Retrospectively evaluation of the effectiveness of surgical approaches to patients with interdental papilla loss

Black triangles formed by a decrease in the height of interdental papilla or complete disappearance of the papilla may cause problems such as esthetic, phonetic, air bubbles occur when talking, food accumulation, and sensitivity. Until today, surgical and non-surgical methods have been used alone or in combination in order to restore the lost interdental papilla. Surgical methods are often preferred as they are cost-effective procedures that allow the reconstruction of papilla by preserving tooth integrity. There are very limited studies comparing the surgical procedures performed in papilla reconstruction in the literature and these studies are mostly case reports. In our retrospective study, we aimed to evaluate the efficacy of using Platelet Rich Fibrin (PRF) or Subepithelial Connective Tissue Graft (SCTG) surgical approaches for papillary reconstruction. Therefore baseline and follow-up data were collected from patients who were treated with PRF or SCTG by the same surgeon. The study was conducted in Hacettepe University Faculty of Dentistry, Department of Periodontology between 2016-2018 and a total of 55 patients' with papilla reconstructions (27 SCTG and 28 PRF) were included in study. 20 patients' data were suitable for the inclusion criteria, regular follow-ups were made at the 1st, 3rd and 6th months. In the PRF and SCTG groups , demographic data, periodontal parameters such as Gingival Index, Plaque Index, Papillary Bleeding Index, pocket depth, keratinized tissue width (KTW), gingival recession, papilla parameters such as the distance between interdental contact point with alveolar crest, the distance between papilla's top point with alveolar crest , the distance between papilla's top point with interdental contact point, Tarnow, Jemt, Papilla Presence Index classifications and patient satisfaction were analyzed and their effectiveness in term of papilla reconstruction was statistically compared. When parameters of SCTG and PRF groups were compared, it was observed that there were significant improvements in most parameters in both groups according to all data of baseline and after treatment. There were no statistically significant difference between the two groups except for KTW data. There was a 1-2 mm decrease in KTW in both groups and this decrease was less in SCTG group. These results suggest that PRF can be used as an alternative to SCTG and may be used for papilla reconstruction and successful results can be obtained. However, it was observed that SCTG was superior to PRF in papillary parameters and classification in time dependent change. Therefore, it may be considered that SCTG may be more successful in cases where larger embrasure should be closed.