GAP Australasian Dentist Sept Oct 2020

Category 76 Australasian Dentist Inject a pyramid to get rid of a triangle A ADFA’s expertise in the field of Dento-Facial Aesthetics was recognised by the team at The Doctors TV when we were approached to assist in developing a segment around using dermal filler injections to improve interdental papilla deficiencies or “black triangles”. The segment aired across the globe in February 2018. If you missed it, you can view it on the AADFA instagram page @ AADFA Australia The topic of dentists taking a more holistic approach to facial aesthetics, by utilising Botox and Dermal Filler injections extra-orally, has certainly excited the profession in recent years. Modern dentists are now using Botulinum Toxin (Botox) with great success for the treatment of “Gummy Smile”, TMD and Bruxism, while also utilising Hyarulonic Acid (HA) Dermal Fillers throughout the facial region to enhance lips and soft tissue profiles/ deficiencies. The abilities of dentists to apply these techniques has resulted in improved aesthetic outcomes for patients and increased revenues for practices. Yet many dentists are still unaware of the potential benefits that these materials offer intra-orally as well. HA products have long been known for their ability to be used intra-orally to improve everything from the healing of extraction sockets and implant sites, through to the treatment of apthous ulcers and periodontal pockets. Hyarulonic Acid is a naturally occurring linear polysaccharide present in the extracellular matrix of connective tissue, synovial fluid, and other tissues. It possesses various physiological and structural functions, such as anti- inflammatory, antioedematous, anti- bacterial and visco-elastic effects, which explain its benefits in the treatment of various anti-inflammatory conditions and wound healing. Recently though, the Australasian Academy of Dento-Facial Aesthetics (www.AADFA.net ), has been involved in the development of a reliable method for addressing intra-oral aesthetic deficiencies using HA Filler. The presence or absence of healthy, attractive, well-proportioned intra-oral soft tissues, the “Pink Aesthetics”, can enhance or diminish the overall facial aesthetics of our patients. Maintenance of the interdental papilla is of particular concern to periodontists, restorative dentists, and patients, as in addition to aesthetic deformities like the dreaded “Black Triangles”, a loss of papilla can also lead to phonetic problems and lateral food impaction. Loss of papilla can be the consequence of several issues, including periodontal disease, after periodontal therapy, traumatic oral hygiene techniques, poorly contoured restorations and tooth loss. Various factors are known to influence the presence or absence of a papilla, such as the availability of underlying osseous support, periodontal biotype and bioform, tooth morphology and contact points. Studies by Dennis Tarnow from 1992, for example, have shown that the distance from the crestal bone to the approximal contact of the teeth plays a critical role in determining whether complete regeneration of the papilla is achieved after the restorative treatment is concluded. Tarnow identified that for successful papilla regeneration, the approximal contact should ideally be at a distance of 5mm from the crestal bone – other researchers have subsequently supported this basic data. Such findings provide dentists with several criteria and DR MYLES HOLT DISCUSSES THE LATEST TECHNIQUE FOR IMPROVING “BLACK TRIANGLES” USING HYALURONIC ACID INJECTION Figure 1. Structure of Hyaluronic Acid Figure 2. Papilla Anatomy clinical Myles Holt