Application of Hyaluronic Acid for Treatment of Interdental Papillary Deficiency: A Systematic Review and Meta-Analysis
Papillary Deficiency Treatment with Hyaluronic Acid
,
Abstract
Objectives: The focused question of this systematic review was “does hyaluronic acid (HA) injection in areas of interdental papillary deficiency reduce black triangles?”
Materials and Methods: A systematic literature search was performed to find clinical studies on human patients with a minimum of 6-month follow-up, published in English from 2005 to May 2020. There were two outcome variables: black triangle area (BTA) change after treatment at different measurement time points compared with baseline, and patient reported outcome measures (PROMs), when available.
Results: Of eight eligible articles (2 randomized clinical trials (RCTs) and 6 non-randomized, non-placebo controlled clinical studies), seven reported that HA injections had a positive impact on reduction of BTA and subsequent papillary augmentation. Six studies were included in meta-analysis and showed that the intervention led to a pooled reduction percentage of 57.7% in BTA after 6 months. Although there were clinical diversities between the studies, all the studies applied the same concentration of HA (approximately 2%), 2-3 mm apical to the papilla tip in several intervals. Some degrees of relapse were reported in some studies.
Conclusion: Within the limits of this study, this systematic review and meta-analysis showed that HA injection can serve as an efficient minimally-invasive treatment for small interdental papillary deficiencies. It is essential to conduct further randomized clinical studies with prolonged follow-ups in order to support this conclusion.
1. LaVacca MI, Tarnow DP, Cisneros GJ. Interdental papilla length and the perception of aesthetics. Pract Proced Aesthet Dent. 2005 Jul;17(6):405-12; quiz 414.
2. Azzi R, Etienne D, Carranza F. Surgical reconstruction of the interdental papilla. Int J Periodontics Restorative Dent. 1998 Oct;18(5):466-73.
3. Cunliffe J, Pretty I. Patients' ranking of interdental "black triangles" against other common aesthetic problems. Eur J Prosthodont Restor Dent. 2009 Dec;17(4):177-81.
4. Hassell TM. Tissues and cells of the periodontium. Periodontol 2000. 1993 Oct;3:9-38.
5. Kokich VO, Kokich VG, Kiyak HA. Perceptions of dental professionals and laypersons to altered dental esthetics: asymmetric and symmetric situations. Am J Orthod Dentofacial Orthop. 2006 Aug;130(2):141-51.
6. Kurth JR, Kokich VG. Open gingival embrasures after orthodontic treatment in adults: prevalence and etiology. Am J Orthod Dentofacial Orthop. 2001 Aug;120(2):116-23.
7. Adriaens PA, Adriaens LM. Effects of nonsurgical periodontal therapy on hard and soft tissues. Periodontol 2000. 2004;36:121-45.
8. Martegani P, Silvestri M, Mascarello F, Scipioni T, Ghezzi C, Rota C, et al. Morphometric study of the interproximal unit in the esthetic region to correlate anatomic variables affecting the aspect of soft tissue embrasure space. J Periodontol. 2007 Dec;78(12):2260-5.
9. Kokich VG. Esthetics: the orthodontic-periodontic restorative connection. Semin Orthod. 1996 Mar;2(1):21-30.
10. Tarnow DP, Cho SC, Wallace SS. The effect of inter-implant distance on the height of inter-implant bone crest. J Periodontol. 2000 Apr;71(4):546-9.
11. Chow YC, Eber RM, Tsao YP, Shotwell JL, Wang HL. Factors associated with the appearance of gingival papillae. J Clin Periodontol. 2010 Aug 1;37(8):719-27.
12. Becker W. Commentary. Esthetic considerations in interdental papilla: remediation and regeneration. J Esthet Restor Dent. 2010 Feb;22(1):29-30.
13. Sharma AA, Park JH. Esthetic considerations in interdental papilla: remediation and regeneration. J Esthet Restor Dent. 2010 Feb;22(1):18-28.
14. Lang NP, Lindhe J. Clinical Periodontology and Implant Dentistry. New York, NY, USA: John Wiley & Sons, 2015.
15. Schropp L, Isidor F. Papilla dimension and soft tissue level after early vs. delayed placement of single-tooth implants: 10-year results from a randomized controlled clinical trial. Clin Oral Implants Res. 2015 Mar;26(3):278-86.
16. Prato GP, Rotundo R, Cortellini P, Tinti C, Azzi R. Interdental papilla management: a review and classification of the therapeutic approaches. Int J Periodontics Restorative Dent. 2004 Jun;24(3):246-55.
17. Becker W, Becker BE. Flap designs for minimization of recession adjacent to maxillary anterior implant sites: a clinical study. Int J Oral Maxillofac Implants. 1996 Jan-Feb;11(1):46-54.
18. Palacci P, Nowzari H. Soft tissue enhancement around dental implants. Periodontol 2000. 2008;47:113-32.
19. Nemcovsky CE. Interproximal papilla augmentation procedure: a novel surgical approach and clinical evaluation of 10 consecutive procedures. Int J Periodontics Restorative Dent. 2001 Dec;21(6):553-9.
20. Lee EK, Herr Y, Kwon YH, Shin SI, Lee DY, Chung JH. I-shaped incisions for papilla reconstruction in second stage implant surgery. J Periodontal Implant Sci. 2010 Jun;40(3):139-43.
21. Nemcovsky CE, Moses O, Artzi Z. Interproximal papillae reconstruction in maxillary implants. J Periodontol. 2000 Feb;71(2):308-14.
22. Rappaport NH, Netscher DT. Plastic surgery techniques applicable to periodontal flap surgery. Periodontol 2000. 1996 Jun;11:95-102.
23. Becker W, Gabitov I, Stepanov M, Kois J, Smidt A, Becker BE. Minimally invasive treatment for papillae deficiencies in the esthetic zone: a pilot study. Clin Implant Dent Relat Res. 2010 Mar;12(1):1-8.
24. Sadat Mansouri S, Ghasemi M, Salmani Z, Shams N. Clinical application of hyaluronic acid gel for reconstruction of interdental papilla at the esthetic zone. J Iran Dent Assoc 2013; 25 (3) :208-213
25. Tanwar J, Hungund SA. Hyaluronic acid: Hope of light to black triangles. J Int Soc Prev Community Dent. 2016;6(5):497-500.
26. Awartani FA, Tatakis DN. Interdental papilla loss: treatment by hyaluronic acid gel injection: a case series. Clin Oral Investig. 2016 Sep;20(7):1775-80.
27. Lee WP, Seo YS, Kim HJ, Yu SJ, Kim BO. The association between radiographic embrasure morphology and interdental papilla reconstruction using injectable hyaluronic acid gel. J Periodontal Implant Sci. 2016 Aug;46(4):277-87.
28. Lee WP, Kim HJ, Yu SJ, Kim BO. Six Month Clinical Evaluation of Interdental Papilla Reconstruction with Injectable Hyaluronic Acid Gel Using an Image Analysis System. J Esthet Restor Dent. 2016 Jul;28(4):221-30.
29. Attenello NH, Maas CS. Injectable fillers: review of material and properties. Facial Plast Surg. 2015 Feb;31(1):29-34.
30. Fakhari A, Berkland C. Applications and emerging trends of hyaluronic acid in tissue engineering, as a dermal filler and in osteoarthritis treatment. Acta Biomater. 2013 Jul;9(7):7081-92.
31. Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ. 2011 Oct 18;343:d5928.
32. Schulz KF, Altman DG, Moher D. CONSORT 2010 statement: Updated guidelines for reporting parallel group randomised trials. J Pharmacol Pharmacother. 2010 Jul;1(2):100-7.
33. Moga C, Guo B, Schopflocher D, Harstall C. Development of a quality appraisal tool for case series studies using a modified Delphi technique. Institute of Health Economics. 2012. Available at: https://www.ihe.ca/publications/development-of-a-quality-appraisal-tool-for-case-series-studies-using-a-modified-delphi-technique.html.
34. Zeng X, Zhang Y, Kwong JS, Zhang C, Li S, Sun F, et al. The methodological quality assessment tools for preclinical and clinical studies, systematic review and meta-analysis, and clinical practice guideline: a systematic review. J Evid Based Med. 2015 Feb;8(1):2-10.
35. Tobías A, Campbell MJ. Modelling influenza epidemics in the relation between black smoke and total mortality. A sensitivity analysis. J Epidemiol Community Health. 1999 Sep;53(9):583-4.
36. Lee W-P, Kim H-J, Yu S-J, Kim B-O. Six Month Clinical Evaluation of Interdental Papilla Reconstruction with Injectable Hyaluronic Acid Gel Using an Image Analysis System. Journal of Esthetic and Restorative Dentistry. 2016;28(4):221-30.
37. Abdelraouf SA, Dahab OA, Elbarbary A, El-Din AM, Mostafa B. Assessment of Hyaluronic Acid Gel Injection in the Reconstruction of Interdental Papilla: A Randomized Clinical Trial. Open Access Maced J Med Sci. 2019 Jun 14;7(11):1834-1840.
38. Bertl K, Gotfredsen K, Jensen SS, Bruckmann C, Stavropoulos A. Can hyaluronan injections augment deficient papillae at implant-supported crowns in the anterior maxilla? A randomized controlled clinical trial with 6 months follow-up. Clin Oral Implants Res. 2017 Sep;28(9):1054-1061.
39. Singh S, Vandana KL. Use of different concentrations of hyaluronic acid in interdental papillary deficiency treatment: A clinical study. J Indian Soc Periodontol. 2019 Jan-Feb;23(1):35-41.
40. Ni J, Shu R, Li C. Efficacy Evaluation of Hyaluronic Acid Gel for the Restoration of Gingival Interdental Papilla Defects. J Oral Maxillofac Surg. 2019 Dec;77(12):2467-2474.
41. Nordland WP, Tarnow DP. A classification system for loss of papillary height. J Periodontol. 1998 Oct;69(10):1124-6.
42. Cardaropoli D, Re S, Corrente G. The Papilla Presence Index (PPI): a new system to assess interproximal papillary levels. Int J Periodontics Restorative Dent. 2004 Oct;24(5):488-92.
43. Chow YC, Wang HL. Factors and techniques influencing peri-implant papillae. Implant Dent. 2010 Jun;19(3):208-19.
2. Azzi R, Etienne D, Carranza F. Surgical reconstruction of the interdental papilla. Int J Periodontics Restorative Dent. 1998 Oct;18(5):466-73.
3. Cunliffe J, Pretty I. Patients' ranking of interdental "black triangles" against other common aesthetic problems. Eur J Prosthodont Restor Dent. 2009 Dec;17(4):177-81.
4. Hassell TM. Tissues and cells of the periodontium. Periodontol 2000. 1993 Oct;3:9-38.
5. Kokich VO, Kokich VG, Kiyak HA. Perceptions of dental professionals and laypersons to altered dental esthetics: asymmetric and symmetric situations. Am J Orthod Dentofacial Orthop. 2006 Aug;130(2):141-51.
6. Kurth JR, Kokich VG. Open gingival embrasures after orthodontic treatment in adults: prevalence and etiology. Am J Orthod Dentofacial Orthop. 2001 Aug;120(2):116-23.
7. Adriaens PA, Adriaens LM. Effects of nonsurgical periodontal therapy on hard and soft tissues. Periodontol 2000. 2004;36:121-45.
8. Martegani P, Silvestri M, Mascarello F, Scipioni T, Ghezzi C, Rota C, et al. Morphometric study of the interproximal unit in the esthetic region to correlate anatomic variables affecting the aspect of soft tissue embrasure space. J Periodontol. 2007 Dec;78(12):2260-5.
9. Kokich VG. Esthetics: the orthodontic-periodontic restorative connection. Semin Orthod. 1996 Mar;2(1):21-30.
10. Tarnow DP, Cho SC, Wallace SS. The effect of inter-implant distance on the height of inter-implant bone crest. J Periodontol. 2000 Apr;71(4):546-9.
11. Chow YC, Eber RM, Tsao YP, Shotwell JL, Wang HL. Factors associated with the appearance of gingival papillae. J Clin Periodontol. 2010 Aug 1;37(8):719-27.
12. Becker W. Commentary. Esthetic considerations in interdental papilla: remediation and regeneration. J Esthet Restor Dent. 2010 Feb;22(1):29-30.
13. Sharma AA, Park JH. Esthetic considerations in interdental papilla: remediation and regeneration. J Esthet Restor Dent. 2010 Feb;22(1):18-28.
14. Lang NP, Lindhe J. Clinical Periodontology and Implant Dentistry. New York, NY, USA: John Wiley & Sons, 2015.
15. Schropp L, Isidor F. Papilla dimension and soft tissue level after early vs. delayed placement of single-tooth implants: 10-year results from a randomized controlled clinical trial. Clin Oral Implants Res. 2015 Mar;26(3):278-86.
16. Prato GP, Rotundo R, Cortellini P, Tinti C, Azzi R. Interdental papilla management: a review and classification of the therapeutic approaches. Int J Periodontics Restorative Dent. 2004 Jun;24(3):246-55.
17. Becker W, Becker BE. Flap designs for minimization of recession adjacent to maxillary anterior implant sites: a clinical study. Int J Oral Maxillofac Implants. 1996 Jan-Feb;11(1):46-54.
18. Palacci P, Nowzari H. Soft tissue enhancement around dental implants. Periodontol 2000. 2008;47:113-32.
19. Nemcovsky CE. Interproximal papilla augmentation procedure: a novel surgical approach and clinical evaluation of 10 consecutive procedures. Int J Periodontics Restorative Dent. 2001 Dec;21(6):553-9.
20. Lee EK, Herr Y, Kwon YH, Shin SI, Lee DY, Chung JH. I-shaped incisions for papilla reconstruction in second stage implant surgery. J Periodontal Implant Sci. 2010 Jun;40(3):139-43.
21. Nemcovsky CE, Moses O, Artzi Z. Interproximal papillae reconstruction in maxillary implants. J Periodontol. 2000 Feb;71(2):308-14.
22. Rappaport NH, Netscher DT. Plastic surgery techniques applicable to periodontal flap surgery. Periodontol 2000. 1996 Jun;11:95-102.
23. Becker W, Gabitov I, Stepanov M, Kois J, Smidt A, Becker BE. Minimally invasive treatment for papillae deficiencies in the esthetic zone: a pilot study. Clin Implant Dent Relat Res. 2010 Mar;12(1):1-8.
24. Sadat Mansouri S, Ghasemi M, Salmani Z, Shams N. Clinical application of hyaluronic acid gel for reconstruction of interdental papilla at the esthetic zone. J Iran Dent Assoc 2013; 25 (3) :208-213
25. Tanwar J, Hungund SA. Hyaluronic acid: Hope of light to black triangles. J Int Soc Prev Community Dent. 2016;6(5):497-500.
26. Awartani FA, Tatakis DN. Interdental papilla loss: treatment by hyaluronic acid gel injection: a case series. Clin Oral Investig. 2016 Sep;20(7):1775-80.
27. Lee WP, Seo YS, Kim HJ, Yu SJ, Kim BO. The association between radiographic embrasure morphology and interdental papilla reconstruction using injectable hyaluronic acid gel. J Periodontal Implant Sci. 2016 Aug;46(4):277-87.
28. Lee WP, Kim HJ, Yu SJ, Kim BO. Six Month Clinical Evaluation of Interdental Papilla Reconstruction with Injectable Hyaluronic Acid Gel Using an Image Analysis System. J Esthet Restor Dent. 2016 Jul;28(4):221-30.
29. Attenello NH, Maas CS. Injectable fillers: review of material and properties. Facial Plast Surg. 2015 Feb;31(1):29-34.
30. Fakhari A, Berkland C. Applications and emerging trends of hyaluronic acid in tissue engineering, as a dermal filler and in osteoarthritis treatment. Acta Biomater. 2013 Jul;9(7):7081-92.
31. Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ. 2011 Oct 18;343:d5928.
32. Schulz KF, Altman DG, Moher D. CONSORT 2010 statement: Updated guidelines for reporting parallel group randomised trials. J Pharmacol Pharmacother. 2010 Jul;1(2):100-7.
33. Moga C, Guo B, Schopflocher D, Harstall C. Development of a quality appraisal tool for case series studies using a modified Delphi technique. Institute of Health Economics. 2012. Available at: https://www.ihe.ca/publications/development-of-a-quality-appraisal-tool-for-case-series-studies-using-a-modified-delphi-technique.html.
34. Zeng X, Zhang Y, Kwong JS, Zhang C, Li S, Sun F, et al. The methodological quality assessment tools for preclinical and clinical studies, systematic review and meta-analysis, and clinical practice guideline: a systematic review. J Evid Based Med. 2015 Feb;8(1):2-10.
35. Tobías A, Campbell MJ. Modelling influenza epidemics in the relation between black smoke and total mortality. A sensitivity analysis. J Epidemiol Community Health. 1999 Sep;53(9):583-4.
36. Lee W-P, Kim H-J, Yu S-J, Kim B-O. Six Month Clinical Evaluation of Interdental Papilla Reconstruction with Injectable Hyaluronic Acid Gel Using an Image Analysis System. Journal of Esthetic and Restorative Dentistry. 2016;28(4):221-30.
37. Abdelraouf SA, Dahab OA, Elbarbary A, El-Din AM, Mostafa B. Assessment of Hyaluronic Acid Gel Injection in the Reconstruction of Interdental Papilla: A Randomized Clinical Trial. Open Access Maced J Med Sci. 2019 Jun 14;7(11):1834-1840.
38. Bertl K, Gotfredsen K, Jensen SS, Bruckmann C, Stavropoulos A. Can hyaluronan injections augment deficient papillae at implant-supported crowns in the anterior maxilla? A randomized controlled clinical trial with 6 months follow-up. Clin Oral Implants Res. 2017 Sep;28(9):1054-1061.
39. Singh S, Vandana KL. Use of different concentrations of hyaluronic acid in interdental papillary deficiency treatment: A clinical study. J Indian Soc Periodontol. 2019 Jan-Feb;23(1):35-41.
40. Ni J, Shu R, Li C. Efficacy Evaluation of Hyaluronic Acid Gel for the Restoration of Gingival Interdental Papilla Defects. J Oral Maxillofac Surg. 2019 Dec;77(12):2467-2474.
41. Nordland WP, Tarnow DP. A classification system for loss of papillary height. J Periodontol. 1998 Oct;69(10):1124-6.
42. Cardaropoli D, Re S, Corrente G. The Papilla Presence Index (PPI): a new system to assess interproximal papillary levels. Int J Periodontics Restorative Dent. 2004 Oct;24(5):488-92.
43. Chow YC, Wang HL. Factors and techniques influencing peri-implant papillae. Implant Dent. 2010 Jun;19(3):208-19.
| Issue | Vol 20 (Continuously Published Article-Based) | |
| Section | Review Article | |
| DOI | https://doi.org/10.18502/fid.v20i19.12867 | |
| Keywords | ||
| Hyaluronic Acid Dental Papilla Gingival Recession Esthetics Dental Gingiva | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Makdisi J, akbari solmaz, Zayeri F, AslRoosta H, Yaghobee S. Application of Hyaluronic Acid for Treatment of Interdental Papillary Deficiency: A Systematic Review and Meta-Analysis. Front Dent. 2023;20.
