Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Dentistry
Year : 2011 | Month : December | Volume : 5 | Issue : 8 | Page : 1688 - 1691

Treatment of Black Triangle by using a Subepithelial Connective Tissue Graft

Plato Palathingal, Jaideep Mahendra

1. MDS, Department of Periodontology, Meenakshi Ammal Dental College, Chennai-95, India. 2. MDS, Ph.D, PGDHM, Professor, Department of Periodontology, Meenakshi Ammal Dental College, Chennai-95, India. PLACE OF STUDY: 1. Meenakshi Ammal Dental College, Chennai-95, India. 2. Meenakshi Ammal Dental College, Chennai-95, India.

Correspondence Address :
Jaideep Mahendra, MDS., Ph.D., PGDHM.,
Professor, Dept. of Periodontology,
Meenakshi Ammal Dental College, Maduravoyal, Chennai,
Tamil Nadu, India
Phone: +91- 9444963973
E-mail: jaideep_m_23@yahoo.co.in

Abstract

One of the most difficult and elusive goals of periodontics in the field of reconstruction, regeneration and esthetic aspect of periodontal therapy is the surgical reconstruction of the lost interdental papilla. Loss of interdental papilla could result in patient complaints such as phonetic problems, food impaction, functional problems and esthetic concern. It is clinically represented by open embrasures and is often referred to as the “black triangle”. Periodontal plastic surgery offers both surgical and non surgical approaches in the treatment of “Black triangle”. This case report demonstrates complete reconstruction of the lost interdental papilla following a semilunar coronally repositioned papilla technique with 6 months follow-up.

Keywords

Black triangle, Subepithelial connective tissue graft,Inter-dental papilla, Papilla reconstruction.

Introduction
One of the major aesthetic challenges in periodontal plastic surgery is related to the ability of rebuilding the lost papilla in the maxillary anterior segment. Absence of the papilla with opening of the black spaces result in ‘Black triangles’ and they are one of the most important aspects of the decision making process of a clinician. This condition may create aesthetic impairments and food impactions (1),(2).

The common causes of the loss of the inter-dental papilla are midline diastema, diverging roots, tooth extractions, traumatic interproximal oral hygiene procedures, abnormal crown forms and periodontal diseases (1).

Several surgical and non-surgical techniques have been proposed to treat soft tissue deformities and to manage the inter-proximal space. The non-surgical approaches are orthodontic, prosthetic and restorative procedures. They modify the interproximal space, thereby inducing modifications of the soft tissues. The surgical techniques aim to recontour, preserve or reconstruct the soft tissue between the teeth and the implants (1).

This case report highlights the importance of the inter-proximal papilla and it’s clinical significance and the progress of the papilla augmentation, based on the use of a sub-epithelial connective tissue graft for the treatment of the “Black triangle”.

Material and Methods

This case was undertaken in the Department of Periodontology at the Meenakshi Ammal Dental College and Hospital, Chennai, India. A 21 year old patient with the class I loss of the inter-dental papilla (3) in the maxillary anterior teeth, with the distance between the bone crest and the Contact point as ≤ 5mm and the height of the inter-dental papilla as < 4mm, was selected for the treatment (Table/Fig 1). The patient had normal alignment of the teeth in the maxillary arch, he was a non smoker and maintained good oral hygiene and no proximal caries or improper restoration werepresent with respect to the site.

The Presurgical Protocol
The treatment protocol was explained to the patient and an informed consent was obtained. After the phase one therapy, the clinical parameters such as the Papilla Index Score and the Height of Interdental Papilla were measured on the 0th-day of the surgery (baseline) and postoperatively on the 90th day and the 180th day.

The Papilla Index Score (Nemcovsky CE 2001) (4)

PIS 0: No papilla was present and there was no curvature of the soft tissue contour. PIS 1: Less than half the papilla height was present as compared to that in the proximal teeth; a convex curvature of the soft tissue contour was observed. PIS2: At least half the papilla height was observed, but it was not in complete harmony with the inter-dental papilla of the proximal teeth. PIS 3: The papilla filled the inter-proximal embrasure to the same level as in the proximal teeth and it was in complete harmonywith the adjacent papilla.

Height of the Inter-dental Papilla (McGuire MK et al 2007) (5)

The height of inter-dental papilla was determined according to McGuire MK et al (2007) (7). In this procedure, the inter-dental papilla was anaesthetized with 2% lignocaine hydrochloride. A William’s periodontal probe was used to measure the distance between the bone crest to the apical end of the contact point (H). Loss of the papilla was determined by measuring the distance between the tip of the inter-dental papilla to the apical end of the contact point (H1). Then, the height of the inter-dental papilla (H2) was determined by substracing H1 from H.

The Surgical Technique Preparation of the Recipient Site The surgical area was anaesthetized with 2% lignocaine hydrochloride which contained 1:2,00,000 adrenaline. A semilunar incision was made 3mm apical to the mucogingival junction facial to the inter-dental area, followed by a pouch like preparation towards the inter-dental area (Table/Fig 2). Intra-sulcular incisions were made around the necks of the adjacent teeth to free the connective tissue attachment from the root surface, to allow the coronal displacement of the gingivo-papillary unit (Table/Fig 3).

Obtaining the Graft from the Donor Site The sub-epithelial connective tissue graft was harvested from the palate (Table/Fig 4), following a “trap door” flap design (6). A No. 15 B.P. blade was used to make a partial thickness horizontal incision, about 3mm apical to the gingival margin of the first premolar, extending towards the first molar. Two vertical incisions were made mesiodistally (Table/Fig 5). A tissue forcep was used to lift the prepared palatal flap edge. It was reflected towards the centre of the palate and the underlying connective tissue was exposed. An incision which was perpendicular to the bone was made around the edge of the connective tissue, facilitating its reflection from the bone. A small periosteal elevator and an Orban’s knife were used to reflect the connective tissue which was harvested. After harvesting the graft, the wound was closed by using 4-0 black silk sutures.

Transferring and Immobilizing the Graft The donor sub-epithelial connective tissue graft which was harvested from the palate was tucked in and pushed coronally within the prepared pouch to support and provide bulk to the coronally positioned interdental papilla (Table/Fig 6). The gingivopapillary unit was then sutured (Table/Fig 7), a tin foil was placed over the surgical site and a periodontal dressing was applied. The patient was prescribed analgesics (Ibuprofen 400mg bid for 3 days) and 0.2% chlorhexidine digluconate mouthrinse twice dailyfor 2 weeks.

Follow Up Post-operatively, the patient was instructed to rinse the mouth with 0.12% chlorhexidine mouthwash for 10 days and to refrain from flossing or interdental brushing for 4 weeks. The sutures were removed after 10 days (Table/Fig 8).The surgical site was evaluated on follow up visits post-operatively on the 90th and the 180th day. Both the clinical parameters were recorded and the post-operative clinical photographs were taken. For clinical and statistical analyses, the measurements at 0-day (baseline), the 90th day and the 180th day were taken into consideration.

Results

The papilla index score (PIS) of the patient on the day of the surgery was PIS 2. The PIS on the 90th day was 3, which remained the same on the 180th day. Hence, there was an increase of 1 PIS unit in the patient on the 180th day. The height of the interdental papilla was 3mm on the day of the surgery, which increased to 4mm on the 90th day and remained the same on the 180th day. There was an increase of 1mm in the height of the inter-dental papilla from the 0th day to the 180th day. A 100% papilla fill was obtained on the 180th day.

Discussion

The success and the predictability of any surgical procedure for treating papilla loss is based on the amount of the papilla fill. This procedure is the first of its kind as it records the height of the interdental papilla, in accordance with the method of McGuire MK et al (2007) (5).

In this case, there was a complete fill of the papilla in the site due to the stability of the connective tissue graft and the maintenance of good oral hygiene.

This procedure was employed in accordance with that of Han TJ and Takie HH (1996) (7). A semilunar coronally repositioned papilla was combined with a sub-epithelial connective tissue graft and it was found to be an effective method of achieving predictable and stable results for treating papilla loss. The success of this grafting procedure was mainly due to the dual blood supply from the underlying connective tissue base and the overlying recipient flap. An excellent colour match and a donor site with a closed wound which provided less post-operative discomfort were the advantages of this technique.

The main advantage of using a tunnel or a pouch like design for this case was that it avoided a horizontal or vertical releasing incision, which helped in maximizing the papillary and the lateral blood supply to the submerged connective tissue graft. The atraumatic management of the tissues, respect for the blood supply and avoidance of tension and pressure are critical for the viability of the tissues and the success for the procedure. This flap design maximizes the soft tissue vascularity and the primary wound closure. The sub-epithelial connective tissue graft was procured by the “Trap door” technique, as described by Edel A (1974) (6). The grafted tissue receives a flow of plasma and an ingrowth of capillaries from the periosteum, the underlying connective tissue and the overlying flaps.

The use of a sub-epithelial connective tissue graft for interproximal papilla augmentation offers a reliable solution to an aesthetic problem. The papilla augmentation procedure is relatively easy and it is based on the principles of plastic surgery techniques.

Future research is indicated to examine the total volume of the embrasure space and also in the use of novel methods to measure the treatment effect in such periodontal plastic procedures.

References

1.
PiniPrato G, Rotundo R, Cortellini P, Tinti C, Azzi R. Inter-dental papilla management: A review and classification of the therapeutic approaches. Int J Periodontics Restorative Dent 2004; 24:246-55.
2.
Tarnow DP, Magner AW, Fletcher P. The effect of the distance from thecontact point to the crest of the bone on the presence or absence of the inter-proximal papilla. J Periodontol 1992; 63:995-96.
3.
Nordland WP, Tarnow DP. A classification system for the loss of papillary height. J Periodontol 1998; 69:1124-26.
4.
Nemcovsky CE. Inter-proximal papilla augmentation procedure: A novel surgical approach and the clinical evaluation of 10 consecutive procedures. Int J Periodontics Restorative Dent 2001; 21:553-59.
5.
McGuire MK, Scheyer ET. A randomized, double-blind, placebocontrolled study to determine the safety and efficacy of cultured and expanded autologous fibroblast injections for the treatment of interdental papillary insufficiency which was associated with the papilla priming procedure. J Periodontol 2007; 78: 4-17.
6.
Edel A. Clinical evaluation of free connective tissue grafts which were used to increase the width of the keratinized gingiva. J Clin Periodontol 1974; 2:185-96.
7.
Han TJ, Takei HH. Progress in gingival papilla reconstruction. Periodontol 2000.1996; 2:65-68.

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