Assessment of Hyaluronic Acid Gel Injection in the Reconstruction of Interdental Papilla: A Randomized Clinical Trial

Abstract

BACKGROUND: Various techniques have been implemented to reconstruct the deficient interdental papilla.AIM: The present trial was conducted to assess the effect of injection of hyaluronic acid gel for the reconstruction of deficient interdental papilla.MATERIAL AND METHODS: Thirty-six deficient interdental papilla sites in ten patients were randomly allocated into two equal groups; intervention group who received the injection of hyaluronic acid (HA) gel and control group who received the injection of saline solution as a placebo. Each deficient papilla received three injections. The first injection was given one week following the re-evaluation period (four weeks after performing full mouth supra-gingival scaling and sub-gingival debridement). The second and third injections were given after three and six weeks, respectively. The height and surface area of black triangles were recorded at baseline before the injection procedures. The participants were recalled after three and six months from the first injection for re-measuring the recorded parameters. At 6 months, patients' satisfaction was also assessed.RESULTS: After three and six months from baseline, the results revealed a statistically significant higher mean decrease in height and surface area of black triangles in favour of the HA group. From three to six months, there was no statistically significant difference between the two groups in both parameters. At 6 months, the HA group showed a statistically significant higher mean satisfaction score than the saline group.CONCLUSION: The use of hyaluronic acid gel for the reconstruction of interdental papillary deficiency was effective with promising levels of patients' satisfaction.

Potential for Hyaluronic Acid in Periodontal Research

“…Abdelraouf et al 2019, used 0.1 mm injectable Restylane (cross-linked HA 20mg/ml) for treatment of black triangles. The gain in height of the papilla in 6 months was 0.06 ± 0.17mm whereas the gain in surface area was found to be 11.8 ± 30.3. patients were significantly satisfied with the treatment results as well (26).…”

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

“…Bertl et al 26 evaluated deficient papillae after filling with saline solution (10 papillae) and HA (11 papillae) and found no difference in papillary volume gain between the groups studied, in the period of 6 months. In contrast, Abdelraouf et al 25 studied a sample of 36 papillae and compared the same experimental groups during the same period of the study aforementioned, concluding that the deficient interdental papillae filled with HA showed better results than those filled with saline solution. The authors 25 believe that this difference in results occurred because the study by Bertl et al 26 uses different concentrations of HA and the papillary defects are in areas adjacent to implants, which alters the biological characteristics, whereas the papillary defects studied by Abdelraouf et al 25 are only around natural teeth.…”

“…Another determining factor for the stability of long‐term results is the level of initial papillary deficiency associated with the degree of papillary reconstruction (complete or partial) 1,25 . Becker et al 11 showed no evidence of worsening of results in completely reconstructed papillae, for 25 months.…”

“…In the literature, the comparison of HA with other products is described only with saline solution 25,26 . Bertl et al 26 evaluated deficient papillae after filling with saline solution (10 papillae) and HA (11 papillae) and found no difference in papillary volume gain between the groups studied, in the period of 6 months.…”

Effect of Hyaluronic Acid Filler Injection on the Interdental Papilla in a Mouse Model of Open Gingival Embrasure

“…Of the 43 IDP loss sites, 100% reconstruction was observed in 29 sites and 39-96% reconstruction was observed in 14 sites [8]. Sara et al reported that the HA filler could successfully reconstruct IDP and the reconstruction catered to patient satisfaction [9].…”