Reduction of Gingival Black Triangles with Dental Pulp or Gingival Stem Cell Injection Therapy: Clinical and Outcomes Research Gaps

Gingival Black Triangles (GBTs), or gingival embrasures, are aesthetically displeasing even when they are not severe enough to require periodontal treatment. Multiple treatment modalities exist, including veneers, composite and other prosthetic modalities, with few, if any, treatments covered by insurance. Demand for GBT treatment is likely to increase with the aging of Baby Boomers, whose use of cosmetic dental procedures exceeds their predecessors. In recent days, stem cell therapy has gained more attention in the regeneration of oral and maxillofacial structures. We propose that the use of Dental Pulp Stem Cells (DPSC) or gingival stem cells for GBT treatment may have clinical, economic, and patient preference advantages that can fill a treatment gap, literally and figuratively. Safety and effectiveness concerns will persist until additional research is funded and conducted but the local nature of treatment would seem to expose patients to fewer risks than systemic use. Targeting the GBTs directly minimizes the long-term self-cleansing problem that other alternatives can create. Longevity is anticipated to exceed veneers and other prosthetic solutions. The cost of stem cell treatment for GBTs will likely be lower than veneers, consistent with the targeted placement. Further, less time in treatment and quicker recovery, both of which are anticipated, are likely to be preferable to patients. We enumerate these potential advantages and suggest a clinical way forward to evaluate the use of stem cell therapy for GBT treatment. Based on the anticipated differences for stem cell treatment of GBTs compared with usual care, we propose approaches for quantifying benefits from the patient perspective and from an economic standpoint. Future research will be needed to confirm the appropriateness of the recommended humanistic and economic evaluations.