Medpark Fill Research
▶ INTRODUCTIONEsthetic demands in contemporary dentistry have increased significantly, with greater emphasis being placed on the harmony of the gingival architecture, particularly in the anterior region. The interdental papilla is a key determinant of periodontal esthetics and plays a crucial role in maintaining gingival harmony and function. Loss of papillary height leads to ―black triangles,‖ which can result in compromised smile esthetics, phonetic difficulties, food impaction, and plaque accumulation.[1] With the increasing emphasis on esthetic dentistry, the management of interdental papillary deficiency has become a significant clinicalchallenge.▶ MATERIALS AND METHODSThis study was designed as a randomized controlled clinical trial conducted in the Department of Periodontology and Oral Implantology. The study population comprised individuals presenting with interdental black triangles in the maxillary and mandibular anterior regions who reported to the outpatient department. A total of 40 patients were recruited using a convenient sampling technique and were randomly allocated into two groups: Group A, which received injectable hyaluronic acid, and Group B, which received Medpark Fill collagen, with 20 patients in each group. Ethical clearance was obtained from the institutional ethics committee prior to the commencement of the study, and informed consent was obtained from all participants after explaining the nature and purpose of the study.Patients included in the study were above 18 years of age and presented with Class I or Class II papillary recession according to Nordland and Tarnow’s classification, with tight proximal contacts.[9] Patients who smoked or chewed tobacco, were medically compromised, had a history of drug-induced gingival hyperplasia, were pregnant or lactating, exhibited grade II or III mobility, had anterior gingival recession, or showed signs of trauma from occlusion were excluded from the study. Participants were also withdrawn if they were unwilling to continue or chose to exit the study voluntarily. All patients underwent Phase I therapy, including oral hygiene instructions and scaling and root planing using an ultrasonic scaler. Prior to treatment, standardized intraoral photographs were taken, and baseline clinical measurements of the black triangle were recorded as the distance from the tip of the interdental papilla to the contact point using a UNC-15 periodontal probe. The clinical procedure was performed under local anesthesia (2% lignocaine hydrochloride with 1:80,000 adrenaline). In Group A, a commercially available cross-linked hyaluronic acid filler (Restylane Lidocaine, Galderma S.A., Sweden) was injected in a volume of less than 0.2mL using a 30-gauge disposable syringe. The needle was inserted 2–3 mm apical to the tip of the interdental papilla and directed coronally at an angle of approximately 45° to the long axis of the tooth, with the bevel facing apically. After injection, the papilla was gently massaged in an incisal direction for one minute using sterile gauze to ensure uniform distribution. In Group B, Medpark Fill, an injectable sterile cross-linked type I collagen-based dermal filler, was administered using the same technique, angulation, and volume to ensure standardization between groups.▶ RESULTSThe distribution of interdental papilla defects (Class I and Class II) between the two groups showed no statistically significant difference (p = 0.752), indicating that both groups were comparable at baseline. In the hyaluronic acid group, 55% of sites exhibited Class I defects and 45% showed Class II defects, whereas in the Medpark Fill collagen group, 60% were Class I and 40% were Class II.Intergroup comparison of black triangle height at baseline, 3 weeks, 6 weeks, and 3 months using the independent t-test revealed no statistically significant difference between the two groups at any time interval (p > 0.05). Although both groups demonstrated a gradual reduction in black triangle height over time, the difference between hyaluronic acid and collagen groups was not statistically significant, suggesting comparable clinical efficacy of both materials.Similarly, comparison of pain perception using the Visual Analogue Scale (VAS) between the two groups at baseline, 3 weeks, and 6 weeks showed no statistically significant difference (p > 0.05). Both groups demonstrated a reduction in pain scores over time, indicating good patient tolerance for both treatment modalities.Patient satisfaction levels between the two groups also showed no statistically significant difference (p = 0.815).In the hyaluronic acid group, 15% of patients were completely satisfied, 40% were partially satisfied, and 45% were partially dissatisfied. In the Medpark Fill collagen group, 30% were completely satisfied, 20% were partially satisfied, and 50% were partially dissatisfied, indicating comparable subjective outcomes.Intragroup comparison using repeated measures ANOVA demonstrated a highly significant reduction in black triangle height over time in both groups (p < 0.001). In the hyaluronic acid group, mean black triangle heigh reduced from 2.30 mm at baseline to 0.80 mm at 3 months, while in the Medpark Fill collagen group, it reduced from 2.15 mm to 0.45 mm. Pairwise comparisons revealed statistically significant reductions at all time intervals in both groups, confirming progressive improvement in papillary fill.With respect to pain perception, the hyaluronic acid group showed a statistically significant reduction over time (p = 0.017), although pairwise comparison indicated that significant reduction was primarily observed between baseline and 6 weeks. In contrast, the Medpark Fill collagen group demonstrated a highly significant reduction in pain scores (p < 0.001), with significant improvements observed at all time intervals. Overall, both hyaluronic acid and Medpark Fill collagen were effective in reducing black triangle height and improving interdental papilla fill over a period of 3 months. However, no statistically significant difference was observed between the two groups in terms of clinical outcomes, pain perception, or patient satisfaction, indicating that both treatment modalities are equally effective for the management of interdental papillary deficiency.▶ MedPark Fill Clinical Results20 patients3-month clinical follow-upBlack Triangle Height: 2.15 mm → 0.45 mmApproximately 79% reductionp < 0.001Significant progressive papillary fillClinical efficacy comparable to Hyaluronic AcidSignificant reduction in pain scores: p < 0.001Up to 79% reduction in Black Triangle Height at 3 monthsMedPark Fill demonstrated significant and progressive improvement in interdental papilla fill, with clinical efficacy comparable to cross-linked hyaluronic acid.
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