Comparative Evaluation of Two Hyaluronic Acid Gel Products for the Treatment of Interdental Papillary Defects

Abstract

Objectives The aim was to investigate the efficacy of single injections of two different hyaluronic acid products, Flex Barrier and Revident, in reducing the size of black triangles to treat Nordland-Tarnow Class I and II recessions. Materials and Methods Forty adult patients were recruited with at least two upper and two lower interdental papilla defects in the front region between canine teeth. According to the Nordland-Tarnow classification of papillary defects, both Class I and Class II recessions were included in the investigation. Patients were randomly assigned to experimental groups to receive single injections of two different hyaluronic acid products, either Flex Barrier or Revident. The untreated sites served as controls. Photographs were taken before and immediately after the treatment, and again after one week and one month. To determine the size of the black triangles, Image J software was used. For statistical analysis, a mixed-design ANOVA was applied. Results Both Flex Barrier and Revident significantly decreased the size of the treated defects immediately after the treatment and also one week later (p<0.001). The beneficial effect of Revident lasted longer than Flex Barrier as it remained significant even after one month in Revident-treated patients, however, not in the Flex Barrier-treated group. Furthermore, Nordland-Tarnow Class I lesions generally showed a greater improvement than Class II lesions. Conclusion In this proof-of-concept, randomized clinical trial we have demonstrated the clinical applicability of both Flex Barrier and Revident, although Revident gave longer-lasting improvements than Flex Barrier. Further trials are needed to optimize multiple-application protocols for treating gingival black triangles.

Hyaluronic Acid Is an Effective Dermal Filler for Lip Augmentation: A Meta-Analysis

“…Due to its multiple advantageous properties, HA is also broadly used in other areas of tissue regeneration, such as orthopedics to treat osteoarthritis and rheumatoid arthritis (24,25). Moreover, it is utilized in ophthalmology, dermatology (26), as well as in certain dental procedures (27)(28)(29).…”

Potential for Hyaluronic Acid in Periodontal Research

“…Both groups showed relapse in 1 week and 1 month although not till the initial level of papilla the results were slightly better in group 2. It was also established that the smaller the defect better is the outcome with both the groups (27).…”

Interdental Papilla Regeneration: The Updates on Several Techniques

“…From 2016 till now, six studies on HA have been published including two RCTs, 12,14 two comparative studies, 19,20 and two case reports. 24,25 Black space reduction was noticed immediately after injection, 10 significant improvement after 3 months, 19,20 but less improvement was shown after 6 months.…”

“…Two studies administered HA using three step technique whereby each step consisted of 0.1 mL HA injection at mucogingival junction, attached gingiva, and 2 to 3mm from tip of papilla. 14 20 Alternatively, another study reported 0.1 mL HA injection at base of papilla and was repeated at 3 and 6 weeks. 19 Generally, there was a significant papillary reconstruction with better results observed in Class I Nordland 14 and thick gingiva.…”

“…CTG resulted in better black space reduction and keratinised tissue width compared to PRF. Both showed improvement from baseline Madel et al14 Twodifferent HA products compared to no HA group Both HA type reduced black triangle immediately and 1 week after injection Singh et al 15 CTG as control and PRF as test. A split thickness with envelope-type flap was elevated Complete interdental space filling was observed in 90% of test group and 95% of control group after 3 months.…”