Papilla stability around Single‐Tooth implant in the esthetic area – A 4‐year retrospective study

Background Soft tissue stability over time in the esthetic area is mandatory to avoid mucosal recession and loss of papilla surrounding dental implants. Several approaches have been described to maximize soft and hard tissue integration. These include the timings for implant placement, guided bone regeneration, and different loading protocols. Therefore, Identifying clinical parameters that may prevent dental implant mucosa recession and dental implant papilla levels loss is key for dental implant success. Aim/Hypothesis The aim of the present study was (1) to evaluate the relationship between dental implant mucosa and dental implant papilla levels, and (2) to identify the clinical parameters associated with dental implant papilla levels stability over time. Material and Methods This is a retrospective study on a cohort of patients seeking a single-tooth implant therapy in a private practice. Two independent examiners analyzed photographs and radiographs taken the day of definitive crown load (baseline) and the last follow-up visit (at least 12 months later) in order to measure peri-implant soft and hard tissue parameters – Mesial and distal Papilla height, Single Implant-crown height, keratinized tissue height, Implant platform bone peak and Mesial bone level-contact point. Repeated measure ANOVA was used to compare soft and hard tissue changes over time. Survival analyses were carried out using the Kaplan-Meier method and groups were compared by log-rank tests. Results Seventy-four patients corresponding to 90 implants were analyzed. No difference was observed between papillae that gained in height (n = 85) and papillae that lost in height (n = 73) except for the timing of the surgical protocol and an incomplete papilla fill (distance from the top of the papilla to the contact point) at baseline (P = 0.006). The probability of developing a mid-buccal peri-implant recession ≥ 1 mm was significantly higher when a papilla loss ≥ 1 mm occurred (P = 0.048). The Cox regression analysis showed that the distance between the interproximal bone peak and the implant platform was significantly and positively associated with the probability of observing a papilla gain (HR = 1.48 + 95% CI 1.06–2.05). Conclusion and Clinical Implications The present findings indicate a dependent association between dental implant mucosa and dental implant papilla levels. The risk of papilla loss is significantly higher with a delayed protocol than with an immediate or immediate-delayed protocol for implant placement. An increased papilla height is more likely to be observed when an increase in the distance between the interproximal bone peak and the dental implant platform is observed between baseline and follow-up.