Chương 3 Mô mềm quanh răng và Implants Jan Lindhe, Jan L. Wennström, and Tord Berglundh

thickness

tooth–implant site will be dependent on the attach-

ment level of the tooth. Choquet et al. (2001) studied

the papilla level adjacent to single-tooth dental

depth at the facial aspect of single-implant restorations and

the natural tooth in the contralateral position (from Chang

et al. 1999).

comparison to the natural tooth, the implant-sup-

ported crown was bordered by a thicker buccal

mucosa (2.0 mm versus 1.1 mm), as assessed at a

level corresponding to the bottom of the probeable

pocket, and had a greater probing pocket depth

(2.9 mm versus 2.5 mm) (Fig. 3-32). It was further

observed that the soft tissue margin at the implant

was more apically located (about 1 mm) than the gin-

gival margin at the contralateral tooth.

Kan et al. (2003) studied the dimensions of the

peri-implant mucosa at 45 single implants placed

in the anterior maxilla that had been in function for

an average of 33 months. Bone sounding measure-

ments performed at the buccal aspect of the implants

showed that the height of the mucosa was 3–4 mm

in the majority of the cases. Less than 3 mm of mucosa

height was found at only 9% of the implants. It

was suggested that implants in this category were

(1) found in subjects that belonged to a thin periodon-

or (3) had an overcontoured facial prosthetic emer-

gence. A peri-implant soft tissue dimension of4 mm

was usually associated with a thick periodontal

implants in 26 patients and in total 27 implant sites.

The distance between the apical extension of the

contact point between the crowns and the bone crest,

as well as the distance between the soft tissue level

and the bone crest, was measured in radiographs.

The examinations were made 6–75 months after

the insertion of the crown restoration. The authors

observed that the papilla height consistently was

about 4 mm, and, depending on the location of the

contact point between adjacent crowns papilla, fill

was either complete or incomplete (Fig. 3-33). The

closer the contact point was located to the incisal

edge of the crowns (restorations) the less complete

was the papilla fill.

Chang et al. (1999) studied the dimensions of

the papillae at implant-supported single-tooth

restorations in the anterior region of the maxilla and

at non-restored contralateral natural teeth. They

found that the papilla height at the implant-

supported crown was significantly shorter and

showed less fill of the embrasure space than the

papillae at the natural tooth (Fig. 3-34). This was par-

ticularly evident for the distal papilla of implant-sup-

ported restorations in the central incisor position,

both in comparison to the distal papilla at the contra-

lateral tooth and to the papilla at the mesial aspect of

the implant crown. This indicates that the anatomy

of the adjacent natural teeth (e.g. the diameter of the

root, the proximal outline/curvature of the cemento-

mm
8

6

4

2

1

2

Papilla index

6

Tooth

of subjects of a thin biotype.

4
*

the adjacent tooth surface and the position of the

contact point between the crowns are obviously key

2

*

papilla fill will be obtained at the single-tooth

implant-supported restoration (Fig. 3.35). Although

there are indications that the dimensions of the

approximal soft tissue may vary between individuals

having thin and thick periodontal biotypes, the height

0

Papilla height

of the papilla at the single-implant restoration seems

to have a biological limit of about 4 mm (compare the

dimension of the interdental papilla). Hence, to

adjacent to single-implant restorations and the natural tooth

in the contralateral position (from Chang et al. 1999).

level) may have a profound influence on the dimen-

sion of the papilla lateral to an implant. Hence, the

wider facial–lingual root diameter and the higher

proximal curvature of the cemento-enamel junction

of the maxillary central incisor – in comparison to

corresponding dimensions of the lateral incisor

(Wheeler 1966) – may favor the maintenance of the

height of the mesial papilla at the single-implant

supported restoration.

Kan et al. (2003) assessed the dimensions of the

peri-implant mucosa lateral to 45 single implants

placed in the anterior maxilla and the 90 adjacent

teeth using bone sounding measurements. The bone

sounding measurements were performed at the

mesial and distal aspects of the implants and at the

mesial and distal aspects of the teeth. The authors

reported that the thickness of the mucosa at the

mesial/distal surfaces of the implant sites was on the

average 6 mm while the corresponding dimension at

the adjacent tooth sites was about 4 mm. It was

further observed that the dimensions of the peri-

achieve a complete papilla fill of the embrasure space,

a proper location of the contact area between the

implant crown and the tooth crown is mandatory. In

this respect it must also be recognized that the papilla

fill at single-tooth implant restorations is unrelated

to whether the implant is inserted according to a one-

or two-stage protocol and whether a crown restora-

tion is inserted immediately following surgery or

delayed until the soft tissues have healed (Jemt 1999;

Ryser et al. 2005).

When two neighboring teeth are extracted, the papilla

at the site will be lost (Fig. 3-36). Hence, at replace-

ment of the extracted teeth with implant-supported

restorations the topography of the bone crest and the

thickness of the supracrestal soft tissue portion are

the factors that determine the position of the soft

tissue margin in the inter-implant area (“implant

papilla”). Tarnow et al. (2003) assessed the height

above the bone crest of the inter-implant soft tissue

(“implant papilla”) by transmucosal probing at 136

anterior and posterior sites in 33 patients who had

maintained implant-supported prostheses for at least