Reconstruction of Interdental Papilla in Esthetic Zone using Hyaluronic Acid Gel: A Clinical Prospective Study

Abstract

Introduction: Interdental papilla deficiency or black triangles are considered to be one of the most challenging dilemmas in esthetic dentistry. Various invasive techniques with less success have been introduced for interdental papilla regeneration. So, to overcome the limitations a non-invasive technique with greater predictability and patient comfort has been introduced using Hyaluronic acid gel (HA). In the present study, the efficacy of 2% Hyaluronic acid gel on interdental papilla enhancement was evaluated clinically along with photographic analysis (Image J Software) and its effect on gingival fibroblast cell culture lines was observed. Aim: To evaluate the changes in buccal triangle dimensions i.e. buccal triangle area (BTA), buccal triangle width (BTW), buccal triangle height (BTH) at baseline and 6 months using commercially available 2% HA gel and to check the effect of HA on proliferative abilities of gingival fibroblast cell culture lines. Materials and Methods: 60 sites in 15 patients were selected and were randomly divided into test and control group. The Test Group received commercially available 2% HA gel and the control group received saline as a placebo.  All the clinical measurements, photographs were taken at 3 weeks, 3 months and 6 months and comparisons among test and control groups were done both for clinical measurements and Image J analysis of photographs for interdental papilla enhancement. MTT assay and XTTT assay was done to check the effect of 2% HA gel on proliferative abilities of gingival fibroblast in cell culture lines. Results: HA treated sites showed gradual and constant improvement in interdental papilla enhancement while the control sites did not show any improvement. Complete interdental papilla reconstruction was seen in 63.3% of test sites at 6 months and 365 of test sites showed partial interdental papilla reconstruction.  HA gel has a positive effect on the proliferative and migratory abilities of gingival fibroblast. Conclusion: HA is a noninvasive voluminizing alternative treatment modality for interdental papilla deficiency. It is biocompatible as it does not cause an adverse reaction. HA gel has a strong effect on the migratory and proliferative abilities of gingival fibroblasts.