Papilla: Don't Call it a Comeback

We have plenty of patients present to our offices desiring a nicer smile. Of course we want to transform our patient's desires into the restorations that we create and give them the smile they've always wanted. However, after we get everything just right, there is one variable that can make or break the case: The tissue.

Let's face it; the tissue gets worked over from the time of preparation, gingival retraction and provisional placement. There's also wear during the time until delivery, all the way to cleaning up the cement on the final restorations. Personally, I've found that the papilla, out of all of the tissue, seems to be what often catches a lot of the "beating."

Often I've removed my provisionals, cleaned up the cement and tried in my final restorations, only to find a "black triangle" present. Even if everything is perfect, there is always the question of whether the papilla will come back. Sometimes we are restoring a case that already has a black triangle present and we have to design the case to be successful in the end.

How do you know? One factor to keep in mind that has been researched in the past and is often referenced is the contact point to bone height [1]. Here are some numbers to consider the next time you're trying to manage the papilla:

• 5mm or Less from Contact Point to Height of Bone = 100% fill


• 6mm or Less from Contact Point to Height of Bone = 56% fill


• 7mm or Less from Contact Point to Height of Bone = 27% fill

Reference:
1. J Periodontol. 1992;63(12):995-996. The effect of the distance from the contact point to the crest of bone on the presence or absence of the interproximal dental papilla. Tarnow DP, Magner AW, Fletcher P.

Jeff Lineberry, DDS, FAGD, Spear Visiting Faculty, Contributing Author. [ www.jefflineberrydds.com ]

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