Papilla and alveolar crest levels in immediate versus delayed single-tooth zirconia implants

Int J Oral Maxillofac Surg. 2017 Aug;46(8):1039-1044. doi: 10.1016/j.ijom.2017.02.007. Epub 2017 Mar 1.


The aim of this study was to determine the correlation between the papilla deficit and the distance between the bone crest at the neighbouring tooth and the contact point of the clinical crown (distance 4) for immediate and delayed zirconia implants. This prospective observational study included 78 patients with 82 implants investigated at the 1-year follow-up. Patients received single-unit zirconia implants (Straumann PURE Ceramic Implant with ZLA surface) that were placed using either the delayed (group A) or immediate (group B) protocol after tooth extraction. The distance of the alveolar crest of the neighbouring tooth to the height of the interdental papilla and the absence of the papilla were also assessed. There was a strong correlation between the papilla deficit and distance 4 in group A (Spearman's rho=0.64). However, in group B, only a weak correlation between the two distances was found (Spearman's rho=0.28). A full soft tissue margin was generated when distance 4 was 7-8mm or less. Delayed implant placement showed a critical distance between the alveolar crest at the neighbouring tooth and the contact point of the crown risking a visible papilla deficit of between 7mm and 8mm.

Keywords: osseointegration; papilla; soft tissue; zirconia implants.

Publication types

  • Observational Study

MeSH terms

  • Alveolar Process / anatomy & histology*
  • Alveolar Process / surgery*
  • Anatomic Landmarks
  • Crowns
  • Dental Implantation, Endosseous / methods*
  • Dental Implants, Single-Tooth*
  • Esthetics, Dental*
  • Female
  • Gingiva / anatomy & histology*
  • Humans
  • Male
  • Prospective Studies
  • Tooth Extraction
  • Zirconium


  • Zirconium
  • zirconium oxide