Incidence of inter-proximal papillabetween a tooth and an adjacentimmediate implant by Diego Lops

1 5 8 0

Journal Name

Manuscript No.

Dispatch: 13.8.08

Journal: CLR

Author Received:

No. of pages: 6

CE: PE: Thanuja/Mini

Incidence of inter-proximal papilla between a tooth and an adjacent immediate implant placed into a fresh extraction socket: 1-year prospective study

Diego Lops Matteo Chiapasco Alessandro Rossi Eriberto Bressan Eugenio Romeo

Authors’ affiliations: Diego Lops, Matteo Chiapasco, Alessandro Rossi, Eriberto Bressan, Eugenio Romeo, Department of Prosthodontics, Dental Clinic, School of Dentistry, University of Milan, Milan, Italy Diego Lops, Matteo Chiapasco, Alessandro Rossi, Eriberto Bressan, Eugenio Romeo, Department of Oral Surgery, Dental Clinic, School of Dentistry, University of Milan, Milan, Italy Diego Lops, Matteo Chiapasco, Alessandro Rossi, Eriberto Bressan, Eugenio Romeo, Department of Prosthodontics, Dental Clinic, School of Dentistry, University of Padova, Padova, Italy

Key words: horizontal distance, immediate implants, inter-proximal papilla, single-tooth

Correspondence to: Eugenio Romeo Department of Prosthodontics Dental Clinic School of Dentistry University of Milan Via Beldiletto 1/3 20142 Milano Italy Tel.: þ 0250319039 fax: þ 0250319040 e-mail: eugenio.romeo@unimi.it

restored with single crown fixed prostheses. The following parameters were assessed: (1) presence/absence of the inter-proximal papilla, (2) gingival index, (3) inter-implant–

prosthesis, vertical distance

Abstract Background: Implant single-tooth replacement with a natural appearance is a challenging

and demanding procedure. The aim of this prospective study was to identify the factors affecting the presence of an inter-proximal papilla between a tooth and an implant.

Methods: Forty-six patients with a total of 46 teeth scheduled for tooth extraction and

immediate implant placement into fresh sockets were included in the study. Immediate implants were positioned after teeth removal. After 4 months of healing, the implants were

tooth distance (ITD) and (4) distance from the base of the contact point to the inter-dental bone (CPB). A computerized analysis was performed to determine ITD and CPB values after

converting perioapical radiographs to digitalized images. Statistical analyses were performed to determine the effect of ITD and CPB on the presence or absence of the inter-proximal papilla.

Results: All the implants were restored, so that a 100% of implant survival rate was

observed after 12 months of function. Mean values were recorded for ITD and CPB parameters, respectively. When ITD was 3–4 mm, and CPB was 3–5 mm, the inter-proximal

(BWUK CLR 1580.PDF 13-Aug-08 22:7 376228 Bytes 6 PAGES n operator=M.Chackalayil)

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 Q2 53 54 55 56 57

C L R

Date: Accepted ’ ’ ’ To cite this article: Lops D, Chiapasco M, Rossi A, Bressan E, Romeo E. Incidence of inter-proximal papilla between tooth and adjacent immediate implant placed into fresh extraction socket: 1-year prospective study. Clin. Oral Impl. Res., xx, 2008; 000–000. doi: 10.1111/j.1600-0501.2008.01580.x

papilla was significantly present (Po0.05).

Conclusions: The recommended inter-proximal space dimensions are 3–4 mm between an implant and the adjacent tooth, and 3–5 mm between the base of the CPB. The interaction between the surgical and prosthetic plans represents the key factor to optimize the edentulous site for predictable anterior single-implant esthetics.

Oral rehabilitation with implant-supported prostheses is a well-documented therapy that is viewed as a routine procedure. Besides, the treatment of a single unit edentulism by means of a single-tooth implant was shown to be successful at the level of implant medium-to-long survival and osseointegration (Palmer et al. 1997; Lindh et al. 1998; Cooper et al. 2001; Gotfredsen 2004; Wennstrom et al. 2005). The application of osseointegration principles to single-tooth and partial edentulism has

c 2008 The Authors. Journal compilation c 2008 Blackwell Munksgaard

CLR 1580

increased patients’ esthetic demands. Nevertheless, an implant that is ossointegrated does not always translate into esthetic success (Phillips & Kois 1998; Kan & Rungcharassaeng 2001). Different surgical and prosthetic management techniques of the hard and soft tissue around implant restorations have been developed to achieve stable and predictable esthetic and functional results. Immediate implant placement after tooth extraction has been advocated to

2 |

O O

Material and methods

The study protocol was approved by the University of Milan Institutional Ethics Committee. Informed consent was obtained from all subjects. Forty-six patients (25 males and 21 females; mean age 47.2 years; range 18â&#x20AC;&#x201C;71) with a total of 46 teeth scheduled for tooth extraction and immediate implant placement into fresh sockets were included in the study. The reasons for tooth extraction were endodontic and caries lesions combined with root or crown fractures. No tooth was removed because of advanced periodontal disease. All patients had been treated with single Astras s Tech Osseospeed implants (AstraTech , GoÂ¨teborg, Sweden). Subjects who qualified for participation in the study were followed for 12 months. All patients presented good general health at the time of the surgical procedure, absence of local inflammation and absence of mucosal disease. The exclusion criteria were: tobacco abuse, i.e., more than 10 cigarettes/day; a history of radiotherapy in the head and neck region; leukocyte diseases at the time of the surgical procedure; uncontrolled diabetes; severe clenching or bruxism; non-compliant patients; and bone grafts or local guided bone regeneration

Clin. Oral Impl. Res. 10.1111/j.1600-0501.2008.01580.x

CLR 1580

(GBR) before implant placement. No patients received more than one implantsupported prosthesis. Opposite dentition was natural teeth for all the selected sites. Patients with a thin biotype were excluded from the study to avoid any influence of this parameter on the papilla presence/absence. To evaluate the biotype, a periodontal probe was placed into the facial aspect of the peri-implant mucosa. The peri-implant biotype was categorized as thin if the outline of the underlying periodontal probe could be seen through the gingiva, and thick if the probe could not be seen (Kan et al. 2003). Routine documentation was as follows: panoramic radiographs taken before treatment and perioapical radiographs taken before treatment, at the time of implant placement, at the time of prosthetic rehabilitation and after 12 months. Surgical procedure

inter-proximal papillae adjacent to singletooth implants to determine whether there is a correlation between the distance from the base of the contact point to the alveolar crest. When the distance between the contact point and the bone crest was o5 mm, the papilla was present 100% of the time. However, the occurrence of the papilla had a frequency below 50% when the distance was more than 5 mm. Similar results were obtained by Gastaldo et al. (2004) in a retrospective examination on the incidence of the inter-proximal papilla between an implant and a tooth; further, it was observed that when the distance between the tooth and the implant was 3, 3.5 or 4 mm the papilla was present most of the time (Po0.05). The aim of the present prospective study on immediate implants placed into fresh extraction sites was to evaluate the effect of the vertical and horizontal distances in determining the presence of the interproximal papilla.

preserve the dimensions of the alveolar ridge regardless of the mode of tooth failure (Lazzara 1989; Rosenquist & Grenthe 1996). On the other hand, these findings are not confirmed by other authors (Botticelli et al. 2004; Arau`jo et al. 2006). Anatomically, bone resorption occurs both bucco-lingually and apico-coronally, and the first 6 months post-extraction are critical, carrying the highest rate of bone resorption in either direction. Bone modeling and remodeling of the socket after tooth extraction was well documented by Botticelli et al. (2004), so that further clinical considerations can be stated in planning for an ideal three-dimensional implant position (Belser et al. 2004). Such a restorative procedure was also recommended to reduce (i) the number of surgical stages and (ii) the interval between tooth removal and the insertion of the implant-supported restoration (Schwartz-arad & Chaushu 1997a, 1997b; Mayfield et al. 1999; Schropp et al. 2005). Medium-term efficacy of immediate implants was demonstrated: survival rates of 96â&#x20AC;&#x201C;99% were shown by Tolman & Keller (1991). A success rate of 92.7% was also reported by Krump & Barnett (1991) after a 4-year follow-up study. An implant survival rate of 93.7% was determined by Rosenquist & Grenthe (1996) for immediate implants positioned into extraction sockets; the follow-up ranged between 1 and 67 months, with a mean of 30.5 months. In addition, achieving optimal peri-implant mucosa dimension is a challenging procedure (Phillips & Kois 1998; Kan et al. 2003) and maintaining it over time can be an equally demanding task. Despite the high success rates reported on osseointegrated implants, the peri-implant mucosal response is not clearly understood. The absence of the inter-proximal papilla can lead to cosmetic deformities, phonetic difficulty and food impaction (Tarnow et al. 2000). Besides, the predictable regeneration of the inter-proximal papilla adjacent to dental implants remains a complex challenge and the peri-implant mucosal response is not clearly understood (Cortellini et al. 1995; Jemt 1997; Azzi et al. 1998). Thus, characterization of the components that affect the presence or the absence of the papilla is of great importance. Choquet & Hermans (2001) investigated the presence or absence of the

(BWUK CLR 1580.PDF 13-Aug-08 22:7 376228 Bytes 6 PAGES n operator=M.Chackalayil)

1 2 Q43 4 Q5 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 Q6 23 24 Q7 25 26 27 Q8 28 29 30 31 32 33 34 35 36 37 38 39 Q9 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56Q10 57

Lops et al . Inter-proximal papilla between tooth and adjacent immediate implant

Tooth removal was performed under local s anesthesia (Carbocaina - AstraZeneca S.p.A., Basiglio, Italia). A full-thickness mucosal flap was raised and the tooth was carefully luxated with the use of small elevators. Forceps were used for tooth extraction and the periodontal ligament attached to the bone in the socket wall was left undisturbed (Botticelli et al. 2004). The socket was prepared with standard drills s using the bony walls as guides. An Astra s implant (AstraTech )was installed. Implant diameter and length depended on the dimension of the edentulous site. Thirty-two implants were inserted into the maxilla and 14 into the mandible, respectively (Table 1). Each implant was positioned so that the marginal level of the sand-blasted portion was placed at the buccal alveolar crest level to achieve a normal emergence profile and maximal Table 1. Implant distribution Implant

Maxillary implants

3.5 mm 9 mm 0 3.5 mm 11 mm 2 3.5 mm 13 mm 3 4 mm 9 mm 0 4 mm 11 mm 12 4 mm 13 mm 9 4.5 mm 9 mm 0 4.5 mm 11 mm 3 4.5 mm 13 mm 3 Total 32

Mandibular implants 0 2 3 0 2 3 0 1 3 14

c 2008 The Authors. Journal compilation c 2008 Blackwell Munksgaard

Selected parameters

Statistical analysis

The effect of ITD and CPB on the presence or absence of the inter-proximal papilla was evaluated by means of statistical analysis. An odds-ratio test was used to find any statistical correlation between the interproximal papilla presence and the ITD and CPB values, respectively. The w2-test was used to evaluate which value of ITD and CPB parameters was significantly associated with the presence or absence of the inter-dental papilla. All hypotheses were performed using the P ¼ 0.05 level of significance.

Results operator (D. L.): GI scores (Lo¨e index 0 and 1) were measured by means of a calibrated plastic probe (TPS probe; Vivadent, Schaan, Liechtenstein). s A computerized analysis (Image-J image processing software) was performed to determine ITD and CPB values (Romeo et al. 2003, 2006) after converting perioapical radiographs to digitalized images s (Canoscan radiograph scanner) (Fig. 2). Radiographs taken 12 months after definitive implant restoration were selected for ITD and CPB measurements. A setting parameter was chosen to set the measurement system; it was the dis-

c 2008 The Authors. Journal compilation c 2008 Blackwell Munksgaard

CLR 1580

tance between implant neck and the most apical point of each fixture, along an ideal line running parallel to the long fixture axis (Romeo et al. 2003). Images were 512 512 pixels, having 64 gray levels. Measurements were made by one of the authors (E. B.) and measured to the nearest half millimeter for ITD values; besides, CPB assessments were rounded off to the nearest millimeter. Ninety-two inter-proximal spaces were examined on the whole. For 10 randomly selected implants (20 papillae), a second set of ITD and CPB measurements was performed to evaluate the intra-observer variability. The mean difference between the first and the second assessment was negligible. Perioapical radiographs (Kodak Ektaspeed EP-22; Eastman Kodak Co., Rochester, NY, USA) were taken with a parallel technique to control projection geometry: the following exposure parameters (65– 90 kV, 7.5–10 mA and 0.22–0.25 s) were used (Haussmann et al. 1989, 1991).

F O O Fig. 2. Computerized analysis performed to determine values of the inter-implant–tooth distance (ITD) and the distance from the base of the contact point to the inter-dental bone (CPB) after converting the perioapical radiograph to a digitalized image: the interproximal bone level next to the adjacent tooth was considered for the apical limit of CPB distance.

The following parameters were assessed: (1) presence/absence of the inter-proximal papilla, (2) gingival index (GI) (Lo¨e & Silness), (3) inter-implant–tooth distance (ITD) and (4) distance from the base of the contact point to the inter-dental bone (CPB): the inter-proximal bone level next to the adjacent tooth was considered for the apical limit of CPB distance (Choquet et al. 2001; Kan et al. 2003). Evaluation of the inter-dental papilla was performed through a clinical examination by using a dicotomical index: the papilla presence or absence was determined visually and perpendicular to the buccal surface of the restoration crown before probing (Fig. 1). The inter-proximal papilla was diagnosed as present if it filled up the entire proximal space and was in good harmony with the adjacent papillae. If less than half or at least half of the papilla was present, the diagnosis was absent papilla. Clinical evaluations were performed by the same

After 8 weeks of healing, the implants were restored with temporary screwed single crowns. After 5 months, the definitive cemented prostheses were positioned. Zinc s oxy-phosphate cement (Temp Bond ; Kerr Mfg. Co., Romulus, MI, USA) was used for the fixation. Different abutments were s selected: 15 customized (Cast-to goldplatinum alloy abutment), 21 standard (titas nium Profile Bi-Abutment ST ) and 10 s zirconia (Ceramic Abutments ST ) abutments. Instead, a similar abutment profile was chosen at the fixture–abutment connection level. A manual torque driver was used to secure the abutment with the fixture by means of a titanium screw as recommended by the manufacturer. Frameworks and esthetic veneers were fabricated in gold alloy and porcelain (26) or zirconia and porcelain (20).

Prosthetic treatment

Fig. 1. Evaluation of the interproximal papilla through a clinical examination perpendicular to the buccal surface of the restoration crown before probing.

vertical bone preservation. Implant was determined to be clinically stable. Proper healing abutment was attached to the implant. The flap was replaced and secured with sutures. All implants were semisubmerged but all parts of the defects were covered by mucosal tissue. Healing abutment was exposed to the oral environment. Removable prostheses or interimfixed bridges were adjusted.

(BWUK CLR 1580.PDF 13-Aug-08 22:7 376228 Bytes 6 PAGES n operator=M.Chackalayil)

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21Q11 22Q12 23Q13 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52Q14 53 54 55 56 57

Lops et al . Inter-proximal papilla between tooth and adjacent immediate implant

3 |

After the healing period all the implants were restored, so that a 100% implant survival rate was observed. During the 12 months of function no prosthetic complications occurred; similarly, no severe soft tissue inflammation was diagnosed around the selected implant-supported restorations. The GI was 0 in 97% of the areas and 1 in 3%. Mean values of 3.2 mm (SD of 0.95 mm) and 3.13 mm (SD of 0.88 mm) were recorded, respectively, for mesial and distal ITD parameters (Table 2). In addition, mean values of 5.6 mm (SD of 1.7 mm)

Clin. Oral Impl. Res. 10.1111/j.1600-0501.2008.01580.x

Q15

Table 2. Dimension of inter-proximal space: horizontal crestal alveolar bone (ITD) and distance from the contact point to the alveolar crest (CPB) Mesial aspect

Distal aspect

Inter-proximal space

Mean ITD

Mean CPB

Papilla present

Papilla absent

Inter-proximal space

Mean ITD

Mean CPB

Papilla present

Papilla absent

3.198 SD 0.949

5.641 SD 1.689

3.135 SD 0.873

5.565 SD 1.59

SD, standard deviation

Table 3. Presence or absence of inter-proximal papilla according to implant–tooth distance (ITD) ITDn (mm)

Papilla present

Papilla absent

Significance (Po0.05)

1–2.5 3–4 44

25 57 10

8 48 7

32 84.2 70

17 9 3

68 15.8 30

3.4 26.68 1.6

No Yes No

n Measurements were rounded off to the nearest half millimeter. N, number of inter-proximal spaces evaluated.

Papilla present

3–5 6–7 47

49 31 12

39 16 7

O C

Discussion

The current results show that an esthetically acceptable implant-supported restoration requires thorough surgical and prosthetic treatment planning. It is very difficult to achieve an esthetic restoration if the implant is not properly placed in the mesio-distal and apico-coronal planes by the surgeon. Also, prosthetic considerations have to be taken into account in the inter-proximal papilla management: the location and size of the inter-proximal

4 |

79.6 51.6 58.3

Papilla absent

Significance (Po0.05)

10 15 5

20.4 48.4 41.7

18.34 0.032 0.334

Yes No No

Measurements were rounded off to the nearest millimeter. N, number of inter-proximal spaces evaluated.

contact area influence the vertical dimension of the inter-dental space between an implant and the adjacent tooth. A review on the management of interdental/inter-implant papilla (Zetu & Wang 2005) addressed factors that may influence its appearance; these mainly included the dimension of the inter-proximal space, the horizontal distance between a tooth and an implant, adequate bone volume, the presence of adjacent tooth attachment and a proper soft tissue thickness. The present study aimed to evaluate the influence of a few parameters (distance between an implant and the adjacent tooth and distance from the inter-dental bone to the apical base of the contact point) on the architecture of the proximal space between an implant and the adjacent tooth. The immediate implant placement technique was chosen to reduce the number of surgical stages and the interval between tooth removal and the insertion of the implant supported. Following extraction of a natural tooth, the edentulous ridge

Clin. Oral Impl. Res. 10.1111/j.1600-0501.2008.01580.x

CLR 1580

CPBn (mm)

Table 4. Presence or absence of inter-proximal papilla according to contact point to bone crest distance (CPB)

and 5.6 mm (SD of 1.6 mm) were recorded for mesial and distal CPB parameters, respectively (Table 2). An odds-ratio investigation showed the influence of both ITD and CPB parameters on the presence of the inter-proximal papilla: scores of 0.83 and 1.09 were calculated for ITD and CPB, respectively. When the ITD was 3–4 mm, the interproximal papilla was present 84.2% of the time. This correlation was statistically significant (w2 ¼ 26.68). Instead, when ITD was o3 mm the inter-proximal papilla was absent 68% of the time. Nevertheless, this correlation was not statistically significant (w2 ¼ 3.4). When ITD was 44.5 mm the inter-proximal papilla was present 70% of the time, but no significant correlation was found (w2 ¼ 1.6) (Table 3). When the distance from the base of the CPB was 3–5 mm, the inter-proximal papilla was present 79.6% of the time. This correlation was statistically significant (w2 ¼ 18.34). On the other hand, when CPB was 6–7 mm the inter-proximal papilla was absent 48.4% of the time. This correlation was not statistically significant (w2 ¼ 0.032). Similarly, up to 7 mm of CPB the papilla was absent 41.7% of the time and no significant correlation was found (w2 ¼ 0.82) (Table 4).

(BWUK CLR 1580.PDF 13-Aug-08 22:7 376228 Bytes 6 PAGES n operator=M.Chackalayil)

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38Q16 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57

Lops et al . Inter-proximal papilla between tooth and adjacent immediate implant

begins to resorb palatally, lingually and towards the apex; the first 6 months postextraction are critical, carrying the highest rate of bone resorption in either direction (Schwartz-arad & Chaushu 1997a, 1997b). Immediate insertion after extraction may be a realistic solution, because bone loss around osseointegrated implants is minimal: Botticelli et al. (2004) documented minimal vertical bone crest resorption around immediate implants after 4 months of healing. It was stated that bone tissue following implant installation in an extraction socket may heal predictably with new bone formation and defect resolution. Nevertheless, a controlled clinical trial performed by Schropp et al. (2005) evaluated inter-proximal papillae and clinical crown height following the placement of single-tooth implants according to early and delayed protocols. It was demonstrated by logistic regression that the risk of presenting no papilla or a negative papilla was seven times greater at baseline for delayed cases than for early cases (33% vs. 8%).

c 2008 The Authors. Journal compilation c 2008 Blackwell Munksgaard

Q17

otherwise, when D2 was 3 mm, there was an interaction between D1 and D2. In accordance with the present study results, they concluded that the ideal distance from the base of the contact point to the bone crest between a tooth and an implant was 3–5 mm. The ideal lateral spacing between implants and between a tooth and an implant was 3–4 mm. Further, there was an interaction between horizontal and vertical distances when the lateral spacing was 43 mm. With regard to the mesio-distal distance, Tarnow et al. (2000) have reported that crestal bone loss was greater for implants spaced 3 mm or less from each other than for implants spaced 3 mm apart. However, they did not analyze the impact of this horizontal distance on the presence of the papilla.

implant placement in extraction sites. Journal of Clinical Periodontology 31: 820–828. Choquet, V., Hermans, M., Adriaenssens, P., Daelemans, P., Tarnow, D.P. & Malevez, C. (2001) Clinical and radiographic evaluation of the papilla level adjacent to single-tooth dental implants. A retrospective study in the maxillary anterior region. Journal of Periodontology 72: 1364–1371. Cooper, L., Felton, D.A., Kugelberg, C.F., Ellner, S., Chaffee, N., Molina, A.L., Moriarty, J.D., Paquette, D. & Palmqvist, U. (2001) A multicenter 12-month evaluation of single-tooth implants restored 3 weeks after 1-stage surgery. International Journal of Oral & Maxillofacial Implants 16: 182–192.

Cortellini, P., Pini Prato, G.P. & Tonetti, M.S. (1995) The modified papilla preservation technique. A new surgical approach for interproximal regenerative procedures. Journal of Periodontology 66: 261–266. Gastaldo, JF., Cury, P.R. & Sendyk, W.R. (2004) Effect of the vertical and horizontal distances between adjacent implants and between a tooth and an implant on the incidence of interproximal papilla. Journal of Periodontology 75: 1242–1246. Gotfredsen, K. (2004) A 5-year prospective study of single-tooth replacements supported by the Astra Tech implant: a pilot study. Clinical Implant Dentistry & Related Research 6: 1–8. Grunder, U. (2000) Stability of the mucosal topography around single-tooth implants and adjacent

tact point and the bony crest. Above 5 mm the occurrence of papilla regeneration is at least 50% but with no predictability, which is in agreement with Tarnow et al. (1992) in their study on the distance between two natural teeth. Instead, Henriksson & Jemt (2004) did not establish any relationship between the presence of papillae and the distance between the contact point and the underlying bone crest (P40.05); 18 patients provided with single-implant restorations in the central incisor area were included in this 1-year comparative study after abutment connection surgery. In addition, Grunder (2000) evaluated the soft tissue stability around single-tooth implants and adjacent teeth: it was found that the total distance from the CPB was almost 9 mm, and all cases had a perfect papilla. These findings were not confirmed by the present study. Besides, parameters affecting the incidence of inter-proximal papilla between a tooth and an implant were also examined by Gastaldo et al. (2004) in 48 patients (80 inter-proximal sites): the distance from the base of the contact point to the bone crest (D1), the distance between a tooth and an implant or between two implants (D2) and the distance from the base of the contact point to the tip of the papilla (D3). When D2 was 3, 3.5 or 4 mm, the papilla was present most of the time (Po0.05) and when D2 was 2 or 2.5 mm, the papilla was absent 100% of the time (Po0.05). Further, when D1 was between 3 and 5 mm, the papilla was present most of the time (Po0.05). Analysis of the interaction between D1 and D2 showed that when D2 was 2.5 mm, the papilla was absent;

References

Arau`jo, M.G, Wennstro¨m, J.L. & Lindhe, J. (2006) Modeling of the buccal and lingual bone walls of fresh extraction sites following implant installation. Clinical Oral Implants Research 17: 606–614. Azzi, R., Etienne, D. & Carranza, F. (1998) Surgical reconstruction of the interdental papilla. International Journal of Periodontics and Restorative Dentistry 18: 467–474. Belser, U., Buser, D. & Higginbottom, F. (2004) Consensus statements and recommended clinical procedures regarding esthetics in implant dentistry. International Journal of Oral & Maxillofacial Implants (Suppl.): 73–74. Botticelli, D., Berglundh, T. & Linde, J. (2004) Hard-tissue alterations following immediate

c 2008 The Authors. Journal compilation c 2008 Blackwell Munksgaard

CLR 1580

Conclusions The results presented can be summarized as follows: A vertical distance of 3–5 mm between the contact point and the inter-dental bone is significantly associated with a full interproximal papilla. A 3–4 mm horizontal distance between an implant and the adjacent tooth is significantly associated with a full inter-proximal papilla. The interaction between the surgical and the prosthetic plans represents the key factor to optimize the edentulous site for predictable anterior single-implant esthetics.

However, the soft tissue filled in the proximal spaces improved significantly from baseline to the 1.5-year follow-up in both groups, with no significant difference found between the groups at follow-up. They concluded that early placement of single-tooth implants may be preferable to a delayed implant placement technique in terms of early generation of inter-proximal papillae and the achievement of an appropriate clinical crown height, but no difference in papilla dimensions was seen at 1.5 years after seating of the implant crown. In addition, Arau`jo et al. (2006) reported that the alveolar ridge follows a resorption after tooth extraction that is quite predictable but probably not influenced by implant insertion as much as believed previously. According to Kois (2001), Kan et al. (2003) and Zetu (2005), the authors stated that the level of the inter-proximal papilla between a tooth and an implant is independent of the proximal bone level next to the implant, but it is related to the interproximal bone level next to the adjacent teeth. Thus, during the surgical procedures, it has been provided to maintain an intact osseous and gingival architecture of the inter-proximal space. The results reported in the present study on the apico-coronal dimension of the inter-proximal area are confirmed in the investigation by Choquet et al. (2001): they established that the papilla level around single-tooth implant restorations is mostly related to the bone level adjacent to the teeth and more specifically to the bone crest. The papillae regeneration after a single implant treatment was successful with a distance of 5 mm between the con-

(BWUK CLR 1580.PDF 13-Aug-08 22:7 376228 Bytes 6 PAGES n operator=M.Chackalayil)

1 2 3 4 5 6 7 8Q20 9 10 11 12 13 14 15 16 17 18 19Q18 20Q19 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57

Lops et al . Inter-proximal papilla between tooth and adjacent immediate implant

5 |

Clin. Oral Impl. Res. 10.1111/j.1600-0501.2008.01580.x

Schropp, L., Isidor, F., Kostopoulos, L. & Wenzel, A. (2005) Interproximal papilla levels following early versus delayed placement of single-tooth implants: a controlled clinical trial. International Journal of Oral & Maxillofacial Implants 20: 753–761. Schwartz-Arad, D. & Chaushu, G. (1997a) Placement of implants into fresh extraction sites: 4 to 7 years retrospective evaluation of 95 immediate implants. Journal of Periodontology 68: 1110–1116. Schwartz-Arad, D. & Chaushu, G. (1997b) The ways and wherefores of immediate placement of implants into fresh extraction sites: a literature review. Journal of Periodontology 68: 915–923. Tarnow, D.P., Cho, S.C. & Wallace, S.S. (2000) The effect of inter-implant distance on the height of inter-implant bone crest. Journal of Periodontology 71: 546–549. Tarnow, D.P. & Eskow, R.N. (1995) Considerations for single-unit esthetic implant restorations. Compendium of Continuing Education in Dentistry 16: 778, 780, 782–784 passim; quiz 788. Tarnow, D.P., Magner, A.W. & Fletcher, P. (1992) The effect of the distance from the contact point to the crest of bone on the presence or absence of the interproximal dental papilla. Journal of Periodontology 63: 995–996. Tolman, D.E. & Keller, E.E. (1991) Endosseous implant placement immediately following dental extraction and alveoloplasty: preliminary report with 6-year follow-up. International Journal of Oral & Maxillofacial Implants 6: 24–28. Wennstrom, J.L., Ekestubbe, A., Grondahl, K., Karlsson, S. & Lindhe, J. (2005) Implant-supported single-tooth restorations: a 5-year prospective study. Journal of Clinical Periodontology 32: 567–574.

Journal of Oral & Maxillofacial Implants 6: 19–23. Lazzara, R.J. (1989) Immediate implant placement into extraction sites: surgical and restorative advantages. International Journal of Periodontics and Restorative Dentistry 9: 332–343. Lindh, T., Gunne, J., Tillberg, A. & Molin, M. (1998) A meta-analysis of implants in partial edentulism. Clinical Oral Implants Research 9: 80–90. Lo¨e, H. & Silness, J.L. (1963) Periodontal disease in pregnancy. I. Prevalence and severity. Acta Odontologica Scandinavica 21: 533–551. Palmer, R.M., Smith, B.J., Palmer, P.J. & Floyd, P.D. (1997) A prospective study of Astra single tooth implants. Clinical Oral Implants Research 8: 173–179. Phillips, K. & Kois, J.C. (1998) Aesthetic periimplant site development. The restorative connection. Dental Clinics of North America 42: 57–70. Romeo, E., Lops, D., Amorfini, L., Chiapasco, M., Ghisolfi, M. & Vogel, G. (2006) Clinical and radiographic evaluation of small-diameter (3.3mm) implants followed for 1 to 7 years. A longitudinal study. Clinical Oral Implants Research 17: 139–148. Romeo, E., Lops, D., Margutti, E., Ghisolfi, M., Chiapasco, M. & Vogel, G. (2003) Implant-supported fixed cantilever prostheses in partially edentulous arches. A seven-year prospective study. Clinical Oral Implants Research 14: 303–311. Rosenquist, B. & Grenthe, B. (1996) Immediate placement of implants into extraction sockets: implant survival. International Journal of Oral & Maxillofacial Implants 11: 205–209.

teeth: 1-year results. International Journal of Periodontics and Restorative Dentistry 20: 11–17. Haussmann, E., Allen, K., Christianson, L. & Genco, R. (1989) Effect of x-ray beam vertical angulation on radiographic alveolar crest level measurement. Journal of Periodontal Research 24: 8–19. Haussmann, E., Allen, K.M. & Piedimonte, M.R. (1991) Influence of variations in projection geometry and lesion size on detection of computersimulated crestal alveolar bone lesions by subtraction. Journal of Periodontal Research 26: 48–51. Henriksson, K. & Jemt, T. (2004) Measurements of soft tissue volume in association with singleimplant restorations: a 1-year comparative study after abutment connection surgery. Clinical Implant Dentistry & Related Research 6: 181–189. Jemt, T. (1997) Regeneration of gingival papillae after single-implant treatment. International Journal of Periodontics and Restorative Dentistry 17: 326–333. Kan, J.Y. & Rungcharassaeng, K. (2001) Site development for anterior single implant esthetics: the dentulous site. Compendium of Continuing Education in Dentistry 22: 221–226, 228, 230–231; quiz 232. Kan, J.Y., Rungcharassaeng, K., Umezu, K. & Kois, J.C. (2003) Dimensions of peri-implant mucosa: an evaluation of maxillary anterior single implants in humans. Journal of Periodontology 74: 557–562. Kois, J.C. (2001) Predictable single tooth peri-implant esthetics. Five diagnostic keys. Compendium of Continuing Education in Dentistry 2: 199–208. Krump, J.L. & Barnett, B.G. (1991) The immediate implant: a treatment alternative. International

(BWUK CLR 1580.PDF 13-Aug-08 22:7 376228 Bytes 6 PAGES n operator=M.Chackalayil)

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57

Lops et al . Inter-proximal papilla between tooth and adjacent immediate implant

6 |

Clin. Oral Impl. Res. 10.1111/j.1600-0501.2008.01580.x

CLR 1580

c 2008 The Authors. Journal compilation c 2008 Blackwell Munksgaard

Q21

Author Query Form _______________________________________________________ Journal Article

CLR 1580

_______________________________________________________ Dear Author, During the copy-editing of your paper, the following queries arose. Please respond to these by marking up your proofs with the necessary changes/additions. Please write your answers clearly on the query sheet if there is insufficient space on the page proofs. If returning the proof by fax do not write too close to the paper's edge. Please remember that illegible mark-ups may delay publication. Query No.

Description AQ: Please check if the suggested running title is OK.

Q1 PE: Please provide accepted date.

Q2 AQ: Please confirm the change of Phillips et al. (1998) to Phillips & Kois (1998) as per the reference list.

Q3 AQ: Please confirm the change of Lazzara et al. (1989) to Lazzara (1989) as per the reference list.

Q4 AQ: Please confirm the change of Rosenquist et al. (1996) to Rosenquist & Grenthe (1996) as per the reference list.

Q5 AQ: Mayfield et al. (1999) has not been included in the list, please include and supply publication details.

AQ: Please confirm the change of year from 2003 to 2005 as per the reference list for the reference Schropp et al (2005).

AQ: Please confirm the change of Tolman and colleagues (1991) to Tolman & Keller (1991) as per the reference list.

AQ: Please confirm the change of year from 2001 to 2003 as per the reference list for the reference Kan et al (2003).

AQ: Choquet & Hermans (2001) has not been included in the list, please include and supply publication details.

Q10

Q11

Q12

Q13

Q14

AQ: Please provide manufacturer information for Cast-to速 gold-platinum alloy abutment company name, town, state (if USA) and country.

AQ: Please provide manufacturer information for Bi-Abutment速 ST: company name, town, state (if USA) and country.

AQ: Please provide manufacturer information for Ceramic Abutments 速 ST: company name, town, state (if USA) and country.

AQ: Please provide manufacturer information for Canoscan 速 radiograph scanner: company name, town, state (if USA) and country.

AQ: Please confirm the change of Hausmann to Haussmann as per the reference list.

Q15

Author Response

Author Query Form _______________________________________________________ Journal

CLR

Article

1580

Description AQ: Zetu & Wang (2005) has not been included in the list, please include and supply publication details.

Q16 AQ: Please check if it is 'a' or 'b' for the reference Schwartz-arad & Chaushu (1997a, b).

Q17 AQ: Please confirm the change of Kan (2003) to Kan et al. (2003) as per the reference list.

Q18 AQ: Zetu (2005) has not been included in the list, please include and supply publication details.

Q19 AQ: Please confirm the change of Yemt to Jemt as per the reference list.

Q20 AQ: Please cite Tarnow and Eskow (2000) in the text or delete from the list.

Q21

Author Response

MARKED PROOF Please correct and return this set Please use the proof correction marks shown below for all alterations and corrections. If you wish to return your proof by fax you should ensure that all amendments are written clearly in dark ink and are made well within the page margins. Instruction to printer Leave unchanged Insert in text the matter indicated in the margin Delete

Textual mark under matter to remain

New matter followed by or through single character, rule or underline or through all characters to be deleted

Substitute character or substitute part of one or more word(s) Change to italics Change to capitals Change to small capitals Change to bold type Change to bold italic Change to lower case Change italic to upright type

under matter to be changed under matter to be changed under matter to be changed under matter to be changed under matter to be changed Encircle matter to be changed (As above)

Change bold to non-bold type

(As above)

Insert ‘superior’ character

through letter or through characters

through character or where required

Insert ‘inferior’ character

(As above)

Insert full stop Insert comma

(As above)

Insert single quotation marks

(As above)

Insert double quotation marks

(As above)

Insert hyphen Start new paragraph No new paragraph

(As above)

Insert or substitute space between characters or words Reduce space between characters or words

or new character or new characters

or under character e.g.

over character e.g.

(As above) or

linking

and/or

or or or

Transpose Close up

Marginal mark

characters

through character or where required

between characters or words affected

and/or