Table of Contents  
ORIGINAL ARTICLE
Year : 2015  |  Volume : 8  |  Issue : 3  |  Page : 299-303  

Assessment of topography of the interdental papilla by ultrasound


1 Department of Periodontology, Career Post Graduate Institute of Dental Sciences and Hospital, Lucknow, Uttar Pradesh, India
2 Department of Radiotherapy, King George's Medical University, Lucknow, Uttar Pradesh, India

Date of Web Publication15-May-2015

Correspondence Address:
Charanjeet Singh Saimbi
House No. C-17, Sector-K, Aliganj, Lucknow - 226 024, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-2870.157066

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  Abstract 

Background: The length of the papilla is usually measured by bone probing under local anesthesia, might cause discomfort to the patients and possibly damage the delicate gingival unit. The purpose of this study was performed to assess the topography of the interdental papilla in different age groups by ultrasound. Materials and Methods: A total of 90 subjects in the age group of 15-40 years were randomly selected. In this study, the measurement of length, width and thickness of the interdental papilla of maxillary and mandibular central incisors were measured by ultrasound. Results: The length of the interdental papilla in maxillary and mandibular central incisors in all the three groups was found to statistically nonsignificant. The width and thickness of the interdental papilla in between maxillary central incisors was found to be more than mandibular interdental papilla. Analysis of variance shows that difference in length and width of interdental papilla in maxillary and mandibular central incisors in the three groups was statistically nonsignificant and the difference in thickness of interdental papilla in maxillary central incisors in the three groups was statistically significant and in mandibular central incisors was not significant. Conclusion: The finding of this study indicates that the length, width and thickness of the interdental papilla does not change with age. Ultrasound procedure is a promising and accurate method for the determination of the interdental papilla noninvasively, reproducibly and avoid radiation hazards.

Keywords: Interdental papilla, noninvasive, topography, ultrasound


How to cite this article:
Kumar V, Saimbi CS, Kumar S, Gupta S, Tripathi AK. Assessment of topography of the interdental papilla by ultrasound. Med J DY Patil Univ 2015;8:299-303

How to cite this URL:
Kumar V, Saimbi CS, Kumar S, Gupta S, Tripathi AK. Assessment of topography of the interdental papilla by ultrasound. Med J DY Patil Univ [serial online] 2015 [cited 2019 Dec 11];8:299-303. Available from: http://www.mjdrdypu.org/text.asp?2015/8/3/299/157066


  Introduction Top


Interdental papilla is the part of the gingiva which occupies the space between two adjacent teeth. It occupies the interdental space as a biological barrier and protects the periodontal structures. It also plays a critical role in the esthetics by providing soft tissue closure between the teeth. [1] The loss of the papilla can lead to cosmetic deformities, phonetic problems, and lateral food impaction. [2]

The length of the papilla with the help of clinical photographs can be measured but by this method the relationship between crestal bone and interdental papillae cannot be evaluated. [3] Lee et al. [4] has proposed another method of measuring the length of the interdental papilla from the papilla tip to the bone crest by periapical radiograph. The major problem with radiography is that it gives two-dimensional representations of complex three-dimensional structures. [5]

Ultrasound was used by Müller et al. [6] for measurement of thickness of the masticatory mucosa and concluded that ultrasonic device yielded valid and relatively reliable information on the thickness of most parts of the masticatory mucosa. Savitha and Vandana [7] assessed gingival thickness by ultrasonographic method and concluded that ultrasonographic method assesses gingiva thickness more accurately, rapidly and atraumatically. Ultrasonography provides a highly accurate and noninvasive technique for periodontal assessment.

In view of the noninvasive nature of the ultrasonography, it has a valuable place in periodontal imaging and is a reproducible technique. It is therefore; in the present study ultrasound was under taken to measure the topography of the interdental papilla in different age group subjects.


  Materials and Methods Top


In this study, 180 interproximal papillae of 90 patients were investigated. The present study was divided on the basis of age into three groups. Each age group consists of 30 patients.

Group I: 15-20 years

Group II: 21-30 years

Group III: 31-40 years

Ultrasound was used for the measurement of length (superoinferior), width (mesiodistal) and thickness (anteroposterior) of the 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 were medically compromised patients, pregnancy, history of taking medication known to increase the risk of gingival hyperplasia and patients with root surface caries or any subgingival restoration or crown.

Measurement of papilla

Ultrasound examination was conducted in the Department of Radiotherapy, King George's Medical University, Lucknow by senior radiologists using a Toshiba Nemio Model SSA-550A Ultrasound Scanner (Toshiba Medical Systems, Tokyo, Japan) with a 7 MHz to 9 MHz transducer, a high-frequency and high-resolution linear probe, which was placed extraorally on the skin of the upper and lower lip [Figure 1] and [Figure 2]. A coupling agent, a commercially available ultrasonic gel (medichem gel) was introduced between the probe tip and the tissue surface, in order to exclude air and to ensure good contact between the probe and the mucosa. The distances were measured on the superoinferior, anteroposterior and mesiodistal planes and the dimensions were recorded. Hard copies of the images were obtained [Figure 3] and [Figure 4].
Figure 1: Transducer probe placed on upper lip to measure the length width and thickness of interdental papilla

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Figure 2: Transducer probe placed on lower lip to measure the length width and thickness of interdental papilla

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Figure 3: Ultrasound imaging of interdental papilla of maxillary central incisors

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Figure 4: Ultrasound imaging of interdental papilla of mandibular central incisors

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Statistics

Mean values and standard deviations were calculated for the measurements of length, width and thickness of the interdental papilla. The analysis of variance test was used to compare the within group and between group variances amongst the study groups, that is, the three different groups. All the statistical analysis was conducted using Statistical Package for Social Sciences (SPSS) version 15.0 (IBM, Armonk, NY, USA) statistical analysis software.


  Results Top


A total of 90 patients were included in the analysis. Mean length of interdental papilla in maxillary central incisors was found to be minimum for Group III (5.68 + 0.33 mm) and maximum for Group I (5.77 + 0.52 mm) and mean length of interdental papilla in mandibular central incisors was found to be minimum for Group I (4.90 + 0.62 mm) and maximum for Group II (5.04 + 1.01 mm) as shown in [Table 1].
Table 1: Mean ± SD length, width and thickness of interdental papilla measured by ultrasound in three groups

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The interdental width of papilla was recorded by ultrasound at mid-point from the tip of the papilla to the crest of bone. The mean width of the interdental papilla in maxilla ranged between 2.30 and 4.50 mm. As shown in [Table 1] width was found to be minimum for Group I 3.19 + 0.56 mm and maximum for Group III 3.33 + 0.60 mm. The mean width of the interdental papilla in mandible ranged between 1.60 and 3.60 mm. Width was found to be minimum for Group II 2.37 + 0.53 mm while width for Group I was found to be 2.50 + 0.49 mm and for Group III was 2.50 + 0.51 mm.

The thickness of the interdental papilla is the distance between the facial papilla to the palatal/lingual papilla was measured by ultrasound at mid-point from the tip of papilla to the crest of bone. As shown in [Table 1], the mean thickness of interdental papilla in maxilla ranged between 2.70 and 5.10 mm. Thickness was found to be maximum for Group II that is,3.93 + 0.72 mm, while thickness for Group III was found to be minimum 3.41 + 0.48 mm. The mean thickness of interdental papilla in mandible ranged between 1.80 and 4.30 mm. Thickness was found to be maximum for Group III, that is, 2.92 + 0.48 mm while thickness for Group I was found to be minimum, that is, 2.79 + 0.44 mm.

Analysis of variance in [Table 2] shows that difference in length and width of interdental papilla in maxillary and mandibular central incisors in the three groups was statistically nonsignificant and the difference in thickness of interdental papilla in maxillary central incisors in the three groups was statistically significant and in mandibular central incisors was not significant.
Table 2: Analysis of variance for length, width and thickness of interdental papilla in different groups

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  Discussion Top


The existence of the interdental papilla and healthy gingiva in harmony with the natural dentition is one of the important esthetic aspects that need to be considered for dental treatment and diagnosis. A variety of methods have been advocated to accurately determine the level of the alveolar crest from the tip of the interdental papilla. [8] Though surgical measurement of the bone and transgingival probing has been confirmed as a valid method of reporting papilla length, [2] it is rather an 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.

Ultrasound is defined as the sound above the range of human hearing that is, above the frequency of 20,000 Hz (normal human hearing is between 20 Hz and 20,000 Hz). The main components of the ultrasonic equipment are the transducer, pulser, receiver, memory, monitor, and keyboard. The transducer converts the electronic impulse (arising from the pulser) into ultrasound waves. It also converts the returning ultrasound echoes (from the tissues) into an electronic impulse to produce an image. [9]

In this study, the mean value of papilla length in maxillary central incisors was 5.77 ± 0.52 mm in Group I, 5.76 ± 0.55 mm in Group II and 5.68 ± 0.33 mm in Group III and in mandible it was 4.90 ± 0.62 mm in Group I, 5.04 ± 1.01 mm in Group II and 4.94 ± 0.49 mm in Group III.

The difference in length measured in maxilla in Group I and Group II was found to be minimum 0.007 mm and in Group I and Group III was found to be maximum 0.093 mm, all the differences were statistically nonsignificant. The difference in length in mandible in Group I and Group III was found to be minimum 0.043 mm and in Group I and Group II was found to be maximum 0.140 mm, all the differences were statistically nonsignificant.

Ultrasound offers great potential in the development of a noninvasive periodontal assessment tool that would offer great yield real-time information. [10] Ultrasonography provides a highly accurate technique for periodontal assessment. [11] In view of the noninvasive nature of the imaging and the avoidance of ionizing radiation, ultrasonography could have a valuable place in periodontal imaging. The scanner could always provide clear imaging of the hard tissues; soft tissues were not always clearly identified. Transducers of higher frequencies might give better results.

In the present study, the technique used for deciding the interdental width of papilla is unique as the measurement was recorded at mid-point from the tip of papilla to the crest of bone. The mean width of interdental papilla in maxillary central incisors ranged between 2.30 and 4.50 mm. Width was found to be minimum for Group I 3.19 + 0.56 mm and maximum for Group III 3.33 + 0.60 mm and in mandibular central incisors it ranged between 1.60 and 3.60 mm. Width was found to be minimum for Group II 2.37 + 0.53 mm while width for Group I was found to be 2.50 + 0.49 mm and for Group III was 2.50 + 0.51 mm.

Most researchers made their interdental measurements between the cementoenamel junction of teeth [3],[12],[13] or at the osseous crest level. [14],[15] Our measurement for the interdental width is taken at mid-point from the tip of papilla to the crest of bone. This allows for a better estimate for total papilla anatomy and does not reply on radiographic inaccuracies or traumatic procedures [16] like most current studies.

In the present study, the thickness of interdental papilla is the distance between the facial papilla to the palatal/lingual papilla at mid-point from the tip of papilla to the crest of bone. The mean thickness of interdental papilla in maxilla ranged between 2.70 and 5.10 mm. The difference in thickness in Group I and Group III was found to be minimum 0.203 mm and in Group II and Group III was found to be maximum 0.520 mm. The differences between Group II and Group III were statistically significant.

The mean thickness of interdental papilla in mandible ranged between 1.80 and 4.30 mm. The difference in thickness in Group II and Group III was found to be minimum 0.047 mm and in Group I and Group III was found to be maximum 0.127 mm; none of the above difference was statistically significant.

The measurements of length, width and thickness of interdental papilla measured by ultrasound were not compared with any studies done in the past since there is scarcity of literature. However, few studies are available wherein measurement of masticatory mucosa [6],[17],[18] and measurement of gingival thickness [7],[19] has been done. However, this study is the first to examine the topography of interdental papilla by ultrasound.

The use of ultrasound does have some limitations. The scanner could always provide clear imaging of the hard tissues; soft tissues were not always clearly identified. Transducers of higher frequencies might give better results. A sample size of 30 subjects in each group was taken. A large sample size including diseased and healthy would have given more scope for better comparison and association in turn precision of results.

The finding of this study indicates that the length, width and thickness of interdental papilla does not change with age. Ultrasound procedure is obviously a promising and correct method for the determination of the interdental papilla noninvasively, reproducibly and avoids radiation hazards. Ultrasound measurement is a fast and painless procedure. Hence, proper application and utilization of this technique can be of great use in dentistry.

 
  References Top

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2.
Tarnow DP, Magner AW, Fletcher P. The effect of the distance from the contact point to the crest of bone on the presence or absence of the interproximal dental papilla. J Periodontol 1992;63:995-6.  Back to cited text no. 2
    
3.
Martegani P, Silvestri M, Mascarello F, Scipioni T, Ghezzi C, Rota C, et al. Morphometric study of the interproximal unit in the esthetic region to correlate anatomic variables affecting the aspect of soft tissue embrasure space. J Periodontol 2007;78:2260-5.  Back to cited text no. 3
    
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;76:1311-4.  Back to cited text no. 4
    
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Chang LC. Factors associated with the interdental papilla height between two maxillary central incisors: A radiographic study. J Periodontol 2012;83:43-9.  Back to cited text no. 13
    
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Cho HS, Jang HS, Kim DK, Park JC, Kim HJ, Choi SH, et al. The effects of interproximal distance between roots on the existence of interdental papillae according to the distance from the contact point to the alveolar crest. J Periodontol 2006;77:1651-7.  Back to cited text no. 16
    
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Müller HP, Schaller N, Eger T, Heinecke A. Thickness of masticatory mucosa. J Clin Periodontol 2000;27:431-6.  Back to cited text no. 17
    
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Ralf KW, Curie D, Hoedt B. B-mode versus A-mode ultrasonographic measurements of mucosal thickness in vivo. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002;93:110-7.  Back to cited text no. 18
    
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2]



 

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