Effectiveness of Hyaluronic Acid Gel Injection with and without PRGF for Management of Interdental Papillary Loss: A Randomized Clinical Trial

Abstract

Background: To evaluate the effectiveness of hyaluronic acid (HA) gel injection with and without plasma rich in growth factors (PRGF) for the management of interdental papillary loss. Methods: A single blinded randomized clinical trial was carried out on 21 subjects with 34 sites. Patients within the age group 18–45 years who had Class I and II papillary recession in the maxillary anterior region were selected. The sites involved were randomly assigned to Group HA alone and Group HA + PRGF. The patients were recalled 4 weeks after receiving supragingival and subgingival instrumentation. HA or HA + PRGF was injected into the defective papilla at baseline and at 3 and 6 weeks. Image based measurements of Papillary Width (PW), Papillary Deficient Height (PDH), Deficient Area (DA), Deficient Volume (DV) were registered at baseline, 3 weeks, 6 weeks and 12 weeks. A vernier caliper was used to measure the papillary depth in the impression made using additional silicone impression material pre- and post-intervention. Results: There was a significant improvement in the within-group comparison of PW, PDH, DA and DV in both the groups. Group HA + PRGF showed significantly greater improvement in comparison to Group HA alone in terms of PDH, DA and DV at 6 and 12 weeks. Conclusions: Even though HA gel has already been established as a promising injectable agent in the minimally invasive treatment of interdental papillary deficiency, PRGF may also have a significant adjuvant effect when used along with HA. Further clinical studies with longer follow up duration, larger sample size and standardization of the tooth shape are required for a better understanding of the adjuvant effect of PRGF when used along with HA.

Hyaluronic acid in Dentoalveolar regeneration: Biological rationale and clinical applications

“…In this regard, injecting HA is considered a minimally invasive strategy to correct the gingival and papillary recession in the esthetic zone by stimulating the migration of fibroblasts and fibrogenesis, with a reasonable duration of outcomes stability. 81 …”

The use of hyaluronic acid injection for treatment of black triangle and reconstruction of lost interdental papilla in anterior teeth: a systematic review

“…Of these 24 studies included, 15 were prospective clinical studies [39,40,[48][49][50][51][52][53][54][55][56][57][58][59][60], and nine were randomised clinical trials [61][62][63][64][65][66][67][68][69]. Table 3 summarises the characteristics of the included studies.…”

“…Most studies investigated the effect of hyaluronic acid injection in treatment of lost interdental papilla prospectively over time [39,40,[48][49][50][51][52][53][54][55][56][57][58][59][60]62]. One study compared hyaluronic acid injection with negative control [64], three studies considered comparison with placebo control (saline injection) [61,65,67], while four studies compared hyaluronic acid injection to different materials, these include, plasma rich growth factors (PRGF) [63], injectable platelet rich fibrin (iPRF) [68], calcium hydroxyapatite filler (Radiesse) [69], and chitosan [66]. Different commercial brands of hyaluronic acid were utilised.…”

“…Moreover, it was found that the higher the concentration of hyaluronic acid, the more favourable the outcome; the use of 5% of hyaluronic acid material has yielded more significant improvement in comparison to 1% and 2% concentrations [55]. In addition, reconstruction of lost interdental papilla was attained with the injection of hyaluronic acid alone as well in combination with other material; plateletrich fibrin [68], plasma rich growth factor [63], and carboxymethyl chitosan [66].…”

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

“…As for the management of the absent and/or partial absence of the interdental papilla, different approaches were described in the literature [3][4][5]. One such widely described option is the surgical reconstruction of the missing interdental papilla [6].…”