Managementofinterdental 1 n 2 periodonticsprevention. The reepithelialization of traumatic injuries can completely restore the papilla 1. Prosthetic gingival reconstruction in a fixed partial restoration. Oct 12, 20 immediate dental implants papilla reconstruction explicit. The patient was assessed according to nordland and. Lost interdental papilla commonly known as black triangles are of great concern from the aesthetic as well as phonetics point of view when occurs in the anterior maxillary region. Sandhu, dds, phd, dip perio abstract migration of maxillary anterior teeth because of the loss of periodontal support can alter the appearance of the esthetic zone. Interproximal papillae reconstruction around implant using. Immediate dental implants papilla reconstruction explicit. Management of papillary loss has shown limited success and is limited to case reports with lack of longterm followup.
Han and takei, used palatal region as donor site where as azzi et al. Loss of interdental papilla is one of the most concerning esthetic problem for the patient and equally challenging for the clinician. Also, papilla reconstruction was maintained for 12 months in the mesial and distal embrasure spaces of the flat platform implant. It has been noted by jemt that the height of the interdental papilla increases over a 2year period after crown delivery 80% of the time.
The present case series demonstrates an interdisciplinary approach with a combination of modified beagles technique and composite restoration to reconstruct interdental papilla between maxillary central incisors with 6 months follow up. Black triangle, subepithelial connective tissue graft,interdental papilla, papilla reconstruction. Pdf the association between radiographic embrasure. Reconstruction of deficit interdental papillae j dent specialities. Loss of interdental papilla marks phonetics, functional and esthetic problem. Surgical reconstruction of interdental papilla using subepithelial.
Iatrogenic causes such as flap surgeries and excision of pyogenic granuloma may also predispose to recession of interdental soft tissue. Honestly, i was hoping i never have to come back here after two years worth of headaches with teeth issues and finally having some relief after everything seemed to have calmed down last year in dec. On clinical examination class ii type of interdental papilla loss was seen between 21 and 22figure 9. The borders of dental papilla are superiorly the base of the. Pdf interdental papilla reconstruction in adult orthodontics. Use of hyaluronic acid as an alternative for reconstruction of interdental papilla 200 mx introduction within the context of historical background we find that in 1934, karl meyer and his assistant john palmer isolated hyaluronic acid ha from cows eyes vitreous humor, for them, it was an unknown chemical substance. Interdental recession or loss of the interdental papilla is one of the greatest challenges facing the dental team. Simplified method of interimplant papilla preservation around. Application of hyaluronic acid gel for reconstruction of interdental papilla was successful in a 6month period. It can be concluded that subepithelial connective tissue graft may be used to successfully augment the gingival papillae adjacent to single tooth implant restoration. Both implants were placed in such way that the interimplant distance was. Dental esthetics is just not confined to the tooth as such but also to the gingival component softtissue.
Complete reconstruction of the lost papilla was achieved in all the three cases 6 months postoperatively. Assessment of papilla contour index showed 90% aesthetic success both for mesial and distal papilla at 6 months. The loss of the papilla in your case is a combination of factors including. In the posterior region, it is broader and was formerly described as having a concave col or bridge shape cohen 1959. Han and takei7 proposed an approach for papilla reconstruction semilunar coronally reposi. The poor esthetic appearance caused by the black triangle, especially in the maxillary anterior region has been a. An evaluation of a periodontal plastic surgical procedure for. Restorative dentistry and papilla reconstruction in reduced periodontium robert azzi, daniel etienne, bernard schweitz restoring the loss of periodontal soft and hard tissues represents a unique challenge for the dental team. Use of prf may thus be the panacea for interdental papilla augmentation. In the second follow up, 10% of subjects showed improvement in interdental papilla reconstruction by 50%. Interdental papilla reconstruction combining periodontal. The interdental papillae fill in the area between the teeth apical to their contact areas to prevent food impaction. Thorough treatment planning is essential for maintenance of the height of the interproximal papillae.
The patient exhibited loss of interdental papilla in the area of tooth number 11 and 21 caused by presence of gingivitis and poor brushing techniques. Misch, in dental implant prosthetics second edition, 2015. Beagle 6 described a pedicle graft procedure utilising the soft tissues palatal to the interdental area to reconstruct new papilla. However, the reconstruction of the lost interdental papilla has been elusive. Jcdr black triangle, subepithelial connective tissue graft. Surgical reconstruction of interdental papilla using. Interdental papilla loss is strongly associated with increasing age, periodontal diseases and post orthodontic treatment.
Carnio, surgical reconstruction of interdental papilla using an interposed subepithelial connective tissue graft. Lee and colleagues 20168 used ha application in interdental papilla of esthetic area, and evaluated its reconstruction with radiographies and anatomical factors. Surgical augmentation of interdental papilla a case series santhanakrishnan muthukumar. This type of recession defect is due to the loss of the interproximal periodontal attachment apparatus. One goal of periodontal plastic surgery is the reconstruction of the interdental papilla. You can either select the files you want to merge from you computer or drop them on the app using drag. S dental college, aurangabad, india 2 department of biotechnology, deogiri college, aurangabad, india. Treatment planning and its sequencing frequently require not only restorative and periodontal care, but also orthodontic therapy.
This causes an enormous effect on the self esteem of a person. Interdental papilla reconstruction combining periodontal and orthodontic therapy in adult periodontal patients. The interdental papillary reconstruction was fairly successful. Interdental papilla an overview sciencedirect topics. The role of subepithelial connective tissue graft for. Papilla reconstruction procedure 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 like papilla reconstruction procedure. Interdental papillae reconstruction inside dental technology. The aesthetics of the patient can be improved by surgical reconstruction of interdental papilla by using an advanced papillary flap interposed with subepithelial connective tissue graft materials and methods. Aesthetic papillary reconstruction a case report of a. Surgical considerations currently there is no predictable surgical procedure to retrieve the interdental papilla 29. Interdental papilla augmentation along with reconstruction of interdental bone to create appropriate support for gingival papilla has been reported. Complete interdental papilla reconstruction was performed when black triangle at initial examination had area of. The surgical techniques used for papilla reconstruction include several approaches.
The purpose of this study was to predict the midline papilla reconstruction in treated median diastema of variable etiology. Inter dental papilla loss, black triangle, papilla reconstruction. Historically, periodontal treatment has been aimed more at the preservation and restoration of health to the periodontium than at the esthetic outcome of treatment. To restore sustainable periodontal health and the normal, esthetic appearance of a healthy 37yearold woman with generalized advanced chronic periodontitis in the maxillary. Migration of maxillary anterior teeth because of the loss of periodontal support can alter the appearance of the esthetic zone. Reconstruction of the lost interdental papilla is one of the most challenging and least predictable problem and hence, it is very important to respect papillary. Surgical reconstruction of the interdental papilla. Splinting of teeth prior to papillary reconstruction may be considered to prevent diastema formation. Interdental papilla, periodontal plastic surgery, platelet rich fibrin. However, even with these different surgical techniques with different flap designs, results are elusive, not predictable and longterm stability are lacking.
Clinical application of hyaluronic acid gel for reconstruction of. The aim of this study is to evaluate the clinical outcome of using the hyaluronic acid gel in reconstructing interdental papillae at the aesthetic zones in a followup period of six months. Methods fiftyseven treated sites from patients 6 males and 7 females were included. The most satisfactory and natural appearance can be obtained by augmenting. In such a scenario connective tissue graft ctg is considered the gold standard for.
Nordland and sandhu published their landmark paper showing not only the successful technique but also more than 10 years of post operative longevity. The interdental papilla reconstruction was fairly successful. Remediation and regeneration, william becker, dds, msd, doi 10. In most of the cases the new technique was consistent for interimplant papilla reconstruction. Several reasons contribute to the loss of interdental papillae, and various surgical and nonsurgical techniques for papillary reconstruction have been proposed. The interdental papillae in the esthetic zone can be a dilemma for both the patient and the therapist. Pdf surgical reconstruction of the interdental papilla.
Root coverage and papilla reconstruction in class iv recession. Jemt in 1999 proposed a technique of preserving the interdental papilla by means of placing a provisional temporary crown which acted as. New technique for inter implant papilla original article of a. Reconstruction of interdental papilla with plateletrich. To achieve reconstruction of the lost interdental papilla is difficult and challenging, as it is associated with the patient smile and esthetics. Out of the 15 embrasure spaces analysed, 100% showed papilla reconstruction at first prosthesis insertion, only 2. Comparison of two surgical techniques for the reconstruction. A total of fifteen sites from ten patients having black triangles papilla recession in the maxillary anterior region were selected and subjected to presurgical evaluation. Postoperative evaluation was done after a week in a month interval for three months. The interdental papilla may be lost or reduced in height, forming black triangles due to various reasons, which gives an unaesthetic appearance when the patient smiles. Immediate dental implants papilla reconstruction vumedi. Surgical microscope was used at 6x magnification in this study to enhance the visual acuity in the narrow. To present a clinical case involving interdental papilla reconstruction with ha in. The recipient site of the interdental space where the papilla is to be created provides a small surface area for either free grafting or pedicle grafting in terms of blood supply for the donor tissue.
Surgical techniques are diverse, but none have given predictable results. The lack of interdental papillae display was the patients chief concern. Surgical augmentation of interdental papilla a case. Interdental papilla definition of interdental papilla by. Clinical evaluation of a surgical procedure for the reconstruction of the interdental papillae, as a treatment modality for unesthetic open embrasure in the maxillary anterior region a pilot study. Reconstruction of lost interdental papilla once the contact point is restored in midline diastema cases are as well important in restoring the esthetics as closure of diastema. Interdental papilla medical definition merriamwebster.
Introduction one of the major aesthetic challenges in periodontal plastic surgery is related to the ability of rebuilding the lost papilla in the maxillary anterior segment. Surgical reconstruction of lost interdental papilla. Interimplant papilla reconstruction by using demineralized. This case report shows a simplified nonsurgical method of preserving the interimplant papilla in the maxillary aesthetic zone. New technique for interimplant papilla reconstruction. The patients were treated for interdental papilla reconstruction with a partial thickness flap. Therefore these benefits of subepithelial connective tissue graft could be utilised for the reconstruction of interdental papilla. Eighty percent of the time it was 6 mm or more figure 2155. Various noninvasive and invasive techniques have been used to augmentreconstruct the interdental papilla, to reclaim the pink triangle.
A 24 year old male patient reported to department for routine dental checkup. Complete reconstruction of the lost papilla was achieved in both the cases 6 months postoperatively. Moreover, the col is a valleylike depression, which connects the buccal and lingual papilla and takes the form of the interproximal contact. One of the most difficult achievements in the periodontal therapy is the reconstruction of interdental papilla that has been lost by periodontal disease. Regeneration of interdental papillae using periodic curettage. A novel tissue engineering technique for regeneration of lost. Interdisciplinary approach to reconstruct papilla in. A novel incision design for interdental papilla reconstruction. There is correlation between ha and interdental papilla growth as long as scientificclinical bases are taken into account such as the nordland and tarnow studies. Int j periodontics a similar surgical procedure using for both the patient and the orthodontist. Reconstruction of interdental papilla using hyaluronic acid the safety and scientific validity of this study is the responsibility of the study sponsor and investigators.
Abstract reconstruction of the interdental papilla that has been lost because of trauma or inflammatory periodontal disease is one. Papilla reconstruction for many years it was thought that once the interdental papilla was lost it was impossible to replace it. Clinical evaluation of papilla reconstruction using. A comparative evaluation of papillary reconstruction by. Fiftyseven sites from patients 6 males and 7 females who had papillae deficiency in the upper anterior area were included in their study. Minimally invasive treatment for reconstruction of deficit. Use of hyaluronic acid as an alternative for reconstruction. The loss of contacts between adjacent teeth results in the recession of interdental papillae.
This article is accompanied by commentary, esthetic considerations in interdental papilla. Ta thickening seen as an elevation of the gingiva that fills the interproximal space between two adjacent teeth. Simplified method of interimplant papilla preservation. Black triangle dilemma and its management in esthetic dentistry. The poor aes thetic appearance in the maxillary anterior as a re sult of the lost papilla has been a dilemma for both the patient and the therapist. In this case since no soft and hard tissue defects were present, restorative method of preserving the interdental papilla was made. In them, it is explained that before undertaking interdental papilla reconstruction, vertical distance between bone crest and apical of crown contact area must be evaluated. Comparison of two surgical techniques for the reconstruction of interdental papilla s shruthi 1, sheela kumar gujjari 2, kiran prakash mallya 3 1 department of periodontology, sri siddhartha dental college and hospital, a constituent of sri siddhartha university, agalkote, tumkur, india 2 department of periodontology, jss dental college and hospital, a constituent of jss university, mysore. However, recent advances have enhanced the periodontists ability to address esthetic concerns. Root coverage and papilla reconstruction using autogenous osseous and connective tissue grafts. In the third follow up at 6 months 43% of samples showed 50% improvement or higher. Reconstruction of interdental papilla using hyaluronic acid. The previous attempts were made to augment the interdental papilla using displaced flaps, connective tissue grafts, and repeated inflammatory stimulation, with diverse results. A novel tissue engineering technique for regeneration of.
The loss of interdental papilla between teeth leads to formation of unaesthetic. Papers related to interdental and interimplant papillae published over the last 30 years were selected and analyzed. Listing a study does not mean it has been evaluated by the u. A novel tissue engineering technique for regeneration of lost interdental papillary height rutuj surana 1, vaishali ashtaputre 1, satish doiphode 1, kiran kharat 2, purshottam rakhewar 1, maya mhaske 1 1 department of periodontics, c. Interdental papilla reconstruction in adult orthodontics article pdf available in world journal of orthodontics 51. Absence of interdental papilla raises concern over phonetic. Interdental papilla reconstruction combining periodontal and. Simultaneous surgical excision of localized gingival overgrowth and papilla reconstruction with subepithelial connective tissue graft. Restorative dentistry and papilla reconstruction in. Nonsurgical methods include restorative, prosthetic and orthodontic techniques to maintain or achieve sufficient interimplant papilla for a pleasing esthetic outcome. In all the three cases a free connective tissue graft was used to reconstruct the lost volume of interdental papilla.
Interdental papilla reconstruction especially at the esthetic zone is among the most difficult periodontal treatments. A novel surgical procedure for papilla reconstruction using. Ceramic veneers with gingivashaded porcelain to replace lost interdental papillae. The interdental papilla, interdental gingiva, is the part of the gingiva that exists coronal to the free gingival margin on the buccal and lingual surfaces of the teeth.
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