Comparative evaluation of Hyaluronic Acid and injectable Platelet Rich Fibrin (I-PRF) as a non-surgical approach for management of black triangle

The interdental papillary deficiency or the Black triangle (BT)" is a large concern for dentists and patients. Loss of interdental papilla may lead to the formation of unappealing dark triangles, resulting in food impaction and plaque buildup. This soft tissue is delicate and fragile; is susceptible to inflammation leading to recession, bone loss or both , due to its low blood supply. In addition to positively affecting smile esthetics, interdental papillae are important to prevent the impaction of food between the teeth and important role in improved phonetics . Non-surgical attempts to treat, these methods are invasive and time-consuming.Non-surgical attempts to treat, these methods are invasive and time-consuming.

Hyaluronic acid (HA) is an essential glycosaminoglycan of the extracellular matrix of the periodontal tissues, and the majority of cells can produce it during several phases of their cell cycle. It is involved in tissue repair and wound healing by stimulating cell proliferation, migration and interaction with several growth factors.

HA has a crucial role in space-filling owing to its hygroscopic nature. Moreover, it regulates osmotic pressure and enhances tissue lubrication and resiliency, which helps in maintaining the structural and homeostatic integrity of tissues the injection of HA showed promising clinical efficacy in the treatment of gingival papilla defects in several studies.

Platelet rich fibrin (PRF) is a type of platelet gel; a matrix of autologous fibrin, which has scored over platelet rich plasma by virtue of its properties, ease of preparation, and cost effectiveness. Platelet cytokines, platelet derived growth factors (PDGF)-α and (PDGF)-β, transforming growth factor beta (TGF)-β and insulin-like growth factor-1 (IGF-1) are gradually released as fibrin matrix is resorbed, aiding the process of healing.

“Injectable platelet-rich fibrin (I-PRF) ”is the most recent and successful advancement in PRF.  I-PRF is referred to be an advanced type of PRF since it is injected (autologous PRF) into afflicted soft tissues, mucous membranes, or skin. It also has special qualities in the regeneration of human tissues. Gene therapy, tissue engineering, and platelets have all been demonstrated to be effective sites for signaling pathways such as platelet-derived growth factor.  that i-PRF demonstrated the ability to release higher concentrations of various growth factors and induced higher fibroblast migration and expression of PDGF, TGF-β, and  collagen .

The purpose of this study is to check the clinical efficacy of injectable- platelet rich fibrin (I- PRF) in comparison to commercially available Hyaluronic acid injections for the treatment of Black triangle.

PROCEDURE : written informed consent form explaining the nature of the study and procedure will be explained to the patient and duly signed by the patient.

v Pre operating phase**:** Consisting of oral hygiene instructions, scaling, root planing.

v Maintenance phase:

·       Baseline recording of clinical parameters

Ø  The degree of papillary deficiency will be recorded according to Nordland and Tarnow classification(1992).

Ø Distance between the contact point of affected teeth to the tip of the papillary point will be measured.

Ø Clinical photographs will be taken.

v Injection phase:

·       Group A: Hyaluronic Acid Group

Ø 3 doses of commercially available hyaluronic acid will be given at each papilla site: at baseline, 3-week and 6-weeks intervals.

·      Group B: Injectable-Platelet Rich Fibrin (I-PRF) Group

Ø Blood sample will be collected in a test tube after that centrifugation will be done for 3 minutes at a low speed (700rpm) to produce a yellow- orange color fluid that is known as injectable platelet-rich fibrin, after that this fluid will be injected to the papilla site. Three doses will be given at each papilla site: at baseline, 3-week and 6-weeks intervals.

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