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Fundamentals of Esthetic Implant Dentistry
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Figure 8.35. A. Prosthetic solution to enhance the interdental papilla by adding a resin material to the fitting surface of the removable partial denture, in order to press and reshape the pontic area. B. The postconfiguration effect of the alveolar ridge. C. The case finally restored with the interproximal papilla shaped in between the pontics.
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Figure 8.36A. Using maximum implants number leads to a jeopardized aesthetic result.
Figure 8.36B. Minimizing the number of implants leads to enhanced papillary architecture.
morphology of the interimplant papilla, despite the fact that it is not yet readily available and long-term results have not been substantiated. Currently, a modified design and a new material are being tested. Implant-supported restorations should consider the biologic width and natural tooth scallop. The margins of restorations follow a curvilinear pattern around the circumference of the teeth, and resemble the parabolic contours of the underlying bone crest and gingival tissue contours that can be achieved using versatile implant designs. The principle behind the use of the parabolic margin, as opposed to a flat and monoplane margin, is that any bone remodeling that follows would replicate a parabolic form. Bone therefore may be maintained more coronal on the proximal surfaces than on the facial and lingual surfaces, hence preserving the bone support of the gingival papillae. The concept of a biologically
derived parabolic implant design might be necessary, especially in the anterior regions of the mouth (Gadiha and Hoit 2003). Prosthetic methods of restoring the interimplant papilla (1) are less invasive, (2) are more convenient to the patient, (3) do not regenerate a real papilla, but help mask the defects, and (4) can be used as a second line of treatment when other treatment options failed. These methods are appropriate for patients who do not want to undergo further invasive treatments, or for older and medically compromised patients.
Noninvasive Methods for Papillary Reconstruction Interestingly, Jemt (1997) observed that the peri-implant papillae can, to some extent, regenerate without any