Quintessence Int. 2024 Mar 27;55(3):180-189. doi: 10.3290/j.qi.b5128447.
Currently, there is no established treatment protocol to treat interdental papillary loss. This research aimed to evaluate the outcomes of interdental papillary reconstruction using minimally invasive surgery, with injectable hyaluronic acid gel.
Seventeen patients were included, each with five sites of class 1 papillary recession (40 sites in the maxilla and 45 sites in the mandible). Subperiosteal tunneling was performed through a horizontal incision made apical to the base of the papilla without penetrating it. The free gingival sulcus was sealed by 000 retraction cord. A total of 0.2 to 0.6 mL hyaluronic acid was injected gradually. The incision was sutured with polyglycolic sutures. Treated sites underwent clinical and digital evaluation at three follow-up time points (1 month, 3 months, and 6 months).
The interdental papillary defect height in the maxillary sites significantly reduced by 60%, 66%, and 42% at 1, 3, and 6 months, respectively. In mandibular sites, the reduction was 54%, 55%, and 40% at the same follow-up time points. Regarding interdental papillary defect surface area in the maxilla, the reduction was 65%, 71%, and 45% at 1, 3, and 6 months. In the mandible, a reduction of 60%, 64%, and 48% was noticed at the same time points. Regarding patients' pain level score, during the day of surgery, 16 patients reported pain; the average pain score out of 10 was 3.94, and 11 patients (64.7%) needed to take analgesics. The pain generally subsided in the following days. At the day of treatment, 12 out of the 17 patients (70.6%) reported mild difficulty in speaking and eating. No complication, hypersensitivity, or allergy was noted in any patient.
Subperiosteal tunneling with hyaluronic acid injection demonstrates clinical improvements in papilla height and papillary recession surface area reduction after 3 months of follow-up, with reduction in improvement after 6 months.
Adjunctive use of hyaluronic acid injection with minimally invasive surgery in interdental papillary management may improve clinical and esthetic outcomes.
目前，尚无治疗牙间乳头缺失的既定治疗方案。本研究旨在评估使用微创注射透明质酸凝胶进行牙间乳头重建的效果。
共纳入 17 名患者，每个患者有 5 处 1 类牙间乳头退缩（上颌 40 处，下颌 45 处）。在距乳头基部上方行骨膜下隧道，不穿透乳头。用 000 号牙周塞治剂封闭游离龈沟。逐渐注射 0.2 至 0.6 毫升透明质酸。用聚乙二醇缝线缝合切口。治疗部位在 3 个随访时间点（1 个月、3 个月和 6 个月）进行临床和数字评估。
上颌牙间乳头缺损高度在 1、3 和 6 个月时分别显著减少了 60%、66%和 42%。下颌牙间乳头缺损高度分别减少了 54%、55%和 40%。在上颌牙间乳头缺损表面面积方面，1、3 和 6 个月时的减少分别为 65%、71%和 45%。下颌牙间乳头缺损表面面积分别减少了 60%、64%和 48%。关于患者疼痛程度评分，手术当天 16 名患者报告疼痛；10 分制平均疼痛评分为 3.94，11 名患者（64.7%）需要服用止痛药。疼痛通常在接下来的几天内减轻。在治疗当天，17 名患者中有 12 名（70.6%）报告轻度说话和进食困难。没有任何患者出现并发症、过敏或过敏反应。
骨膜下隧道联合透明质酸注射治疗牙间乳头高度和牙间乳头退缩表面面积在 3 个月随访时可获得临床改善，6 个月后改善减少。
微创牙间乳头管理中辅助使用透明质酸注射可改善临床和美观效果。
