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Background: Research investigating the potential link between gingival microvascular blood flow and inflammatory status is scarce. This study aims to assess color doppler flow imaging (CDFI) and micro-flow imaging (MFI) as tools for the assessment of gingival papilla blood flow (GPBF) and to examine their diagnostic utility as a noninvasive means of detecting gingival bleeding. Methods: CDFI and MFI were used to assess the GPBF grade (0–4) of 140 anterior gingival papilla sites in advanced periodontitis patients. Correlations between GPBF grades and periodontal characteristics were examined, and diagnostic performance as a means of predicting bleeding on probing (BOP) was examined using receiver operating characteristic curves. Results: GPBF grades 0 and 1 assessed by the MFI were 14.29% and 15.71% respectively, lower than the 28.57% and 24.29% assessed by the CDFI. In contrast, MFI detected a higher frequency of GPBF grade 2 sites (40.71%) relative to CDFI (22.14%). The CDFI and MFI provided consistent results in 62.14% of the sites, while the MFI demonstrated higher ratings in rest 37.86% of the sites. A significant positive correlation was detected between GPBF grade and the modified gingival index (MGI), bleeding index (BI), BOP, and probing depth (PD). It showed high accuracy for CDFI or MFI to diagnosing BOP with a sensitivity of 80.51% and 96.43% and a specificity of 77.27% and 57.14%, respectively. Area under the receiver operator characteristic curve values when predicting BOP based on the GPBF grade determined using CDFI and MFI approaches 0.887 (95% CI 0.833–0.942) and 0.917 (95% CI 0.862–0.972), respectively, and there were no significant differences between these values (Z = − 1.502, p = 0.133). Conclusions: Both MFI and CDFI can be employed for the evaluation of GPBF, and MFI is better suited to detecting mild inflammation. Trial registration ChiCTR2200066021 (Date of registration: 22/11/2022). [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Clinical Considerations Conclusion Treatment of gingival recession in the anterior mandible is more complex due to unique anatomic features including excessive tension due to frenal and muscle attachments, thin tissue, shallow vestibule, and narrow interdental space. These features are particularly limiting in the presence of deep recession and negatively impact the success most routine soft tissue grafting procedures. The recently proposed laterally closed tunnel combined the benefit of tension management from tunneling rather than incising papillae with lateral closure of deep recession to minimize the need for coronal advancement.This is an effective, although technically demanding procedure. This report presents a method of facilitating tunnel preparation by utilizing superficial papillary access incisions bilaterally in the papilla between the lateral incisor and canine. This papilla has the least tension and most robust interdental volume and blood supply. This incision creates a mini flap that facilitates tunnel dissection and graft placement.Because the mini flap is used for graft insertion, the suturing for lateral closure can be performed before graft insertion. The result is reduced technical difficulty. [ABSTRACT FROM AUTHOR]

Abstract Background Research investigating the potential link between gingival microvascular blood flow and inflammatory status is scarce. This study aims to assess color doppler flow imaging (CDFI) and micro-flow imaging (MFI) as tools for the assessment of gingival papilla blood flow (GPBF) and to examine their diagnostic utility as a noninvasive means of detecting gingival bleeding. Methods CDFI and MFI were used to assess the GPBF grade (0–4) of 140 anterior gingival papilla sites in advanced periodontitis patients. Correlations between GPBF grades and periodontal characteristics were examined, and diagnostic performance as a means of predicting bleeding on probing (BOP) was examined using receiver operating characteristic curves. Results GPBF grades 0 and 1 assessed by the MFI were 14.29% and 15.71% respectively, lower than the 28.57% and 24.29% assessed by the CDFI. In contrast, MFI detected a higher frequency of GPBF grade 2 sites (40.71%) relative to CDFI (22.14%). The CDFI and MFI provided consistent results in 62.14% of the sites, while the MFI demonstrated higher ratings in rest 37.86% of the sites. A significant positive correlation was detected between GPBF grade and the modified gingival index (MGI), bleeding index (BI), BOP, and probing depth (PD). It showed high accuracy for CDFI or MFI to diagnosing BOP with a sensitivity of 80.51% and 96.43% and a specificity of 77.27% and 57.14%, respectively. Area under the receiver operator characteristic curve values when predicting BOP based on the GPBF grade determined using CDFI and MFI approaches 0.887 (95% CI 0.833–0.942) and 0.917 (95% CI 0.862–0.972), respectively, and there were no significant differences between these values (Z = − 1.502, p = 0.133). Conclusions Both MFI and CDFI can be employed for the evaluation of GPBF, and MFI is better suited to detecting mild inflammation. Trial registration ChiCTR2200066021 (Date of registration: 22/11/2022).

Background: Modern dentistry has increasingly valued conservative and biologically less invasive clinical practices, seeking to preserve the patients’ tissues and natural dental elements. Most extractions in the dental clinic are preceded by periodontal disease that presents bone and gingival tissue loss, compromising the aesthetics as well as the support of dental elements. Objectives: The clinical approach in these cases often involves bone exertion followed by the successful installation of osseointegrated implants. Material and Methods: In this study, a case of extensive periodontal involvement and mobility of dental elements was carried out in a minimally invasive way, using the Er:YAG laser for periodontal decontamination and the hemolasertherapy technique to regenerate adjacent tissues, totaling nine weeks of treatment. Results: Clinical and radiographical improvement of tissue health and complete preservation of dental elements were observed. Conclusion: The patient underwent a follow-up appointment 2 years after the start of treatment when it was still possible to verify the stability of the clinical condition and the tissue gains obtained. [ABSTRACT FROM AUTHOR]

Objective: A comparative assessment of the aesthetic result of a single dental implant (DI) prosthetics using standard or custom abutments. Methods: A customized gingival former and a custom abutment were applied in patients of the main group, while patients of the control group received a standard gingival former and a stock abutment. The aesthetic assessment was carried out on photographs using the Pink Esthetic Score (PES) and White Esthetic Score (WES) scales. Results: Better aesthetic results were obtained in the main group compared to the control one. At subsequent stages of the study, a further aesthetical improvement was observed compared with the initial assessment result. Conclusion: The formation of a marginal gingiva matching the anatomical shape of the neck of the missing tooth enables to fabricate a customized abutment and a dental crown of the correct anatomical shape. The physiological dimensions and the correct eruption profile of the prosthetic crown contribute to the formation of interdental papillae where they were originally absent. The listed advantages of this method improve the RES and PES results of prosthetics on a single-unit DI.

Objective : To investigate the incidence, severity, susceptibility sites of gingival papillary recession (GPR) in adults after orthodontic treatment and the clinical impact of tooth extraction on GPR. Methods: A total of 82 adult patients were recruited and then divided into extraction and non-extraction groups according to whether the orthodontic teeth were extracted (teeth that needed to be extracted when performing orthodontic treatment). The gingival conditions of the two groups of patients before and after treatment were recorded using intraoral photos, and the incidence, severity and predilection sites of GPR after correction were investigated. Results: The results indicated that GPR occurred in 29 patients after correction, with an incidence rate of 35.4%. A total of 1648 gingival papillae were recorded among the 82 patients after correction, of which 67 exhibited atrophy, with an incidence of 4.1%. All occurrences of GPR were classified as papilla presence index 2 (PPI 2) (mild). The condition is most likely to occur in the anterior tooth area, especially in the lower incisor area. The results indicated that the incidence of GPR was substantially higher in the extraction group than in the non-extraction group, with the difference statistically significant. Conclusion: Following orthodontic treatment, adult patients will have a certain proportion of mild GPR, which is more common in the anterior tooth area, especially the lower anterior tooth area. [ABSTRACT FROM AUTHOR]

Gingival "black triangle" is common in clinical which due to interdental papilla recession. The cause of the loss of papilla is multi-factorial and it may be caused by the absorption of interdental alveolar bone or abnormal tooth position. Besides, it is a common complication after orthodontics and implant surgery. Recession of gingival papilla influences interdental plaque control, increasing food impaction and alveolar bone absorption, causing aesthetic and pronunciation problems. Thus, the way of reducing or eliminating the gingival "black triangle" has become one of the most essential problems for dentists. Concentrated growth factor (CGF) and low-level-laser therapy have been widely used, respectively, and CGF was considered as the only self-substance which has soft tissue regeneration function. This study aims to evaluate the efficacy of regenerating interdental papilla by Liquid phase concentrated growth factor (LPCGF) injection with low-level-laser therapy (LLLT). [ABSTRACT FROM AUTHOR]

Objective To investigate the application of digital immediate implant and angle screw channel abutment in the aesthetic area and the related influencing factors by reviewing the data of one case of immediate implant repair of the upper anterior teeth and related literature. Methods One case of refractory chronic apicitis of the upper anterior teeth involved immediate implantation after extraction. The digital information of the patient was obtained by CBCT and intraoral scanning. According to the information from the patients, a preoperative evaluation was performed; a treatment scheme was formulated; a minimally invasive extraction was performed; implants were placed under a digital guide plate; and temporary restoration was immediately performed. Six months after the operation, the patients underwent individualized mold removal, and angle screw channel fixation was completed. We observed the cosmetic effects and soft and hard tissue and gingival contour maintenance effects after restoration and reexamined the patients 6 months after restoration. In addition, the relevant literature was reviewed. Results The height of the gingival margin and gingival papilla and gingival contour of this patient were well maintained. The red and white aesthetic effect was good. There was no redness or swelling of the gingiva nor obvious changes in the soft and hard tissues around the implant 6 months after restoration, and the patient was satisfied. The results in the literature review show that a preoperative design based on CBCT and intraoral scanning data combined with digital software and a whole digital guide plate make the procedure more accurate and safer. These factors can not only avoid important anatomical structures and serious surgical complications but can also result in implantation in the best three-dimensional position. In addition, the application of digital impression technology and CAD/CAM increases the efficiency, speed, accuracy, simplicity, and comfort of oral impressions and the construction of temporary and final prostheses more precise and faster, greatly improving clinical efficiency. Conclusion Digital immediate implant and angle screw channel abutment is a good method to restore the aesthetics and function of missing teeth and to avoid the complications caused by adhesive residue.

Our case reports probe whether intentional replantation is a feasible and successful treatment for teeth with radicular developmental groove. Radicular developmental groove is an anatomical malformation that often leads to combined periodontal-endodontic lesion. Treatment of complex radicular groove presents a great challenge to the operator. Two cases of periodontal compromised teeth with this developmental anomaly were treated with intentional replantation and followed up for 2 years. The teeth were asymptomatic and functional. The periodontal probing depths decreased from original 10 mm to 2-3 mm. The receded gingival papillae associated with the teeth was regenerated two years after intentional replantation. With careful case selection and treatment planning, intentional replantation may be a predictable alternative treatment modality for the combined endodontic-periodontal lesion accompanied with radicular developmental groove. [ABSTRACT FROM AUTHOR]

The morphology of the gingival papilla plays an important role in the aesthetics of oral soft tissue. Gingi⁃ val papilla recession forms a visible black triangle, causing a series of problems such as aesthetic defects, pronunciation disorders and food impaction and even endangering the health of periodontal tissue. Gingival papilla reconstruction is an effective way to eliminate the black triangle. However, the treatment of lost or collapsed gingival papilla is unsuccess⁃ ful. Reconstruction of the interdental papilla for aesthetics zone is the most difficult and challenging periodontal treat⁃ ment. In this article, we review the past literature and summarize the factors affecting the appearance of gingival papilla, including the distance between the contact point and the alveolar crest, the distance between roots, divergent roots, inter⁃ dental width, embrasure morphology, crown shape, and gingival biotype. The classification of the gingival papilla based on the loss of papillary height and the nonsurgical and surgical methods for the reconstruction of gingival papilla are re⁃ viewed to provide a reference for doctors to reconstruct the gingival papilla.

Purpose: The purpose of this study was to evaluate in dogs the area between implants after prosthetic restoration within 5 mm distance between the contact point (CP) between crowns and the bone crest (BC). Materials and Methods: The mandibular premolars of 6 dogs were extracted bilaterally. After 12 weeks of healing, each dog received 8 implants. On each side, 2 implants were separated by 2 mm (group 1) and 2 by 3 mm (group 2). After a healing period (3 months), the implants were restored with temporary acrylic resin prostheses and after 4 more weeks, with definitive metallic prostheses. After 8 weeks, the distance between the CP and the papilla (P) was measured. The distance between a line extending from the CP and the gin gival height at the distal extension of the prosthesis (DE) was also measured. Digital radiographic images were obtained for evaluation of the CP-BC and BC-P distances and the analysis of bone resorption adjacent to the implant surfaces. Results: The median CP-P distances were 1.75 mm and 1.98 mm for groups 1 and 2, respectively; the median CP-DE distances were 2.60 and 2.69, respectively. The mean CP-BC distances were 5.64 mm and 6.45 mm, for groups 1 and 2, respectively; mean BC-P distances were 3.07 mm and 3.55 mm, respectively. Discussion and Conclusions: The differences in distances of 2 and 3 mm between implants did not present significant differences in the formation of papillae or in crestal resorption. The CP-BC distances for prostheses should be different from those of natural teeth because in natural teeth, the biologic width is already present, and in the case of implant-supported prostheses, it will develop following second-stage surgery. [ABSTRACT FROM AUTHOR]

Prosthetic dental restorations alone do not produce esthetics. They must be in harmony with the surrounding gingiva, especially the gingival papilla. This case report describes the enhancement of the gingival papilla between an implant replacing the maxillary left central incisor and a provisional crown on the maxillary left lateral incisor. Esthetic harmony was disrupted by the absence of an interproximal papilla. First, provisional crowns on the implant and adjacent tooth were used in an attempt to remodel the interproximal gingival tissue, but the esthetic result was not satisfactory. The second attempt involved orthodontic extrusion of the lateral incisor in an incisal direction, The gingival tissue migrated incisally, thus restoring the deficient papilla and establishing restorative and gingival harmony. Both the implant and the lateral incisor were restored with ceramic crowns. (Quintessence Int 2002;33:581-565) [ABSTRACT FROM AUTHOR]

Many clinicians have reported on the success of immediately loaded implants supporting a bilaterally stabilized provisional fixed prosthesis. This protocol offers several advantages, including increased masticatory function, minimized uncontrolled transmucosal loading through crossarch stabilization, improvement of psychologic well-being, and reduction in treatment time. However, the development and maintenance of proper dentogingival esthetics in the edentulous maxilla presents substantial challenges for the implant team. This article presents the specific pretreatment diagnostic requirements for immediate loading of single-stage implants and demonstrates a new surgical technique, followed by appropriate prosthodontic management, to develop an optimal gingival profile with interdental papillae surrounding a natural-looking dentition. One hundred fifty-one ITI implants were placed into 22 dental arches and immediately loaded with a 1-piece fixed prosthesis. The results of this technique over the last 5 years are presented. [ABSTRACT FROM AUTHOR]

Objective To evaluate the role of the combined periodontic-orthodontic treatment in the esthetic reconstruction of the anterior teeth area following periodontitis. Methods Thirteen adult patients with anterior teeth displacements were treated. The probing pocket depth (PD; 102 teeth, 612 sites), bleeding on probing (102 teeth, 204 sites), papilla index (PI; 128 papillae), and papillary height (PH; 128 papillae) of each patient were assessed at baseline, 3 months after the initial therapy, and the end of the orthodontic treatment. Non-parametric and paired-sample t tests were carried out for the statistical analysis of the data. Results Three months after initial therapy, the sites with PD⩽3 mm accounted for 79.58% (487/612) of the observed teeth, and 88.73% (181/204) of the buccal and lingual sites of the :eeth showed negative bleeding on probing. These findings were better than those at baseline [26.31% (161/612) and 22.06% (45/204), respectively] (P>0.05), but no significant difference was observed compared with pro-orthodontic treatment (P>0.05). Prior to orthodontic treatment, the levels of the PI of 8 and 21 papillae were HI and II, respectively, among the 128 observed papillae. After the orthodontic treatment, 51 papillae were at level III and 68 papillae were at level D . The PH of the 102 papillae was 2.84 mm±0.62 mm after orthodontic treatment. This result indicated significant difference compared with that of pre-orthodontic treatment (1.69 mm± 0.57 mm) (P<0.05). Conclusion After initial therapy, moderate orthodontic teeth movements may reconstruct the interproximal soft tissue, with esthetic improvement of the papillary level and resolution of the periodontal defects. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this review is to analyse the use of hyaluronic acid injection in the interdental space to reconstruct the papilla in animal models and humans., Materials and Methods: Electronic databases were searched up to May 2022, and additional hand searching was performed. The search strategy was implemented according to the PRISMA guidelines. The inclusion criteria were: studies written in English, studies using hyaluronic acid, in vivo studies, studies with a precise number of specimens, case series with ≥6 patients, and studies published after 2010. The risk of bias was assessed for each study that could be evaluated., Results: A total of 19 articles were selected and reviewed in this review. Due to the great heterogeneity of the protocols and materials, comparison between studies was not possible. However, using this technique, the studies found statistically significant improvements in most cases. The filling percentages ranged from 19% to 100%. Regarding patient satisfaction, the few studies that evaluated this parameter found statistically significant results with most patients willing to repeat the experience. Regarding side effects, only two studies reported them. Moreover, the procedure does not seem to be very painful., Conclusion: The results suggest that hyaluronic acid injections seem to be effective in reconstructing papillary volume. However, to date, too few clinical trials with a high level of proof have been conducted on this technique. Future studies will have to work on the size of the sample, the concentration of the product, the number of injections and the injection method.

Among the factors that contribute to the papilla formation and crestal bone preservation between contiguous implants, this animal study clinically and radiographically evaluated the interimplant distances (IDs) of 2 and 3 mm and the placement depths of Morse cone connection implants restored with platform switch. Bilateral mandibular premolars of 6 dogs were extracted, and after 12 weeks, the implants were placed. Four experimental groups were constituted: subcrestally with ID of 2 mm (2 SCL) and 3 mm (3 SCL) and crestally with ID of 2 mm (2 CL) and 3 mm (3 CL). Metallic crowns were immediately installed with a distance of 3 mm between the contact point and the bone crest. Eight weeks later, clinical measurements were performed to evaluate papilla formation, and radiographic images were taken to analyze the crestal bone remodeling. The subcrestal groups achieved better levels of papillae formation when compared with the crestal groups, with a significant difference between the 3 SCL and 3 CL groups (P = .026). Radiographically, the crestal bone preservation was also better in the subcrestal groups, with statistically significant differences between the 2SCL and 2CL groups (P = .002) and between the 3SCL and 3CL groups (P = .008). With the present conditions, it could be concluded that subcrestal implant placement had a positive impact on papilla formation and crestal bone preservation, which could favor the esthetic of anterior regions. However, the IDs of 2 and 3 mm did not show significantly different results. [ABSTRACT FROM AUTHOR]

Implant esthetics has been the focus of attention for the past decade, and one vital issue is the effect of interimplant distance on interimplant papilla formation and crestal bone loss. The aim of this study was to evaluate the effect of 1, 2, and 3 mm of interimplant distance on papilla formation and crestal resorption in submerged and nonsubmerged Ankylos implants after prosthetic restoration. Bilateral mandibular premolars of 7 dogs were extracted, and after 12 weeks each dog received 8 implants. Implants were placed so that 3 interimplant distances were created at 1 mm (group 1), 2 mm (group 2), and 3 mm (group 3). The sides and the position of the groups were randomly selected. Twelve weeks after placement, the implants received metallic prostheses that allowed 5 mm of space between the prosthetic contact point (CP) and the crestal bone (CB). After 8 weeks, the distance between the CP and the papilla (CP-P) and the gingival height at the distal proximal aspect of the prosthesis (CP-DE) was clinically measured. Radiographic images were obtained to measure the distance of the CP to the CB within the interimplant surfaces (CP-IP) and adjacent to the edentulous surfaces (CP-ED). The clinical measurement of CP-P for submerged and nonsubmerged implants was 3.57 ± 1.17 mm and 3.10 ± 0.82 mm for group 1, 3.57 ± 0.78 mm and 3.16 ± 0.87 mm for group 2, and 3.35 ± 0.55 mm and 3.07 ± 0.93 mm for group 3. The CP-DE was 3.25 ± 0.77 mm for submerged and 2.78 ± 0.64 mm for nonsubmerged implants. The CP-IP for the submerged and nonsubmerged implants was 6.91 ± 0.95 mm and 7.68 ± 2.73 mm for group 1, 7.46 ± 1.43 mm and 5.87 ± 1.71 mm for group 2, and 7.72 ± 0.81 mm and 7.59 ± 1.33 mm for group 3. The CP-ED was 6.77 ± 1.33 mm for submerged implants and 6.03 ± 1.58 mm for nonsubmerged implants. There were no statistical significant differences for any of the measured parameters. We conclude that when the distance from the CP to the CB was 5 mm, interimplant distances of 1 to 3 mm did not affect papilla formation or crestal resorption of submerged or nonsubmerged implants in the dog model. [ABSTRACT FROM AUTHOR]

The aim of this investigation was to determine whether gingival fibroblast progenitor cells undergo division and whether there is evidence of migration of their progeny from the paravascular sites within the interdental gingival septum (IGS). 30 male hooded Lister rats aged 6 weeks, were killed in groups of ten, 3, 75 and 171 h after a single injection of tritiated thymidine. Autoradiographs were examined transverse Historesin sections of the papilla between second and third mandibular molars in 29 specimens, taken from equidistant intervals between the col and alveolar bone crest. Median grain counts in the whole papilla were greatest within 10 μm of blood vessels at 3 h (p<0.02) and decreased throughout the papilla with time (p<0.0001). The median grain counts at level 5. nearest the periodontal ligament, were greatest at all times (p<0.01). The distance of labelled nuclei from blood vessel walls increased with time, most notably at level 5 (p<0.001 ). The mean Clustering Index increased (p<0.01) from 4.6% at 3 h to 12.3% and 11 .6% at 75 h and 171 h respectively. At 75 h the median grain count of clustered nuclei was smaller (p<0.01 ) than that of non- clustered nuclei. These data are consistent with the occurrence of clonal division and migration within the IGS and the presence of a slowly cycling cell population near to the periodontal ligament. [ABSTRACT FROM AUTHOR]

The aims of this investigation were to determine whether connective tissue progenitor cells in the interdental gingival septum (IGS) have a paravascular origin, and how the distribution of 3HTdR-labelled cells within the IGS changes with time after a single injection, 30 male hooded Lister rats aged 6 weeks, were killed in groups of ten, 3, 75 and 171 h after a single injection of tritiated thymidine. Autoradiographs were examined of 3 transverse Historesin sections of the papilla between second and third mandibular molars in 29 specimens, taken at equidistant intervals between the col and alveolar bone crest. At all times and levels, 73.9-93.0% of labelled cells and 72.0-79.0% of unlabelled cells lay within 50 μm of blood vessels (BVs). the highest percentages of labelled cells (PLCs) occured within 5μm of BVs (P<0.001) although mean nuclear density here was lowest (P<0.017), and there was a significant diminution of PLC (P<0.05) with increasing distance from BVs, occurring most precipitously5-10 μm from vessel walls. Sites of significantly increased PLC at 3 h also approximated to sites in which mean BV densities were greatest. At 3 h , a number of discrete sites with significantly increased PLCs (P<0.05) were found within two zones, each equivalent to 40% of IGS volume and juxtaposed with each tooth. At later times, additional sites of raised PLC appeared throughout the IGS. Overall PLCs in the upper two levels and within 5 μm of BVs also increased over the timecourse (P<0.01). These data are consistent with the existence of paravascular connective tissue progenitor cells within the outer zones of the IGS closest to the teeth. Labelled cell destributions at 75 h and 171 h did not provide firm evidence of translocation within the IGS. [ABSTRACT FROM AUTHOR]

Oral soft tissue has been a highlight topic these days. The morphology of gingival papilla is one of the most important factors influencing esthetics of oral soft tissue. The loss of gingival papilla height leads to black triangle. In anterior region, the black triangle not only results in functional disorder, but also brings in speech problems and esthetic concerns. Researchers from home and abroad reported some morphological factors influencing the height of gingival papilla: Age, gingival biotype, crown form, contact point-crest distance, interdental distance, divergence angle, embrasure morphology, etc. Clinicians must understand the factors that influence the presence of the interproximal. [ABSTRACT FROM AUTHOR]

Abstract: A 33-year-old woman presented with what looked like an epulis at the interdental papilla between 22 and 23. We excised the lesion and histopathological examination surprisingly showed the presence of a well-differentiated squamous cell carcinoma that was not invading the underlying bone. We then did a radical excision including extraction of teeth followed by bony reconstruction. No recurrence or metastases have been seen during a follow-up of 12 months. [Copyright &y& Elsevier]

Background: loss of the interdental papillae leads to the formation of a black triangle, which compromises smile esthetics and contributes to food impaction and plaque accumulation. The aim of this study was to evaluate the efficacy of the injection of hyaluronic acid (HA) and compare it to that of physiological saline solution in the restoration of deficient gingival papillae in vivo and in vitro ., Methods: Twenty-four patients with 68 deficient gingival papillae were recruited for this clinical trial with a split-mouth design. The deficient gingival papillae on one side of the anterior maxilla were injected with HA, and those on the other side were injected with physiological saline solution. The heights of the gingival papillae and the areas of the black triangles were measured from clinical photographs obtained before and 6 and 12 months after treatment. Additionally, the proliferation and migration of gingival fibroblasts were evaluated after HA and physiological saline treatment by an in vitro study., Results: the results revealed that the injection of HA yielded 0.198 and 0.28 mm gingival papilla increasement at 6 and 12 months, respectively, relative to the baseline (P<0.05). However, deficient gingival papillae also grew by 0.278 mm at 12 months in the group that received physiological saline solution (P<0.05). The injection of HA significantly improved deficient gingival papillae 6 months earlier than the injection of physiological saline solution. HA also significantly accelerated the proliferation and migration of gingival fibroblasts in vitro ., Conclusions: The present study confirms that the injection of HA could increase the height of gingival papillae for improving gingival papilla defects. However, the effect is not superior to that of physiological saline solution. This trial was registered in the Chinese Clinical Trial Registry (ChiCTR-ONC-17011781) (28/06/2017). http://www.chictr.org.cn/showproj.aspx?proj=19931., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/atm-20-7599). The authors have no conflicts of interest to declare., (2021 Annals of Translational Medicine. All rights reserved.)

In addition to restoring oral function, stable aesthetic outcome has become the goal of oral implant therapy. To ensure the harmonious appearance of the restoration and the natural tooth and to obtain the ideal hard and soft tissue structure, clinicians should have a clear understanding of the factors that influence the success of aesthetics and apply different technique accordingly. In view of the recent progress in the field of oral implant, the factors affecting the aesthetic outcome of implant treatment were discussed including neck design of implant, design of customized abutment, tissue regeneration and gingival papilla height, so as to provide clinical reference to improving the aesthetic outcome of oral implant treatment.