8 A NON- INASIVE RADIOGRAPHIC NON- INASIVE...The aim of present study was to measure the length of...
Transcript of 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
University Journal of Dental Sciences, An Official Publication of Aligarh Muslim University, Aligarh. India 43
University J Dent Scie 2018; Vol. 4, Issue 3
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.
University Journal of Dental Sciences, An Official Publication of Aligarh Muslim University, Aligarh. India 44
University J Dent Scie 2018; Vol. 4, Issue 3
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]
University Journal of Dental Sciences, An Official Publication of Aligarh Muslim University, Aligarh. India 45
University J Dent Scie 2018; Vol. 4, Issue 3