Correlation of papilla to crestal bone levels around single tooth implants in immediate or delayed crown protocols

Purpose: The purposes of this study are to determine if there is a difference in the papilla fill between implant and teeth comparing immediate provisionalized and delayed single tooth implant restorations, and to determine the relationships between the vertical and horizontal bone levels to papilla filling the inter-dental region with single implant restorations. Patients and Methods: Two groups of patients treated with single tooth implant restorations were prospectively followed. One group had immediate provisionalization of their implants, and the second group a delayed approach. Serial radiographs and photographs were used to collect bone level measurements for the vertical distance between contact point to bone level on the adjacent tooth, implant, and the midcrestal region. The horizontal distances were also recorded. Papilla morphology was scored 1 through 4. Univariate analysis was used to evaluate the relationships between bone levels and papilla morphology. Results: There were no differences between papilla or bone levels comparing immediate provisionalization to delayed approaches. There were significant (P < .05) relationships between the vertical distance from contact point to bone levels, with the distance from the contain point to the adjacent tooth the distance most critical to papilla maintenance. There were no significant relationships between horizontal distance and papilla maintenance. Conclusion: As the distance from the contact point to the implant increased, there was a significant chance of loss of papilla. There was no difference between delayed or immediate provisionalization and papilla scores. The horizontal distance from adjacent tooth bone level did not correlate to papilla score within the range of clinically relevant distances. (c) 2005 American Association of Oral and Maxillofacial Surgeons