is more pronounced in the 1st year after extraction. Ridge resorption results in loss of interdental papillae and creation of unesthetic black triangles. Root submergence technique (RST) is a procedure where the tooth is decoronated and submerged at or below the alveolar bone level. The goal of the technique is to maintain the attachment complex of the tooth, which will prevent the alveolar bone resorption at the site with maintained soft tissue profile resulting in better esthetic results. The present case describes a relatively bloodless and minimally invasive modified RST that can be implemented in routine clinical practice with the predictable esthetic outcome.

“Ovate Pontic”- Esthetic Enhancement of the Anterior Restorations.

Esthetics is of prime concern when replacing any anterior tooth. The prosthesis should resemble the adjacent natural tooth closely. Out of many types of pontic designs, ovate pontic may serve the purpose of providing good esthetics and phonetics. It will maintain interdental papilla and help to maintain good gingival health. In addition to it ovate pontic has an advantage of immediately replacing the missing anterior tooth.

Morphological patterns of gingival recession in adult chilean population / Patrones morfológicos de recesiones gingivales en población chilena adulta

The aim of this study was to determine the prevalence of morphological patterns of gingival recession, attachment loss, and type of interdental papilla in adult subjects of different age in a Chilean population. A total of 105 patients with ages ranging from 18 to 64 years of both sexes participated in our study. The prevalence of gingival recession was 92.38 percent, affecting 530 teeth. The morphological pattern of gingival recession most common was class II (34.94 percent), followed by types III, I and IV. According to ANOVA test, differences were significant in relation to the mean number of affected teeth. Of those who had recessions, females had a slightly higher prevalence. The range 18-34 years showed a prevalence of 82.22 percent and from 35 years increased to 100 percent. The vertical extent between 0-3mm and horizontal between 4-7mm were the most prevalent affected 88.68 percent and 59.05 percent of teeth, respectively. Attachment loss was 3-4mm in 316 teeth (59.62 percent), and the most prevalent interdental papillae on the different patterns was type I (40.18 percent) followed by type III (21.88 percent). Differences were statistically significant (p=0.001) in relation to age of individuals who presented diferent morphological patterns of gingival recession. For the others parameters (depth and width of the recession, attachment loss) we found no statistically significant differences with a confidence interval of 95 percent. These findings represent a contribution for the evaluation of gingival recession in our population, particularly in the anterior aesthetic zone.

El objetivo fue determinar los patrones morfológicos de recesión gingival más prevalentes junto al grado de pérdida de inserción clínica y tipo de papila interdentaria en una muestra de población chilena. Se evaluaron 105 pacientes de ambos sexos, con edades entre 18 y 64 años. La prevalencia de recesión gingival fue del 92,38 por ciento, afectando 530 dientes. El patrón morfológico de recesión más frecuente fue el clase II (34,94 por ciento), seguido por los tipos III, I y IV. Según la Prueba de ANOVA, fueron encontradas diferencias significativas en relación a las medias de dientes afectados entre los individuos que presentaban recesión. El sexo femenino presentó una prevalencia ligeramente mayor. En el rango de 18-34 años se observó una prevalencia de 82,22 por ciento y desde los 35 años aumentó al 100 por ciento. La extensión vertical entre 0-3mm y horizontal entre 4-7mm fueron las más prevalentes y afectaron al 88,68 por ciento y 59,05 por ciento de los dientes, respectivamente. La perdida de inserción más habitual fue del rango 3-4mm en 316 dientes (59,62 por ciento ). El tipo de papila interdentaria en las recesiones gingivales fue del tipo I (40.18 por ciento) seguido por el tipo III (21.88 por ciento). Se encontraron diferencias estadísticamente significativas (p=0.001) en relación a la edad de los individuos que presentaron estos patrones morfológicos de recesión gingival y quiénes no. Estos resultados representan una contribución para la evaluación de la recesión gingival en nuestra población, particularmente en la zona estética anterior.

Assessment of gingival contours for esthetic diagnosis and treatment: A clinical study.

Background: The purposes of this study were to quantify some clinical parameters that are useful as esthetic guidelines when the gingival contour is modified and to compare the left and right sides of the six maxillary anterior teeth. Materials and Methods: Two hundred and forty interdental papilla sites in 20 healthy patients were evaluated. Interdental papilla heights of maxillary anterior teeth were measured from the gingival zenith, along with clinical crown lengths. Percentages of papilla height to crown length were computed and defined as papilla proportion, mesial papilla proportion (MPP) and distal papilla proportion (DPP). Results: Mean interdental papilla heights of maxillary teeth was 3.83 mm mesially and 3.8 mm distally. Mean MPP was 43.69% ( n = 120) and DPP was 44.57% ( n = 120). No significant differences were found between MPP and DPP for maxillary incisors ( P ≥ 0.5). Conclusion: Papilla proportions were approximately 44% for all tooth groups. Canines demonstrated a trend toward increased distal papilla heights. In the present study the average MPP and DPP of the central incisor (CI), lateral incisor (LI) and canine (CA) measured were 43%, 41%, 46%, 40%, and 42% 51% respectively.

Fibroma osificante periférico: revisión de la literatura y presentación de dos casos clínicos / Peripheral ossifying fibroma: review of the literature and report of two cases

El Fibroma Osificante Periférico (FOP) es una lesión reactiva que se localiza frecuentemente en las papilas interdentales, puede ser sésil o pediculada, indolora, del mismo color de la mucosa o rojiza, su tamaño varía de pocos milímetros a centímetros de diámetro, en ocasiones puede causar pérdida de los dientes adyacentes o resorción ósea. Se reportan dos casos de pacientes masculinos de 36 y 40 años de edad, quienes son referidos por sus odontólogos tratantes por lesiones en el Maxilar. En ambos casos se localiza en papila interdental del Incisivo Central y Lateral derecho (11 y 12), y se presentan como lesiones tumorales de aproximadamente 1 cm de diámetro, circunscritas, rojas, sangrantes y de superficie lisa y brillante

The Peripheral ossifying fibroma (POF) is a reactive lesion that is located in the interdental papilla often can be sessile or pedunculated, painless; the color of the mucosa or red, its size ranging from a few millimeters to centimeters in diameter, sometimes can cause loss of adjacent teeth or bone resorption. We report two cases of male patients 36 and 40 years of age who are referred by their dentists for injuries to his jaw. In both cases, interdental papilla located at 11 and 12 and are presented as mass lesions approximately 1 cm in diameter, circumscribed, red, bleeding and surface smooth and shiny

Gingival Enlargement - A Case Series.

Gingival enlargement condition finds a unique place in literature, because it has been associated with a variety of local and systemic factors. Management of these conditions is dependent on the accurate diagnosis. In this case series 3 cases of gingival enlargements with various conditions i.e, pregnancy associated , drug induced, inflammatory associated have been described in terms of clinical course, management of these conditions both surgically and non surgically. It is also concluded that in all forms of gingival enlargements, good oral hygiene is necessary to minimize the effects of systemic factors. The selective usage of the medication with possible alternative of drug choices than the medication associated with gingival enlargement, Education and awareness regarding the special conditions like puberty and pregnancy is essential in order to reduce the occurrence of gingival enlargement. Although spontaneous reduction in the size of gingival enlargement.

Prognosis V/S Etiology : Midline Papilla Reconstruction After Closure of Median Diastema.

Reconstruction of lost interdental papilla once the contact point is restored in midline diastema cases are as well important in restoring the esthetics as closure of diastema. Aim: The purpose of this study was to predict the midline papilla reconstruction in treated median diastema of variable etiology. Method : The treated sample consisted of 40 patients with variable etiology of midline diastema (6 of abnormal labial frenum, 6 of mesiodens ,8 of anodontia or microdontia, 8 of para functional habits, 6 of flared or rotated incisors and 6 of dentoalveolar disproportion) with otherwise healthy periodontium. The method used was PPI (papilla presence index) by D.Cardaropoli. Results: The study suggests that prognosis for papillary reconstruction is not good in cases of mesiodens. Conclusion: In spite of getting a good contact point, various other factors are playing a role in achieving good esthetics in cases of median diastema.