Papilla Recession Research Articles

Influence of miniscrew-assisted rapid palatal expansion (MARPE) on the interdental papilla height of maxillary central incisors

ObjectivesTo evaluate the influence of miniscrew-assisted rapid palatal expansion (MARPE) on the interdental papilla height of maxillary central incisors.Materials and methodsPatients who completed MARPE treatment at the Radboud University Medical Center between 2018 and 2021 were included in this retrospective study. The papilla height between the maxillary central incisors was evaluated on frontal intraoral photographs taken before expansion (T0) and 1.5 years after MARPE treatment (T1) using the Jemt classification. The difference in Jemt score at T0 and T1 was the primary outcome variable. In addition, gender, age, Angle classification, MARPE duration, midpalatal suture maturation stage, maximal central diastema (MCD) immediately after expansion, crown width to length ratio (W/L), pretreatment overlap of maxillary central incisors, and the distance between the approximal contact point of the central incisors and the bone crest (CP-B) were also record.ResultsTwenty-two patients were included (2 men, 20 women, mean age 27.3 ± 8.8 years) and 4 patients (18%) showed a significant reduction in the Jemt score following MARPE (p = 0.04), indicating papilla recession. Interdental papilla recession was significantly associated with the increase of CP-B (p = 0.02), smaller W/L (p < 0.01), overlapping of maxillary central incisors (p < 0.01), and smaller MCD immediately after expansion (p = 0.02).ConclusionsOne and a half years after MARPE, 18% of patients exhibited mild recession of papilla height of the maxillary central incisors. Overlapping and smaller W/L of maxillary central incisors were prognostic factors for interdental papilla recession.Clinical relevanceClinicians have to be aware of and inform the patients about the occurrence of papilla recession following MARPE.

Clinical investigation of gingival papilla recession after orthodontic treatment in adults.

To investigate the incidence, severity, susceptibility sites of gingival papillary recession (GPR) in adults after orthodontic treatment and the clinical impact of tooth extraction on GPR. A total of 82 adult patients were recruited and then divided into extraction and non-extraction groups according to whether the orthodontic teeth were extracted (teeth that needed to be extracted when performing orthodontic treatment). The gingival conditions of the two groups of patients before and after treatment were recorded using intraoral photos, and the incidence, severity and predilection sites of GPR after correction were investigated. The results indicated that GPR occurred in 29 patients after correction, with an incidence rate of 35.4%. A total of 1648 gingival papillae were recorded among the 82 patients after correction, of which 67 exhibited atrophy, with an incidence of 4.1%. All occurrences of GPR were classified as papilla presence index 2 (PPI 2) (mild). The condition is most likely to occur in the anterior tooth area, especially in the lower incisor area. The results indicated that the incidence of GPR was substantially higher in the extraction group than in the non-extraction group, with the difference statistically significant. Following orthodontic treatment, adult patients will have a certain proportion of mild GPR, which is more common in the anterior tooth area, especially the lower anterior tooth area.

Relation of CAD/CAM zirconia dental implant abutments with periodontal health and final aesthetic aspects; A systematic review.

Using dental implants to replacing missing teeth and satisfy both functional and aesthetic needs is one of the mainstream dental treatments. New approaches including computer-aided design and computer-assisted manufacture (CAD/CAM) have been introduced to improve these elements. This systematic review aimed to compare CAD/CAM zirconia (Zr) implant abutments with other available abutments in terms of peri-implant health and aesthetics. Five electronic databases (PubMed, Web of Science, Scopus, ProQuest, and Embase) were scoured for clinical studies evaluating Zr abutments reporting on the outcomes of interest including interproximal papilla stability (PS), papilla recession (REC), pink and white esthetic score (PES, WES), marginal bone level (MBL), color, and soft tissue contour. A hand searches in English language journals until September 2020 complemented the search. Two tools of Joanna Briggs Institute and Jaded Score calculation were used for the risk of bias assessment. No quantitative synthesis of the data was done due to high heterogeneity. A total of six studies from the 412 ones obtained from the search were included. The study designs were either prospective cohort (n=3) or randomized clinical trial (n=3). Papilla fill, WES, PES, and the distance from the bone crest of adjacent teeth to the contact point (CPB) and inter-tooth-implant distance (ITD) was not significantly different between Zr CAD/CAM and Zr stock abutments. However, soft tissue stability and REC index were better in Zr CAD/CAM abutments. Higher soft tissue stability can be achieved for Zr compared to titanium abutments with either stock or CAD/CAM abutments. Key words:Dental implants, Dental abutment, Computer-Assisted Design, Computer-Aided Manufacturing, Zirconia abutment, Soft tissue stability.

Efficacy of concentrated growth factor with low-level laser for the regeneration of interdental papilla defects.

Gingival "black triangle" is common in clinical which due to interdental papilla recession. The cause of the loss of papilla is multi-factorial and it may be caused by the absorption of interdental alveolar bone or abnormal tooth position. Besides, it is a common complication after orthodontics and implant surgery. Recession of gingival papilla influences interdental plaque control, increasing food impaction and alveolar bone absorption, causing aesthetic and pronunciation problems. Thus, the way of reducing or eliminating the gingival "black triangle" has become one of the most essential problems for dentists. Concentrated growth factor (CGF) and low-level-laser therapy have been widely used, respectively, and CGF was considered as the only self-substance which has soft tissue regeneration function. This study aims to evaluate the efficacy of regenerating interdental papilla by Liquid phase concentrated growth factor (LPCGF) injection with low-level-laser therapy (LLLT).

The influence of gingival phenotype on the morphology of the maxillary central papilla

BackgroundPreservation of the interdental papilla is an essential part of the functional and esthetic rehabilitation of dental treatment. It has been described that thicker gingival tissues are more resistant to recession. The main objective of this investigation was to analyze whether a thin gingival phenotype represents a potential risk indicator affecting interdental papilla fill, height, or width in an esthetic region between maxillary central incisors. The secondary goals were: (1) to analyze parameters describing the papilla—fill, height, width, and effect of papilla base width on the vertical papillary dimension; (2) to determine correlation between different non-invasive measurements of gingival thickness; (3) to compare both sexes.MethodsA total of 54 periodontally healthy students (20–30 years old) were included in the study. Gingival thickness was measured using Pirop Ultrasonic Biometer. Gingival phenotype was also assessed by gingival probe transparency. Papilla height and width were measured, and the degree of papilla recession was classified.ResultsNo significant relationship between papilla fill, height, width and gingival probe transparency or gingival thickness was found. Gingival thickness and gingival probe transparency showed a significant relationship (P < 0.001). There was a significant relationship between papilla height and papilla fill (P = 0.028). A papilla which filled the interdental space completely seemed to be shorter. A strong positive correlation between papilla height and papilla width was found (P < 0.0001). The papilla between maxillary central incisors was significantly higher in males (P = 0.01).ConclusionThe appearance of the interdental papilla may be influenced by various factors. Within the limitations of this study, the results showed that the thin gingival phenotype alone is no potential risk indicator affecting interdental papilla fill, height, or width. It seems that there may be some effect of papilla base width on its vertical dimension. Gingival probe transparency is a simple reliable method of assessment of gingival thickness with a threshold value of 1-mm gingival thickness between the thick and thin phenotypes.

The Interrelation among Configuration of Embrasure and Recession of Median Papilla

Background: The aim of this study was to find interrelation among embrasure configuration and recession of median papilla was. To assess impact of extent from the point of contact to bone crest (BC) on the existence of the interproximal papilla by radiographic method and to evaluate the extent between the papilla tip (PT) to the BC by comparing clinical and radiographic methods were the objectives. Methods: With the use of periapical radiographs (paralleling cone technique in RVG with grid) of the maxillary central incisors, the central papilla was evaluated in 100 adults. To evaluate and compare the extent between PT and BC, bone sounding was used. The vertical measurements were: papilla recession, contact point (CP) to BC, CP to proximal cement-enamel junction (pCEJ), and papilla height. The interdental width was the horizontal measurement. According to width interproximally and pCEJ to point of contact extent, total four study groups were divided: long narrow, short narrow, long wide, and short wide. Results: The comparison among radiographic method and clinical method revealed that there was statistically no significant difference between two methods among long-narrow and short-wide group. However, statistically significant difference was noted among short-narrow and long-wide group. Conclusion: Median papilla recession was associated with a wide-long type of embrasure configuration. Although many features such as periodontal phenotype and shape of teeth may influence the probability of the existence of the inter-proximal papilla, therefore the interconnections between these factors are not clear and require further research.

Effect of full sulcular versus papilla-sparing flap on periodontal parameters in periradicular surgeries: A systematic review and meta-analysis.

Background:Access to apical root canal system is gained after flap elevation using various incision techniques. Soft-tissue healing after periradicular surgery may include gingival recession, papilla recession, changes in probing depth, and clinical attachment loss.Objective:The objective of this study was to compare the effect of full sulcular flap design versus papilla-sparing flap design on the periodontal parameters in periradicular surgeries.Materials and Methods:It was a systematic review and meta-analysis. Electronic and manual searches were conducted in multiple databases including PubMed, Dental and Oral Sciences, Cochrane, and CINAHL Plus until May 2019. Initial search yielded 2575 studies with 5 articles meeting the inclusion criteria. The primary outcomes assessed were gingival recession and change in the papilla height. The secondary outcomes evaluated were probing depth, clinical attachment loss, postoperative pain, bleeding, and discomfort. Random-effects model was employed for computation of effect size, and forest plots were made.Results:Out of the five articles that satisfied the inclusion criteria, three were randomized control trials and two were nonrandom trials. No significant differences were found in the gingival recession (P = 0.79), papilla height (P = 0.55), gingival bleeding, and plaque indices. Statistically significant differences in probing depth (P = 0.006) and clinical attachment loss (P = 0.0004) were observed for the two flap designs in probing depth (P = 0.006) and clinical attachment loss (P = 0.0004).Conclusions:The present systematic review and meta-analysis showed that probing depth and attachment loss are affected by the choice of flap design. On the other hand, gingival recession and papilla height are not influenced by the type of incision. However, finding of the present review may change if more studies on this topic will be included in the future. Therefore, more clinical trials with long-term follow-ups are needed.

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.

Radiographical vertical and horizontal distances influencing the presence of interproximal papilla between maxillary central incisors

Conventional tooth the presence of interdental papillae in the maxillary anteriorregion plays a key esthetic role. The presence or absence of the interproximal papillais of great concern to periodontists, orthodontists, restorative dentists and to patientsThe aim of the study was to determine the association between different distancesand central papilla recessionThe central papilla was visually assessed in 50 adults students of age rangedbetween (19-25 years) in dental clinic, then by using standardized periapicalradiographs for the maxillary central incisors, the following vertical distances weremeasured: papilla tip to contact point (PT-CP), bone crest to contact point (BC-CP),proximal cementoenamel junction to contact point (pCEJ-CP), bone crest to papillatip BC-PT(the papilla height (PH)).Interdental width (IDW) was measuredhorizontally. Subjects were divided into 2 groups according to interdental width(IDW) and pCEJ-CP distance respectively: 1. (28) subjects with IDW≤2mm andpCEJ–CP &gt;4 mm as narrow-long group 2. (22) Subjects with IDW≤2mm and pCEJ–CP ≤ 4 mm as narrow-short group.Narrow-long group exhibited more papilla recession, (PT-CP) mean was 2.5mmand the difference was statistically significant. Positive correlations were foundbetween (BC-CP), (pCEJ-CP), (IDW) and central papilla recession and more strongercorrelations were found with (BC-CP) (r = 0.856). Papilla height was negativelycorrelated with (BC-CP), (pCEJ-CP), (IDW) and stronger correlation was foundbetween papilla height and (BC-CP) (r = -0.502)Central papilla recession is associated with narrow interdental width and longpCEJ-CP distance, papilla presence influenced by different distances, some of themare (BC-CP), (pCEJ-CP), (IDW) distances, (BC-CP) had stronger effect on thepresence of central papilla.

Augmentation of Interdental Papilla with Platelet-rich Fibrin.

Background:Dental esthetics has become a great concern for both dental practitioners and patients in addition to maintaining oral health. The presence of interproximal papillae between the maxillary anterior teeth is a key esthetic component. Recession of interdental papilla leads to various functional problems such as food impaction, phonetics and esthetic problems such as the formation of black triangle which poses a great challenge.Aim:This study aims to evaluate the augmentation of interdental papilla with platelet-rich fibrin.Materials and Methods:A total of 25 sites from systemically healthy individuals with papillary recession (Nordland and Tarnow class 1 and 2) were recruited in the study. Han and Takei procedure was planned and augmentation was done with platelet-rich fibrin. Various parameters such as distance from the tip of the contact point to the gingival margin, width of the keratinized gingiva, and Jemt score were measured at baseline, 3 and 6 months postoperatively. Healing index was measured at the 1st, 2nd, and 3rd week postoperatively.Results:Data collected were statistically analyzed. Mean value of distance from the contact point to the gingival margin was 4.38 mm at baseline and at 6-month postoperatively, it reduced to 0.36 mm. There was an increase in width of the keratinized gingiva which was clinically and statistically significant. Other parameters such as healing index, Jemt score, and visual analog scale (aesthetics) were also statistically significant postoperatively.

Association between central papilla recession and gingival and interdental smile line.

Interdental soft tissues play a critical role in pink esthetics. The presence and preservation of the interdental papillae in the esthetic zone is as crucial as the shape and contour of the anterior teeth in achieving an esthetically pleasing smile. The present study determines the association of central papilla recession with gingival and interdental smile line in periodontally healthy patients of different age groups. The present study included 200 patients equally divided into 21 to 40 years and 41 to 60 years age groups. The clinical and photographic evaluation of the central papilla, with midfacial gingiva, and its relationship with the vermilion border was performed. In total, 137 patients exhibited presence of central papilla, whilst 63 patients had central papilla recession with variable extent. The male patients predominantly had presence of central papilla in both the age groups, with 86% and 64%, compared with 74% and 50% in females, respectively. High gingival smile line was seen in the majority of the patients (62%), and this trend was similar to high interdental smile line (82% of the patients). Esthetics is affected in individuals having papilla recession along with high gingival smile line and interdental smile line as compared to individuals with low or cupid bow gingival smile line and interdental smile line.

Papillary Height and its Relation with Interproximal Distances and Cementoenamel Junction in Subjects with Chronic Periodontitis. A Cross-Sectional Study.

Presence of intact interdental papilla is considered as an essential component of aesthetic dentistry. Loss or absence of interdental papilla creates black triangles which are unpleasing. The purpose of the present study was to determine relation of interproximal distances and cementoenamel junction with the classification of interdental papilla recession after surgical exposure in chronic periodontitis patients. This cross-sectional, single masked study group involved 198 interdental papillae in 50 chronic periodontitis patients subjected to open flap debridement. The subjects were divided into three groups according to loss of height of interdental papillae: Class I papilla, Class II papilla, Class III papilla. The interproximal distances included vertical and horizontal distance. The vertical distance was measured from apical point of the contact area to alveolar crest; horizontal distance was measured between roots at the alveolar crest. Distance from mid buccal cementoenamel junction to apical point of the contact area was also measured. The vertical distance was found to be significantly affecting all the classes of loss of papillary height (p<0.05). Significantly positive correlation was found between vertical distance and buccal cementoenamel junction (p<0.05). On applying multiple linear regressions vertical distance was found to be strongest determinant of loss of papillary height. Although interproximal distances and cementoenamel junction affect the height of interdental papilla, other factors influencing the existence of interdental papilla should also be taken into consideration for treatment planning to achieve better aesthetics.

Evaluation of the association between embrasure morphology and central papilla recession by radiographic method.

The objective of this study was to evaluate the association between embrasure morphology and central papilla recession. The central papilla was assessed in 372 adults using standardized periapical radiographs of the maxillary central incisors. The following vertical distances were measured: h1, papilla tip to contact point (PT-CP); h2, proximal cementoenamel junction to contact point (pCEJ-CP); h3, bone crest to contact point (BC-CP); and h4, bone crest to papilla tip (BC-PT). Vertical lines were measured along the long axis of the tooth. Horizontal distance was measured as w2 (distance between the two central incisors at the proximal CEJ level, ie, the interdental width). All participants were divided into four groups according to their w2 and h2 measurements: narrow-long (w2 ≤ 2 mm and h2 > 4 mm), narrow-short (w2 ≤ 2 mm and h2 ≤ 4 mm), wide-long (w2 > 2 mm and h2 > 4 mm), and wide-short (w2 > 2 mm and h2 ≤ 4 mm). A statistically significant positive relationship was evident between central papilla recession and age, and a statistically significant negative relationship was evident between age and papilla height in all study groups. The study found that occurrence of central papilla recession is significantly related to age with a wide interdental width and long pCEJCP distance. However, other factors also determine whether the interdental papilla is present or not, and further study of the interaction among these factors is warranted.

Embrasure morphology and central papilla recession.

Background:The aim of this study was to ascertain the effects of vertical and horizontal distances between the maxillary central incisors on the presence of interproximal dental papilla and to assess the association between the embrasure morphology and central papilla recession.Materials and Methods:The central papilla was visually assessed in 50 subjects using the standardized periapical radiographs of maxillary central incisors. The following vertical distances were measured; distance from the contact point to papilla tip, CP to proximal cementoenamel (pCEJ) junction, bone crest to CP (BC-CP) and BC-PT. The horizontal distance measured was interdental width (IDW) at pCEJ level. The measurements were recorded using a digital electronic caliper.Results:Significant association between the embrasure morphology and central papilla recession was observed for all study groups. All the interdental variables were significantly related to the presence of interdental papillae, with BC-CP distance being the strongest determinant of central papilla presence. The percentage of interdental papilla presence was 100% when the BC-CP distance was ≤6 mm and IDW ranged between 0.5 and 1.5 mm. Central papilla recession was observed most frequently with wide-long and narrow-long embrasure morphology.Conclusion:In relation to maxillary central incisors, all the interdental variables have significant influences on the presence of interdental papillae, with distance from BC to CP being the strongest determinant of central papilla presence.

Comparison between different papillary recession classification systems

Background/purposeTraditional classification systems to assess interdental papillary levels are based only on the vertical relationship among the papilla tip, contact point, and cementoenamel junction. However, the width of papilla recession (PR) is highly visible in terms of dental esthetics. A new classification system is presented to assess central PR and compare differences between the new system and existing systems. Materials and methodsThecentral papillawas visually assessed in 450 adults using standardized periapical radiographs of the maxillary central incisors. The PR classification system presented here is based on vertical and horizontal dimensions of the PR area. Central PR was classified according to the PR system and the system of Nordland and Tarnow (TC). ResultsNinety individuals who had no PRs were classified as degree 0 according to the classification of both TC and Chang. A total of 330 individuals (73.3%) were classified as TC I (Tarnow), and 46, 89, 16, and 183 participants were classified as PR I, PR II, PR III, and PR IV (Chang). Thirty individuals were classified as TC II, and all were classified as PR IV. ConclusionThis study confirmed a significant correlation between the two existing classification methods. The proposed PR classification system characterizes open embrasures in greater detail than previous systems.

Factors Associated With the Interdental Papilla Height Between Two Maxillary Central Incisors: A Radiographic Study

Various factors affect the central maxillary incisor papilla height (PH) and central clinically observable PH (COPH) such that a study of these factors and their interactions is needed. This study reports on an investigation of the factors associated with PH and COPH in patients with and without papilla recession. The central papilla was visually assessed in 450 adults using standardized periapical radiographs of maxillary central incisors. Various vertical and horizontal distances were measured including the lengths from the proximal cemento-enamel junction (pCEJ) to apical contact point (CP), bone crest (BC) to CP (BC-CP), BC to pCEJ (BC-pCEJ), and papilla tip (PT) to CP (PT-CP) and the interdental width at the pCEJ level (IW), width at the BC level (crest width [CW]), and width at the PT level (PTW). PH was defined as the length from the PT to BC, and COPH was defined as the length from the PT to pCEJ. Simple analyses for PH and COPH were performed, and significant variables were entered into multiple linear regression models. Among all study patients, papilla recession status and PT-CP were significant independent predictors of PH (both P <0.001). Age, papilla recession status, PT-CP, and BC-pCEJ were significant independent predictors of COPH (all P <0.001). Among patients with papilla recession, CW and PT-CP independently predicted PH (both P <0.001). All variables tested (except sex and CW) were significantly associated with COPH in patients with papilla recession, especially IW, PTW, PT-CP, and BC-pCEJ (P <0.001 for these variables). The effects of age and BC-pCEJ on COPH change differed in patients without and with recession, suggesting that the initial change in COPH was large but later slowed after recession occurred while there was no severe interdental bone loss progression. However, additional clinical study is needed to find out other variables that may decrease or ameliorate the severity of central papilla recession by restorative/prosthetic or orthodontic intervention and to confirm this possibility.

Variables Affecting the Gingival Embrasure Space in Aesthetically Important Regions: Differences between Central and Lateral Papillae

This study evaluated different variables to determine their role in the appearance of the central and lateral upper jaw papillae. 292 interdental embrasures were examined. Personal variables were: age, smoke, and use of interproximal hygiene devices. The clinical characteristics were: tooth shape, periodontal biotype and papilla appearance. Radiographic measurements were: root to root distance at the cemento-enamel junction (horizontal distance), and bone crest to interdental contact point distance (vertical distance). The papilla recession increased with patient age. The horizontal distance of the central papilla was always greater (up to 1 mm) than that of the other papillae. The vertical distance of the central papilla was greater (up to 2 mm) than that of the other papillae for each class except for the normal one (Nordland & Tarnow classification). For vertical distances ≤5 mm, papillae were almost always present; for distances up to 6 mm, the lateral papillae belonging to the normal class disappeared, while the central papilla remained in 11% of cases; central papillae of class 1 were present in larger proportions until a vertical distance of 8 mm. The present observational study shows that differences on clinical and radiographic determinants do exist between central and lateral papillae. This variance should be strictly taken in account for a harmonious and stable treatment outcome on this highly aesthetic area.

Gingival veneer: Mask the unesthetic

Periodontal diseases result in damage and destruction of the supporting structures of the teeth, including the bone and periodontal ligament. In some cases, there is loss of gingival coverage of the teeth in esthetic regions, with gingival recession and loss of interdental papilla. The surgical treatment in such situations is costly, requires prolonged healing time, and the results are often unpredictable; this makes it an unpopular choice. The reconstruction of these areas with prosthesis like gingival veneer can be useful to correct the deformities remaining after the control of periodontal diseases, especially in the maxillary anterior region. Dental practitioners can provide comfortable and accurately fitting gingival veneers, that are very stable and esthetically restore the interdental papilla and gingival recession defects. This method is an innovative treatment option for dealing with esthetic challenges and long-term dental health.

Assessment of Parameters Affecting the Presence of the Central Papilla Using a Non‐Invasive Radiographic Method

This study was performed to assess the relationship between radiopaque landmarks and central papilla presence and height. The probability of the presence of a central papilla has been related to the bone crest-contact point distance. Papilla height has been measured by inserting a dental probe under local anesthesia, but this method is invasive. It would be desirable to assess the influence of other dental landmarks on the presence and height of the papilla and to use a non-invasive method for measurement of papilla height that is simple, accurate, and accepted readily by patients. Periapical radiographs were obtained in 310 adults with fully erupted permanent dentition, healthy gingiva (plaque and gingival indexes of 0 to 1), and well-aligned maxillary central incisors. Semisoft radiopaque material was placed to fill the space coronal to the papilla tip, which enabled it to be visualized without probing. Vertical and horizontal distances were measured with an electric ruler. The presence of a full central papilla was related significantly to age, papillary height, and distances from the bone crest to the contact point, the buccal cemento-enamel junction, and the proximal cemento-enamel junction. When confounding factors were controlled using multifactorial logistic regression, the distance from the bone crest to the proximal cemento-enamel junction was the strongest determinant of papilla presence. Standard periapical radiography is a non-invasive method that can be used to study determinants of the presence of a central papilla. The factors linked to papilla recession were age, bone crest-contact point distance, bone crest-proximal cemento-enamel junction distance, and papilla height. Bone crest-proximal cemento-enamel junction distance, the strongest predictor of the probability of papilla recession, might be used to predict this probability after prosthetic or orthodontic interventions.

The association between embrasure morphology and central papilla recession

To discover the association between embrasure morphology and central papilla recession. The central papilla was visually assessed in 330 adults using standardized periapical radiographs of the maxillary central incisors. The following vertical distances were measured: papilla recession [i.e., the distance from the papilla tip (PT) to the contact point (CP)], bone crest (BC) to contact point (BC-CP), proximal cementoenamel junction (pCEJ) to contact point (pCEJ-CP), and papilla height (PH). The horizontal distance measured was the inter-dental width. Subjects were divided into four groups according to inter-dental width and pCEJ-CP distance, respectively: narrow-long, narrow-short, wide-long, and wide-short. A statistically positive relationship was evident between central papilla recession and age, and a statistically negative relationship was evident between age and PH in all study groups. Central papilla recession as a result of ageing is most frequently associated with a wide inter-dental width and long pCEJ-CP distance. However, other factors affect the likelihood of the presence of the inter-dental papilla, and further study of the interaction among these factors is warranted.