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Non-Surgical Cosmetic Treatment Modalities for Interdental Papilla Reconstruction "Black Triangles": An
Ayah Elhaj1, Bashar Shatta1, Sheila Nguyen1
1Academic Plastic Surgery, Blizard Institute, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK.
Background:
The interdental papilla plays a vital role in dental and facial aesthetics, as the loss of papilla manifests as unesthetic "black triangles". In recent years, non-surgical approaches such as hyaluronic acid injections, autologous platelet concentrates, laser therapy, and microneedling with vitamin C have emerged as alternatives to technically demanding and unpredictable surgical reconstruction.
Aim:
To evaluate the effectiveness, patient satisfaction, and safety of cosmetic non-surgical treatment modalities for the correction of black triangles.
Materials And Methods:
A comprehensive literature search was conducted using the PubMed, Cochrane Library, Scopus, and Embase databases, from January 2013 to January 2024. All case series, cohort studies, and randomized controlled trials with relevant outcomes were included. The BestBETs methodology was used, and the risk of bias was assessed using the "Quality Assessment Tool for Quantitative Studies."
Results:
A total of 19 human studies met the inclusion criteria. Of these, six studies were classified as level II evidence, while the remaining 13 were categorized as level III or level IV evidence. Based on level II evidence, hyaluronic acid injections were effective and safe for correcting the black triangles and improving the smile. Evidence on non-surgical modalities such as autologous platelet concentrates, photobiomodulation therapy, and microneedling with vitamin C remains limited. Based on level II to level IV evidence, these conservative treatments are recommended as clinically effective for filling black triangle spaces, demonstrating high patient satisfaction and minimal adverse events.
Conclusion:
Non-surgical cosmetic treatments offer a promising alternative for reconstructing interdental papilla deficiencies, with benefits including reduced complications and favorable aesthetic outcomes. However, the current evidence remains limited, and findings should be interpreted with caution. Further well-designed, standardized clinical trials are required to establish the effectiveness, long-term stability, and patient-centred outcomes of these interventions.
