The treatment of black triangles in modern dentistry involves various approaches, both surgical and nonsurgical. Surgical methods aim to reconstruct or preserve gingival tissue using techniques such as soft tissue flaps or augmentation. Some invasive surgical methods proposed for papilla reconstruction and correction of black triangle recession include repeated interproximal curettage, Beagle's pedicle graft procedure, free epithelialized and de-epithelialized gingival grafts, and subepithelial connective tissue grafts. The success rate of surgical augmentation depends on the thickness of the gingiva biotype. Orthodontic treatment can also be used to reshape and decrease the embrasure space. An alternative option is minimally invasive procedures for tissue re-volumizing and papilla anatomical-functional reconstruction. Hyaluronic acid (HA) has been used for minimally invasive papilla reconstruction, leveraging its volumizing filler effect. Non-surgical strategies based on hyaluronan are gaining ground internationally. The immediate goal of minimally invasive treatment for interdental papilla loss and black triangle disease is mechanical protection and gingival restoration. Promoting tissue hydration, fibroblast vitality, and collagen deposition may offer a long-term regenerative medicine solution. Additionally, natural-origin, High Purification Technology Polynucleotides (PN HPTTM) are exploited for wound healing and counteracting connective tissue depletion. PNs-based medical devices are widely used in Europe and other countries for various indications, including orthopedics (intra-articular administration), dermatology (intra-dermal injections), and vulvo-vaginal application. PNs have minimal protein contaminants and allergic risks due to advanced purification techniques. Their hydrophilic nature provides hydration and acts as a volume enhancer. Recent in vitro studies demonstrate improved gingival fibroblast viability and collagen deposition with PNs. The purpose of this clinical investigation is to assess the safety and clinical performance of RDM36 in the treatment of periodontal gingival contraction and in black triangles syndrome (BTS).
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
40
Patients treated with RDM36; two perpendicular infiltrations (buccal, palatal) of a quantity of 0.2 ml of PN HPT
patients treated with saline solution; two perpendicular infiltrations (buccal, palatal) of a quantity of 0.2 ml of saline solution
Occurrence of adverse device effects (ADE) and serious adverse device effects (SADE) - Safety outcome
Time frame: From enrollment to the end of treatment at 26 weeks (± 2 weeks) from baseline
Clinical performance of RDM36 in the 2D modification of the "black triangle" lesion through photographic documentation using Image-J software obtained from a scan (TRIOS 6 3Shape intraoral scanner) and from superimposition compared to baseline
Time frame: Visit 2 (6 ± 1 weeks)
Clinical performance of RDM36 in the 2D modification of the "black triangle" lesion through photographic documentation using Image-J software obtained from a scan (TRIOS 6 3Shape intraoral scanner) and from superimposition compared to baseline
Time frame: From enrollment to the end of treatment at 26 weeks (± 2 weeks) from baseline
Patients' subjective evaluation of the aesthetic improvement of black triangle syndrome through the Visual Analogue Scale (VAS, 0-10 score, where 0=very satisfactory and 10=unsatisfactory)
Time frame: From enrollment to the end of treatment at 26 weeks (± 2 weeks) from baseline
Patients' subjective evaluation of the aesthetic improvement of black triangle syndrome through the Global Aesthetic Improvement Scale (GAIS)
GAIS, rated on a 5-point scale (1= very much/extremely improved; 2= much improved; 3= improved; 4= no change; 5= worse)
Time frame: From enrollment to the end of treatment at 26 weeks (± 2 weeks) from baseline
Patients' subjective evaluation of the aesthetic improvement of black triangle syndrome through the Likert scale
5 point-Likert scale, from 1 to 5 indicating how satisfied is the patient (1 - Extremely dissatisfied, 5 - Extremely satisfied)
Time frame: From enrollment to the end of treatment at 26 weeks (± 2 weeks) from baseline
Evaluation of the clinical performance of RDM36 in the 3D modification of the "black triangle" lesion through a scanner volumetric analysis (TRIOS 6 3Shape) and Blender software.
Time frame: From enrollment to the end of treatment at 26 weeks (± 2 weeks) from baseline
Papilla's colorimetric evaluation using a colorimeter (OPTISHADE STYLEITALIANO) that will objectively rank the stability or improvement of gingival health on a red scale
Time frame: From enrollment to the end of treatment at 26 weeks (± 2 weeks) from baseline
Periodontal health evaluation through Plaque Index (PI)
The PI is a dichotomous parameters (0 = absence, 1 = presence)
Time frame: From enrollment to the end of treatment at 26 weeks (± 2 weeks) from baseline
Periodontal health evaluation through Bleeding on Probing (BOP)
The BOP is a dichotomous parameters (0 = absence, 1 = presence)
Time frame: From enrollment to the end of treatment at 26 weeks (± 2 weeks) from baseline
Periodontal health evaluation through Recession (REC) at the study site
REC is measured in millimeters (PD: \< 4 mm = health, \> 4mm = periodontal disease)
Time frame: From enrollment to the end of treatment at 26 weeks (± 2 weeks) from baseline
Periodontal health evaluation through Probing Depth (PD) at the study site
PD is measured in millimeters (PD: \< 4 mm = health, \> 4mm = periodontal disease)
Time frame: From enrollment to the end of treatment at 26 weeks (± 2 weeks) from baseline
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