Dental papilla analysis: A multifactorial view point

Abstract

Full papillae serve both esthetic and functional roles. Black triangles have perplexed clinicians by interrupting the harmony of the smile. Several studies in the past have attempted to understand the appearance of black triangles. Bone to contact distance is the most discussed factor involved in black triangle appearance, but there seems to be countless others. Newer research has focused on systemic as well as local anatomical factors such as age, interdental width, and tissue thickness. The aim of this study was to evaluate papilla fullness with regards to bone to contact distance, interdental width, periodontal biotype, tooth type, and age.

333 papillae from 50 patients of the dental hygiene department of the Herman Ostrow School of Dentistry of the University of Southern California were examined. The age of each patient was recorded. After adequate anesthesia, each sextant was examined for papilla fullness. Periodontal sounding was used to measure both the bone to contact distance and the bone to papilla distance. The interdental space was measured at the base of the papilla with a periodontal probe from the transitional line angles of the adjacent teeth. Using transgingival probing, a diagnosis of thick or thin periodontal biotype was assessed.

The age range of our population was between 14 to 77 years of age (mean = 49 years). 229 of the 333 papilla examined were full (68.8%). Premolars are the most common teeth with full papillae, followed by molars, maxillary incisors, and finally mandibular incisors. Periodontal biotype had no effect on black triangle appearance while increased bone to contact distance had a positive effect on black triangle appearance (p=.000). This relationship was also true when controlled for interdental width and age. Increased age had a statistically significant role in black triangle appearance (p=.001), and this relationship was true when controlled for bone to contact distance (p=000). Interdental width was not significant in black triangle appearance (p=.557), unless bone to contact distance was controlled (p<.01). Black triangle appearance is complex in original and a multifactorial approach such as this one is best suited to predict their existence.