• 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.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 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 Dental Rehabilitation and Applied Science
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• v.30 no.1
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• pp.81-92
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• 2014

It is so hard to obtain optimal anterior esthetics in the implant prosthesis. This is not only because of hard and soft tissue problem such as alveolar bone resorption and interdental papilla loss but also because of prosthetic limitation related to marginal exposure of metal abutment and metal ceramics and low transillumination. In this case, guided soft tissue healing is obtained using a long term provisional restoration with soft and hard tissue augmentation or immediate implantation. Then, this healed tissue is transferred to final master model using a customized impression coping and the implant is restored with a customized zirconia abutment and a all ceramics. This case presents satisfying result esthetically and functionally.