Interdental papilla regeneration on natural teeth in the esthetic sector: Integrating orthodontics into a...

The presence of interdental papillae plays a key role in smile aesthetics, and their restoration is one of the most difficult treatments in dentistry. In a healthy periodontium and in the absence of external factors, the lack or incomplete presence of a papilla is determined by the distance between the interdental bone crest and the proximal contact point. Given the limitations of periodontal surgery, the possibilities offered by orthodontics (complemented by cosmetic dentistry and aesthetic medicine) are presented here as a first-line approach for achieving optimal mimicry of the lost papillae.

The aim of this article is to present an analytical and therapeutic protocol for papillary regeneration in two steps: first, the precise identification of the etiology of papillary loss on natural teeth; second, the proposal of a clinical solution adapted to each etiology.

The visual filling of the papillary "black triangle" can be achieved using dental tissue (called "white" papillary regeneration), through different techniques that enable cervical displacement of the proximal contact point, or with gingival tissue (called "pink" papillary regeneration), visually compensating for the underlying bone defect.

Papillary restoration does not have a single universal protocol, but instead requires a tailored approach based on the specific etiology. Several etiologies can coexist, thus adding to the complexity of case management.

Informing patients about the risk of uncertain outcomes is essential, as is the need for reassessment at every stage of treatment.