The use of hyaluronic acid injection for treatment of black triangle and reconstruction of lost interdental papilla in anterior teeth: a systematic review.

OBJECTIVE: Non-surgical therapeutics to reconstruct lost interdental papilla are evolving; these include hyaluronic acid injection. The aim of this systematic review is to evaluate the efficacy, safety, and long-term outcomes of hyaluronic acid injection in the treatment of black triangles and reconstruction of lost interdental papilla in anterior teeth. MATERIALS AND METHODS: The protocol was registered in PROSPERO (CRD42023446875) and in accordance with the Cochrane Handbook of Systematic Reviews of Interventions and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis 'PRISMA'. The search involved four databases, PubMed/MEDLINE, The Cochrane Library, Google Scholar, and ProQuest for ''grey literature' with additional manual search for studies published up to May 2024. Human clinical studies of a prospective nature (randomised clinical trials and prospective cohort studies) were included. Exclusion criteria were case reports, case series, review articles, letter to editor, personal opinion, and animal studies. Furthermore, studies which utilised hyaluronic acid injection in conjunction with other therapeutic material, tissue graft, or any surgical procedure were also excluded. The data were extracted independently by the two authors and incorporated after consensus. The risk of bias was assessed using the RoB2: the revised Cochrane risk of bias tool for randomised clinical trials and the Newcastle Ottawa scale for prospective cohort studies. RESULTS: 24 studies, 15 prospective clinical studies and nine randomised clinical trials, were included with a total of 898 interdental papillae injected with hyaluronic acid. The studies showed promising outcomes in the reconstruction of lost interdental papilla with minimal adverse reactions. Risk of bias assessment among prospective clinical studies revealed 13 good quality studies with only two poor studies while the randomised clinical trials consisted of three with low, one with some concern, and five studies with high risk of bias. However, due to the high heterogeneity, a meta-analysis was not feasible.  Conclusion: Hyaluronic acid injection is an effective minimally invasive approach in treating black triangles and reconstructing lost interdental papilla in the anterior teeth. Further long-term well-designed randomised clinical trials employing standardised procedures are essential to validate this treatment and provide better quality of evidence.

Use of a 2-Piece Small Diameter Implant in the Esthetic Zone in a Site of Chronic Residual Periapical Lesion: A Case Report with 1-Year Follow-Up and Histopathological Examination.

BACKGROUND Replacing missing teeth in the anterior region of the jaw can be challenging due to the limited available interdental space. Improper selection or inadequate placement of a dental implant in this situation can affect the adjacent anatomical structures negatively. What if, in addition, a residual intraosseous chronic inflammatory lesion was present? The objective of this case report is to demonstrate the step-by-step surgical procedures of replacing a maxillary lateral incisor in a patient with a residual lesion with a satisfactory outcome. CASE REPORT A 63-year-old female patient with an extracted maxillary lateral incisor presented for implant placement. Radiographically, a residual periapical lesion with mild atrophy of the alveolar bone and fairly low density with sparse trabeculation was noted. Owing to the limited restorative space, a Straumann Bone Level Tapered Implant Ø2.9 mm (Small Cross-Fit connection, Roxolid, SLActive) was placed. Histopathological evaluation revealed a definitive diagnosis of periapical granuloma. After 1 year, the clinical examination revealed a successful outcome, and the patient was satisfied with the result. CONCLUSIONS This case report shows a successful clinical and radiographical outcome after 1 year of a 2-piece small diameter dental implant, the Straumann Bone Level Tapered Implant, diameter 2.9 mm, replacing a missing maxillary lateral incisor after enucleating the lesion with histopathological examination.

Endo-Perio Relationship Knowledge, Understanding, and Confidence Among Dentists.

Purpose: Proper knowledge and confidence regarding Endo-Perio relationship plays an important role in correct clinical decisions and management of these conditions. The aim of this study is to assess dentists' knowledge and understanding, in addition, their confidence regarding Endo-Perio relationship, consequently, to investigate the prevalence of misconceptions. Methods: This cross-sectional study, conducted from December 2021 to March 2022, utilized voluntary anonymous questionnaire, distributed among general dentists, graduates of King Abdulaziz University, Faculty of Dentistry, Jeddah, Saudi Arabia, year of 2021 (n = 151). The questionnaire had two parts, demographic and 13 closed ended scientific questions to assess knowledge and understanding with 4 points Likert scale after each question to assess confidence and misconceptions. Descriptive statistics and Chi-square test at a statistical significance of P-value <0.05 were conducted to analyze the data using SPSS. Results: Total of 98 participants completed the questionnaire setting a response rate of (64.9%). Only (21.4%) had sufficient overall knowledge and understanding regarding Endo-Perio relationship with no significant association found between knowledge and gender (p = 0.8). A little more than one-third of our participants (37.83%) were overly confident; false confident, thus, had misconceptions. Conclusion: Our study revealed that the majority of our participants had deficient knowledge regarding Endo-Perio relationship. Thus, to compensate for this reported deficiency, changing teaching strategies and implementing continuing education courses are suggested. More studies assessing the interaction between knowledge and confidence in different dental topics are needed.

Familial Presentation of Ankyloglossia and Localized Periodontitis.

An association between ankyloglossia and periodontitis has not previously been reported. This case series describes three sisters who each had ankyloglossia and a molar/incisor pattern of localized periodontitis. The concurrent presentation of both conditions within the family suggests that further investigation of genetic factors that might concurrently affect the pathogenesis of both disorders may be warranted.