The Effect of Hyaluronic Acid Gel Injection on The Reconstruction of Deficient Interdental Papilla
DOI:
https://doi.org/10.56056/amj.2025.364Keywords:
Black triangle, Hyaluronic acid, Inadequate interdental papilla, ReconstructionAbstract
Background and objectives: The use of hyaluronic acid as injectable gel into gaps where interdental papillae are absent can refill black triangles. This study aims to evaluate the effects of two concentrations of hyaluronic acid on papilla regeneration by measuring the black triangle height.
Methods: This prospective interventional study carried out in Khanzad specialized dental center in Erbil city-Kurdistan region/Iraq through the period of 6 months from 1st of March 2023, to 1st of September 2023 on a sample of 20 patients with deficient tissue between their central and lateral incisors. A split-mouth technique was employed for the administration of hyaluronic acid with concentrations of 22mg/ml and 20mg/ml. Each region received three injections each three weeks. Participants were re-evaluated after three and six months. An ANOVA test was used to compare mean values.
Results: There was a statistically significant disparity in black triangle height between the groups (p = 0.013) after three months. Later, after a duration of six months, there was compelling evidence of a distinction between the two groups (p = 0.004). For the 22mg\ml group, full coverage was achieved in six months by 60% (12 out of 20) while for the 20mg\ml group it was only 40% (8 out of 20).
Conclusions: Both concentrations showed significant effect on reconstruction of missing interdental papilla with more effect in the 22 mg\ml group (p < 0.01).
Downloads
References
Lee WP, Kim HJ, Yu SJ, Kim BO. Six-month clinical evaluation of interdental papilla reconstruction with injectable hyaluronic acid gel using an image analysis system. J Esthet Restor Dent. 2016;28(4):221-30.
Thomas M, Reddy R, Reddy BJ. Perception differences of altered dental esthetics by dental professionals and laypersons. Indian J Dent Res. 2011;22(2):242-7.
Lee WP, Seo YS, Kim HJ, Yu SJ, Kim BO. The association between radiographic embrasure morphology and interdental papilla reconstruction using injectable hyaluronic acid gel. J Periodontal Implant Sci. 2016 Aug;46(4):277-87.
Kassab MM, Cohen RE. The etiology and prevalence of gingival recession. J Am Dent Assoc. 2003;134(2):220-5.
Kleber B, Schenk H. Etiology of gingival recessions. Dtsch Zahnarztl Z. 1989;44(11):845-8.
Kundapur PP, Bhat KM, Bhat GS. Association of trauma from occlusion with localized gingival recession in mandibular anterior teeth. Dent Res J. 2009;6(2): 71-74.
Greenwell H, Fiorellini J, Giannobile W, Offenbacher S, Salkin L, Townsend C, et al. Oral reconstructive and corrective considerations in periodontal therapy. J Periodontol. 2005;76(9):1588-600.
Löe H, Ånerud Å, Boysen H. The natural history of periodontal disease in man: prevalence, severity, and extent of gingival recession. J Periodontol. 1992;63(6):489-95.
Singh VP, Uppoor AS, Nayak DG, Shah D. Black triangle dilemma and its management in esthetic dentistry. Dent Res J. 2013;10(3):296.
Bichacho N. Papilla regeneration by noninvasive prosthodontic treatment: segmental proximal restorations. Pract Periodontics Aesthet Dent. 1998;10(1):75, 7-8.
Ahila E, Kumar RS, Reddy VK, Pratebha B, Jananni M, Priyadharshini V. Augmentation of interdental papilla with platelet-rich fibrin. Contemp Clin Dent. 2018;9(2):213.
Ni J, Zhong Z, Wu Y, Shu R, Wu Y, Li C. Hyaluronic acid vs. physiological saline for enlarging deficient gingival papillae: a randomized controlled clinical trial and an in vitro study. Ann Transl Med. 2021;9(9): 759. doi: 10.21037/atm-20-7599.
Patil SC, Dhalkari CD, Indurkar MS. Hyaluronic acid: Ray of hope for esthetically challenging black triangles: A case series. Contemp Clin Dent. 2020;11(3):280.
Dahiya P, Kamal R. Hyaluronic acid: a boon in periodontal therapy. N Am J Med Sci. 2013;5(5):309.
Longaker MT, Harrison MR, Crombleholme TM, Langer JC, Decker M, Verrier ED, et al. Studies in fetal wound healing: I. A factor in fetal serum that stimulates deposition of hyaluronic acid. J Pediatr Surg. 1989;24(8):789-92.
Balazs EA, Denlinger JL. Viscosupplementation: a new concept in the treatment of osteoarthritis. J Rheumatol Suppl. 1993; 39:3-9.
Srisuwan T, Tilkorn DJ, Wilson JL, Morrison WA, Messer HM, Thompson EW, et al. Molecular aspects of tissue engineering in the dental field. Periodontology 2000. 2006;41(1):88-108.
Necas J, Bartosikova L, Brauner P, Kolar J. Hyaluronic acid (hyaluronan): a review. Vet. Med. 2008;53(8):397-411.
Rajan P, Baramappa R, Rao NM, Pavaluri AK, Indeevar P, Rahaman SMU. Hyaluronic Acid as an adjunct to scaling and root planing in chronic periodontitis. A randomized clinical trial. J Clin Diagn Res. 2014;8(12): ZC11.
Saed S, Askora A, Enan G, Ahmed R. Innovative strategies for biotechnological production of hyaluronic acid from different sources. BFSZU. 2024;2023(4):35-48.
Pitale U, Pal PC, Thakare G, Verma M, Dhakad S, Pandey R. Minimally invasive therapy for reconstruction of lost interdental papilla by using injectable hyaluronic acid filler. J Indian Soc Periodontol. 2021;25(1):22.
Rohrich RJ, Ghavami A, Crosby MA. The role of hyaluronic acid fillers (Restylane) in facial cosmetic surgery: review and technical considerations. Plast Reconstr Surg. 2007;120(6S):41S-54S.
Vedamurthy M. Soft tissue augmentation-Use of hyaluronic acid as dermal filler. Indian J Dermatol Venereol Leprol. 2004; 70:383.
Abdelraouf SA, Dahab OA, Elbarbary A, El-Din AM, Mostafa B. Assessment of hyaluronic acid gel injection in the reconstruction of interdental papilla: a randomized clinical trial. Open Access Maced J Med Sci. 2019;7(11):1834.
Awartani FA, Tatakis DN. Interdental papilla loss: treatment by hyaluronic acid gel injection: a case series. Clin Oral Investig. 2016; 20:1775-80.
Becker W, Gabitov I, Stepanov M, Kois J, Smidt A, Becker BE. Minimally invasive treatment for papillae deficiencies in the esthetic zone: a pilot study. Clin Implant Dent Relat Res. 2010;12(1):1-8.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Aseel Hasan Mahmood Algurairi, Dilyar Ahmed Baban

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The copyright on any article published in AMJ (The Scientific Journal of Kurdistan Higher Council of Medical Specialties )is retained by the author(s) in agreement with the Creative Commons Attribution Non-Commercial ShareAlike License (CC BY-NC-SA 4.0)










