The Esthetic Outcome of Interproximal Papilla Between Implant-Restored Unilateral and Bilateral Maxillary Central Incisors: A Cross-Sectional Comparative Study

Int J Oral Maxillofac Implants. 2022 Sep-Oct;37(5):1063-1070. doi: 10.11607/jomi.9563.


Purpose: Restoring the esthetics of anterior teeth with implants is challenging. This study aimed to evaluate the esthetic outcome of interproximal papilla between implant-restored unilateral and bilateral maxillary central incisors.

Materials and methods: A total of 56 adults with implant restorations in the maxillary central incisors were enrolled, including 40 cases of unilateral incisors and 16 cases of bilateral incisors. Photographic and radiographic assessments were performed, and patient-reported esthetic satisfaction was collected.

Results: The papilla index (PI) in the unilateral group was superior to that in the bilateral group (P = .002). Patients in the two groups reported equal satisfaction regarding the final esthetic outcome (P = .470). Statistically significant differences were noted between the two groups in papilla height (P = .000), implant-implant or implant-tooth distance (P = .002), and vertical distance from the implant platform to the bone crest (P = .000). In the bilateral group, tested variables were not correlated with PI by nonparametric Spearman correlation. In the unilateral group, the multivariate binary logistic regression model showed that incomplete papilla fill was associated with abutment type (OR = 0.019), implant-tooth distance (range, 2.1 to 6.2 mm; OR = 6.435), and distance from the bone crest to the contact point (range: 3.5 to 6.9 mm; OR = 4.589).

Conclusion: In implant-restored maxillary central incisors, PI in the unilateral group was superior to that in the bilateral group. In the bilateral group, no clinical variable was correlated with PI. In the unilateral group, the risk of incomplete papilla fill was reduced by the customized zirconia abutment and was increased by the larger implant-tooth distance and higher distance from the bone crest to the contact point.

MeSH terms

  • Adult
  • Cross-Sectional Studies
  • Dental Implants*
  • Dental Implants, Single-Tooth*
  • Esthetics, Dental
  • Gingiva
  • Humans
  • Incisor
  • Maxilla / surgery


  • Dental Implants