Minimally invasive treatment for reconstruction of deficit interdental papillae: a pilot study

Background and Aim: Black triangles, the open interdental embrasures appear very unaesthetic and may give rise to various concerns chiefly, food impaction, difficulty in phonetics and gradually periodontitis. Gingival black triangles have a multifactorial etiology and a range of treatment options. The aim of this study was to evaluate the clinical application of injectable hyaluronic acid gel (non-animal based) for reconstruction of gingival black triangles in anterior esthetic zone. Materials and Methods: Four systemically healthy adult individuals with at least one anterior site with class I or class II interdental papilla loss were recruited. Following local anesthesia, ~0.2 ml of hyaluronic acid gel was injected directly into the base of papilla 2-3 mm apical to the coronal tip of the involved papilla using 23 gauge needle. The injection was repeated after 20 days. The patients were monitored for the results in the subsequent follow-ups. Lost papilla surface area was calculated using clinical photographs taken at baseline, 1 month, 3 month and 6 month post-operative follow-ups. Differences in the lost papillary surface area between baseline and post-operative clinical photographs were statistically analyzed using SPSS 19.0 version using ANOVA test. Results: Each site was individually evaluated.Application of hyaluronic acid for reconstruction of gingival black triangle was successful in a 6-month follow-up period. 5 sites had complete papilla reconstruction and 3 sites had 34-57% of reconstruction rate. Conclusion: Results from this pilot study are encouraging and present the evidence that class I and class II gingival black triangles can be enhanced by injecting hyaluronic acid gel. Thus injectable hyaluronic acid gel may be a promising treatment for enhancing gingival papillary esthetics.