Peri‐Implant Papilla Reconstruction: Realities and Limitations

Abstract

In recent years, esthetic demands in dentistry have been climbing ever higher, driven by an enhanced awareness of beauty and physical appearance. Because gingival esthetics has become an important factor in the overall success of most implant-supported restorations, the loss of the peri-implant papilla leads to an esthetic handicap known as black hole disease. Today, one of the most challenging aspects of periodontal reconstructive surgery is to obtain a predictable peri-implant papilla in the esthetic zone. Starting with the facts about the morphology of the peri-implant tissues, to the various parameters influencing papilla reconstruction around implants, this article gives a brief overview of various papilla preservation and reconstruction techniques around implants.

Correcting loss of a papilla following orthodontic space opening (Atherton patch) through implant supported rehabilitation. A case report

“…Different surgical techniques to generate interproximal papilla have been tried (11-14), but because no long-term studies have been conducted, no particular technique is recommended over another (15). …”

I-shaped incisions for papilla reconstruction in second stage implant surgery

“…The level of inter-implant papilla is influenced by the previous bone level, soft tissue quantity and quality, peri-implant biotypes, implant position, and inter-implant distance [6]. Therefore soft and hard tissue quality and quantity, peri-implant biotype [17], implant diameter, position, and emergence profile [18] should be considered with adequate treatment planning and evaluation of the surgical site prior to implant placement. If needed, ridge augmentation procedures using guided bone regeneration or/and connective tissue grafts are carried out prior to implant placement to attain a more acceptable esthetic result in the inter-implant papillary area.…”

Clinical Considerations of Open Gingival Embrasures

“…50 Fibers are stretched vertically instead of perpendicularly from the implant surface and there is reduced blood supply, further complicating papilla restoration. 51 A soft tissue deficiency of 1-2 mm occurs because the biological width around an implant is apical to the platform for the abutment. 52 As a result, the biological width of implants is located subcrestally rather than the supracrestal location with natural teeth.…”