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Aim: To evaluate the efficacy of platelet-rich fibrin (PRF) or connective tissue graft (CTG) in papilla reconstruction (PR) with semilunar incision (SI) technique.
Materials and Methods: A total of 55 sites (27 CTG and 28 PRF) from 20 patients who underwent PR with either PRF or CTG placed with SI in the maxillary anterior region were included in the study. Baseline (BL) and follow-up (T1( first month), T3 (third month), T6 (sixth month)) clinical data including periodontal evaluations (gingival index (GI), plaque index (PI), papillary bleeding index, pocket depth (PD), keratinized tissue width (KTW), gingival recession), papilla-associated recordings (alveolar crest-interdental contact point (AC-IC), alveolar crest-papilla tip (AC-PT), papilla tip-interdental contact point (PT-IC), papilla height loss (PHL), interdental tissue stroke (ITS) and papilla presence index (PPI)) and patient satisfaction were analyzed.
PT-IC was taken as the primary outcome measure. Normal distribution was assessed by histogram and Shapiro-Wilk test. Continuous variables were represented as mean±SD whereas the categorical variables were reported as numbers and percentages. Chi-square test was used for the comparison of the categorical variables. Since the data was normally distributed, Friedman test was used to analyze the time-dependent changes in both groups and the inter-group comparisons were made with Mann-Whitney test. Generalized Estimating Equation was used for analyzing qualitative and quantitative data, time-dependent changes, and the difference between two methods. Data analysis was performed in IBM SPSS Statistics Version 23, and p<0.05 was considered as a significance threshold.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Platelet-rich fibrin (PRF) | A total of 28 sites from 12 patients who underwent papilla reconstruction with PRF placed with semilunar incision in the maxillary anterior region were included in PRF group. ( Data of 12 patients were included in the study.) |
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| Connective tissue graft (CTG) | A total of 27 sites from 8 patients who underwent papilla reconstruction with CTG placed with semilunar incision in the maxillary anterior region were included in CTG group. (Data of 8 patients were included in the study.) |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| retrospective data analysis | Other | The data of the patients who underwent papilla reconstruction surgery by one of the authors (S.O.B.) using semilunar incision with either PRF or CTG in the maxillary anterior teeth were included in the study. All selected patients had consent for using their data.The data of the patients included in the study were analyzed.(Baseline (BL) and follow-up (T1( first month) , T3 (third month), T6 (sixth month)) clinical data including periodontal evaluations (gingival index (GI), plaque index (PI), papillary bleeding index, pocket depth (PD), keratinized tissue width (KTW), gingival recession), papilla-associated recordings (alveolar crest-interdental contact point (AC-IC), alveolar crest-papilla tip (AC-PT), papilla tip-interdental contact point (PT-IC), papilla height loss (PHL), interdental tissue stroke (ITS) and papilla presence index (PPI)) and patient satisfaction were analyzed.) |
| Measure | Description | Time Frame |
|---|---|---|
| Alveolar crest-Interdental contact point (AC-IC mm) | Crestal bone height was measured after administering local anesthesia for each mesiofacial or distofacial test site. UNC-15(HuFriedy, Chicago, IL, USA) periodontal probe was positioned inter-proximally in the gingival sulcus in a corono - apical direction which was parallel to the long axis of the tooth. The probe was advanced apically until it contacted the crest of the alveolar bone. The distance between the crestal bone and interdental contact point was reported as AC-IC . (measurements are in millimeters) | baseline |
| Alveolar crest-Interdental contact point (AC-IC mm) | Crestal bone height was measured after administering local anesthesia for each mesiofacial or distofacial test site. UNC-15(HuFriedy, Chicago, IL, USA) periodontal probe was positioned inter-proximally in the gingival sulcus in a corono - apical direction which was parallel to the long axis of the tooth. The probe was advanced apically until it contacted the crest of the alveolar bone. The distance between the crestal bone and interdental contact point was reported as AC-IC . (measurements are in millimeters) | T1:1st month |
| Alveolar crest-Interdental contact point (AC-IC mm) | Crestal bone height was measured after administering local anesthesia for each mesiofacial or distofacial test site. UNC-15(HuFriedy, Chicago, IL, USA) periodontal probe was positioned inter-proximally in the gingival sulcus in a corono - apical direction which was parallel to the long axis of the tooth. The probe was advanced apically until it contacted the crest of the alveolar bone. The distance between the crestal bone and interdental contact point was reported as AC-IC . (measurements are in millimeters) | T3:3rd month |
| Alveolar crest-Interdental contact point (AC-IC mm) | Crestal bone height was measured after administering local anesthesia for each mesiofacial or distofacial test site. UNC-15(HuFriedy, Chicago, IL, USA) periodontal probe was positioned inter-proximally in the gingival sulcus in a corono - apical direction which was parallel to the long axis of the tooth. The probe was advanced apically until it contacted the crest of the alveolar bone. The distance between the crestal bone and interdental contact point was reported as AC-IC . (measurements are in millimeters) |
| Measure | Description | Time Frame |
|---|---|---|
| Gingival index (GI) ( by Löe & Silness 1963) | The Gingival Index (GI) scores each site on a 0 to 3 scale, with 0 being normal and 3 being severe inflammation characterized by edema, redness, swelling, and spontaneous bleeding. The GI uses the following scoring system: 0 = normal gingiva
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Inclusion Criteria:
Exclusion Criteria:
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In Hacettepe University Periodontology Department (Jun 2016-Feb 2018), 186 patients treated with PR were scanned and the data of 55 sites (27 CTG and 28 PRF) from 20 patients meeting the criteria were included.
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Hacettepe University, Faculty of Dentistry, Periodontology Department | Ankara | Sıhhiye | 06230 | Turkey (Türkiye) |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 29229072 | Background | Sharma E, Sharma A, Singh K. The role of subepithelial connective tissue graft for reconstruction of interdental papilla: Clinical study. Singapore Dent J. 2017 Dec;38:27-38. doi: 10.1016/j.sdj.2017.05.001. | |
| 32792824 | Background | Singh D, Jhingran R, Bains VK, Madan R, Srivastava R. Efficacy of Platelet-rich Fibrin in Interdental Papilla Reconstruction as Compared to Connective Tissue Using Microsurgical Approach. Contemp Clin Dent. 2019 Oct-Dec;10(4):643-651. doi: 10.4103/ccd.ccd_936_18. |
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| T6: 6th month |
| Alveolar crest-Papilla tip (AC-PT mm) | Crestal bone height was measured after administering local anesthesia for each mesiofacial or distofacial test site. UNC-15(HuFriedy, Chicago, IL, USA) periodontal probe was positioned inter-proximally in the gingival sulcus in a corono - apical direction which was parallel to the long axis of the tooth. The probe was advanced apically until it contacted the crest of the alveolar bone. The distance between the crestal bone and the tip of the interdental papilla was reported as AC-PT. (measurements are in millimeters) | baseline |
| Alveolar crest-Papilla tip (AC-PT mm) | Crestal bone height was measured after administering local anesthesia for each mesiofacial or distofacial test site. UNC-15(HuFriedy, Chicago, IL, USA) periodontal probe was positioned inter-proximally in the gingival sulcus in a corono - apical direction which was parallel to the long axis of the tooth. The probe was advanced apically until it contacted the crest of the alveolar bone. The distance between the crestal bone and the tip of the interdental papilla was reported as AC-PT. (measurements are in millimeters) | T1:1st month |
| Alveolar crest-Papilla tip (AC-PT mm) | Crestal bone height was measured after administering local anesthesia for each mesiofacial or distofacial test site. UNC-15(HuFriedy, Chicago, IL, USA) periodontal probe was positioned inter-proximally in the gingival sulcus in a corono - apical direction which was parallel to the long axis of the tooth. The probe was advanced apically until it contacted the crest of the alveolar bone. The distance between the crestal bone and the tip of the interdental papilla was reported as AC-PT. (measurements are in millimeters) | T3:3rd month |
| Alveolar crest-Papilla tip (AC-PT mm) | Crestal bone height was measured after administering local anesthesia for each mesiofacial or distofacial test site. UNC-15(HuFriedy, Chicago, IL, USA) periodontal probe was positioned inter-proximally in the gingival sulcus in a corono - apical direction which was parallel to the long axis of the tooth. The probe was advanced apically until it contacted the crest of the alveolar bone. The distance between the crestal bone and the tip of the interdental papilla was reported as AC-PT. (measurements are in millimeters) | T6: 6th month |
| Papilla tip-Interdental contact point (PT-IC mm) | the periodontal probe was positioned inter-proximally. The distance between interdental contact point and the tip of the interdental papilla was reported as PT-IC. (measurements are in millimeters) | baseline |
| Papilla tip-Interdental contact point (PT-IC mm) | the periodontal probe was positioned inter-proximally. The distance between interdental contact point and the tip of the interdental papilla was reported as PT-IC. (measurements are in millimeters) | T1:1st month |
| Papilla tip-Interdental contact point (PT-IC mm) | the periodontal probe was positioned inter-proximally. The distance between interdental contact point and the tip of the interdental papilla was reported as PT-IC. (measurements are in millimeters) | T3:3rd month |
| Papilla tip-Interdental contact point (PT-IC mm) | the periodontal probe was positioned inter-proximally. The distance between interdental contact point and the tip of the interdental papilla was reported as PT-IC. (measurements are in millimeters) | T6: 6th month |
| Papilla Height Loss (PHL)(Nordland and Tarnow classification system) | Each interdental papilla was scored as 0-3 based upon Nordland and Tarnow's classification system The following scores were assigned to the papilla at baseline, T1,T3 and T6. Normal:Interdental papilla fills embrasure space to the apical extent of the interdental contact point/area. Class-I. The tip of the interdental papilla lies between the interdental contact point and the most coronal extent of the inter proximal CEJ (the cemento-enamel junction) (space present but inter proximal CEJ is not visible) Class-II.The tip of the interdental papilla lies at or apical to the interproximal CEJ but coronal to the apical extent of the facial CEJ(interproximal CEJ visible) Class-III.The tip of the interdental papilla lies level with or apical to the facial CEJ | baseline |
| Papilla Height Loss (PHL)(Nordland and Tarnow classification system) | Each interdental papilla was scored as 0-3 based upon Nordland and Tarnow's classification system The following scores were assigned to the papilla at baseline, T1,T3 and T6. Normal:Interdental papilla fills embrasure space to the apical extent of the interdental contact point/area. Class-I. The tip of the interdental papilla lies between the interdental contact point and the most coronal extent of the inter proximal CEJ (the cemento-enamel junction) (space present but inter proximal CEJ is not visible) Class-II.The tip of the interdental papilla lies at or apical to the interproximal CEJ but coronal to the apical extent of the facial CEJ(interproximal CEJ visible) Class-III.The tip of the interdental papilla lies level with or apical to the facial CEJ | T1:1st month |
| Papilla Height Loss (PHL)(Nordland and Tarnow classification system) | Each interdental papilla was scored as 0-3 based upon Nordland and Tarnow's classification system The following scores were assigned to the papilla at baseline, T1,T3 and T6. Normal:Interdental papilla fills embrasure space to the apical extent of the interdental contact point/area. Class-I. The tip of the interdental papilla lies between the interdental contact point and the most coronal extent of the inter proximal CEJ (the cemento-enamel junction) (space present but inter proximal CEJ is not visible) Class-II.The tip of the interdental papilla lies at or apical to the interproximal CEJ but coronal to the apical extent of the facial CEJ(interproximal CEJ visible) Class-III.The tip of the interdental papilla lies level with or apical to the facial CEJ | T3:3rd month |
| Papilla Height Loss (PHL)(Nordland and Tarnow classification system) | Each interdental papilla was scored as 0-3 based upon Nordland and Tarnow's classification system The following scores were assigned to the papilla at baseline, T1,T3 and T6. Normal:Interdental papilla fills embrasure space to the apical extent of the interdental contact point/area. Class-I. The tip of the interdental papilla lies between the interdental contact point and the most coronal extent of the inter proximal CEJ (the cemento-enamel junction) (space present but inter proximal CEJ is not visible) Class-II.The tip of the interdental papilla lies at or apical to the interproximal CEJ but coronal to the apical extent of the facial CEJ(interproximal CEJ visible) Class-III.The tip of the interdental papilla lies level with or apical to the facial CEJ | T6: 6th month |
| Interdental Tissue Stroke (ITS) (Jemt's classification system) | The following scores were assigned to the papilla at baseline, T1,T3 and T6. Each interdental papilla was scored as 0-3 based upon Jemt's classification system Score 0: No papilla is present Score 1: Less than half of the height of the papilla is present Score 2: Half or more of the height of the papilla is present Score 3: The papilla fills up the entire proximal space | baseline |
| Interdental Tissue Stroke (ITS) (Jemt's classification system) | The following scores were assigned to the papilla at baseline, T1,T3 and T6. Each interdental papilla was scored as 0-3 based upon Jemt's classification system Score 0: No papilla is present Score 1: Less than half of the height of the papilla is present Score 2: Half or more of the height of the papilla is present Score 3: The papilla fills up the entire proximal space | T1:1st month |
| Interdental Tissue Stroke (ITS) (Jemt's classification system) | The following scores were assigned to the papilla at baseline, T1,T3 and T6. Each interdental papilla was scored as 0-3 based upon Jemt's classification system Score 0: No papilla is present Score 1: Less than half of the height of the papilla is present Score 2: Half or more of the height of the papilla is present Score 3: The papilla fills up the entire proximal space | T3:3rd month |
| Interdental Tissue Stroke (ITS) (Jemt's classification system) | The following scores were assigned to the papilla at baseline, T1,T3 and T6. Each interdental papilla was scored as 0-3 based upon Jemt's classification system Score 0: No papilla is present Score 1: Less than half of the height of the papilla is present Score 2: Half or more of the height of the papilla is present Score 3: The papilla fills up the entire proximal space | T6: 6th month |
| Papilla presence index (PPI) (by Cardaropoli et al.) | The following scores were assigned to the papilla at baseline, T1,T3 and T6. PPI 1: the papilla is completely present and coronally extends to the contact point to completely fill the interproximal embrasure. PPI 2: the papilla is no longer completely present and lies apical to the contact point. But the interproximal CEJ (iCEJ) is still not visible. PPI 3: the papilla is moved more apical and iCEJ becomes visible. PPI 4: the papilla lies apcal to both iCEJ and buccal CEJ. Each interdental papilla was scored as 1-3 based upon PPI. | baseline |
| Papilla presence index (PPI) (by Cardaropoli et al.) | The following scores were assigned to the papilla at baseline, T1,T3 and T6. PPI 1: the papilla is completely present and coronally extends to the contact point to completely fill the interproximal embrasure. PPI 2: the papilla is no longer completely present and lies apical to the contact point. But the interproximal CEJ (iCEJ) is still not visible. PPI 3: the papilla is moved more apical and iCEJ becomes visible. PPI 4: the papilla lies apcal to both iCEJ and buccal CEJ. Each interdental papilla was scored as 1-3 based upon PPI. | T1:1st month |
| Papilla presence index (PPI) (by Cardaropoli et al.) | The following scores were assigned to the papilla at baseline, T1,T3 and T6. PPI 1: the papilla is completely present and coronally extends to the contact point to completely fill the interproximal embrasure. PPI 2: the papilla is no longer completely present and lies apical to the contact point. But the interproximal CEJ (iCEJ) is still not visible. PPI 3: the papilla is moved more apical and iCEJ becomes visible. PPI 4: the papilla lies apcal to both iCEJ and buccal CEJ. Each interdental papilla was scored as 1-3 based upon PPI. | T3:3rd month |
| Papilla presence index (PPI) (by Cardaropoli et al.) | The following scores were assigned to the papilla at baseline, T1,T3 and T6. PPI 1: the papilla is completely present and coronally extends to the contact point to completely fill the interproximal embrasure. PPI 2: the papilla is no longer completely present and lies apical to the contact point. But the interproximal CEJ (iCEJ) is still not visible. PPI 3: the papilla is moved more apical and iCEJ becomes visible. PPI 4: the papilla lies apcal to both iCEJ and buccal CEJ. Each interdental papilla was scored as 1-3 based upon PPI. | T6: 6th month |
| baseline |
| Gingival index (GI) ( by Löe & Silness 1963) | The Gingival Index (GI) scores each site on a 0 to 3 scale, with 0 being normal and 3 being severe inflammation characterized by edema, redness, swelling, and spontaneous bleeding. The GI uses the following scoring system: 0 = normal gingiva
| T1:1st month |
| Gingival index (GI) ( by Löe & Silness 1963) | The Gingival Index (GI) scores each site on a 0 to 3 scale, with 0 being normal and 3 being severe inflammation characterized by edema, redness, swelling, and spontaneous bleeding. The GI uses the following scoring system: 0 = normal gingiva
| T3:3rd month |
| Gingival index (GI) ( by Löe & Silness 1963) | The Gingival Index (GI) scores each site on a 0 to 3 scale, with 0 being normal and 3 being severe inflammation characterized by edema, redness, swelling, and spontaneous bleeding. The GI uses the following scoring system: 0 = normal gingiva
| T6: 6th month |
| Gingival recession (GR-mm) | The distance between buccal CEJ and the most coronal extent marginal gingiva was reported as GR. (measurements are in millimeters) | baseline |
| Gingival recession (GR-mm) | The distance between buccal CEJ and the most coronal extent marginal gingiva was reported as GR. (measurements are in millimeters) | T1:1st month |
| Gingival recession (GR-mm) | The distance between buccal CEJ and the most coronal extent marginal gingiva was reported as GR. (measurements are in millimeters) | T3:3rd month |
| Gingival recession (GR-mm) | The distance between buccal CEJ and the most coronal extent marginal gingiva was reported as GR. (measurements are in millimeters) | T6: 6th month |
| Keratinized tissue width (KTW-mm) | It extends from the free gingival margin to the mucogingival junction and consists of the free gingiva as well as the attached gingiva. The distance between the most coronal extent free gingiva in buccal and the most coronal extent mucogingival junction was reported as KTW. (measurements are in millimeters) | baseline |
| Keratinized tissue width (KTW-mm) | It extends from the free gingival margin to the mucogingival junction and consists of the free gingiva as well as the attached gingiva. The distance between the most coronal extent free gingiva in buccal and the most coronal extent mucogingival junction was reported as KTW. (measurements are in millimeters) | T1:1st month |
| Keratinized tissue width (KTW-mm) | It extends from the free gingival margin to the mucogingival junction and consists of the free gingiva as well as the attached gingiva. The distance between the most coronal extent free gingiva in buccal and the most coronal extent mucogingival junction was reported as KTW. (measurements are in millimeters) | T3:3rd month |
| Keratinized tissue width (KTW-mm) | It extends from the free gingival margin to the mucogingival junction and consists of the free gingiva as well as the attached gingiva. The distance between the most coronal extent free gingiva in buccal and the most coronal extent mucogingival junction was reported as KTW. (measurements are in millimeters) | T6: 6th month |
| Pocket depth (PD-mm) | Periodontal probe was positioned in the gingival sulcus . The distance between the top of the free gingiva and the bottom of the sulcus was reported as PD. (measurements are in millimeters) | baseline |
| Pocket depth (PD-mm) | Periodontal probe was positioned in the gingival sulcus . The distance between the top of the free gingiva and the bottom of the sulcus was reported as PD. (measurements are in millimeters) | T1:1st month |
| Pocket depth (PD-mm) | Periodontal probe was positioned in the gingival sulcus . The distance between the top of the free gingiva and the bottom of the sulcus was reported as PD. (measurements are in millimeters) | T3:3rd month |
| Pocket depth (PD-mm) | Periodontal probe was positioned in the gingival sulcus . The distance between the top of the free gingiva and the bottom of the sulcus was reported as PD. (measurements are in millimeters) | T6: 6th month |
| Plaque index (PI) (by Silness & Löe 1964 ) | 0- No plaque
The PI of the individual can be obtained by adding the values of each tooth and dividing by the number of teeth examined. | baseline |
| Plaque index (PI) (by Silness & Löe 1964 ) | 0- No plaque
The PI of the individual can be obtained by adding the values of each tooth and dividing by the number of teeth examined. | T1:1st month |
| Plaque index (PI) (by Silness & Löe 1964 ) | 0- No plaque
The PI of the individual can be obtained by adding the values of each tooth and dividing by the number of teeth examined. | T3:3rd month |
| Plaque index (PI) (by Silness & Löe 1964 ) | 0- No plaque
The PI of the individual can be obtained by adding the values of each tooth and dividing by the number of teeth examined. | T6: 6th month |
| Papillary Bleeding Index(PBI) (by Saxer & Muhlemann 1975) | The PBI has proven to be particularly useful for assessing inflammation in the interdental papillae by recording bleeding on probing in the interdental areas during the course of treatment. Grade 0- no bleeding, normal papilla Grade 1- 20-30 seconds after probing the mesial and distal sulcus with a periodontal probe, a single bleeding point is observed. Grade 2- A fine line of blood or several bleeding points become visible at the gingival margin. Grade 3- Triangle The interdental triangle becomes more or less filled with blood Grade 4- Immediately after probing, blood flows into the interdental area to cover portions of the tooth and/or gingiva The PBI is calculated by dividing the bleeding number by the total number of papilla examined. | baseline |
| Papillary Bleeding Index(PBI) (by Saxer & Muhlemann 1975) | The PBI has proven to be particularly useful for assessing inflammation in the interdental papillae by recording bleeding on probing in the interdental areas during the course of treatment. Grade 0- no bleeding, normal papilla Grade 1- 20-30 seconds after probing the mesial and distal sulcus with a periodontal probe, a single bleeding point is observed. Grade 2- A fine line of blood or several bleeding points become visible at the gingival margin. Grade 3- Triangle The interdental triangle becomes more or less filled with blood Grade 4- Immediately after probing, blood flows into the interdental area to cover portions of the tooth and/or gingiva The PBI is calculated by dividing the bleeding number by the total number of papilla examined. | T1:1st month |
| Papillary Bleeding Index(PBI) (by Saxer & Muhlemann 1975) | The PBI has proven to be particularly useful for assessing inflammation in the interdental papillae by recording bleeding on probing in the interdental areas during the course of treatment. Grade 0- no bleeding, normal papilla Grade 1- 20-30 seconds after probing the mesial and distal sulcus with a periodontal probe, a single bleeding point is observed. Grade 2- A fine line of blood or several bleeding points become visible at the gingival margin. Grade 3- Triangle The interdental triangle becomes more or less filled with blood Grade 4- Immediately after probing, blood flows into the interdental area to cover portions of the tooth and/or gingiva The PBI is calculated by dividing the bleeding number by the total number of papilla examined. | T3:3rd month |
| Papillary Bleeding Index(PBI) (by Saxer & Muhlemann 1975) | The PBI has proven to be particularly useful for assessing inflammation in the interdental papillae by recording bleeding on probing in the interdental areas during the course of treatment. Grade 0- no bleeding, normal papilla Grade 1- 20-30 seconds after probing the mesial and distal sulcus with a periodontal probe, a single bleeding point is observed. Grade 2- A fine line of blood or several bleeding points become visible at the gingival margin. Grade 3- Triangle The interdental triangle becomes more or less filled with blood Grade 4- Immediately after probing, blood flows into the interdental area to cover portions of the tooth and/or gingiva The PBI is calculated by dividing the bleeding number by the total number of papilla examined. | T6: 6th month |
| Patient-based variables | Evaluation was made using the Visual Analog Scale( VAS- 0-10). The experienced pain values, the aesthetic expectations , The gained aesthetics / difficulty variables. these three criteria were evaluated together ( patient satisfaction ) | T1:1st month |
| Patient-based variables | Evaluation was made using the Visual Analog Scale( VAS- 0-10). The experienced pain values, the aesthetic expectations , The gained aesthetics / difficulty variables. these three criteria were evaluated together ( patient satisfaction ) | T3:3rd month |
| Patient-based variables | Evaluation was made using the Visual Analog Scale( VAS- 0-10). The experienced pain values, the aesthetic expectations , The gained aesthetics / difficulty variables. these three criteria were evaluated together ( patient satisfaction ) | T6: 6th month |
| 30195268 | Background | Carnio J, Carnio AT. Papilla reconstruction: Interdisciplinary consideration for clinical success. J Esthet Restor Dent. 2018 Nov;30(6):484-491. doi: 10.1111/jerd.12411. Epub 2018 Sep 8. |