The Clinical Effects of Using Collagen Matrix in Papilla Augmentation: a Prospective Clinical Trial.

Introduction and Hypothesis of the Study:

The focus on achieving highly esthetic dental outcomes has increased nowadays, especially with the improvement of restorative and periodontal surgical techniques. Black triangles, an unesthetic occurrence due to lack of papilla, can occur when there is loss of the periodontal interproximal attachment apparatus. Plaque associated periodontal disease has been the most common reason for black triangle formation. However, it can also be caused by trauma, improper restorations contours, aggressive flossing, spacing between teeth and iatrogenic damage.

Patients with black triangles usually complain from unpleasant esthetic appearance, particularly when it harvests calculus, stains, and food. It usually gets worse with time requiring more attention in cleaning these open gingival embrasures using interdental brushes and floss.

Many surgical and non-surgical treatment modalities have been proposed as possible treatments for papilla loss. The non-surgical approach includes repeated root planning and curettage, and correcting contact points orthodontically to help induce papilla fill. Surgical papilla augmentation remains a challenge in periodontal regeneration due to the restricted interdental space and patterns of blood supply to the area. Many surgical techniques were suggested to overcome these challenges; semilunar incision where the papilla is left untouched, the use of a pedicle flap in a microsurgical technique without releasing incisions and papilla augmentation with customized connective tissue graft using the interproximal tunneling technique .The current literature on surgical correction techniques are mainly comprised of case reports and case series, and no standard surgical treatment of black triangles has been devised yet.

Collagen based matrices (CM) is a bovine-equine collagen-based tissue. Due to its strong mechanical properties, it acts as scaffold material for cell migration and helps in the overall healing process. CM has become very widely used and has proved its superiority in many periodontal procedures due to its excellent tissue color matching.