Effectiveness of Hyaluronic Acid Injection in the Reconstruction of Interdental Papilla: A Systematic Review

Purpose: The loss of interdental papilla (IDP) is a significant esthetic concern often associated with black triangles (BT). BT are potential consequences of periodontitis, orthodontic treatment, and anatomical variations due to their influence on the critical distance from the contact point to the bone crest. Various treatment options, both invasive and non-invasive, have been proposed to address this issue. Recently, the injection of hyaluronic acid (HA) has emerged as a promising minimally invasive alternative. This systematic review aims to evaluate the effectiveness of HA injections for IDP reconstruction in esthetic zones in humans.
Materials and Methods: A comprehensive literature search was conducted using Cochrane library, PubMed/MEDLINE, and Embase databases with keywords like “interdental papilla,” “hyaluronic acid,” and “human”. Change in BT mean height (mm) was considered as the primary outcome while percentage of change in BT area was considered as the secondary outcome.
Results: 177 articles were screened, and 15 eligible studies were included, focusing on the therapeutic effects of HA injections on interdental papilla dimensions in humans. Clinical trials have demonstrated varying degrees of success and patient satisfaction with HA injections for IDP reconstruction over a period of 4 weeks to 25 months. Several studies showed significant improvements related to BT height and width, although complete papilla fill remains unpredictable. Higher success rates were observed in the maxilla compared to the mandible, and patients with thicker gingival phenotype showed better outcomes. The initial size of the defect, the number of HA applications and the analysis method significantly influenced the results.
Conclusion: HA injections look promising for IDP reconstruction. However, the need for multiple injections and long-term efficacy remains to be fully understood. Further research is necessary to standardise treatment protocols and evaluate long-term outcomes and patient satisfaction comprehensively. Keywords: black triangle, esthetic, gingiva, hyaluronic acide, periodontitis, regeneration