The Role of the Implant Housing in Obtaining Aesthetics: Generation of Peri-Implant Gingivae and Papillae-Part I Smuckler H, Castellucci F, Capri D. Pract Proced Aesthet Dent. 2003;15:141–149.
Although endosseous implant restorations have proven to be highly predictable over the long term, we as practitioners must strive to meet both the aesthetic and functional demands of our patients for implant restorations to be deemed wholly successful. Thus, our goal should be restoration-driven implant placement that is seamless with the adjacent teeth in the contour of both the soft tissues and prostheses. This goal requires an intimate understanding of the hard and soft tissues in which the implant will be placed (ie, the implant housing) and the knowledge to surgically intervene to improve on these tissues.
When evaluating a site for future implant placement, it is imperative to consider restorative concerns. If postex-traction bone resorption does not allow for placement of the implant that will result in ideal aesthetics, adjunctive regenerative procedures could be indicated to improve hard and soft tissue parameters. Postextraction resorption can be avoided or minimized by using immediate implant placement, immediate–delayed implant placement, or socket-preservation techniques.
Papillae formation is dependent on the interdeproximal implant housing, the position of the contact point, the form and contours of the adjacent teeth, surgical technique, and sculpting of the soft tissue collar at phase II surgery. The minimal distance from implant to adjacent tooth that will allow adequate interdental septal bone and papilla formation is 1.5 mm. Ideally, a 2-mm distance between the tooth and implant would prevent bone resorption and allow for moldable interproximal tissues to allow for the formation of an acceptable papilla. Vertically, the implant platform should be placed in line with the facial bone of the adjacent teeth, from 1.5 mm to 4 mm apical to the interproximal crest depending on the degree of scallop and thickness of the soft tissues in the area of implant placement. The implant also requires an adequate buccolingual dimension of the implant housing, and in the maxillary anterior should be placed, if possible, palatal to an imaginary arc formed by the facial surfaces of the adjacent teeth, allowing for 1.5 mm to 2 mm of bone on both the labial and palatal surfaces of the implant.