March 30, 2021
One of the most important tissues that helps in protecting the teeth are the gums or the gingiva. The gingiva braces the tooth and plays a key role in its blood and nerve supply. The gingiva is also present in between two teeth. This is called the interdental papilla. The word 'papilla' refers to any soft tissue protuberance. In this case, the soft tissue is the gingiva between two teeth.
The interdental papilla can help in determining the health of the tissues surrounding the teeth and is a crucial component of aesthetics. The width of the interdental papilla depends on the space between two teeth, height of the underlying bone, the point of contact between two adjacent teeth, distance between roots of adjacent teeth and shape of the teeth. In the front teeth, the interdental papilla is thinner compared to the back teeth. The interdental papilla of the front teeth is pyramidal in shape whereas in the back teeth it is called a col. The thickness of interdental papilla should be such that it is resilient to any foreign pathogen invasion. A thin interdental papilla is fragile and more susceptible to microbes. The loss of interdental papilla can be a concern for both aesthetics and the overall health of the tissues.
Interdental papilla can be lost because of many reasons. Firstly, an active disease affecting the periodontium (tissue system supporting the tooth) can recess the interdental papilla. Secondly, an active orthodontic treatment (braces) that leads to change in the position of teeth can lead to the loss of interdental papilla. A decreased bone height is another reason that leads to the absence of interdental papilla. If a patient has a received a crown on one tooth, then the interdental papilla adjacent to that tooth might be lost. Another reason for interdental loss of papilla is the formation of pockets. These are formed when the attachment between gingiva and the tooth loosens, creating a passage for microorganisms to infect and inflame the periodontium.
When the interdental papilla are lost, it leads to the formation of a black triangular space. When this is seen in the front teeth, it directly compromises the patient's smile. Moreover, the loss of interdental papilla can affect the phonetics (speech) as well. This is because the the black open triangles create a passage for air to pass through leading to unwanted sounds. Food lodgement is another issue that can occur in gingival black triangles. These reasons make us realize that a lost interdental papilla needs to be rebuilt for both aesthetic and funtional purpose.
Before beginning with the treatment of lost interdental papilla, it is important to know the extent of the loss and the possible cause behind the loss of the soft tissue. An overzealous method of toothbrushing can often damage the interdental papilla. In such cases, the patient is educated about the proper toothbrush that he or she should use and the technique in which the brush should be moved around the teeth. Materials like pink porcelain, composite resin and removable acrylic can help in both rebuilding the interdental papilla and masking the lost soft tissues. In some cases, the removal of enamel (first hard tissue layer of the tooth) near the contact point can be done to increase the distance between the teeth. When this happens, the teeth try to move towards each other to close the created space. This leads to the soft tissue taking a new contour and the thus restoring the lost interdental papilla.
A scrapping technique can also be used to recreate the lost interdental papilla. Every 15 days for 3 months, the patient's interdental papilla is curetted (cut). Over a period of 9 months, regeneration of the interdental papilla can be seen. A recent technique for re-establishing the interdental papilla is hyaluronic acid injections or gels. This chemical was initially used as a filler for skin conditions but now it has also shown its efficacy in the treatment of lost interdental papilla. Clinical results have shown that there is no relapse of the lost tissue after hyaluronic acid injections. Invasive surgical techniques include raising and repositioning a flap of the adjacent soft tissues into the interdental papilla region. These flaps are raised after placing incisions at the needed areas depending on the extent of loss of the soft tissue. These procedures are done under local anesthesia and is usually a painless procedure.
Interdental papilla is a vital component of the oral cavity. Apart from being an aesthetic feature, it represents the condition of the oral health in general. A sound interdental papilla thus assures better health of the teeth and its adjacent structures overall.