A Scoping Review of Papillary Reconstruction Techniques Around Teeth and Implants

Background Loss of interdental papillae around teeth and implants presents both aesthetic and functional challenges, contributing to patient dissatisfaction and oral health complications. A variety of surgical and non‐surgical techniques have been proposed to address this issue, yet there remains uncertainty regarding their comparative effectiveness. Objective This scoping review aimed to evaluate the current evidence on papillary reconstruction techniques, focusing on their effectiveness in restoring papillary height and aesthetic appearance around natural teeth and dental implants. Methods Following PRISMA‐ScR guidelines, systematic reviews and randomised controlled trials (RCTs) published in English up to June 2024 were identified through MEDLINE, Embase and Cochrane CENTRAL. Studies included adult participants undergoing papillary reconstruction with at least 6 months of follow‐up. Risk of bias was assessed using the ROBIS and Cochrane Risk of Bias 2.0 tools. Results Twelve studies (five systematic reviews, seven RCTs) met inclusion criteria. Techniques assessed included connective tissue grafts (CTG), platelet‐rich fibrin (PRF), hyaluronic acid (HA) injections and adjunctive modalities such as orthodontics. CTG consistently demonstrated superior outcomes in increasing papillary height but involved higher morbidity. PRF showed moderate effectiveness with less postoperative discomfort. HA injections offered a non‐surgical alternative with variable results, particularly ineffective around implants. The heterogeneity of study designs, outcome measures and follow‐up durations limited direct comparisons and the strength of conclusions. Conclusions Connective tissue grafts remains the most effective technique for papillary reconstruction, with PRF as a promising alternative. HA injections may benefit select patients with tooth‐associated papillary loss but lack efficacy around implants. High variability and bias in existing studies highlight the need for well‐designed RCTs with standardised methodologies to guide clinical decision‐making.