Clinical Evaluation of the Use of Surgical Tube Technique Versus Hyaluronic Acid Gel Injection in Reconstruction of the Interproximal Papilla in Patients With Class II Papillary Deficiency
试验速览
- 阶段
- 不适用
- 发起方
- 入组人数
- 24
- 试验地点
- 1
- 主要终点
- interdental papilla loss (Decrease of black triangle area ) (mm2)
研究概览
简要总结
Restoring defective interdental papilla partially or totally in structure and function creates a challenge in dental field owing to the small working space and limited blood supply to the area.
This led to the innovation of different techniques for treatment of defective interdental papilla that aimed at papillary tissue augmentation reported to be attained through influencing connective tissue cell proliferation, providing clot stability, protecting the reconstructed site during wound healing.
Among these techniques is the injection of hyaluronic acid gel have been considered of the latest non-invasive technique to escape drawbacks of surgeries. Though proved to have some positive results in the literature however still entails unpredicted complete gingival papilla improvement because of the diverse injection methods, cycles, dosage, and the course of treatment that needs further optimization, in addition to the lack of unified patient inclusion criteria, especially the gingival biotype .
Several surgical techniques designed to host the richest effective known sub-epithelial connective tissue graft had failed to allow maximum benefit of the graft due to the disadvantages from the number and location of incisions of their flap design, which possibly disrupt the blood supply needed added to unconsidered flap thickness, and flap retraction that impacted the success of soft tissue grafting.
Surgical Tube technique has recently been developed optimizing flap thickness, flap retraction and tension to escape disturbance of the blood supply of the graft by its use of apical incisions and containment of the graft within a rich vascular enclosed bed, thereby offering an attempt to guarantee integrity of soft tissue with no disruption of blood supply.
详细描述
The interdental papilla is the gingival portion that fills the proximal area under the contact between two adjacent teeth, where it is defined as gingival tissues extending from incisal tip of the papilla to a line tangential to the adjacent margins of the adjacent teeth. Anatomically, it is small and delicate with a diminutive blood supply, it is almost the most important esthetic part during smiling.
Nordland & Tarnow 1998 classified papillary loss according to system which utilizes 3 identifiable anatomical landmarks: the interdental contact point, the facial apical extent of the cemento-enamel junction (CEJ) and the interproximal coronal extent of the CEJ. Normal Interdental papilla fills embrasure space to the apical extent of the interdental contact point/area. Class I which the tip of the interdental papilla lies between the interdental contact point and the most coronal extent of the interproximal CEJ (space present but interproximal CEJ is not visible). Class II which the tip of the interdental papilla lies at or apical to the interproximal CEJ but coronal to the apical extent of the facial CEJ (interproximal CEJ visible). Class III which the tip of the interdental papilla lies level with or apical to the facial CEJ.
The absence of interdental papilla contributes to chronic retention of food debris leading to subsequent affection of periodontal health and esthetically unaccepted black triangle. To be influenced by the initial position of the teeth (diastema), the length of gingival niche area, triangular shaped crown, divergent roots and periodontal bone loss. Also tooth brush trauma and decreased keratinization due to ageing has also been implicated as a causative factor of interdental papilla loss.
Reconstruction of papillary insufficiency is one of the most difficult and challenging periodontal treatments. This is because the interdental papilla is a small, fragile area with minor blood supply which seems to be the major limiting factor in all surgical and augmentation techniques.
The injection of biocompatible hyaluronic acid gel (HA) have been considered conventional non-invasive techniques for treatment of deficient papilla. Hyaluronic acid (0.1) mm It 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. Furthermore, 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.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Single (Outcomes Assessor)
盲法说明
Due to the type of intervention only the outcome assessor and the statistician will be blinded.
Single blinded:
- Blinding of the participants is not applicable.
- Blinding of the operator is not applicable.
- Outcome assessor (primary and secondary outcomes) and biostatistician will be blinded.
入排标准
- 年龄范围
- 25 Years 至 40 Years（Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Highly motivated patients with papillary deficiency types II, according to Nordland and Tarnow 1998 classification will be selected, having at least one deficient papilla in the anterior region.
- •Distance between the contact point and inter-proximal bone crest (CP-BC) of ≤ 7 mm and probing depth of ≤ 4 mm at the deficient papillary site (Abdelraouf etal. 2019).
- •Patients with full mouth plaque index (PI) and gingival index (GI) scores should be between 0-
- •Healthy patients free of any medical condition.
排除标准
- •● Patients with medical conditions that may affect periodontal healing or regeneration.
- •Patients with a history of allergic reactions, pregnant or breastfeeding females, smokers and alcoholics.
- •Patients with current or previous drugs intake that may predispose to gingival enlargement.
- •Patients under orthodontic treatment or had orthodontic treatment in the past six months.
- •Carious teeth, proximal restorations or fixed prosthesis.
- •Patients with a history of traumatic oral hygiene measures or periodontal surgeries over the last six months at the area of interest or having any scar tissue.
- •Poor oral hygiene patients.
结局指标
主要结局
interdental papilla loss (Decrease of black triangle area ) (mm2)
时间窗: 6 months
The surface area of the black triangle (SABT) is assessed using standardized digital clinical photographs analyzed by an image analysis program (Photoshop Cs 5, Adobe Systems, San Jose, CA, USA). The surface area of the black triangle was assessed from the photographs taken at baseline (before injection), 3 and 6 months from the first injection. - 10 mm William's graduated periodontal probe was used as a scale for calibration.
次要结局
- Gain in papillary height(6 months)
研究者
waleed mohammad sabry
lecturer Assistant
Cairo University