title: Interproximal tissue dimensions in relation to adjacent implants in the anterior maxilla: clinical observations and patient aesthetic evaluation.
abstract: OBJECTIVE
  This clinical study aimed to assess (i) interproximal tissue dimensions between adjacent implants in the anterior maxilla, (ii) factors that may influence interimplant papilla dimensions, and (iii) patient aesthetic satisfaction.
  
  
  METHODS
  Fifteen adults, who had two or more adjacent implants (total of 35) in the anterior maxilla, participated in the study. The study design involved data collection from treatment records, clinical and radiographic assessment, and a questionnaire evaluating aesthetic satisfaction.
  
  
  RESULTS
  The median vertical dimension of interimplant papillae, i.e., distance from tip of the papilla to the bone crest, was 4.2 mm. Missing papilla height (PH) at interimplant sites was on average 1.8 mm. Median proximal biologic width at interimplant sites was 7 mm. The most coronal bone-to-implant contact at implant-implant sites was located on average 4.6 mm apical to the bone crest at comparable neighbouring implant-tooth sites. The tip of the papilla between adjacent implants was placed on average 2 mm more apically compared with implant-tooth sites. The contact point between adjacent implant restorations extended more apically by 1 mm on average compared with implant-tooth sites. Median missing PH was 1 mm when an immediate provisionalization protocol had been followed, whereas in the case of a removable temporary it was 2 mm. Split group analysis showed that for missing PH<or=1 mm, the median horizontal distance between implants at shoulder level was 3 mm. Patient satisfaction with the appearance of interimplant papillae was on average 87.5%, despite a Papilla Index of 2 in most cases.
  
  
  CONCLUSIONS
  The apico-coronal proximal biologic width position and dimension appear to determine papilla tip location between adjacent implants. There was a significant association between the provisionalization protocol and missing PH, which was also influenced by the horizontal distance between implants. Patient aesthetic satisfaction was high, despite a less than optimal papilla fill.
authors.affiliation: Eastman Dental Hospital & Institute, University College London Hospitals NHS Foundation Trust, London WC1X 8LD, UK. stella.k@hotmail.co.uk
authors.forename: Styliani
authors.initials: S
authors.lastname: Kourkouta
authors.forename: Konstantina Dina
authors.initials: KD
authors.lastname: Dedi
authors.forename: David W
authors.initials: DW
authors.lastname: Paquette
authors.forename: André
authors.initials: A
authors.lastname: Mol
mesh_terms: D000328:Adult; D000368:Aged; D003442:Crowns; D000044:Dental Abutments; D015921:Dental Implants; D004955:Esthetics, Dental; D005260:Female; D005881:Gingiva / Q000033:anatomy & histology*; D006801:Humans; D008297:Male; D008437:Maxilla / Q000601:surgery*; D008875:Middle Aged; D017060:Patient Satisfaction; D015203:Reproducibility of Results; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D014716:Vertical Dimension
chemical_list: D015921:Dental Implants