Photobiomodulation Therapy in the Management of "Black Triangles" Due to the Absence of the Gingival Interdental Papilla

The absence of an interdental papilla, termed "black triangle," presents a challenge in aesthetic restorations. Photobiomodulation therapy (PBMT) is the non-thermal therapeutic use of light in order to positively modulate biological activity and has shown promise in tissue regeneration, wound healing, and inflammation reduction. This case report introduces a modified PBM protocol known as "hemolasertherapy" aimed at regenerating the gingival interdental papilla to fill the black triangle. In this case report, a 34-year-old female with an unaesthetic black triangle between the maxillary central incisors presented for treatment. Before surgical intervention, our suggested protocol was proposed and explained, detailing potential risks and outcomes. After proper scaling root planning, a suggested protocol with PBM was made. PBM application with a 635 nm wavelength diode laser at four points around the area between the two maxillary central incisors was made: coronal third and apical third of the papilla and mesial and distal of the papilla. Then, bleeding was provoked with a curette inside the sulcus between 11 and 21 (concerned area) by applying pressure on the junctional epithelium and the supracrestal connective tissue. After a few seconds, blood spontaneously filled the "black triangle" coronal to the interdental papilla and was left undisturbed. At this point, PBM was applied again on the same four points already described. The irradiation parameters during all PBM treatments were contact mode and continuous mode, 635 nm wavelength, spot size of 8mm, power of 50 mW, irradiation time on each point of 50 seconds, and energy density of 4.976 J/cm2. After the intervention, the patient was prohibited from smoking, using mouthwash, drinking, and brushing for two hours. The exact same procedure was repeated five and 10 days after the first intervention. Follow-up was made for three months after the intervention. The assessment indicated a minor increase in the papilla height, which was not enough for a complete closure of the "black triangle." However, there was a reduction in the appearance of the black triangle. This case report suggests that PBM if used within our suggested protocol can increase the height of the gingival interdental papilla leading to a more pleasant aesthetic appearance. It is important to note that its effectiveness might be limited to specific conditions. In summary, the presented case report showcased a slight extension of the gingival interdental papilla. Further studies are essential to validate these observations.

Orthodontic tooth extrusion to regenerate missing papilla adjacent to maxillary anterior single implants: A 2- to 7-year retrospective study

INTRODUCTION

Regeneration of the missing papilla adjacent to single implants in the esthetic zone has always been challenging, despite advances in vertical hard and soft tissue regeneration. Orthodontic tooth extrusion has been shown to effectively gain alveolar bone and gingival tissue. This retrospective study evaluated the effectiveness of orthodontic tooth extrusion on regenerating missing papilla between existing maxillary anterior single implant and its adjacent tooth.

METHODS

Patients who underwent orthodontic tooth extrusion to regenerate missing papilla adjacent to a single implant in the esthetic zone were included in this study. The gingival phenotype, orthodontic extrusion movement, proximal bone level, dento-implant papilla level, facial gingival level, mucogingival junction level, and keratinized tissue width, of the extruded tooth were recorded at pre-orthodontic extrusion (T0 ), post-orthodontic extrusion and retention (T1 ), and latest follow-up (T2 ).

RESULTS

A total of 17 maxillary single tooth had orthodontic tooth extrusion to regenerate missing papilla adjacent to 14 maxillary anterior single implants in 14 patients. After a mean follow-up time of 48.4 months, implant success rate was 100% (14/14), with none of the orthodontically extruded teeth being extracted. After a mean extrusion and retention period of 14.3 months, a mean orthodontic extrusion movement of 4.62 ± 0.78 mm was noted with a mean proximal bone level gain of 3.54 ± 0.61 mm (77.0% efficacy), dento-implant papilla level gain of 3.98 ± 0.81 mm (86.8% efficacy), and facial gingival tissue gain of 4.27 mm ± 0.55 mm (93.4% efficacy). A mean keratinized tissue width gain of 4.17 ± 0.49 mm with minimal mean mucogingival junction level change of 0.10 ± 0.30 mm were observed. The efficacy of orthodontic eruption movement on dento-implant papilla gain was less in the thin (80.5%) phenotype group when compared with that in the thick (91.5%) phenotype group.

CONCLUSIONS

Within the confines of this study, orthodontic extrusion is an effective, noninvasive method in regenerating mid-term stable proximal bone and papilla adjacent to maxillary anterior single implants.

CLINICAL SIGNIFICANCE

This retrospective study presents a mid-term result on orthodontic extrusion as a mean to regenerate dento-implant papilla defect. The extended retention period following orthodontic extrusion showed stable and efficacious proximal bone and papilla gain.

Papilla regeneration by injectable stem cell therapy with regenerative medicine: long-term clinical prognosis

Black triangle (BT), an open interproximal space between teeth, can cause aesthetic concerns, food impaction, phonetic difficulties and periodontitis. The aim of this study was to determine the possibility and long-term prognosis of novel papilla regeneration with regenerative medicine, i.e. tissue-engineered papilla (TEP), and to investigate the potential of a tissue-engineering method for soft-tissue augmentation, especially aesthetic improvement of BT, with mesenchymal stem cells (MSCs) as the isolated cells, platelet-rich plasma (PRP) as the growth factor and hyaluronic acid (HA) as the scaffold. The parameters were assessed from a clinical point of view by measuring the distance from the tip of the interproximal papilla to the base of the contact area in each study region. The mean volumes, operation times and follow-up periods of TEP were 1.32 ± 0.25 ml, 2.2 ± 1.62 times and 55.3 ± 17.7 months; the mean improved BT values were 2.55 ± 0.89 mm. An aesthetic improvement was achieved. TEP was able to provide aesthetic improvement of black triangle and predictable results, and could emerge as another novel option for periodontal regenerative therapy in periodontal diseases.