title: Effect of the vertical and horizontal distances between adjacent implants and between a tooth and an implant on the incidence of interproximal papilla.
abstract: BACKGROUND
  The interproximal dental papilla is considered an essential component of the anterior and posterior regions of the maxilla and mandible. The absence of this structure has esthetic and phonetical consequences and lateral food impaction problems occur with the implant-supported prosthesis. The aims of the present study were to: 1) evaluate the effect of the vertical and horizontal distances between adjacent implants (group 1) and between a tooth and an implant (group 2) on the presence of the interproximal dental papilla; and 2) determine whether the interaction between the vertical and horizontal distances might be associated with the incidence of the papilla.
  
  
  METHODS
  In 48 patients, 96 interproximal sites in group 1 and 80 in group 2 were examined. The distance from the base of the contact point to the bone crest (D1), the distance between tooth and implant or between two implants (D2), and the distance from the base of the contact point to the tip of the papilla (D3) were measured.
  
  
  RESULTS
  In both groups, when D2 was 3, 3.5, or 4 mm, the papilla was present most of the time (P < 0.05), and when D2 was 2 or 2.5 mm, the papilla was absent 100% of the time (P < 0.05). Further, in group 2, when D1 was between 3 and 5 mm, the papilla was present most of the time (P < 0.05). However, in Group 1, only when D1 was 3.0 mm was the papilla present most of the time (P < 0.05). For both groups, analysis of the interaction between D1 and D2 showed that when D2 was < or = 2.5 mm, the papilla was absent; otherwise, when D2 was > or = 3 mm, there was an interaction between D1 and D2.
  
  
  CONCLUSIONS
  We conclude that the ideal distance from the base of the contact point to the bone crest between adjacent implants is 3 mm and, between a tooth and an implant, 3 mm to 5 mm. The ideal lateral spacing between implants and between tooth and implant is 3 mm to 4 mm. Further, there is an interaction between horizontal and vertical distances when the lateral spacing is greater than 3 mm.
authors.affiliation: Department of Periodontics and Implantology, School of Dentistry, University of Santo Amaro, Santo Amaro, Brazil.
authors.forename: Jose Fabio
authors.initials: JF
authors.lastname: Gastaldo
authors.forename: Patricia Ramos
authors.initials: PR
authors.lastname: Cury
authors.forename: Wilson Roberto
authors.initials: WR
authors.lastname: Sendyk
mesh_terms: D000328:Adult; D000368:Aged; D000539:Alveolar Process / Q000473:pathology; D002508:Cephalometry; D003442:Crowns; D003758:Dental Implantation, Endosseous / Q000379:methods*; D015921:Dental Implants; D017267:Dental Prosthesis Design; D019094:Dental Prosthesis, Implant-Supported; D005260:Female; D005881:Gingiva / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010512:Periodontal Index; D013499:Surface Properties; D014070:Tooth / Q000473:pathology*
chemical_list: D015921:Dental Implants