8 a non- inasive radiographic non- inasive...the aim of present study was to measure the length of...

ABSTRACT : Aim: The length of inter-dental papilla is usually measured by trans- gingival probing

under local anesthesia which might cause discomfort to the patients and possibly damage the delicate

gingival unit. The aim of present study was to measure the length of interdental papilla from tip of papilla to

the crestal bone with a radiopaque material.

Materials and Methods: A total of 90 subjects in the age group of 15 to 40 years were randomly selected

and radiographs were used to measure the length of inter- dental papilla of maxillary and mandibular

central incisors from tip of papilla to the crest of the bone.

Results: The length of inter- dental papilla in maxillary and mandibular central incisors in all the three

groups was found to be statistically non- significant. Mean length of inter- dental papilla in maxillary

central incisors was minimum for Group I (4.70+0.56 mm) and maximum for Group II (4.82+0.59 mm)

and in mandibular central incisors was minimum for Group I (3.93+0.56 mm) and maximum for Group III

(4.11+0.46 mm).

Conclusion: The periapical radiographs combined with the use of a radiopaque material can be used to

investigate the length of inter- dental papilla. A thorough understanding about the inter-dental papilla is

necessary for the clinician to obtain esthetic outcomes for the patient.

1 2 3 4 5Vivek Kumar, Charanjeet Singh Saimbi, Amrita, Neelu Verma, Mahender Pratap1Senior Lecturer, Department of Periodontology and Oral Implantology, Hazaribag College of Dental Sciences and Hospital, Hazaribagh 2Professor, Department of Periodontology and Oral Implantology, University College of Medical Sciences, Bhairhwara, Nepal 3Senior Lecturer, Department of Periodontology and Oral Implantology, Uttaranchal Dental and Medical Research Institute, Dehradun4Senior Lecturer, Department of Periodontology and Oral Implantology, Career Institute of Dental Sciences and Hospital, Lucknow 5Senior lecturer, Department of Orthodontics and Dentofacial Orthopaedics, Uttaranchal Dental and Medical Research Institute, Dehradun

INTRODUCTION

Inter- dental papilla is the part of gingiva that occupies the

space between two adjacent teeth covering inter- dental space

as a biological barrier and protects the periodontal structures.

It also plays a critical role in aesthetics by providing soft tissue

closure between the teeth (Zetu and Wang 2005).[1] The loss

of papilla can lead to cosmetic deformities, phonetic

problems and lateral food impaction (Tarnow et al 1992).[2]

The length of inter-dental papilla can be measured by clinical

photographs but it does not evaluate its relationship with the

crestal bone.[3] Lee et al (2005)[4] proposed another method

for measuring the length of interdental papilla that was from

papilla tip to the bone crest by periapical radiographs.

Radiographs are one of the valuable diagnostic methods in

dentistry and provide information about tissue changes.

These changes can be stored and re-assessed at any time for

comparison between pre-treatment and post-treatment

parameters. Radiographic assessments have some inherent

A NON- INASIVE RADIOGRAPHIC METHOD

TO ASSESS THE LENGTH OF INTER-

DENTAL PAPILLA

Journal of Dental Sciences

University

University Journal of Dental Sciences, An Official Publication of Aligarh Muslim University, Aligarh. India 42

University J Dent Scie 2018; Vol. 4, Issue 3

ResearchArticle

Keywords:

Inter- dental papilla;

Bone probing; Radiograph.

Conflict of interest: Nil

No conflicts of interest : Nil

drawbacks. These include variations in projection geometry,

exposure and processing errors as well as masking of osseous

structures by various anatomic structures.[5] Ionizing

radiation is the major problem with radiography, although the

radiation burden is low and are two-dimensional

representations of complex three dimensional structures.[6]

Despite the known limitation, radiographs can be

useful non-invasive method to measure the length of inter-

dental papilla from the crestal bone to top of it. The purpose of

present study was to measure the length of interdental papilla

from the top of papilla to the crestal bone with radiopaque

material.

Material and Methods:

The study subjects were selected on the basis of inclusion and

exclusion criteria and were divided on the basis of age into

three groups. Each group consisted of thirty patients and one

hundred eighty inter- proximal papillae of ninety patients

were investigated.

The three groups formed were: - Group I: 15-20 years, Group

II: 21-30 years and Group III: 31- 40 years. Radiographs were

used for measuring the length of interdental papilla of

maxillary and mandibular central incisors. Inclusion criteria

were systemically healthy patients, patient with visible closed

contact point, healthy periodontal tissues with no loss of

attachment, presence of maxillary and mandibular central

incisors and exclusion criteria included medically

compromised patients, pregnancy, history of taking

medication known to increase the risk of gingival hyperplasia

and patients with root surface caries or any sub-gingival

restoration or crown.

Measurement of inter- dental papilla:

A radiopaque material consisting of 2:1 mixture of zinc

oxide/eugenol and barium sulfate was placed on tip of the

papilla with a probe for the measurement of length of inter-

dental papilla. Care was taken not to place the radiopaque

material to apical side, which would make the radiographic

length shorter. Only a minimal amount of radiopaque material

was needed since the radiopacity was greatly enhanced by the

contrast media. A periapical radiograph was taken using

parallel cone techniques with a XCP (Extension Cone

Paralleling) device (Figure 1-3). All films were developed

using the same processor following the manufacturer's

instructions.

Figure 1: XCP (Extension Cone Paralleling) device

Figure 2: Radiograph taken with XCP device to measure the

length of maxillary inter- dental papillae

Figure 3: Radiograph taken with XCP device to measure the

length of mandibular inter- dental papilla

The films were digitized using a flat bed scanner with a

scanning resolution of 300 dpi using a Canon 2000AC flatbed

scanner (Canon Japan Inc., Tokyo, Japan) with a transparency

module, and saved in as tagged-image file format. The

superioinferior dimensions of all patients were measured.

The scanned images were transferred to Corel Draw Graphic

Suit X5. Using the line connector tool, a line was drawn from



tip of papilla to the crest of bone. The length of line was

displayed in size property box of the software. The software

then displayed the distance between these two points.

Statistical analysis:

Mean values and standard deviations were calculated for

measurements of the length of interdental papilla. The

Analysis of Variance test was used to compare within group

and between group variances amongst the study groups that

was the three different groups. All the statistical analysis was

performed using SPSS (Statistical Package for Social

Sciences) Version 15.0 statistical Analysis Software.

Results:

Mean length of inter-dental papilla in maxillary central

incisors was found to be minimum for Group I (4.70+0.56

mm) and maximum for Group II (4.82+0.59 mm) and mean

length of inter-dental papilla in mandibular central incisors

was minimum for Group I (3.93+0.56 mm) and maximum for

Group III (4.11+0.46 mm) as shown in Table I.

Table I. Mean length (mm) of inter- dental papilla in three

groups of maxillary and mandibular central incisors

Analysis of variance (Table II) shows the difference in length

of inter-dental papilla in maxillary and mandibular central

incisors in three groups was statistically non-significant.

Table II. Analysis of variance for length of inter- dental

papilla in different groups

DISCUSSION

The existence of inter- dental papilla and healthy gingiva in

harmony with natural dentition is one of the important

esthetic aspects that needs to be considered for dental

treatment and diagnosis. A variety of methods have been

advocated to accurately determine the level of alveolar crest

from the tip of inter- dental papilla (Kohl et al 1961).[7]

Though surgical measurement of bone and trans- gingival

probing has been confirmed as a valid method of reporting

papilla length (Tarnow 1992),[2] it is rather a invasive

method since administrating of local anesthesia is likely to

cause the patient some discomfort, pain and complication,

thus making the clinician hesitate to use it in daily practice.

Ionizing radiation is major problem with radiography,

although the radiation burden is low. The radiographic length

for the measurement of inter- dental papilla is non invasive

and usually requires minimal patient co-operation (Van Der

Stelt et al 1985).[8] By using radiopaque material, it would be

possible to non-invasively measure papilla length in relation

to the crestal bone.

In this study, radiographic length was measured by placing

zinc oxide/eugenol and barium sulfate in a ratio of 2:1 which

was used to indicate the papilla tip. Chen et al 2010[9] also

used zinc oxide/eugenol as a radiopaque material in there

study. Chang 2007[10] used Cavit G as a radiopaque material

in a study to find the association between embrasure

morphology and central papilla recession. Lee et al 2005[4]

measured the length of soft tissue from the tip of papilla to

crestal bone by non invasive method using a mixture of an

endodontic sealer and barium sulfate in a ratio of 2:1 as a

radiopaque material. It was easy to place zinc oxide/eugenol

on the soft tissue before it sets. When it sets, it attaches to the

soft tissues, and does not detach, even in the presence of

saliva. Unlike an endodontic sealer, which was sticky, it was

easy to remove zinc oxide/eugenol from the mucosa after

radiographs were taken. An endodontic sealer can detach

from the soft tissue, especially when there is no isolation of

saliva.

In this study, the mean value of radiographic papilla length in

maxilla was 4.70 ± 0.56 mm in group I, 4.82 ± 0.59 mm in

group II and 4.73 ± 0.34 mm in group III. These results are in

accordance with the studies done by Lee et al. (2005),[4]

Chang (2008),[11] Chang (2012)[12] and Wahi et al

(2013).[5]

The difference in length measured by radiography in Group I

and Group III was found to be minimum 0.023 mm and in

Group I and Group II was maximum 0.113 mm, all the

differences were statistically non-significant.



The mean value of radiographic papilla length in mandible

was 3.93±0.56 mm in group I, 4.07 ±0.86 mm in group II and

4.11 ±0.46 mm in group III. The differences in length

measured by radiography in Group I and III was found to be

maximum 0.177 mm and in Group II and III was minimum

0.033 mm. All the differences were statistically non-

significant. Thus it was concluded that periapical radiography

combined with the use of a radiopaque material can be used to

investigate the length of an inter- dental papilla from the tip of

papilla to crest of bone. A thorough understanding of inter-

dental papilla is necessary for the clinician to obtain esthetic

outcomes for the patient.

REFERENCES :

1. Zetu L, Wang HL. Management of inter-dental/ inter-

implant papilla. J Clin Periodontol 2005 ;32:831-839

2. Tarnow DP, Magner AW, Fletcher P. The effect of the

distance from the contact point to the crest of the bone on

the presence or absence of inter-proximal dental papilla.

J Periodontol 1992 ;63:995-996

3. Martegani P, Silvestri M, Mascarello F, Scipioni T,

Ghezzi C, Rota C et al. Morphometric study of the inter-

proximal unit in the esthetic region to correlate anatomic

variables affecting the aspect of soft tissue embrasure

space. J Periodontol 2007 ;78:2260-2265

4. Lee DW, Kim CK, Park KH, Cho KS, Moon IS. Non-

invasive method to measure the length of soft tissue from

the top of the papilla to the crestal bone. J Periodontol

2005 ;76:1311-1314

5. Wahi S, Chinna K, Chhabra V, Bhatnagar R. Invasive

versus non-invasive method of assessment of distance

between the tip of papilla to the crest of inter-dental bone.

Eur J Gen Dent 2013 ;2:37-41

6. Jeffcoat MK, Wang IC, Reddy MS. Radiographic

diagnosis in Periodontics. Periodontol 2000 1995 ;7:54-

68

7. Kohl JT, Zander HA. Morphology of inter- dental

gingival tissues. Oral Surg, Oral Med & Oral Pathol 1961

;60:287-295

8. Van PF, Van LW, Geraets WGM, Alons CL. Digitized

image processing and pattern recognition in dental

radiographs with emphasis on the inter- dental bone. J

Clin Periodontol 1985 ;12:815-821

9. Chen MC, Liao YF, Chan CP, KU YC, Pan WL, Tu YK.

Factors influencing the presence of inter- proximal

dental papillae between maxillary anterior teeth. J

Periodontol 2010 ;81:318-324

10. Chang LC. The association between embrasure

morphology and central papilla recession: A noninvasive

assessment method. Chang Gung Med J 2007 ;30:445-

452

11. Chang LC. Assessment of parameters affecting the

presence of central papilla using a non-invasive

radiographic method. J Periodontol 2008 ;79:603-609

12. Chang LC. Factors associated with the inter- dental

papilla height between two maxillary central incisors: A

radiographic study. J Periodontol 2012 ;83:43-49

CORRESPONDING AUTHOR:

Dr. Vivek Kumar

308/A, Behind New AG Colony, Doraanda, Ranchi,

834002-Jharkhand

Email : [email protected]



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