# Minimally invasive pouch technique with leukocyte platelet rich fibrin compared to non-invasive hyaluronic acid injection in reconstruction of interdental papilla in esthetic zone: a randomized clinical trial

## TL;DR

This study compares two minimally invasive methods for reconstructing interdental papilla in the esthetic zone and finds both effective.

## Contribution

The study introduces a comparison of a minimally invasive Pouch technique with L-PRF and a non-invasive HA injection for interdental papilla reconstruction.

## Key findings

- Both groups showed significant improvement in clinical parameters at 3 and 6 months.
- Patient satisfaction improved in both groups with no significant difference between them.
- No significant difference was found in primary or secondary outcomes between the groups at 6 months.

## Abstract

Interdental papilla deficiency is of high concern from the esthetic and functional perspectives. Several invasive approaches have been reported for interdental papilla reconstruction. However, the long-term success of invasive approaches is still controversial, therefore this study aimed to assess the minimally invasive Pouch technique using Leukocyte Platelet Rich Fibrin compared to non-invasive Hyaluronic acid gel injection in the reconstruction of Interdental papilla in esthetic zone.

The study was designed as a randomized, controlled, double-blinded, and phase (IV) clinical trial. The trial was registered retrospectively with the date (21/7/2023) and registration number (NCT05953896). A total sample size of 20 cases was planned to be recruited. i.e. (10 patients in each group). Patients with deficient interdental papilla class I or II in the esthetic zone were selected, then patients were randomized using computer-generated block randomization into two equal groups: group A (L-PRF) and group B (HA gel). Blinding was performed in selection of patient intervention, while blinding of the intervention wasn’t applicable since both interventions are completely different. The clinical and radiographic parameters were assessed at 3 and 6 months, As well as evaluation of patient satisfaction between the two tested groups.

Both groups showed significant improvement in all clinical parameters at 3 months and 6 months postoperatively. Assessment of patient satisfaction showed overall improvement in both groups after 6 months, with successful reduction in the mean value of black triangle height of the PRF group: (0.9 ± 0.52), and HA group: (0.6 ± 0.46), with no significant difference (P value: 0.178 ns) between the two groups at 6 months. No significant difference was found in the primary outcomes, and secondary outcomes between the study groups at 6 months.

Both injectable HA and multilayered L-PRF gave successful results that can be comparable to the invasive surgical techniques.

The online version contains supplementary material available at 10.1186/s12903-025-06127-7.