Realities and Limitations in the Management of the In-terdental Papilla Between Implants: Three Case Reports Elian N, Jalbout AN, Cho S-C, Froum S, Tarnow DP. Pract Proced Aesthet Dent. 2003;15:737–744.
The increasing emphasis of esthetic outcomes for implant therapy certainly highlights the progress we have made. No longer are we so concerned with the presence or absence of osseointegration, but are focusing more and more on the patient-driven expectations of esthetics. Soft tissue esthetics at that! One of the most difficult aspects of esthetic implant therapy is managing the soft tissue contours associated with multiple dental implants. These areas frequently have a flattened ridge that makes it very difficult to develop a scalloped soft tissue contour on a predictable basis.
This case series reviews pertinent literature regarding papilla height associated with dental implants and presents 3 cases that were evaluated and treated with this information in mind. The first 2 cases were constructed anticipating a soft tissue height of 5 mm in the papilla area, as would be similar with interdental papillae. The inadequate results of these cases caused the authors to reduce their expectations to 3 mm and used ridge augmentation procedures to aid this cause. The success of these efforts can be judged by reviewing the clinical photographs.
The authors recognize the potential impact of the interimplant distance on bone resorption. As such, the therapeutic goal was to maintain at least 3 mm of horizontal distance between 2-piece implants. This rationale considers the predicted loss of crestal bone height associated with interface placement at the level of crestal bone and goes 1 step further to consider the loss of crestal bone width between implants. It is this interimplant distance that could be critical in maintaining bone height long-term, and consequently soft tissue, ie, papilla height. Based on a previous report, the authors anticipate approximately 1.3 mm of horizontal bone loss from the implant between 2 implants that would be 2.6 mm. Therefore, 3 mm should allow for the maintenance of crestal height between the 2 implants.
The results of the presented cases demonstrate that we have a long way to go to fully understand the factors dictating these soft tissue dimensions. The clinical cases do not present convincing evidence that the procedures attempted provide a better handle on this difficult problem. However, I do think the considerations given to the biologic interactions of the tissues with the implants provides an important starting point in our attempts to overcome the esthetic compromises associated with papilla development between dental implants.