• Journal of Periodontal and Implant Science
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• v.31 no.3
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• pp.633-640
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• 2001

As the public becomes concerned with looking younger and healthy, aesthetic considerations will become more relevant to dental treatment planning. The purpose of this study was to evaluate the relationship between interdental papilla existence and the distance from contact point to interdental alveolar crest in the maxillary anterior dentition of korean. Fifty-nine Korean adult consist of adults. 34 males and 25 females participated in the study. Papilla Index(PI) was recorded. The distance between contact point and interdental alveolar crest was measured by sounding with Williams probe. Measurement were carried out in 257 maxillary anterior interproximal area. The results showed that mean PI was 1.95 and mean distance between contact point and interdental alveolar crest was 5.07mm. The correlation between the papilla index and distance was negative and statistically significant(r=-0.819; p=0.000). A high negative correlation existed between PI and distance from contact point to alveolar crest. When the distance between contact point and alveolar crest was 4mm, the papilla got lost on a half of all cases. When the distance was 5mm, the papilla was present almost 11%. When the distance was 6mm, the papilla was present 4%. When the distance was 7mm or more, the papilla was lost in all cases.

• Journal of the Korean Academy of Esthetic Dentistry
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• v.10 no.1
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• pp.30-45
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• 2001

In recent years, clinicians' and dentists' esthetic demands in dentistry have increased rapidly. The ultimate goal in modern restorative dentistry is to achieve "white" and "pink" esthetics in the esthetically important zones. Therefore, modern esthetic dentistry involves not only the restoration of lost teeth and their associated hard tissues, but increasingly the management and reconstruction of the encasing gingiva with adequate surgical techniques. Interdental space are filled by interdental papilla in the healthy gingiva, preventing plaque deposition and protecting periodontal tissue from infection. This also inhibits impaction of food remnants and whistling through the teeth during speech. These functional aspects are obviously important, but esthetic aspects are important as well. Complete and predictable restoration of lost interdental papillae remains one of the biggest challenges in periodontal reconstructive surgery. One of the most challenging and least predictable problems is the reconstruction of the lost interdental papilla. The interdental papilla, as a structure with minor blood supply, was left more or less untouched by clinicians. Most of the reconstructive techniques to rebuild lost interdental papillae focus on the maxillary anterior region, where esthetic defects appear interproximally as "black triangle". Causes for interdental tissue loss are, for example, commom periodontal diseases, tooth extraction, excessive surgical periodontal treatment, and localized progressive gingiva and periodontal diseases. If an interdental papilla is absent because of a diastema, orthodontic closure is the treatment of choice. "Creeping" papilla formation has been described by closing the interdental space and creating a contact area. In certain cases this formation can also be achieved with appropriate restorative techniques and alteration of the mesial contours of the adjacent teeth. The presence of an interdental papilla depends on the distance between the crest of bone and the interproximal contact point, allowing it to fill interdental spaces with soft tissue by altering the mesial contours of the adjacent teeth and positioning the contact point more apically. The interdental tissue can also be conditioned with the use of provisional crowns prior to the definitive restoration. If all other procedures are contraindicated or fail, prosthetic solutions have to be considered as the last possibility to rebuild lost interdental papillae. Interdental spaces can be filled using pink-colored resin or porcelain, and the use of a removable gingival mask might be the last opportunity to hide severe tissue defects.

• The korean journal of orthodontics
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• v.44 no.2
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• pp.54-61
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• 2014

Objective: This study aimed to propose clinical guidelines for placing miniscrew implants using the results obtained from 3-dimensional analysis of maxillary anterior interdental alveolar bone by cone-beam computed tomography (CBCT). Methods: By using CBCT data from 52 adult patients (17 men and 35 women; mean age, 27.9 years), alveolar bone were measured in 3 regions: between the maxillary central incisors (U1-U1), between the maxillary central incisor and maxillary lateral incisor (U1-U2), and between the maxillary lateral incisor and the canine (U2-U3). Cortical bone thickness, labio-palatal thickness, and interdental root distance were measured at 4 mm, 6 mm, and 8 mm apical to the interdental cementoenamel junction (ICEJ). Results: The cortical bone thickness significantly increased from the U1-U1 region to the U2-U3 region (p < 0.05). The labio-palatal thickness was significantly less in the U1-U1 region (p < 0.05), and the interdental root distance was significantly less in the U1-U2 region (p < 0.05). Conclusions: The results of this study suggest that the interdental root regions U2-U3 and U1-U1 are the best sites for placing miniscrew implants into maxillary anterior alveolar bone.

• Journal of Periodontal and Implant Science
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• v.31 no.3
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• pp.625-631
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• 2001

The anatomic structure around interproximal area plays an important role not only in the natural teeth, but also in the implant. The loss of papilla can lead to cosmetic deformity, phonetic problem, food impaction on the anterior dentition, and masticatory problem, food impaction and proximal caries on the posterior dentition. The purpose of this study was to evaluate the relationship between interdental papilla existence and distance from contact point to alveolar crest in Korean posteior dentition. 45 Korean adult patients(31males, 14 females) participated in this study. Measurements were carreid out total 126 interproximal areas, 18 first premolar, 31 second premolar, 40 first molar, and 37 second molar areas. Papilla index was recorded as suggested by Jemt. Distance between contact point and alveolar crest measrued by Florida $probe^{R}$, after flap elevation. Each distance was measured 10 times by every 0.1mm unit. The results showed that the mean Papilla index 1.37 and mean distance between contact point and alveolar crest was 7.44mm. The correlation between the Papilla index and distance was high negative correlation(Pearson correlation=-0.47), and it was statistically significant(P=0.000) When the distance between contact point and alveolar crest was 5mm, the loss of papilla was appeared almost in half cases. When the distance was 6mm, the papilla loss was present 95%, when 7mm, the papilla loss was 100%.

• Journal of Periodontal and Implant Science
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• v.46 no.4
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• pp.277-287
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• 2016

Purpose: The purpose of this study was to evaluate the clinical efficacy of enhancing deficient interdental papilla with hyaluronic acid gel injection by assessing the radiographic anatomical factors affecting the reconstruction of the interdental papilla. Methods: Fifty-seven treated sites from 13 patients (6 males and 7 females) were included. Patients had papillary deficiency in the upper anterior area. Prior to treatment, photographic and periapical radiographic standardization devices were designed for each patient. A 30-gauge needle was used with an injection-assistance device to inject a hyaluronic acid gel to the involved papilla. This treatment was repeated up to 5 times every 3 weeks. Patients were followed up for 6 months after the initial gel application. Clinical photographic measurements of the black triangle area (BTA), height (BTH), and width (BTW) and periapical radiographic measurements of the contact point and the bone crest (CP-BC) and the interproximal distance between roots (IDR) were undertaken using computer software. The interdental papilla reconstruction rate (IPRR) was calculated to determine the percentage change of BTA between the initial and final examination and the association between radiographic factors and the reconstruction of the interdental papilla by means of injectable hyaluronic acid gel were evaluated. Results: All sites showed improvement between treatment examinations. Thirty-six sites had complete interdental papilla reconstruction and 21 sites showed improvement ranging from 19% to 96%. The CP-BC correlated with the IPRR. More specifically, when the CP-BC reached 6 mm, virtually complete interdental papilla reconstruction via injectable hyaluronic acid gel was achieved. Conclusions: These results suggest that the CP-BC is closely related to the efficacy of hyaluronic acid gel injection for interdental papilla reconstruction.

• Journal of Periodontal and Implant Science
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• v.41 no.6
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• pp.273-278
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• 2011

Purpose: To analyze the dimensions of the embrasure space between the maxillary central incisors as potential factors influencing interdental papilla fill and height. Methods: The embrasure dimensions between the maxillary central incisors of 100 subjects (40 females/60 males) were assessed with clinical, study model, and radiographic examinations. Variables of the complete and deficient papilla fill groups were compared. Multiple regression analyses were performed to investigate potential influence of the distance between the contact point and bone crest (CP_BC), horizontal interdental distance (HID), and facio-lingual thickness (FLT) at the papilla base on complete/deficient papilla fill and papilla height (PH). Results: CP_BC was the only variable that showed a significant difference between the complete and deficient papilla groups (P<0.05). When the CP_BC was less than 5 mm, the embrasure spaces between the maxillary central incisors were completely filled with interdental papilla. Multiple regression analyses revealed that a significant predictor for complete/deficient papilla fill was CP_BC, and significant predictors for PH were CP_BC and HID (P<0.05). Conclusions: The chances of complete papilla fill increased as CP_BC decreased, while PH increased as CP_BC and HID increased. However, the FLT of the papilla base did not appear to affect papilla fill or PH. From an esthetic perspective, CP_BC as well as HID should be considered as factors influencing the topography of interdental papilla.

• Journal of Dental Rehabilitation and Applied Science
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• v.33 no.4
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• pp.278-283
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• 2017

Purpose: The aim of this study was to evaluate the interdental distances of anterior, premolar, and molar teeth at the cementoenamel junction (CEJ) and 2 mm below the CEJ in healthy natural dentition with cone-beam computerized tomography (cone-beam CT) in order to provide valuable data for ideal implant positioning relative to mesiodistal bone dimensions. Materials and Methods: Two hundred patients who visited Dental Hospital, Wonkwang University, who had natural dentition with healthy interdental papillae, and who underwent cone-beam CT were selected. The cone-beam CT images were converted to digital imaging and communication in medicine (DICOM) files and reconstructed in three-dimensional images. To standardize the cone-beam CT images, head reorientation was performed. All of the measurements were determined on the reconstructed panoramic images by three professionally trained dentists. Results: At the CEJ, the mean maxillary interdental distances were 1.84 mm (anterior teeth), 2.07 mm (premolar), and 2.08 mm (molar), and the mean mandibular interproximal distances were 1.55 mm (anterior teeth), 2.20 mm (premolar), and 2.36 mm (molar). At 2mm below the CEJ, the mean maxillary interdental distances were 2.19 mm (anterior teeth), 2.51 mm (premolar), and 2.60 mm (molar), and the mean mandibular interproximal distances were 1.86 mm (anterior teeth), 2.53 mm (premolar), and 3.01 mm (molar). Conclusion: The interdental distances in the natural dentition were larger at the posterior teeth than at the anterior teeth and also at 2 mm below the CEJ level compared with at the CEJ level. The distances between mandibular incisors were the narrowest and the distances between mandibular molars were the widest in the entire dentition.

• Imaging Science in Dentistry
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• v.51 no.2
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• pp.155-165
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• 2021

Purpose: This study aimed to evaluate changes of the alveolar bone and interdental bone septum of the mandibular incisors through cone-beam computed tomography (CBCT) after orthodontic treatment of mandibular dental crowding without dental extraction. Materials and Methods: The sample consisted of 64 CBCT images(32 pre-treatment and 32 post-treatment) from 32 adult patients with class I malocclusion and an average age of 23.0±3.9 years. The width and height of the alveolar bone and interdental septum, the distance between the cementoenamel junction (CEJ) and the facial and lingual bone crests, and the inclination of the mandibular incisors were measured. Results: The distance between the CEJ and the marginal bone crest on the facial side increased significantly (P<0.05). An increased distance between the CEJ and the bone crest on the facial and lingual sides showed a correlation with the irregularity index (P<0.05); however, no significant association was observed with increasing mandibular incisor inclination (P>0.05). The change in the distance between the CEJ and the marginal bone crest on the facial side was correlated significantly with bone septum height(P<0.05). Conclusion: Bone dehiscence developed during the treatment of crowding without extraction only on the incisors' facial side. Increasing proclination of the mandibular incisor was not correlated with bone dehiscence. The degree of dental crowding assessed through the irregularity index was associated with the risk of developing bone dehiscence. The interdental septum reflected facial marginal bone loss in the mandibular incisors.

• Imaging Science in Dentistry
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• v.40 no.4
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• pp.179-185
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• 2010

Purpose : Cortical bone thickness is one of the important factor in mini-implant stability. This study was performed to investigate the buccal cortical bone thickness at every interdental area as an aid in planning mini-implant placement. Materials and Methods : Two-dimensional slices at every interdental area were selected from the cone-beam computed tomography scans of 20 patients in third decade. Buccal cortical bone thickness was measured at 2, 4, and 6 mm levels from the alveolar crest in the interdental bones of posterior regions of both jaws using the plot profile function of $Ez3D2009^{TM}$ (Vatech, Yongin, Korea). The results were analyzed using by Mann-Whitney test. Results : Buccal cortical bone was thicker in the mandible than in the maxilla. The thickness increased with further distance from the alveolar crest in the maxilla and with coming from the posterior to anterior region in the mandible (p<0.01). The maximum CT value showed an increasing tendency with further distance from the alveolar crest and with coming from posterior to anterior region in both jaws. Conclusion : Interdental buccal cortical bone thickness varied in both jaws, however our study showed a distinct tendency. We expect that these results could be helpful for the selection and preparation of mini-implant sites.

• Imaging Science in Dentistry
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• v.49 no.1
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• pp.9-17
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• 2019

Purpose: This study aimed to introduce a novel method to evaluate the alveolar bone and interdental septum in the anterior mandible using cone-beam computed tomography (CBCT). Materials and Methods: Fifty-six CBCT scans from adult patients were selected. The CBCT scans were obtained before and after orthodontic treatment. The following measurements were taken: width of the alveolar bone and the interdental septum, height of the interdental septum, height of the bone plates, distance between the cementoenamel junction and marginal bone crests, and vertical positioning of the mandibular incisor, using the lingual plane as a reference. To test the reproducibility and the stability of the lingual plane, a triangle was traced in the anterior mandible. The intra-class correlation coefficient(ICC) was used to determine intra- and inter-examiner agreement. The paired Student t-test was used to evaluate the area of the triangle and the reproducibility of all measurements. Results: The ICC was excellent for the alveolar bone and dental measurements (0.9989 and 0.9977, respectively), as well as for the interdental septum (0.9987 and 0.9961, respectively). The area of the triangles showed stability in the lingual plane (P>0.05). For the alveolar bone, mandibular incisor, and interdental septum measurements, no statistically significant differences were found between the 2 examiners(P>0.05), confirming the technical reliability of the measurements. Conclusion: The method used in this study provides a valid and reproducible assessment of alveolar bone dimensions in the anterior mandible measured on CBCT images.