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VOLUME 23 , ISSUE 5 ( May, 2022 ) > List of Articles


Evaluation of Regenerative Potential of Locally Delivered Vitamin C along with Microneedling in the Treatment of Deficient Interdental Papilla: A Clinical Study

Annapurna Ahuja, Ruchi Staffy Mohina Minz, Aiswarya Mishra, Sharmila Kumari

Keywords : Interdental Papilla, Microneedling, Periodontal therapy, Regeneration, Vitamin C

Citation Information : Ahuja A, Minz RS, Mishra A, Kumari S. Evaluation of Regenerative Potential of Locally Delivered Vitamin C along with Microneedling in the Treatment of Deficient Interdental Papilla: A Clinical Study. J Contemp Dent Pract 2022; 23 (5):503-507.

DOI: 10.5005/jp-journals-10024-3338

License: CC BY-NC 4.0

Published Online: 10-08-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Aim: To evaluate the efficacy of intrapapillary injections of vitamin C along with microneedling (MN) in enhancing deficient interdental papilla (IDP) in esthetic zones clinically. Materials and methods: Fifteen patients diagnosed with black triangles according to Norland classification system for loss of papillary height were selected. After oral prophylaxis and baseline measurements of insufficient interdental papilla, the vitamin C injection was loaded in disposable syringe 30G × 1/2’’ needle. The needle was inserted at 45° angle, 2–3-mm apical to the involved papilla and all surrounding areas. Each involved papilla was injected with an amount till blanching was visible. After that, MN was done in the required area. This method was repeated for 5 times at 7 days intervals consecutively. The final clinical photographs and measurements were recorded after 7 days of last dose administered. Results: There was a statistically significant difference in the mean IDP height observed over the time period (p = 0.002). Conclusion: An overall healthy appearance of gingiva with a remarkable increase in papilla growth was observed. Clinical Significance: Vitamin C injection along with MN can be considered as an alternative to invasive surgical procedures in reconstruction or regeneration of the missing IDP.

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  1. Beagle JR. Surgical reconstruction of the interdental papilla: case report. Int J Periodontol Rest Dent 1992;12(2):145–151. PMID: 1521996.
  2. Jemt T. Regeneration of gingival papillae after single-implant treatment. Int J Periodontol Rest Dent 1997;1794):326–333. PMID: 9497723.
  3. Nemcovsky CE. Interproximal papilla augmentation procedure: a novel surgical approach and clinical evaluation of 10 consecutive procedures. Int J Periodontol Rest Dent 2001;21(6):553–559. PMID: 11794566.
  4. Lee EK, Herr Y, Kwon YH, et al. I-shaped incisions for papilla reconstruction in second stage implant surgery. J Periodontol Implant Sci 2010;4(3):139–143. DOI: 10.5051/jpis.2010.40.3.139.
  5. Nemcovsky CE, Moses O, Artzi Z. Interproximal papillae reconstruction in maxillary implants. J Periodontol 2000;71(2):308–314. DOI: 10.1902/jop.2000.71.2.308.
  6. Grunder U. The inlay-graft technique to create papillae between implants. J Esthet Dent 1997;9:165–168. PMID: 9468880.
  7. Choquet V, Hermans M, Adriaenssens P, et al. Clinical and radiographic evaluation of the papilla level adjacent to single-tooth dental implants. A retrospective study in the maxillary anterior region. J Periodontol 2001;72(10):1364–1371. DOI: 10.1902/jop.2001.72.10.1364.
  8. Tarnow DP, Cho SC, Wallace SS. The effect of inter-implant distance on the height of inter-implant bone crest. J Periodontol 2000;71(4):546–549. DOI: 10.1902/jop.2000.71.4.546.
  9. Tarnow DP, Eskow RN. Considerations for single-unit esthetic implant restorations. Compend Contin Educ Dent 1995;16(8):778–784. PMID: 8620396.
  10. Tarnow DP, Magner AW, Fletcher P. The effect of the distance from the contact point to the crest of bone on the presence or absence of the interproximal dental papilla. J Periodontol 1992;63(12):995–996. DOI: 10.1902/jop.1992.63.12.995.
  11. Rajguru SA, Pathak TS, Padhye AM, et al. Interimplant papilla reconstruction. J Contemp Dent 2014;4(1):30. DOI: 10.5005/jp-journals-10031-1065.
  12. Becker W, Gabitov I, Stepanov M, et al. Minimally invasive treatment for papillae deficiencies in the esthetic zone: a pilot study. Clin Implant Dent Relat Res 2010;12(1):1–8. DOI: 10.1111/j.1708-8208.2009.00247.x.
  13. Yussif NM, Abdul Aziz MA, Abdel Rahman AR. Evaluation of the anti-inflammatory effect of locally delivered vitamin C in the treatment of persistent gingival inflammation: clinical and histopathological study. J Nutr Metab 2016;2016. DOI: 10.1155/2016/2978741.
  14. Yussif NM, Rahman AR, El Barbary A. Minimally invasive non-surgical locally injected vitamin C versus the conventional surgical depigmentation in treatment of gingival hyperpigmentation of the anterior esthetic zone: a prospective comparative study. Clin Nutr Exp 2019;24:54–65. DOI: 10.1016/j.yclnex.2018.12.003.
  15. Carr AC, Frei B. Toward a new recommended dietary allowance for vitamin C based on antioxidant and health effects in humans. Am J Clin Nutr 1999;69:1086–1107. DOI: 10.1093/ajcn/69.6.1086.
  16. Chapple IL, Matthews JB. The role of reactive oxygen and antioxidant species in periodontal tissue destruction. Periodontol 2000. 2007;43:160–232. DOI: 10.1111/j.1600-0757.2006.00178.x.
  17. Yan Y, Zeng W, Song S, et al. Vitamin C induces periodontal ligament progenitor cell differentiation via activation of ERK pathway mediated by PELP1. Protein Cell 2013;4(8):620–627. DOI: 10.1007/s13238-013-3030-0.
  18. El-Taukhy MA, Salama SM, Abou–Shousha SA, et al. Effects of chronic ethanol and vitamin C administration on production of tumor necrosis factor-alpha and interleukin-6 in rats. Egypt Journal Immunol 2006;13(1):1–10. PMID: 17974145.
  19. Iriarte C, Awosika O, Rengifo–Pardo M, et al. Review of applications of microneedling in dermatology. Clin Cosmet Investig Dermatol 2017;10:289–298. DOI: 10.2147/CCID.S142450.
  20. Pinnell SR, Murad S, Darr D. Induction of collagen synthesis by ascorbic acid: a possible mechanism. Arch Dermatol 1987;123(12):1684–1686. DOI: 10.1001/archderm.123.12.1684.
  21. Murad S, Grove D, Lindberg KA, et al. Regulation of collagen synthesis by ascorbic acid. Proc Natl Acad Sci USA 1981;78(5):2879–2882. DOI: 10.1073/pnas.78.5.2879.
  22. Norland WP, Tarnow DP. A classification system for loss of papillary height. J Periodontol 1998; 69(10):1124–1126. DOI: 10.1902/jop.1998.69.10.1124.
  23. Boyera N, Galey I, Bernard BA. Effect of vitamin C and its derivatives on collagen synthesis and cross‐linking by normal human fibroblasts. Int J Cosmetic Sci 1998; 20(3):151–158. DOI: 10.1046/j.1467-2494.1998.171747.x.
  24. El-Mofty M, Elkot S, Ghoneim A, et al. Vitamin C mesotherapy versus topical application for gingival hyperpigmentation: a clinical and histopathological study. Clin Oral Invest 2021;25(12):6881–6889. DOI: 10.1007/s00784-021-03978-6.
  25. Ozsagir ZB , Saglam E , Yilmaz BS, et al. Injectable platelet-rich fibrin and microneedling for gingival augmentation in thin periodontal phenotype: A randomized controlled clinical trial. J Clin Periodontol 2020;47(4):489–499. DOI: 10.1111/jcpe.13247.
  26. Daniels A, Jefferies S. Analysis of capacity of novel, anti-oxidant tooth paste, small population clinical study: comparison to levels of gingival inflammation reduction reported in historical control and therapeutic tooth brushing studies. Temple University School of Dentistry, Clinical Research and Biomaterials Analysis and Review Report, CS Bioscience, New York.
  27. Toraman A, Arabaci T, Aytekin Z, et al. Effects of vitamin C local application on ligature-induced periodontitis in diabetic rats. Journal of applied oral science.2020;28:e20200444:27. DOI: 10.1590/1678-7757-2020-0444.
  28. Al-Abdaly MMA, Alghamdi AS, Alshehri AH, et al. Topical application of ascorbic acid solution as an adjunctive method of periodontal therapy among wet snuff users after prosthodontics therapy. Open J Stomatol 202; 11(3):119–132. DOI: 10.4236/ojst.2021.113010.
  29. Abdullah M, Jamil RT, Attia FN. Vitamin C (Ascorbic Acid). In: StatPearls. Treasure Island, FL: StatPearls Publishing; 2022. Available at: PMID: 29763052.
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