Creation of Interimplant Papillae Through a Split-Finger Technique

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Creation of Interimplant Papillae Through a Split-Finger Technique
March 2004
Misch, Carl E. DDS, MDS; Al-Shammari, Khalaf F. DDS, MS; Wang, Hom-Lay DDS, MDS
Dental Implant March 2004, Volume 13, Issue 1
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Abstract
Purpose: The purpose of this pilot study is to propose a technique, the split-finger approach, to preserve/promote papillae formation.
Materials and Methods: Twenty-one patients with 39 implants consecutively placed in the maxillary anterior region were evaluated at 6 months to 1 year after prosthodontic restoration. The implants evaluated included 16 single-tooth implants, 1 2-unit implant prosthesis, 2 4-unit tooth implants, 1 6-unit prostheses, and 1 7-unit restoration. The papillae were recorded as 0 = no papillae; 1 = =50% of the gingival embrasure height; 2 = >50% but <100% of embrasure height; 3 = 100% closure of the proximal space; and 4 = overgrowth of the interproximal tissue.
Results: Data from this pilot study showed no class 0, class 1, or class 4 interproximal papillae after the final restoration. The 16 single-tooth restorations and 32 papillae had an average mesial papilla score of 3 and an average of 2.82 for the distal interproximal space. The average papilla score of the other implant papillae sites were 2.7 at 6 months to 1 year. A lower papilla score was noted in interimplant papillae.
Conclusions: The proposed split-finger technique could serve as a clinically useful alternate procedure to promote/augment papillae formation around dental implants.
References
1. Jemt T, Lekholm U, Grondal K. Three-year follow-up study of early single implant restoration ad modum Branemark. Int J Periodont Rest Dent. 1990; 10: 340-349.
2. Laney WR, Jemt T, Harris D, et al. Osseointegrated implants for single-tooth replacement: progress report from a multicenter prospective study after 3 years. Int J Oral Maxillofac Implants. 1994; 9: 49-54.
3. Henry PH, Laney WR, Jemt T, et al. Osseointegrated implants for single-tooth replacement: a prospective 5-year multicenter study. Int J Oral Maxillofac Implants. 1996; 11: 450-455.
4. Schmitt A, Zarb GA. The longitudinal clinical effectiveness of osseointegrated dental implants for single-tooth replacement. Int J Prosthod. 1993; 6: 187-202.
5. Tarnow D, Eskow R. Considerations for single-unit esthetic implant restorations. Compend Contin Educ Dent. 1995; 16: 778-784.
6. De Lange GL. Aesthetic and prosthetic principles for single-tooth implant procedures: an overview. Pract Periodontics Aesthet Dent. 1995; 7: 51-61.
7. Belser UC, Bernard JP, Buser D. Implant-supported restorations in the anterior region: prosthetic considerations. Pract Periodontics Aesthet Dent. 1996; 8: 875-883.
8. Stein JM, Nevins M. The relationship of the guided gingival frame to the provisional crown for a single-implant restoration. Compendium. 1996; 17: 1175-1182.
9. Garber DA. The esthetic dental implant: letting restoration be the guide. J Oral Implantol. 1996; 22: 45-50.
10. Grunder U, Spielman H-P, Gaberthuel T. Implant-supported single-tooth replacement in the aesthetic region: a complex challenge. Implant Report. 1996; 8: 835-842.
11. Myenberg KH, Imoberdorf MJ. The aesthetic challenges of single-tooth replacement: a comparison of treatment alternatives. Pract Periodontics Aesthet Dent. 1997; 9: 727-735.
12. Adell R, Lekholm U, Branemark PI. Surgical procedures. In: Branemark PI, Zarb GA, Albrektsson T, eds. Tissue Integrated Prostheses. Osseointegration in Clinical Dentistry. Chicago: Quintessence; 1985: 211-232.
13. Moy PK, Weinlaendes M, Kenny EB. Soft tissue modifications of surgical techniques for placement and uncovery of osseointegrated implants. Dent Clin North Am. 1989; 33: 665-681.
14. Kois J. Altering gingival levels: the restorative connection. Part I: biologic variables. J Esthet Dent. 1994; 6: 3-9.
15. Phillips K, Kois JC. Aesthetic peri-implant site development. The restorative connection. Dent Clin North Am. 1998; 42: 57-70.
16. Abrams L. Augmentation of the deformed residual edentulous ridge for fixed prostheses. Compend Cont Edu Gen Dent. 1980; 1: 205-215.
17. Siebert SS, Cohen PW. Periodontal considerations in preparation for fixed and removable prosthodontic. Dent Clin North Am. 1987; 1: 205-215.
18. Bahat O, Fontanesi R, Preston J. Reconstruction of the hard and soft tissues for optimal placement of osseointegrated implants. Int J Periodontics Restorative Dent. 1993; 13: 255-275.
19. Davidoff SR. Developing soft tissue contours for implant-supported restorations: a simplified method for enhanced aesthetics. Pract Periodontics Aesthet Dent. 1996; 8: 507-513.
[Medline Link] [Context Link]
20. Adriaenssens P, Hermans M, Ingber A, et al. Palatal sliding strip flap: Soft tissue management to restore maxillary anterior esthetics at stage 2 surgery: a clinical report. Int J Oral Maxillofac Implants. 1999; 14: 30-36.
21. Misch CE. Single-tooth implants difficult, yet overused. Dent Today. 1992: 11: 46, 48-51.
22. Misch CE, ed. Single-Tooth Implants: Contemporary Implant Dentistry, 2nd ed. St. Louis: Mosby; 1999: 397-428.
23. Israelson H, Plemos JM. Dental Implants, regenerative techniques, and periodontal plastic surgery to restore maxillary anterior esthetics. Int J Oral Maxillofac Implants. 1993; 8: 555-561.
24. Hertel RC, Bludrop PA, Kalk W, et al. Stage 2 surgical techniques in endosseous implantation. Int J Oral Maxillofac Implants. 1994; 9: 273-278.
25. Palacci P. Amenagement des tissus peri-implantaires Interet de la regeneration des papilles. Realites Cliniques. 1992; 3: 381-387.
26. Palacci P. Peri-implant soft tissue management: papilla regeneration technique. In: Palacci P, Ericsson I, Engstrand P, et al., eds. Optimal Implant Positioning and Soft Tissue Management for the Branemark System. Chicago: Quintessence; 1995: 59-70.
27. Kinsel RD, Lamb RE. Development of gingival esthetics in the terminal dentition patient prior to dental implant placement using a full arch transitional prosthesis: a case report. Int J Oral Maxillofac Implants. 2001; 16: 583-589.
28. Nemcovsky CE, Moses O, Artize Z. Interproximal papillae reconstruction in maxillary implants. J Periodont. 2000; 71: 308-314.
[Context Link]
29. Wohrle PS. Single-tooth replacement in the aesthetic zone with immediate provisionalization. Fourteen consecutive case reports. Pract Periodontics Aesthet Dent. 1998; 10: 1107-1114.
30. Petrungaro PS. Immediate restoration of dental implants after tooth removal: a new technique to provide esthetic replacement of the natural tooth system. Int Magazine of Oral Implant. 2000; 2: 6-16.
31. Kois JC, Kan JY. Predictable peri-implant gingival esthetics: five diagnostic keys. Compend Contin Educ Dent. 2001; 22: 199-206.
32. Kois JC, Kan JY. Predictable peri-implant gingival aesthetics: surgical and prosthodontic rationales. Pract Proced Aesthet Dent. 2000; 13: 691-698.
33. Saadoun AP, LeGall M, Touati B. Selection and ideal tridimensional implant position for soft tissue aesthetics. Pract Periodontics Aesthet Dent. 1999; 11: 1063-1073.
34. Misch CE. The split finger technique for creation of interimplant papilla. A pilot study. Continium. 2001; Winter: 1-3.
35. Jemt T. Regeneration of gingival papillae after single-implant treatment. Int J Periodont Rest Dent. 1997; 17: 327-333.
36. Azzi R, Etienne D, Takei H, et al. Surgical thickening of the existing gingiva and reconstruction of interdental papillae around implant-supported restorations. Int J Perio & Restor Dent. 2002; 22: 71-77.