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Fundamentals of Esthetic Implant Dentistry
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Figure 8.17. C. A two adjacent implants at the time of the second-stage surgery. Note the use of very small diameter healing abutments. D. Soft tissue punch to uncover the implants. E. Abutments connected. Note the development of the papilla between implants due to platform switching. F. The case restored finally.
G Figure 8.17G. Radiographic view showing the bone levels maintained between implants when platform switching is used.
maintaining proximal osseous contours at stable levels in immediate implant placement; however, in delayed implant placement therapy, it is necessary for the bone-grafting procedure to regenerate bone on the scalloped margins. (See Figure 8.18.)
Soft Tissue Procedures for Reconstruction of the Interimplant Papillae Because of the fragile nature of the peri-implant soft tissue, reduced blood supply at the soft tissue ends, and the postoperative soft tissue remodeling factor, most of the soft tissue methods have attained neither great success nor predictable long-term clinical results. This explains the poor prognosis of any surgical reconstruction attempt to reconstruct the interimplant papilla. To quantify the value of the keratinized tissues in relation to the presence of the interimplant papilla, a study (Lee et al. 2005b) evaluated the effect of the width of the keratinized mucosa as well as the distance from the base
Figure 8.18. A scalloped implant design.
of the contact point to the crestal bone. The study also examined the effect of the horizontal distance between two adjacent implants. This study examined 72 interproximal papillae between two adjacent implants (interimplant papilla) in 52 patients who had implants placed adjacent to each other and had a prosthesis in place for more than one year. The radiographic length (RL) of the papilla, the width of the keratinized mucosa (WK) from the tip of the papilla, and the vertical distance between the base of the contact point and interimplant crestal bone level (CC) were measured. The horizontal distance (HD) between the two implants at the fixture-abutment interface level was also measured. The study stated that a wider WK indicates that mucosa around the implants was more voluminous and had a thicker peri-implant biotype, leading to the thicker RL. The distance from the base of the contact point to the crestal bone did not influence the length of the interproximal papilla between two implants. The papilla fill was closely related with the HD between two implants. When the dis-