CTRI

The interdental papilla is a part of the gingival tissue that fills the space between teeth, known as the gingival embrasure located just beneath the area where the teeth come into contact. It is gingival tissue that is keratinized and covered by stratified squamous epithelium.

In the case of anterior teeth the interdental papilla usually has a pyramidal shape, while in posterior teeth, it adopts a more col shaped form. The facial and lingual surfaces gradually taper towards the interproximal contact area, while the mesial and distal surfaces exhibit a slight concavity.

The form, location, and existence of the interdental papilla are influenced by the underlying alveolar bone, the proximal contact point, and the approximal area of adjacent teeth. Cohen was the first to describe its morphology

The papillae in the maxillary anterior region plays an important role in dental aesthetics. An open gingival embrasure can lead to various complications, including food impaction, increased plaque buildup, reduced self-cleansing ability, and a higher risk of periodontal disease².

The absence of papilla results in a visible gap between teeth, commonly referred to as a black triangle¹. Several factors contribute to the formation of black triangles, such as periodontal disease, root angulation, triangular-shaped crowns, improper brushing techniques, aging, tooth loss, and the length of the embrasure area¹^.

Several techniques can be utilized to restore missing gingival papilla, including restorative procedures, orthodontic treatment, interdisciplinary approaches and various surgical augmentation methods⁴. Among the surgical options, the autogenous subepithelial connective tissue graft is highly recommended due to its superior aesthetics, long-term stability, predictable and reproducible outcomes. However, its major drawback lies in the need for donor site that creates an additional surgical site to harvest the graft, which may reduce patient’s willingness².

There is a greater emphasis on minimally invasive periodontal therapy, as it offers the advantages of faster healing, enhanced aesthetics, minimally invasive, and greater patient compliance².

Hyaluronic acid (HA) is recently used as a gingival filler for the reconstruction of lost interdental papillae¹. It is an important part of the structural matrix, HA plays a crucial role in maintaining tissue integrity. Its functions include intercellular communication, relieves pain, faster wound healing, stimulating neovascularization, and helps in collagen synthesis¹ .In 2010, Beker et al. were the first to utilize injectable hyaluronic acid (HA) filler for the treatment of papillary recession, demonstrating promising outcomes².

Gingival phenotype refers to the thickness of the gingiva and width of keratinized tissue around the teeth⁽⁵⁾. It plays a crucial role in determining the success of various dental treatments ,particularly periodontal procedures such as root coverage techniques and dental implant placement⁶. Assessing the gingival phenotype before initiating treatment is essential, as different phenotypes respond differently to inflammation, surgical intervention and restorative procedures. Proper evaluation helps improve treatment outcomes and prognosis ,ensuring more predictable and stable results⁶ .

Gingival phenotype are generally categorized into 2 types; thick flat and thin scalloped. When the gingival thickness measures 1.5 mm or more , it is classified as the thick gingival phenotype. In contrast, gingiva measuring less than 1.5 mm in thickness is referred to as thin gingival phenotype.