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Perfect Harmony in White - DENTSPLY Friadent

Perfect Harmony in White - DENTSPLY Friadent

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% 70 60 50 40 30 20 10 0 Table 3. Presence/Absence of Papilla – Time of implant placement Time of implant placement (n=240) Time Immediate Delayed Late n total 16 45 59 % papilla present 67 70 41 % papilla absent 33 30 69 Presence/Absence of Papilla Depending on time of implant placement (n=120) light_22 67 33 70 immediate delay immediate late n=16 n=45 n=59 papilla present papilla not present 30 41 59 Table 3: Influence of time of implant placement on presence or absence of papilla Out of a total of 120 FRIALIT ® implants, 16 were placed immediately after tooth loss or extraction, 45 implants were placed delayed immediate and 59 implants were placed late. In cases of immediate or delayed immediate implant placement a papilla was present two thirds of the time (immediate: 67%; n=16/delayed: 70%; n=45). The papilla was present in 41% of times, if implant placement was performed after a complete osseous healing of the extraction site. Discussion Various factors, such as type of tissue, restoration contour and previous surgi- cal or non-surgical therapy influence the presence or absence of the papilla. The purpose of this study was to determine the influence of vertical distance between contact point and the crest of bone, as well as that of horizontal distance between tooth and implant on the presence or absence of the dento- implant papilla. The significance of time of implant placement was evaluated. A vertical distance from the base of the contact point to the crest of bone between 3 to 6 mm is a good prerequisite for a spontaneous inter-proximal papilla. A vertical distance below 3 mm or above 9 mm reduces a predictable papilla regeneration significantly. Gingival esthetics around endosseous implants is not only determined by vertical dimensions but also by interproxi- mal space. A horizontal distance between implant and adjacent tooth of 2 to 3 mm complies with anatomical data of teeth and favors the reestablish- ment of interproximal papillae. The distance between implant and adjacent tooth should not be shorter than 2 mm, due to clinical and restorative problems when creating the emergence profile. A horizontal distance above 3 mm reduces the probability of papilla re-establishment considerably. The results demonstrate the importance of the time of implant placement on the predicta- bility of papilla regeneration. The earliest possible implant placement pre- serves periimplant bone structures and determines the shape of overlying

soft tissue contours. When implant placement was performed after a complete osseous healing of the extraction site the papilla was present in less than half of the time. In implant dentistry, the maintenance and/or re-establishment of inter- proximal areas which provide adequate space for healthy, natural and esthetic papillae between implants and adjacent teeth, are of importance for long-term success. If ideal hard and soft tissues are present at the time of tooth extraction, it seems feasible to preserve them, rather than delay implant placement and allow for resorption. Recently, a new custom healing abutment (FRIADENT ® EsthetiCap) has been introduced to facilitate the support of hard and soft tissues to mimic the natural tooth emergence contours 7 . FRIADENT ® EsthetiCaps are made from PEEK- acrylic to which zirconium oxide was added for stabilization and radio- opacity. Not only is this procedure more predictable than trying to re- generate these tissues in a delayed implant protocol, but it also involves less surgery for the patient. This results in reduced potential morbidity, lower cost to the patient and significantly shorter treatment time. Study results: The earliest possible implant placement preserves peri-implant bone structures and determines the shape of the overlying soft tissue contours: Decreased papilla regeneration if vertical distance from dento-implant contact point to bone crest < 3 mm and > 6 mm. Decreased papilla regeneration if horizontal dento-implant space < 2 mm and > 4 mm. References 1_Takei HH: The interdental space. Dent Clin North Am 1980; 24 (2): 169-176 2_Cohen B, Ibbetson RJ: The morphology of the dental embrasure and reflections on its significance. J Dent Assoc S Afr 1988; 43 (11): 507-511 3_Tarnow DP, Magner AW, Fletcher: The effect of the distance from the contact point to the crest of bone on the presence or absence of the interproximal dental papilla. J Periodontol 1992; 63 (12): 995-996 4_Schnabel T, Dhom G, Gehrke P: Anatomische Voraussetzungen für eine Papillenpräsenz bei Einzelzahnimplantaten. Dent Implantol 1998; 2 (3): 180-188 5_Gehrke P, Enomoto H, Neugebauer J, Schnabel T. Contribution of interproximal dento-implant architecture on papilla presence or absence. Scientific poster: 7th International Symposium on Periodontics & Restorative Dentistry Boston, June 1-4, 2000 6_Tarnow D, Elian N, Fletcher P, Froum S, Magner A, Cho SC, Salama M, Salama H, Garber DA: Vertical distance from the crest of bone to the height of the interproximal papilla between adjacent implants. J Periodontol 2003; 74 (12): 1785-1788. 7_Wheeler SL, Vogel RE, Casellini R: Tissue preservation and maintenance of optimum esthetics: A clinical report. Int J Oral Maxillofac Implants 2000; 15 (27): 265-271. light_23

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