Vertical distance from the crest of bone to the height of the interproximal papilla between adjacent implants

Background: As patient demand increases for more natural restorations in the esthetic zone, clinicians must have the highest level of skill and knowledge to maintain or reform the interdental papilla between teeth, between implants and teeth, and between adjacent implants. To date, there are no reports that have measured the distance from the contact point to the bony crest between implants. One reason for this may be the fact that, with two adjacent implants, the contact point of the crown can be established at any distance from the gingival margin according to the restorative dentist's specifications. Therefore, in this study, the height of the soft tissue to the crest of bone was measured between two adjacent implants independent of the location of the contact point. The purpose of this study was to determine the range and average height of tissue between two adjacent implants. Methods: A total of 136 interimplant papillary heights were examined in 33 patients by eight different examiners in five private dental offices. After administration of appropriate local anesthesia, a standardized periodontal probe was placed vertically from the height of the papilla to the crest of bone. The measurements were rounded off to the nearest millimeter. Results: The mean height of papillary tissue between two adjacent implants was 3.4 mm, with a range of 1 mm to 7 mm. Conclusions: Clinicians should proceed with great caution when placing two implants adjacent to each other in the esthetic zone. In most cases, only 2, 3, or 4 mm of soft tissue height (average 3.4 mm) can be expected to form over the interimplant crest of bone. These results showed that modification of treatment plans may be necessary when esthetics are critical for success.