• Journal of the Korean Academy of Esthetic Dentistry
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• v.10 no.1
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• pp.30-45
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• 2001

In recent years, clinicians' and dentists' esthetic demands in dentistry have increased rapidly. The ultimate goal in modern restorative dentistry is to achieve "white" and "pink" esthetics in the esthetically important zones. Therefore, modern esthetic dentistry involves not only the restoration of lost teeth and their associated hard tissues, but increasingly the management and reconstruction of the encasing gingiva with adequate surgical techniques. Interdental space are filled by interdental papilla in the healthy gingiva, preventing plaque deposition and protecting periodontal tissue from infection. This also inhibits impaction of food remnants and whistling through the teeth during speech. These functional aspects are obviously important, but esthetic aspects are important as well. Complete and predictable restoration of lost interdental papillae remains one of the biggest challenges in periodontal reconstructive surgery. One of the most challenging and least predictable problems is the reconstruction of the lost interdental papilla. The interdental papilla, as a structure with minor blood supply, was left more or less untouched by clinicians. Most of the reconstructive techniques to rebuild lost interdental papillae focus on the maxillary anterior region, where esthetic defects appear interproximally as "black triangle". Causes for interdental tissue loss are, for example, commom periodontal diseases, tooth extraction, excessive surgical periodontal treatment, and localized progressive gingiva and periodontal diseases. If an interdental papilla is absent because of a diastema, orthodontic closure is the treatment of choice. "Creeping" papilla formation has been described by closing the interdental space and creating a contact area. In certain cases this formation can also be achieved with appropriate restorative techniques and alteration of the mesial contours of the adjacent teeth. The presence of an interdental papilla depends on the distance between the crest of bone and the interproximal contact point, allowing it to fill interdental spaces with soft tissue by altering the mesial contours of the adjacent teeth and positioning the contact point more apically. The interdental tissue can also be conditioned with the use of provisional crowns prior to the definitive restoration. If all other procedures are contraindicated or fail, prosthetic solutions have to be considered as the last possibility to rebuild lost interdental papillae. Interdental spaces can be filled using pink-colored resin or porcelain, and the use of a removable gingival mask might be the last opportunity to hide severe tissue defects.

• Journal of Periodontal and Implant Science
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• v.46 no.4
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• pp.277-287
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• 2016

Purpose: The purpose of this study was to evaluate the clinical efficacy of enhancing deficient interdental papilla with hyaluronic acid gel injection by assessing the radiographic anatomical factors affecting the reconstruction of the interdental papilla. Methods: Fifty-seven treated sites from 13 patients (6 males and 7 females) were included. Patients had papillary deficiency in the upper anterior area. Prior to treatment, photographic and periapical radiographic standardization devices were designed for each patient. A 30-gauge needle was used with an injection-assistance device to inject a hyaluronic acid gel to the involved papilla. This treatment was repeated up to 5 times every 3 weeks. Patients were followed up for 6 months after the initial gel application. Clinical photographic measurements of the black triangle area (BTA), height (BTH), and width (BTW) and periapical radiographic measurements of the contact point and the bone crest (CP-BC) and the interproximal distance between roots (IDR) were undertaken using computer software. The interdental papilla reconstruction rate (IPRR) was calculated to determine the percentage change of BTA between the initial and final examination and the association between radiographic factors and the reconstruction of the interdental papilla by means of injectable hyaluronic acid gel were evaluated. Results: All sites showed improvement between treatment examinations. Thirty-six sites had complete interdental papilla reconstruction and 21 sites showed improvement ranging from 19% to 96%. The CP-BC correlated with the IPRR. More specifically, when the CP-BC reached 6 mm, virtually complete interdental papilla reconstruction via injectable hyaluronic acid gel was achieved. Conclusions: These results suggest that the CP-BC is closely related to the efficacy of hyaluronic acid gel injection for interdental papilla reconstruction.

• Journal of the Korean Academy of Esthetic Dentistry
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• v.30 no.2
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• pp.91-101
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• 2021

The interdental papilla area is a difficult area for connective tissue graft (CTG) due to its narrow space. So Regeneration of interdental papilla is very challenging work. It is very difficult when the teeth have contact with adjacent teeth, but if there was only 3mm of space between the teeth, CTG was not very difficult. Therefore, through the orthodontic force, a 3mm space between the teeth was intentionally created. The CTG was performed using a microblade, and only one vertical incision was performed off the gingival margin, and the graft was performed by inserting the grafts through here. After a period of maintenance, I was able to gather the teeth again with orthodontic force and regenerate the interdental papilla. I named this technique ELSA Technique (Enlargement of space - Labial graft - Squeezing - for Augmentation of papilla). If interdental papilla is lost due to periodontal disease, ELSA techniques can regenerate interdental papilla very efficiently.

• Journal of the Korean Academy of Esthetic Dentistry
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• v.29 no.2
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• pp.84-91
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• 2020

Regeneration of interdental papilla damaged by periodontal disease is a very challenging task. So far, many dentists have devised and introduced great surgical methods. Comparing the pros and cons of the methods introduced so far, I came up with the best way to regenerate interdental papilla. Temporarily creating space between narrow interdental papilla, which cannot be solved by periodontal surgery alone, was a great help for connective tissue graft(CTG). The CTG was performed using a microblade, and only one vertical incision was performed off the gingival margin, and the graft was performed by inserting the grafts through here. Along with the orthodontic treatment, the area between the narrow interdental papilla was widened to make it easier for the CTG was carried out. After a period of maintenance, I was able to gather the teeth again with orthodontic force and regenerate the interdental papilla. I named this method ELSA (Enlargement of space-Labial graft-Squeezing-for Augmentation of papilla) technique.

• Journal of Periodontal and Implant Science
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• v.41 no.6
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• pp.273-278
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• 2011

Purpose: To analyze the dimensions of the embrasure space between the maxillary central incisors as potential factors influencing interdental papilla fill and height. Methods: The embrasure dimensions between the maxillary central incisors of 100 subjects (40 females/60 males) were assessed with clinical, study model, and radiographic examinations. Variables of the complete and deficient papilla fill groups were compared. Multiple regression analyses were performed to investigate potential influence of the distance between the contact point and bone crest (CP_BC), horizontal interdental distance (HID), and facio-lingual thickness (FLT) at the papilla base on complete/deficient papilla fill and papilla height (PH). Results: CP_BC was the only variable that showed a significant difference between the complete and deficient papilla groups (P<0.05). When the CP_BC was less than 5 mm, the embrasure spaces between the maxillary central incisors were completely filled with interdental papilla. Multiple regression analyses revealed that a significant predictor for complete/deficient papilla fill was CP_BC, and significant predictors for PH were CP_BC and HID (P<0.05). Conclusions: The chances of complete papilla fill increased as CP_BC decreased, while PH increased as CP_BC and HID increased. However, the FLT of the papilla base did not appear to affect papilla fill or PH. From an esthetic perspective, CP_BC as well as HID should be considered as factors influencing the topography of interdental papilla.

• Journal of Periodontal and Implant Science
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• v.31 no.3
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• pp.633-640
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• 2001

As the public becomes concerned with looking younger and healthy, aesthetic considerations will become more relevant to dental treatment planning. The purpose of this study was to evaluate the relationship between interdental papilla existence and the distance from contact point to interdental alveolar crest in the maxillary anterior dentition of korean. Fifty-nine Korean adult consist of adults. 34 males and 25 females participated in the study. Papilla Index(PI) was recorded. The distance between contact point and interdental alveolar crest was measured by sounding with Williams probe. Measurement were carried out in 257 maxillary anterior interproximal area. The results showed that mean PI was 1.95 and mean distance between contact point and interdental alveolar crest was 5.07mm. The correlation between the papilla index and distance was negative and statistically significant(r=-0.819; p=0.000). A high negative correlation existed between PI and distance from contact point to alveolar crest. When the distance between contact point and alveolar crest was 4mm, the papilla got lost on a half of all cases. When the distance was 5mm, the papilla was present almost 11%. When the distance was 6mm, the papilla was present 4%. When the distance was 7mm or more, the papilla was lost in all cases.

• The Journal of Korean Academy of Prosthodontics
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• v.55 no.3
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• pp.286-291
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• 2017

Maintaining the blood supply of the interdental alveolar bone is crucial for preserving the interdental papilla. Rebuilding the interimplant papilla between adjacent implants is more difficult than rebuilding the interdental papilla between the natural tooth and implant. Therefore, preserving the interimplant tissue is necessary when adjacent implants are closely placed. In this case report, three effective methods for maintaining the surrounding tissue, namely strategic serial extraction, immediate implantation, and provisionalization of adjacent maxillary central incisors, were performed. The marginal gingiva and interimplant papilla were well maintained for 24 months.

• Journal of Periodontal and Implant Science
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• v.31 no.3
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• pp.625-631
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• 2001

The anatomic structure around interproximal area plays an important role not only in the natural teeth, but also in the implant. The loss of papilla can lead to cosmetic deformity, phonetic problem, food impaction on the anterior dentition, and masticatory problem, food impaction and proximal caries on the posterior dentition. The purpose of this study was to evaluate the relationship between interdental papilla existence and distance from contact point to alveolar crest in Korean posteior dentition. 45 Korean adult patients(31males, 14 females) participated in this study. Measurements were carreid out total 126 interproximal areas, 18 first premolar, 31 second premolar, 40 first molar, and 37 second molar areas. Papilla index was recorded as suggested by Jemt. Distance between contact point and alveolar crest measrued by Florida $probe^{R}$, after flap elevation. Each distance was measured 10 times by every 0.1mm unit. The results showed that the mean Papilla index 1.37 and mean distance between contact point and alveolar crest was 7.44mm. The correlation between the Papilla index and distance was high negative correlation(Pearson correlation=-0.47), and it was statistically significant(P=0.000) When the distance between contact point and alveolar crest was 5mm, the loss of papilla was appeared almost in half cases. When the distance was 6mm, the papilla loss was present 95%, when 7mm, the papilla loss was 100%.

• Journal of Periodontal and Implant Science
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• v.33 no.4
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• pp.563-571
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• 2003

One of the central components of periodontal therapy is the improvement of esthetics. The presence and appearance of interdental papillae plays an important role of periodontal esthetics. The aim of the present study was to investigate how immediate provisional restoration preserve the shape of interdental papilla around the extraction socket and the width of bucco-lingual of gingiva. Another aim was to investigate the change in the interdental papilla and the amount of vertical bone fill of a extraction socket in relation to the interdental alveolar bone levels adjacent the alveolar socket. A total of 19 patients (11 male, 8 female, mean age of 50.57${\pm}$8.16), who visited the Department of Periodontology, Pusan National University and had more than one anterior tooth scheduled to be extracted due to an advanced periodontal disease were included in the present study. After initial periodontal therapy, the extracted teeth were reshaped of the root and placed into the socket followed by splinting with adjacent teeth with self-curing resin. The width of hucco-lingual of gingiva and interdental papilla height were measured at baseline, 1, 3, 6, 9 and 12 month and the periapical radiographic examination were taken at baseline, 6 and 12month following the extraction. The amount of vertical bone fill in the extraction socket were calculated. At 12 months following the extraction, the changes in mesial and distal interdental papilla and the width of bucco-lingual showed -1.06${\pm}$0.48mm, -0.844${\pm}$0.50mm, -1.50${\pm}$0.96m, relatively. The positional change in the interproximal papillae was significantly associated with the interdental bone level adjacent to the extraction socket(p=0.028). The higher the interproximal bone level adjacent the extraction socket, the greater the amount of bone fill in the extraction socket(p<0.001). In conclusion, it was thought that immediate provisional restoration could minimize the loss of the width of bucco-lingual and interproximal papillae around the extraction socket. In addition, the higher the interproximal bone level adjacent the extraction socket, the greater the amount of bone fill and the smaller the reduction of papillary height around the extraction socket.

• Journal of Periodontal and Implant Science
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• v.26 no.3
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• pp.763-769
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• 1996

A depressed alvelolar ridge and a collapsed interdental papilla in the anterior region may interfere with esthetic prosthodontic repair. The resultant sequelas will cause overcontoured prosthesis or dark shadow under pontic which may not suffice our patients' esthetic demands. So, surgical periodontal treatment has been needed for esthetic repair in deformed ridges and extensive interproximal spacing. Our treatment option alters Dr.Abram's roll technique to make palatally extended connective tissue secondary pedicle flap to obtain additonal connective tissue. Blood supply maintenance, least trauma, and no secondary wound is advantages in this modification.