Disparity in embrasure fill and papilla height between tooth- and implant-borne fixed restorations in the anterior maxilla: a cross-sectional study

Purpose The objective of the present study was to compare inter-proximal fill and papilla height between different embrasures. Material & Methods One hundred and fifty non-smoking consecutive patients (mean age 54, range 32-73; 63 males and 87 females) without periodontal disease were selected in a multidisciplinary practice during regular supportive care. All had been treated for multiple tooth loss in the anterior maxilla at least 1year earlier by means of a fixed restoration on teeth (n=50) or implants (n=100) using straightforward procedures (without hard and/or soft tissue augmentation). Embrasure fill was assessed by means of Jemt's papilla index and papilla height was registered following local anaesthesia by means of bone sounding by one clinician. Results Tooth-pontic and tooth-implant embrasures demonstrated comparable inter-proximal fill and papilla height (58% Jemt's score 3; mean papilla height 4.1mm). Between missing teeth, embrasure fill and papilla height were lower regardless of the embrasure type. The implant-implant and implant-pontic embrasure demonstrated comparable outcome (42% Jemt's score 3; mean papilla height3.3mm; p0.416), which was significantly poorer when compared to the pontic-pontic embrasure (82% Jemt's score 3; mean papilla height 3.7mm; p0.019). Overall, papilla index and papilla height demonstrated a weak correlation (Spearman's correlation coefficient: 0.198; p=0.002). Conclusions The re-establishment of a papilla is difficult when there is no tooth involved. In that scenario a short papilla should be expected and implant-borne restorations demonstrate the poorest outcome. Moreover, an implant with a pontic may not perform better than adjacent implants.