Papillary Reconstruction using Hyaluronic Acid: A Review

Abstract

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.

Keywords: gingival papilla; hyaluronic acid; periodontal plastic surgery; periodontitis.

Fig 1

PRISMA flow chart

Fig 2

Risk of bias assessment of included studies. Risk of bias graph for animal studies, using the SYRCLE’s tool, averaged per item. Risk of bias graph for randomised human trials, using the Cochrane Collaboration’s tool, averaged per item. The green, yellow and red colours depict the percentages of studies with low, unclear or high risk of bias of the total number of assessed studies.