INTER DENTAL PAPILLA

INTRODUCTION;

Oral mucosa consists of masticatory mucosa which lines the gingival and hard palate

Specialized mucosa which covers the dorsum of tongue.

Remaining part called lining mucosa.

Gingival is a part of oral mucosa that covers the alveolar process of jaw and surround the neck
of tooth.
Gingival consists of free gingival or marginal, gingival attached gingival and interdental papilla

HISTORY:

Interdental papillae (also known as gingival papillae) occupy the space between adjacent teeth.
Morphologically, the papillae were described first in 1959. .. It has only recently been correctly
described by Cohen.Before this time, an interdental papillas sole function was to deflect
interproximal food debris. Now it is understood that the physiology of the papilla is more complex.
It not only acts as a biological barrier in protecting the periodontal structures, but also plays a
critical role in the esthetics of teeth.

DEFINITION

The interdental gingiva occupies the gingival embrasure, which is the interproximal space
beneath the area of tooth contact. Theinterdental papilla can be pyramidal or have a "col" shape

MORPHOLOGY

due to the presence of interdental papilla the free gingival margin follows more or less accentuated
scalloped course through out the dentition
The shape of interdental papilla is determined by the contact relationship between the teeth and the
width of approximal tooth surfaces and the course of cej.in anterior regions it is pyramidal in shape in
molar regions the papilla are more flattened in buccolingual directions.a concavity or col is established in
premolar and molar regions..
In molars and premolars interdental papilla have vestibular portion and lingual or palatal portion
separated by col region.
HISTOLOGY
IN HISTOLOGICAL SECTION IT IS COVERED BY THIN NON KERATINIZED EPITHELIUM.THIS
EPITHELIUM HA SMANY FEATURES IN COMMON WITH THE JUNCTIONAL EPITHELIUM..

Depending on the presence of inter dental papilla in relation to cej

norland and tarnow classified gingival recession as follows

Lymphatic drainage

lymphatic flow from the interdental papilla drains into collecting lymphatic vessels running
buccolingually on the alveolar crest of the interdental papilla. This may be an important
anatomical feature during inflammation throughout the oral cavity in that the drainage function is
maintained by part of lymphatic flow that is not impaired during the healing process.

Causes of loss of papilla

Absolute causes of loss of papilla

1. Periodontal infections
2. Osseous surgery
3. Traumatic tooth extraction

Relative causes
1.

Gingival bio type thick or thin

2. Gingival embrasure due to root divergence

There are several studies conducted on interdentally papilla

Classical study conducted by tarnow et.al correlates the presence of

absence of interdentally papilla with the distance between from the
alveolar crest to contact area
Presence of interdentally papilla is 100% if the distance is less than or
equal to less than or equal to 5mm
Presence o interdentally papilla is 56% if the distance between alveolar
crest and contact point is 6mm
Presence of interdentally is in 27% of cases if the distance between alveolar
crest and contact point is 7mm
Another study conducted by kokich observed that if the gingival space is
greater than 3mm it is considered as visibly aesthetic problem for both
dentist and patient
The presences of gingivalspaces can also be age related
Studies conducted by kokimura et.al showed that patients greater than
20years ofa age are more prone to interdentally loss of papilla this is
because of
1. Thinning of oral epithelim
2. Decrease of keratinization
3. Decrease in the height of papilla

PROCEDURES INVOLVING PAPILLA REGERATION

Surgical and non surgical approaches
Non surgical approaches include
Correction of traumatic oral hygiene procedures
Restorative and prosthetic corrections
Orthodontic approach

Surgical approach include

Papillary reconstruction
Papillary recontouring
Papillary preservation
1. Conventional papillary preservation flap
2. Simplified papillary preservation flap
3. Modified papillary preservation flap

CONCLUSION

Now it is understood that the physiology of the papilla is more complex. It not
only acts as a biological barrier in protecting the periodontal structures, but also
plays a critical role in the esthetics of teeth. Hence, it is very important to respect
papillae integrity and minimize their removal during dental procedures as much
as possible.

1.