clinician and dentist's esthetic demand in dentistry have increased rapidly, driven by an enhanced awareness of beauty and esthetics. The ultimate goal in modern restorative dentistry is to achieve “white” and “pink” esthetics in esthetically important zones. “White esthetics” is the natural dentition or the restoration of dental hard tissues with suitable materials. “Pink esthetics” refers to the surrounding soft-tissues, which includes the interdental papilla and gingiva that can enhance or diminish the esthetic result. In this presentation,non surgical way of management with hyaluronic acid.

1. THE ASSOCIATION BETWEEN
RADIOGRAPHIC EMBRASURE
MORPHOLOGY AND INTERDENTAL
PAPILLA RECONSTRUCTION
USING INJECTABLE HYALURONIC
ACID GEL
Dr .Vikram kumar
Junior Resident
Prosthodontics unit

2. AIM:
 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.

3. Hyaluronic acid
- glycosaminoglycan
-extracellular matrix in almost all tissues.
 It binds water to maintain tissue structure and its
characteristics, including consistency, biocompatibility, and
hydrophilicity,
 it an excellent moisturizer in cosmetic dermatology and
skin-care products.

 To date, injectable hyaluronic acid gel has been successfully
used to reduce wrinkles and improve other similar facial
deformities

4. The injectable hyaluronic acid gel (Teosyal
Puresense Global Action®, Teoxane, Geneva,
Switzerland) and disposable 30G×1/2” needle
(Jungrim Medical, Seoul, Korea) were then loaded

5. Method material
 Fifty-seven (57) treated sites
13 patients (6 males and 7 females)
papillary deficiency in the upper anterior area
Age-27 and 35 years, mean age -32 years
0.01 cc by injecting 0.002 cc of hyaluronic acid gel
outcome after 6 months

6. Comparasion parameter(0 to 6 month)
 Photographic:
photographic measurements of the
- black triangle area(BTA)
-height (BTH)
-width (BTW)
 Periapical radiographic
-contact point(CP)
-bone crest (BC)

8. Inclusion criteria
 patients with at least 1 papillary deficient site
in the upper anterior area
 plaque index (0-1)
 and gingival index ( 0 -1)

9. EXCLUSION CRITERIA
 Patients medical history i.e pregnant,DM
 Patients taking medication known to
increase the risk of gingival enlargement
 Who were currently receiving orthodontic
treatment on the upper anterior area were
exclude
 Diastema, black triangle area is too small

10. Procedure
 The single injection dose from the injection
assistance device was set to 0.002 cc.
 The injectable hyaluronic acid gel were then
loaded,using 30gauze needle

11.  The needle was inserted at a 45° angle, 2–3 mm apical to the
involved papilla .
 A single-point injection technique was employed, and the
bevel of the injection needle was applied sloping upward.
 Each involved papilla was injected with a total of 0.01 cc by
injecting 0.002 cc of hyaluronic acid gel each time, for a total
of 5 times, at 3-week intervals, until the black triangle was
no longer clinically observable.

13. Outcome measurements
 All sites showed improvement between
treatment examinations.
 Thirty-six sites had complete interdental
papilla reconstruction
 21 sites showed improvement ranging from
19% to 96%.

15. According to photograph
no clinical signs of a black triangle in 36 site
Complete interdental papilla reconstruction
(CIPR) group
clinically observable black triangle in 21 site
partial interdental papilla reconstruction
(PIPR) group.

17. According to statistically
 CP-BC showed a statistically significantly
strong correlation with the rate of papilla
reconstruction
 there was no statistically significant
correlation between the IDR and papilla
reconstruction
 Cp-BC has positive corelation with
BW,BH,and BA

18. CP-BC vs rate of papilla
reconstruction

19. IDR vs papilla
reconstruction

20. CP-BC VS BW,BH,and BA

21. disccusion
 In the present study, we used a photographic
standardization device developed in-house to
increase the reproducibility of clinical photographs
taken of the interdental papilla areas.
 Interestingly, most cases with a CP-BC of up to 6 mm
showedCIPR, but as the distance increased beyond
this cut-off, the IPRR tended to decrease
 Interdental papillae are generally considered
biologically safe and stable with a CP-BC up to 5 mm

22.  Within the limits of this study, the CP-BC was
found to be correlated with the BTA, BTH,
and BTW, but not with the IDR
 all the groups, pain perception decreased
from 1st to 3rd injections and there were no
adverse reactions of different concentration.
Mild pain or discomfort was reported in the
patients for 24 h at each visit of injection

23. Singh et 2019 Use of different concentrations of hyaluronic
acid in interdental papillary deficiency treatment: A
clinical study
 hyaluronic acid (HA) gel in three different concentrations – 1%, 2%,
and 5% , to evaluate its efficacy in the enhancement of deficient
interdental papilla
 5% of HA showed highly significant enhancement (P = 0.001) of
19.2%, 20.6% 18.2% at 1, 3, and 6 months, respectively. On
photographic analysis, 5% of HA showed 41%, 42.9%, and 39.8% at
1, 3, and 6 months, respectively.
 In this study.The post-injection pain was least in 1% of HA group and
more in 5% HA of group.

24.  Tarnow et al.have also reported that there was
virtually no interdental papillary deficiency at a
CP-BC ≤5 mm.
 Chen et al. conducted a study on only the upper
anterior area and reported that, when CP-BC was
≤4 mm, interdental papillae were present in
100% of the cases, whereas when this distance
was ≥7 mm, interdental papillae were always
deficient.

25.  CP-BC is considered the most important
associated factor for the presence of the
interdental papilla in this study
 Although other studies have reported that
gender, interproximal embrasure area,
interdental papilla length, and crown
morphology are associated factors

26. CONCLUSION
 Within the limits of this study, the CP-BC was found to be
correlated with the BTA, BTH, and BTW, but not with the
IDR.
 Interdental papilla reconstruction using injectable
hyaluronic acid gel allowed successful reconstruction
when the CP-BC was ≤6 mm, but for the CP-BC >6 mm,
the increased distance resulted in a decreased IPRR.
 Therefore, the CP-BC is closely associated with the
efficacy of hyaluronic acid gel injection for the
reconstruction of deficient interdental papillae in the
upper anterior area.

27. REFERENCES
 Tarnow DP, Eskow RN. Considerations for single-
unit esthetic implant restorations. Compend
Contin Educ Dent 1995;16:778-84.
 Tarnow DP, Magner AW, Fletcher P.The effect of
the distance from the contact point to the crest
of bone on the presence or absence of the
interproximal dental papilla. J Periodontol
1992;63:995-6.
 Singh . Use of different concentrations of hyaluronic
acid in interdental papillary deficiency treatment: A
clinical study.Ji Soc perio:2019 : 23 (1) : 35-41