Hyaluronic acid vs. physiological saline for enlarging deficient gingival papillae: a randomized controlled clinical trial and an in vitro study

Abstract

Background: loss of the interdental papillae leads to the formation of a black triangle, which compromises smile esthetics and contributes to food impaction and plaque accumulation. The aim of this study was to evaluate the efficacy of the injection of hyaluronic acid (HA) and compare it to that of physiological saline solution in the restoration of deficient gingival papillae in vivo and in vitro.Methods: Twenty-four patients with 68 deficient gingival papillae were recruited for this clinical trial with a split-mouth design. The deficient gingival papillae on one side of the anterior maxilla were injected with HA, and those on the other side were injected with physiological saline solution. The heights of the gingival papillae and the areas of the black triangles were measured from clinical photographs obtained before and 6 and 12 months after treatment. Additionally, the proliferation and migration of gingival fibroblasts were evaluated after HA and physiological saline treatment by an in vitro study.Results: the results revealed that the injection of HA yielded 0.198 and 0.28 mm gingival papilla increasement at 6 and 12 months, respectively, relative to the baseline (P<0.05). However, deficient gingival papillae also grew by 0.278 mm at 12 months in the group that received physiological saline solution (P<0.05).The injection of HA significantly improved deficient gingival papillae 6 months earlier than the injection of physiological saline solution. HA also significantly accelerated the proliferation and migration of gingival fibroblasts in vitro.Conclusions: The present study confirms that the injection of HA could increase the height of gingival papillae for improving gingival papilla defects. However, the effect is not superior to that of physiological saline solution. This trial was registered in the Chinese Clinical Trial Registry (ChiCTR-ONC-17011781)

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

“…The Deficient Area reduction was 13.6% and 23.6% at 6 and 12 months, respectively, which is slightly worse than ours, in spite of a double HA concentration used. It is possible that in the Ni et al study [ 11 ], the larger baseline Deficient Area with respect to our study (1.9 vs. 0.61 mm 2 ) reflected a reduced regenerative potential.…”

“…Ni et al evaluated injections of 16 mg/mL HA (corresponding to 1.6%) against physiological saline solution in the reconstruction of deficient gingival papillae [ 11 ]. The multiple injection protocol was similar to ours (baseline, 3 and 6 weeks later), and the follow-up was at 6 and 12 months.…”

“…Injecting HA into the connective tissue has been proposed to solve the issue of interdental papilla recession, by promoting the migration of fibroblasts and fibrogenesis [ 3 , 10 ]. Hitherto, a handful of studies have described the effect of injecting HA as a filler for lost interdental papilla reconstruction, and most previous studies were case series with a relatively small sample size [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ]. All these studies concluded that the use of HA to treat deficient interdental papilla results in significant improvement, and therefore it appears as a promising therapy to address patients’ aesthetic concerns.…”

Systematic Review and Meta-Analysis of the Use of Hyaluronic Acid Injections to Restore Interproximal Papillae

“…Even more, it had the lowest dispersion. The study by Ni [17] has a high sample size but with a large amplitude, which reduced its weight in this review by up to 6%.…”

“…Overall, there was statistically significant difference in black triangle reduction between maxillary and mandibular sites at 3 and 6 months with more reduction observed in maxillary one. On the other hand, the study of Ni [17] was the only one RCT that concluded the study with a comparison with physiological saline solution with no statistically significant differences. The study used a split-mouth design.…”