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Risk Indicators of Papillary Recession in the Anterior Maxilla: Risk Indicators of Papillary Recession
Abstract
PurposeThe interdental papilla is the portion of the gingiva that occupies the space between two adjacent teeth. When papillary recession occurs, an array of problems arises ranging from phonetics to food impaction and esthetic concerns. The aim of this study was to identify risk indicators for visible papillary recession in the anterior maxilla among a Caucasian population utilizing an advanced analytical approach.Materials and MethodsA dataset of 211 adult dentate Caucasian patients that had undergone intraoral assessment of midline papillary recession and extra-oral assessment of visible papillary recession during maximum (“Duchenne”) smile was utilized. An enhanced analytical approach was employed to identify risk indicators for papillary recession.ResultsApproximately one-third of the participants (38%) demonstrated papillary recession during maximum smile (“visible papillary recession”). An association between sex (male preference) and visible papillary recession was found in this sample population, while age was found to be a risk indicator for papillary recession in individuals over 65 years of age.Conclusions
Visible midline papillary recession in the maxilla is a highly prevalent clinical entity in Caucasian individuals, thus the development of efficacious treatment modalities for papillary regeneration is necessary. Findings of the present study on risk indicators for visible papillary absence, namely sex and age, may facilitate clinicians in treating patient with compromised interdental aesthetics as well as identifying patients that are in high risk for loss of interdental tissues.Clinical SignificanceFindings of the present study on risk indicators for visible papillary absence, namely sex and age, indicate the need for careful assessment and meticulous treatment planning with respect to preservation of the interdental tissues. The consideration of these risk indicators can facilitate dentists to identify patients at risk for papillary recession.
... Furthermore, the actual visibility of a papilla recession should also be taken into account in the assessment of smile esthetics. Former research demonstrated that 84-91% of the subjects revealed interdental papillae upon smiling [17,18]. Even in 87% of the subjects with a low gingival smile line, their interdental papillae was visible [17]. ...
... The mean age was significantly higher in patients who exhibited papilla recession compared to patients without papilla recession, 34.3 years versus 26.5 years, respectively. This is in line with former studies [8,11,18]. Although the visibility of recessions decreases with age, the risk of developing recessions increases with increasing age. ...
Purpose
To evaluate the influence of orthodontic treatment with surgically assisted rapid maxillary expansion (SARME) on the interdental papilla height of maxillary central incisors.
Methods
In this retrospective study, patients who completed orthodontic treatment including SARME at the Radboud University Medical Center Orthodontic Department before December 2019 were included. Frontal intraoral photographs taken before (T1) and after completion of treatment (T2) were examined to determine the papilla height between the maxillary central incisors using the Jemt classification. The difference between the Jemt classification at T1 and T2 (∆Jemt) was defined as the primary outcome variable. Secondary outcome variables were gender, age, treatment duration, type of expansion appliance, maximal central diastema during expansion, pretreatment overlapping between the central incisors, gingival biotype, crown morphology and the distance between the bone crest and incisal contact point. Kappa statistics and paired t‑tests were used to determine reliability of the measurements. Pearson’s Χ ² test and independent t‑tests were used to compare the variables between the groups of patients with and without papillary recession. Finally, multiple logistic regression analysis was performed.
Results
In all, 93 patients fulfilled the inclusion criteria and were included in the study. The Jemt score worsened for 30 patients (32%) between T1 and T2, indicating the occurrence of papillary recession. Incisal overlapping, crown morphology, small width to length ratio, increasing age and an increasing distance between crestal bone and the incisal contact point were factors associated with papillary recession.
Conclusion
After orthodontic treatment including SARME, one third of patients exhibited recession of papilla height of the maxillary central incisors.
... "Black triangles" associated with papilla defects are a significantly displeasing aesthetic factor for patients, ranked only behind visible caries or exposed crown margins. 1 More than 90% of patients show interdental papillae when smiling and almost half of patients have papillary recession. 2,3 The interdental papillae surrounding >60% of implant-supported crowns lack complete fill. 4,5 Loss of interdental papilla can also lead to caries, food or plaque accumulation, and altered word pronunciation. ...
... 4,5 Loss of interdental papilla can also lead to caries, food or plaque accumulation, and altered word pronunciation. [2][3][4] Thus, interdental papillary loss is not strictly an aesthetic issue. Yet, no predictable treatment is available. ...
Introduction
Loss of the interdental papilla, leading to the formation of black triangular spaces just below the contact area of adjacent teeth, is one of the most challenging periodontal conditions to treat and often requires an interdisciplinary approach by the periodontist, restorative dentist, and orthodontist. Although these “black triangles” may appear quite small from a clinician's standpoint, they can have a significant impact on oral health satisfaction for patients. This case series illustrates a novel minimally invasive approach to restore interdental papilla deficiencies.
Case Presentation
Four interdental papilla defects were treated in three females. No patients were lost to follow‐up over 6 months. The surgery consisted of a horizontal incision placed apical to the area of papillary loss in the alveolar mucosa just beyond the mucogingival junction. An interdental subperiosteal tissue space was then created by tunneling toward and under the dental papilla. Once adequate release was achieved, dermal filler was administered into and underneath the deficient papilla. The papillary margins were then sealed with cyanoacrylate and additional dermal filler was injected as needed to achieve ideal papillary fill. Six months after treatment there was an improvement in patient‐satisfaction regarding papilla fill demonstrated by a mean increase in visual analogue scale (VAS) measurements of 62.46%. Mean papilla fill was 1.75 mm.
Conclusion
This surgical technique demonstrates the restoration of deficient interdental papillae between teeth and implants, and perhaps as importantly, a considerable improvement in patient‐based outcomes quantified through VASs.
... Por otro lado, Nichani et al., informan una fuerte correlación con la forma coronal (20), Joshi et al., afirman que la papila interdental además de la forma coronal también está correlacionada significativamente a CO-PC, biotipo gingival y ángulo gingival (21), y Ionannou et al., mencionan como factores de riesgo para la recesión a pacientes de sexo masculino y mayores de 65 años (22). ...
Objectives: To identify the main factors associated with the recession of the interdental papilla of the upper
central incisors. Material and Methods: A non-probabilistic sample of 86 patients from the section of the Periodontal
and Implant Section of the Department of Dentistry of the Peruvian Air Force Central Hospital was
analyzed. The study was observational, correlational, transversal and prospective. Factors such as coronal tooth
shape and gingival biotype were clinically evaluated; and radiographically, with the parallel technique, distances
of the cement enamel proximal junction to the point of interdental contact (UCEp-PC), papilla tip to the point of
interdental contact (PP-PC), bone crest to the point of interdental contact (CO-PC), bone crest to the cement enamel
proximal junction (CO-UCEp), interdental width (AI), width of the bone crest (AC) and width of the tip of
the papilla (APP). Results: In all study patients, the recession level, CO-PC and APP were significant individual
predictors (p <0.05) of papillary height (PA). In patients with papillary recession, CO-PC, APP and PP-PC were
significant predictors (p <0.05) of AP. In addition, CO-PC was the only significant predictor (p <0.001) of AP in
patients without papillary recession. Conclusions: The PC, CO-PC and APP PP distances are the main factors
associated with recession of the interdental papilla of upper central incisors and together predict papillary height.
... A limitation of this study is that although the sample size was sufficient to obtain a sufficient power in testing for differences in Jemt score between T0 and T1, the sample size and strong collinearities among the data precluded multivariable linear or logistic regression analyses involving multiple independent factors such as W:L ratio and incisal overlapping, which aimed to estimate the individual effects of the independent variables on papilla recession. Some factors that are associated with papilla recession, such as smoking, tooth brushing technique, gingival inflammation, gingival thickness, and width of the crestal alveolar bone [29] between the central incisors were also not quantified. A much larger study population would be required to investigate the potential risk factors for papilla recession following MARPE in a future clinical study. ...
Objectives
To evaluate the influence of miniscrew-assisted rapid palatal expansion (MARPE) on the interdental papilla height of maxillary central incisors.
Materials and methods
Patients who completed MARPE treatment at the Radboud University Medical Center between 2018 and 2021 were included in this retrospective study. The papilla height between the maxillary central incisors was evaluated on frontal intraoral photographs taken before expansion (T0) and 1.5 years after MARPE treatment (T1) using the Jemt classification. The difference in Jemt score at T0 and T1 was the primary outcome variable. In addition, gender, age, Angle classification, MARPE duration, midpalatal suture maturation stage, maximal central diastema (MCD) immediately after expansion, crown width to length ratio (W/L), pretreatment overlap of maxillary central incisors, and the distance between the approximal contact point of the central incisors and the bone crest (CP-B) were also record.
Results
Twenty-two patients were included (2 men, 20 women, mean age 27.3 ± 8.8 years) and 4 patients (18%) showed a significant reduction in the Jemt score following MARPE (p = 0.04), indicating papilla recession. Interdental papilla recession was significantly associated with the increase of CP-B (p = 0.02), smaller W/L (p < 0.01), overlapping of maxillary central incisors (p < 0.01), and smaller MCD immediately after expansion (p = 0.02).
Conclusions
One and a half years after MARPE, 18% of patients exhibited mild recession of papilla height of the maxillary central incisors. Overlapping and smaller W/L of maxillary central incisors were prognostic factors for interdental papilla recession.
Clinical relevance
Clinicians have to be aware of and inform the patients about the occurrence of papilla recession following MARPE.
... Por otro lado, Nichani et al., informan una fuerte correlación con la forma coronal (20), Joshi et al., afirman que la papila interdental además de la forma coronal también está correlacionada significativamente a CO-PC, biotipo gingival y ángulo gingival (21), y Ionannou et al., mencionan como factores de riesgo para la recesión a pacientes de sexo masculino y mayores de 65 años (22). ...
Objectives: To identify the main factors associated with the recession of the interdental papilla of the upper central incisors. Material and Methods: A non-probabilistic sample of 86 patients from the section of the Periodontal and Implant Section of the Department of Dentistry of the Peruvian Air Force Central Hospital was analyzed. The study was observational, correlational, transversal and prospective. Factors such as coronal tooth shape and gingival biotype were clinically evaluated; and radiographically, with the parallel technique, distances of the cement enamel proximal junction to the point of interdental contact (UCEp-PC), papilla tip to the point of interdental contact (PP-PC), bone crest to the point of interdental contact (CO-PC), bone crest to the cement enamel proximal junction (CO-UCEp), interdental width (AI), width of the bone crest (AC) and width of the tip of the papilla (APP). Results: In all study patients, the recession level, CO-PC and APP were significant individual predictors (p
... Therefore, the association of food impaction with failing or failed implant cannot be neglected and should be optimally managed. [4][5][6] First, it is essential to understand the difference between food lodgment and food impaction. Unlike food impaction which is a more chronic condition, food lodgment is the mere lodgment of food particles and debris around the peri-implant tissues that can be removed by natural self-cleansing mechanisms. 1 The natural cleansing mechanisms such as the flushing action of the saliva, movement of the tongue, and occlusal forces help in displacing the food particles and prevent its lodgment into the interdental/interimplant embrasure space. ...
Background
Food impaction is a common risk factor for the initiation of peri‐implant inflammation and failure of the osseointegrated implant. Although clinicians do acknowledge the presence of food impaction around implants and implant‐retained prosthesis, no classification system has yet classified the food impaction around the implant and implant‐retained prosthesis.
Purpose
The present paper aims to identify and classify the plausible etiology of food impaction around implants and implant‐related prosthesis.
Materials and Methods
The following search terms were utilized for data search: “Food Impaction” AND “Implants” AND “Food Impaction” AND “Perimplantitis” AND “Food Impaction” AND “Classification.” Articles that were written in the English language in PubMed and Cochrane Library database from 1930 till September 2018 were scrutinized. A total of 24 articles were scrutinized, out of which only 15 articles were selected.
Results
Food impaction around implants is broadly classified into five categories based on the number of implants, nature of implants prosthesis involved for replacement and relation of the implant prosthesis to the adjacent tooth, restoration, or prosthesis.
Conclusion
This is the first classification designed to classify food impaction around dental implants and implant‐retained prosthesis. The classification can be used by clinicians for optimal diagnosis, interpretation, and treatment plan for patients.
... Por otro lado, Nichani et al., informan una fuerte correlación con la forma coronal (20), Joshi et al., afirman que la papila interdental además de la forma coronal también está correlacionada significativamente a CO-PC, biotipo gingival y ángulo gingival (21), y Ionannou et al., mencionan como factores de riesgo para la recesión a pacientes de sexo masculino y mayores de 65 años (22). ...
Objetivo: Identificar los principales factores asociados a la recesión de la papila interdental de incisivos centrales superiores. Material y métodos: Se analizó una muestra no probabilística de 86 pacientes de la sección de Periodoncia e Implantes del Departamento de Estomatología del Hospital Central de la Fuerza Aérea del Perú. El tipo de estudio fue observacional, correlacional simple, transversal y prospectivo. Se evaluaron clínicamente factores como forma coronal dentaria y biotipo gingival; y radiográficamente distancias de la unión cemento esmalte proximal al punto de contacto interdentario (UCEp-PC), punta de la papila al punto de contacto interdentario (PP-PC), cresta ósea al punto de contacto interdentario (CO-PC), cresta ósea a la unión cemento esmalte proximal (CO-UCEp), ancho interdental (AI), ancho de la cresta ósea (AC) y ancho de la punta de la papila (APP). Resultados: En todos los pacientes de estudio, el nivel de recesión, CO-PC y APP fueron predictores individuales significativos (p
Background
Natural teeth in the anterior maxilla are critical in determination the esthetic outcome of single implant prosthesis.
Purpose
The present study aimed to explore aesthetics of natural teeth in the anterior maxilla using the Pink Esthetic Score/White Esthetic Score (PES/WES) index. Additionally, inherent weak spots of natural teeth and high‐risk parameters of prostheses were also considered.
Material and methods
This cross‐sectional study was performed by photographic analysis.
Results
A total of 102 subjects and 306 teeth (the right incisor, lateral incisor and canine) were included. The grand means of the PES and WES were 12.92 and 8.75, respectively. The score of soft tissue margin, soft tissue contour and outline/volume of the crown were significantly lower than other variables. The PES and WES showed a downward trend with age. Most of the PES/WES values of the females exceeded those of the males.
Conclusion
The average level of natural teeth in PES and WES assessment were around 13 and 9, respectively. The soft tissue margin, soft tissue contour and outline/volume of the crown were high‐risk parameters for the esthetic outcomes of implant reconstructions. Underlying factors, such as age and gender, contributed to the esthetics of natural teeth change.
Purpose:
Soft tissue interactions with ceramic dental implants have previously been shown to have favorable esthetic outcomes. This study aimed to evaluate the papilla-crown proportion around zirconia implants in a 3-year follow-up study and the correlation between the gingival biotype and changes in papillary height.
Materials and methods:
This was a prospective study of 39 patients with 40 single-gap implants (Straumann PURE Ceramic ZLA Implant). The papilla-crown proportion was assessed after 3 months, 1 year, and 3 years. In addition, correlations between the peri-implant biotypes and changes in papillary heights were evaluated.
Results:
The papilla-crown proportion improved from 35.5% after 3 months to 41.7% after 3 years. The gingival biotype was correlated very weakly to papilla height alterations. Significant papillary fill was observed in the interdental space between 3 months and 3 years (p < 0.001).
Conclusions:
An ideal papilla-crown proportion of 40% around single implants was observed after 3 years. A thin or thick gingival biotype showed a very weak correlation with soft tissue alterations.
The objectives of this study were to record the prevalence and degree of absence of the maxillary midline interdental papilla and the proportion of patients displaying the maxillary midline papilla during maximum smile among a Caucasian population. Papillary recession was found in 46.4% of study participants (n = 211), while the prevalence of visible recession among maxillary midline papilla during maximum smile was 38.4%, which was statistically significantly less than that of patients diagnosed intraorally with loss of papillary height (P < .001). Correlations between age and level of lip line as well as age and visible papillary recession were identified for individuals over 65 years of age. The high prevalence of midline papillary recession in the maxilla found in this population suggests that loss of papillary height constitutes a substantial clinical challenge.
The objectives of this study were to record the prevalence and degree of absence of the maxillary midline interdental papilla and the proportion of patients displaying the maxillary midline papilla during maximum smile among a Caucasian population. Papillary recession was found in 46.4% of study participants (n = 211), while the prevalence of visible recession among maxillary midline papilla during maximum smile was 38.4%, which was statistically significantly less than that of patients diagnosed intraorally with loss of papillary height (P < .001). Correlations between age and level of lip line as well as age and visible papillary recession were identified for individuals over 65 years of age. The high prevalence of midline papillary recession in the maxilla found in this population suggests that loss of papillary height constitutes a substantial clinical challenge.
Two hundred forty interdental papilla sites in 20 healthy patients were investigated. Interdental papilla heights of maxillary anterior teeth were measured from the gingival zenith, along with clinical crown lengths. Percentages of papilla height to crown length were computed and defined as papilla proportion, mesial papilla proportion (MPP), and distal papilla proportion (DPP). Mean interdental papilla heights of maxillary anterior teeth were 4 mm mesially and 4.1 mm distally. Mean MPP was 42% (n = 120), and mean DPP was 43% (n = 120). No significant differences were found between MPP and DPP for maxillary incisors (P >/= .5). Canines demonstrated a trend toward increased distal papilla heights. Papilla proportions were approximately 40% for all tooth groups. A more apical position of distal papilla heights from anterior to posterior teeth, mentioned in the literature, was not confirmed by the present data.
This study was designed to determine whether the distance from the base of the contact area to the crest of bone could be correlated with the presence or absence of the interproximal papilla in humans. A total of 288 sites in 30 patients were examined. If a space was visible apical to the contact point, then the papilla was deemed missing; if tissue filled the embrasure space, the papilla was considered to be present. The results showed that when the measurement from the contact point to the crest of bone was 5 mm or less, the papilla was present almost 100% of the time. When the distance was 6 mm, the papilla was present 56% of the time, and when the distance was 7 mm or more, the papilla was present 27% of the time or less.
It has been long known that the clinical appearance of healthy marginal periodontium differs from subject to subject and even among different tooth types. Many features are genetically determined; others seem to be influenced by tooth size, shape and position and biological phenomena such as gender, growth and age.
The purpose of this study was to determine the thickness of facial gingiva among Indians and its association with age, gender and dental arch.
The study group included 16 males and 16 females with an age range of 16-38 years. Gingival thickness was assessed in the maxillary and mandibular anteriors by transgingival probing.
It was observed that the younger age group had significantly thicker gingiva than that of the older age group. The gingiva was found to be thinner in females than males and, in the mandibular arch than the maxilla.
In the present study, it was concluded that gingival thickness varies according to age, gender and dental arch.
Using stereo‐images, topographical features within the maxillary papillary gingiva between the lateral and central incisors were investigated in 36 healthy young adults. The features studied were surface stippling, presence of a gingival groove, papillary length and papillary area.
The prevalence of stippling was found to be 95%. The intensity of stippling varied considerably between individuals, the mean being 2.6 depressions/mm ² . A gingival groove only occured in 19% of the cases examined. The maximum length of the papilla from the base to its most incisal tip was measured in relation to the length of the crown of the lateral incisor. This ratio was found to be close to 0.5, indicating a healthy papilla reaching about halfway to the incisal edge. The surface area of the papilla was measured in relation to the labial surface area of the lateral incisor. This ratio was close to 0.25, indicating that the papillary surface under healthy conditions amounts to about 1/4 of the labial surface of the lateral incisor crown.
Changes resulting from 20 days of plaque accumulation were also investigated. A mean GI of 0.8 was recorded at the end of the experimental period; however, no measureable changes in stippling intensity or papillary shape could be established. These findings suggest that the early stages of gingivitis are characterized mainly by changes in gingival colour, while changes in surface texture and shape are secondary characteristics of clinical inflammation.
Purpose: This study was designed to determine the perceptions of lay people and dental professionals with respect to minor variations in anterior tooth size and alignment and their relation to the surrounding soft tissues.
Materials and Methods: Smiling photographs were intentionally altered with one of eight common anterior esthetic discrepancies in varying degrees of deviation, including variations in crown length, crown width, incisor crown angulation, midline, open gingival embrasure, gingival margin, incisal plane, and gingiva-to-lip distance. Forty images were randomized in a questionnaire and rated according to attractiveness by three groups: orthodontists, general dentists, and lay people; 300 questionnaires were distributed.
Results: The response rate was 88.2% for orthodontists, 51.8% for general dentists, and 60.6% for lay people. The results demonstrated threshold levels of noticeable difference between the varying levels of discrepancy. A maxillary midline deviation of 4 mm was necessary before orthodontists rated it significantly less esthetic than the others. However, general dentists and lay people were unable to detect even a 4-mm midline deviation. All three groups were able to distinguish a 2-mm discrepancy in incisor crown angulation. An incisal plane cant of 1 mm as well as a 3-mm narrowing in maxillary lateral incisor crown width were required by orthodontists and general dentists to be rated significantly less esthetic. Lay people were unable to detect an incisal plane asymmetry until it was 3 mm, or a lateral incisor narrowing until it reached 4 mm. Threshold levels for open gingival embrasure and gingiva-to-lip distance were both at 2 mm for the orthodontic group. Open gingival embrasure became detectable by the general dentists and lay people at 3 mm, whereas gingiva-to-lip distance was classified by these groups as noticeably unattractive at 4 mm.
The purpose of this research was to quantify the visual display (presence) or lack of display (absence) of interdental papillae during maximum smiling in a patient population aged 10 to 89 years. Four hundred twenty digital single-lens reflex photographs of patients were taken and examined for the visual display of interdental papillae between the maxillary anterior teeth during maximum smiling. Three digital photographs were taken per patient from the frontal, right frontal-lateral, and left frontal-lateral views. The data set of photographs was examined by two examiners for the presence or absence of the visual display of papillae. The visual display of interdental papillae during maximum smiling occurred in 380 of the 420 patients examined in this study, equivalent to a 91% occurrence rate. Eighty-seven percent of all patients categorized as having a low gingival smile line (n = 303) were found to display the interdental papillae upon smiling. Differences were noted for individual age groups according to the decade of life as well as a trend toward decreasing papillary display with increasing age. The importance of interdental papillae display during dynamic smiling should not be left undiagnosed since it is visible in over 91% of older patients and in 87% of patients with a low gingival smile line, representing a common and important esthetic element that needs to be assessed during smile analysis of the patient.
The purpose of this study was to evaluate factors associated with the fill of inter-dental spaces by gingival papillae.
Ninety-six adult subjects were evaluated. Papilla score (PS), tooth form/shape, interproximal contact length and gingival thickness were recorded for 672 maxillary anterior and first pre-molar interproximal sites. Statistical analyses included a non-parametric chi(2) test, anova, the Mixed Procedure for SAS and Pearson's correlation coefficient (r).
Papilla deficiency was more frequent in older subjects (p<0.05), as papilla height decreased 0.012 mm with each year of increasing age (p<0.05). Competent papillae (complete fill inter-dentally) were associated with: (1) crown width: length >or=0.87; (2) proximal contact length >or=2.8 mm; (3) bone crest-contact point <or=5 mm; and (4) interproximal gingival tissue thickness >or=1.5 mm. Gingival thickness correlated negatively with PS (r=-0.37 to -0.54) and positively with tissue height (r=0.23-0.43). Tooth form (i.e. crown width to length ratio) correlated negatively with PS (r=-0.37 to -0.61). Other parameters failed to show any significant effects.
Gingival papilla appearance was associated significantly with subject age, tooth form/shape, proximal contact length, crestal bone height and interproximal gingival thickness.
There is a close relationship between the contact, contour, and shape of the teeth that creates the interproximal space with the help of the interdental gingiva. The interdental gingiva, composed of the facial and lingual papillae and the col, is a unique area anatomically and histologically. The high incidence of caries and periodontal disease in the interproximal area is partially the result of this histologic and anatomic make-up and the great accumulation of bacterial plaque.
In restorative dentistry, it is important to recreate an interproximal area that will minimize a long facial-lingual col area, provide adequate space for interdental gingiva, minimize food impaction and retention, and allow for ease in plaque removal by the patient.
The present study investigated the location of the gingival margin, following denudation of the interdental alveolar bone. In seven patients apically positioned flap procedures were performed in such a way that complete interdental denudation was achieved. Teeth showing interdental osseous craters were excluded from the study. Three years post‐treatment a mean pocket depth of 2.17 mm was found. No differences in attachment level prior to and 3 years after treatment could be assessed.
Results showed a mean distance of 4.33 mm between the location of the gingival margin 3 years post‐treatment and the bone level during surgery. This finding is discussed in relation to the question of how much alveolar bone should be removed if, in case of extensive carious lesion or crown fracture, the cervical outline of the restoration is located near the bone level.
A classification system for loss of papillary height is proposed. It uses readily identifiable anatomical landmarks for reference, and sorts the degree of loss into 3 classes. The 3 broad categories allow for a quick descriptive assessment. In addition to the basic classification, it is suggested that additional and incremental description may be included to further define the defects.
The creation of an esthetic implant restoration with gingival architecture that harmonizes with the adjacent dentition is a formidable challenge. The predictability of the peri-implant esthetic outcome may ultimately be determined by the patient's own presenting anatomy rather than the clinician's ability to manage state-of-the-art procedures. To more accurately predict the peri-implant esthetic outcome before removing a failing tooth, 5 diagnostic keys are discussed. These keys include relative tooth position, form of the periodontium, biotype of the periodontium, tooth shape, and position of the osseous crest.
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.
The purpose of the present longitudinal study was to evaluate the association between root proximity and the risk for alveolar bone loss (ABL).
We used data from the Veterans Affairs Dental Longitudinal Study, a closed-panel longitudinal cohort study of 1,231 men enrolled in 1968 with triennial follow-up examinations. Periapical radiographs of mandibular incisors from subjects with > or =10 years of follow-up were selected. Interradicular distance (IRD) at the cemento-enamel junction and alveolar bone levels at baseline and last follow-up were measured using digitized radiographs. The rate of progressive ABL was determined and expressed as millimeters per 10 years. Site-specific multivariate regression models were fit to evaluate the association between IRD and ABL rate, adjusting for age and smoking. Empirical standard errors and generalized estimating equations were used to account for the correlation among sites within subjects.
There were 473 dentate subjects, aged 28 to 71 years at baseline, with > or =10 years of follow-up data available for analyses. The mean follow-up time was 23 years. The mean IRD was 1.0 +/- 0.3 mm, and the mean ABL rate during 10 years was 0.61 +/- 0.59 mm. There was a significant non-linear association between IRD and ABL rate (P <0.005). Compared to sites with IRD > or =0.8 mm, sites with IRD <0.6 mm were 28% (95% confidence interval [CI]: 11% to 48%) more likely to lose > or =0.5 mm of bone during 10 years (relative risk: 1.28 [95% CI: 1.11 to 1.48]) and 56% (95% CI: 11% to 117%) more likely to lose > or =1.0 mm of bone during 10 years (relative risk: 1.56 [95% CI: 1.11 to 2.17]).
IRD <0.8 mm is a significant local risk factor for alveolar bone loss in mandibular anterior teeth. Measurement of IRD may have important prognostic value in making treatment decisions.
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