226
Fundamentals of Esthetic Implant Dentistry
interdental papillae according to their marginal level. They subdivided the interdental papillae into three classes (see Figures 8.4A–D):
•
Class I: Tip of the interdental papilla lies between the interdental contact point and the most coronal extent
• •
of the interproximal cementoenamel junction (CEJ) (space is present, but interproximal CEJ is not visible). Class II: Tip of the interdental papilla lies at or apical to the interproximal CEJ (interproximal CEJ is visible). Class III: Tip of the interdental papilla lies level with or apical to the facial CEJ.
Tarnow and others (1992) developed a useful classification for clinically identifying the predictability of the presence of interdental papillae. They concluded that when the measurement from the contact point of the natural tooth to the crest of the bone was 5 mm or less, the papilla was present almost 100% of the time; when the A
B
Figure 8.1. A. The papilla bone support at the time of tooth extraction. B. The bone support of the papilla is totally lost due to bone resorption 6 weeks’ postextraction.
A
B
Figure 8.2. A. The Sharpey’s fibers are responsible for maintaining the shape of the interdental papilla between natural teeth. B. Absences of interimplant papilla between dental implants due to the absence of Sharpey’s fibers.
Figure 8.3A, B. An illustration showing the difference between implants and natural teeth in terms of papilla predictability.
Figure 8.4. A. Class I Nordland classification. B. Class II Nordland classification. C. Class III Nordland classification.