Int J Stomatol

Int J Stomatol ›› 2026, Vol. 53 ›› Issue (5): 719-727.doi: 10.7518/gjkq.2026020

• Review • Previous Articles    

Factors affecting peri-implant gingival papilla height recession in the aesthetic zone and reconstruction strategies

Kunming Liu(),Zhihong Zhang()   

  1. School of Stomatology, Bengbu Medical University, Bengbu 233030, China
  • Received:2025-04-05 Revised:2025-06-21 Online:2026-09-01 Published:2026-08-28
  • Contact: Zhihong Zhang E-mail:3296814935@qq.com;zzhzqr@ustc.edu.cn
  • Supported by:
    Key Research and Development Plan of Anhui Province(2023s07020006)

RichHTML

2

PDF (PC)

9

Abstract:

Restoring peri-implant papillae in the aesthetic zone is a critical step for attaining balance between aesthetics and functionality in dental implant restoration. However, substantial height recession directly affects implant functionality and aesthetic results, and the distinctive anatomical configuration of peri-implant papillae continues to pose a serious challenge to maintaining the effectiveness and long-term stability of restorations. This article examines three major aspects: the anatomical basis of the papilla, influencing factors, and reconstruction strategies. The identified key factors affecting the height of peri-implant papillae in the aesthetic zone include anatomical, surgical, prosthetic design, and patient-speci-fic factors. Current reconstruction strategies primarily include conventional surgical augmentation techniques and novel biotechnologies, providing reference for papilla preservation and reconstruction in aesthetic zone implant therapy.

Key words: dental implants, gingival papilla, aesthetics, black triangle, influencing factors, treatment planning, new biotechnology

CLC Number: 

  • R783

TrendMD: 
[1] Tavelli L, Barootchi S, Avila-Ortiz G, et al. Peri-implant soft tissue phenotype modification and its impact on peri-implant health: a systematic review and network meta-analysis[J]. J Periodontol, 2021, 92(1): 21-44.
[2] Mahasneh SA, Goodwin M, Pretty I, et al. The use of radiographs to assess the impact of the distance between the contact area and the crest of the bone to predict the presence or absence of interdental papilla: an in vivo study[J]. Br Dent J, 2023. doi: 10. 1038/s41415-023-6184-z .
doi: 10. 1038/s41415-023-6184-z
[3] Godani A, Iyer J, Nadgere J, et al. Impact of immediate interim restoration on peri-implant tissues around immediately placed single dental implants in the esthetic region: a systematic review and meta-analysis[J]. J Prosthet Dent, 2025, 134(4): 1075-1088.
[4] Berlucchi I, Francetti L, Del Fabbro M, et al. The influence of anatomical features on the outcome of gingival recessions treated with coronally advanced flap and enamel matrix derivative: a 1-year prospective study[J]. J Periodontol, 2005, 76(6): 899-907.
[5] Noverraz S, Noverraz Y, Xi T, et al. Influence of surgically assisted rapid maxillary expansion on the interdental papilla height of maxillary central incisors[J]. J Orofac Orthop, 2021, 82(6): 372-381.
[6] Xiao YZ, Lin ZQ, Wang PS, et al. Relationship of gingival phenotypes and faciolingual thickness, papilla height, and gingival angle in a Chinese population[J]. Int J Periodontics Restorative Dent, 2021, 41(1): 127-134.
[7] Yang G, Cao J, Hu WJ, et al. Measurements of the gingival papillae architecture using cone-beam computed tomography in young Chinese adults[J]. Peer-J, 2020, 8: e10006.
[8] Albrektsson T, Johansson C. Osteoinduction, osteoconduction and osseointegration[J]. Eur Spine J, 2001, 10(): S96-S101.
[9] Yuan X, Pei XB, Chen JL, et al. Comparative analyses of the soft tissue interfaces around teeth and implants: insights from a pre-clinical implant model[J]. J Clin Periodontol, 2021, 48(5): 745-753.
[10] Abrahamsson I, Berglundh T, Wennström J, et al. The peri-implant hard and soft tissues at different implant systems. A comparative study in the dog[J]. Clin Oral Implants Res, 1996, 7(3): 212-219.
[11] Chanthasan S, Mattheos N, Pisarnturakit PP, et al. Influence of interproximal peri-implant tissue and prosthesis contours on food impaction, tissue health and patients’ quality of life[J]. Clin Oral Implants Res, 2022, 33(7): 768-781.
[12] Berglundh T, Armitage G, Araujo MG, et al. Peri-implant diseases and conditions: consensus report of workgroup 4 of the 2017 World Workshop on the classification of periodontal and peri-implant disea-ses and conditions[J]. J Clin Periodontol, 2018, 45(): S286-S291.
[13] Choquet V, Hermans M, Adriaenssens P, et al. Clinical and radiographic evaluation of the papilla level adjacent to single-tooth dental implants. A retrospective study in the maxillary anterior region[J]. J Pe-riodontol, 2001, 72(10): 1364-1371.
[14] Salama H, Salama MA, Garber D, et al. The interproximal height of bone: a guidepost to predictable aesthetic strategies and soft tissue contours in ante-rior tooth replacement[J]. Pract Periodontics Aesthet Dent, 1998, 10(9): 1131-1141, 1142.
[15] Jung RE, Heitz-Mayfield L, Schwarz F, et al. Evidence-based knowledge on the aesthetics and maintenance of peri-implant soft tissues: osteology foundation consensus report part 3-aesthetics of peri-implant soft tissues[J]. Clin Oral Implants Res, 2018, 29(): 14-17.
[16] Papapanou PN, Sanz M, Buduneli N, et al. Perio-dontitis: consensus report of workgroup 2 of the 2017 World Workshop on the Classification of Pe-riodontal and Peri-Implant Diseases and Conditions[J]. J Periodontol, 2018, 89(): S173-S182.
[17] Fischer KR, Büchel J, Testori T, et al. Gingival phenotype assessment methods and classifications revi-sited: a preclinical study[J]. Clin Oral Investig, 2021, 25(9): 5513-5518.
[18] Di Gianfilippo R, Valente NA, Toti P, et al. Influen-ce of implant mucosal thickness on early bone loss: a systematic review with meta-analysis[J]. J Perio-dontal Implant Sci, 2020, 50(4): 209-225.
[19] Jung RE, Becker K, Bienz SP, et al. Effect of peri-implant mucosal thickness on esthetic outcomes and the efficacy of soft tissue augmentation procedures: consensus report of group 2 of the SEPA/DGI/OF workshop[J]. Clin Oral Implants Res, 2022, 33(): 100-108.
[20] Souza AB, Tormena M, Matarazzo F, et al. The influence of peri-implant keratinized mucosa on brushing discomfort and peri-implant tissue health[J]. Clin Oral Implants Res, 2016, 27(6): 650-655.
[21] Chen ST, Buser D, Sculean A, et al. Complications and treatment errors in implant positioning in the aesthetic zone: diagnosis and possible solutions[J]. Periodontol 2000, 2023, 92(1): 220-234.
[22] Monje A, Roccuzzo A, Buser D, et al. Influence of buccal bone wall thickness on the peri-implant hard and soft tissue dimensional changes: a systematic review[J]. Clin Oral Implants Res, 2023, 34(3): 157-176.
[23] Chen ST, Darby IB, Reynolds EC. A prospective cli-nical study of non-submerged immediate implants: clinical outcomes and esthetic results[J]. Clin Oral Implants Res, 2007, 18(5): 552-562.
[24] Chandran KRS, Goyal M, Mittal N, et al. Accuracy of freehand versus guided immediate implant placement: a randomized controlled trial[J]. J Dent, 2023, 136: 104620.
[25] 任帅吉, 杜静冰. 美学区单颗牙缺失即刻种植与拔牙位点保存后延期种植的临床效果分析[J]. 中国口腔种植学杂志, 2024, 29(6): 561-567.
Ren SJ, Du JB. Comparison of clinical outcomes between immediate implantation and delayed implantation following alveolar ridge preservation for single-tooth loss in the aesthetic zone[J]. Chin J Oral Implantol, 2024, 29(6): 561-567.
[26] Raj A, Pradhan S, Shetty P, et al. Comparison of crestal bone loss and papilla fill after conventional and immediate implant placement: a 12 month clinical and radiographic prospective study[J]. F1000-Res, 2023, 12: 821.
[27] Atieh MA, Shah M, Abdulkareem M, et al. The socket shield technique for immediate implant placement: a systematic review and meta-analysis[J]. J Esthet Restor Dent, 2021, 33(8): 1186-1200.
[28] MacLean S, Hermans M, Villata L, et al. A retrospective multicenter case series evaluating a novel 3.0-mm expanding tapered body implant for the rehabilitation of missing incisors[J]. Quintessence Int, 2016, 47(4): 297-306.
[29] Frizzera F, Calazans NNN, Pascoal CH, et al. Flapless guided implant surgeries compared with conventional surgeries performed by nonexperienced individuals: randomized and controlled split-mouth clinical trial[J]. Int J Oral Maxillofac Implants, 2021, 36(4): 755-761.
[30] Froum SJ, Wang WC, Hafez T, et al. Incision design and soft tissue management to maintain or establish an interproximal papilla around integrated implants: a case series[J]. Int J Periodontics Restorative Dent, 2018, 38(1): 61-69.
[31] Luo W, Wang XY, Chen YQ, et al. Radiographic evaluation of a cross-shaped incision technique for thick-gingiva and thin-gingiva patients treated with implant-supported fixed prosthesis[J]. BMC Oral Health, 2021, 21(1): 655.
[32] Lee EK, Herr Y, Kwon YH, et al. I-shaped incisions for papilla reconstruction in second stage implant surgery[J]. J Periodontal Implant Sci, 2010, 40(3): 139-143.
[33] Parihar AS, Manas A, Gopinath PV, et al. A compa-rative study of mid-crestal incision and diode laser shaped incision to assess papilla level in second stage dental implant surgery[J]. J Pharm Bioallied Sci, 2022, 14(): S236-S238.
[34] Saleh MHA, Urban IA, Alrmali A, et al. Papilla reconstruction using a vertical interproximal tunnel approach[J]. Int J Oral Implantol, 2023, 16(1): 55-64.
[35] Kamakshi LNVA, Uppoor AS, Nayak DG, et al. Evaluation of papilla levels following three diffe-rent techniques for the second stage of implants-a clinical and radiographic study[J]. J Indian Soc Pe-riodontol, 2021, 25(2): 120-127.
[36] Kois JC. Predictable single-tooth peri-implant esthetics: five diagnostic keys[J]. Compend Contin Educ Dent, 2004, 25(11): 895-896, 898, 900, 906-907.
[37] Siegenthaler M, Strauss FJ, Gamper F, et al. Ante-rior implant restorations with a convex emergence profile increase the frequency of recession: 12-mon-th results of a randomized controlled clinical trial[J]. J Clin Periodontol, 2022, 49(11): 1145-1157.
[38] González-Martín O, Lee E, Weisgold A, et al. Contour management of implant restorations for optimal emergence profiles: guidelines for immediate and delayed provisional restorations[J]. Int J Periodontics Restorative Dent, 2020, 40(1): 61-70.
[39] Chu SJ. Inverted body-shift concept in macroimplant design to enhance biologic and esthetic outcomes: a clinical report[J]. J Prosthet Dent, 2021, 126(6): 720-726.
[40] Lops D, Romeo E, Mensi M, et al. CAD/CAM abutments in the esthetic zone: a systematic review and meta-analysis of soft tissue stability[J]. J Clin Med, 2023, 12(11): 3847.
[41] Wang LN, Wang TT, Lu YF, et al. Comparing the clinical outcome of peri-implant hard and soft tissue treated with immediate individualized CAD/CAM healing abutments and conventional healing abutments for single-tooth implants in esthetic areas over 12 months: a randomized clinical trial[J]. Int J Oral Maxillofac Implants, 2021, 36(5): 977-984.
[42] BinShabaib MS, Mehmood A, Akram Z, et al. Peri-implant clinical and radiographic status and whole salivary cotinine levels among cigarette and waterpipe smokers and never-smokers[J]. J Oral Sci, 2018, 60(2): 247-252.
[43] Stefanini M, Marzadori M, Tavelli L, et al. Peri-implant papillae reconstruction at an esthetically fai-ling implant[J]. Int J Periodontics Restorative Dent, 2020, 40(2): 213-222.
[44] Urban IA, Mancini L, Wang HL, et al. The ‘iceberg’ connective tissue graft technique for peri-implant papilla augmentation following interproximal bone reconstruction[J]. Int J Periodontics Restora-tive Dent, 2024, 44(5): 510-519.
[45] Yi ZM, Miao XH, Wang L, et al. A customized subepithelial connective tissue graft for interdental papilla reconstruction and soft tissue augmentation[J]. J Esthet Restor Dent, 2022, 34(3): 451-460.
[46] Marques T, Santos NBMD, Sousa M, et al. Mixed-thickness tunnel access (MiTT) through a linear vertical mucosal incision for a minimally invasive approach for root coverage procedures in anterior and posterior sites: technical description and case series with 1-year follow-up[J]. Dent J, 2023, 11(10): 235.
[47] Happe A, Schmidt A, Neugebauer J. Peri-implant soft-tissue esthetic outcome after immediate implant placement in conjunction with xenogeneic acellular dermal matrix or connective tissue graft: a rando-mized controlled clinical study[J]. J Esthet Restor Dent, 2022, 34(1): 215-225.
[48] Panwar M, Kosala M, Malik D, et al. Comparison of acellular dermal matrix allografts and connective tissue autografts in soft-tissue augmentation around immediate implants: a pilot study[J]. Med J Armed Forces India, 2022, 78(): S251-S257.
[49] Urban IA, Barootchi S, Urban IA, et al. Hard- and soft-tissue reconstruction in the anterior maxilla for esthetic implant therapy[J]. Compend Contin Educ Dent, 2023, 44(7): 385-389, 390.
[50] Wessels R, Vervaeke S, Seyssens L, et al. A 5-year cohort study on early implant placement with gui-ded bone regeneration or alveolar ridge preservation with connective tissue graft[J]. Clin Implant Dent Relat Res, 2020, 22(6): 697-705.
[51] Miron RJ, Pikos MA, Estrin NE, et al. Extended platelet-rich fibrin[J]. Periodontol 2000, 2024, 94(1): 114-130.
[52] Sharma K, Roy S, Kumari A, et al. A comparative evaluation of soft and hard tissue changes around dental implants placed with and without platelet-rich fibrin[J]. Cureus, 2023, 15(3): e36908.
[53] Tavelli L, Barootchi S, Rasperini G, et al. Clinical and patient-reported outcomes of tissue engineering strategies for periodontal and peri-implant reconstruction[J]. Periodontol 2000, 2023, 91(1): 217-269.
[54] Latimer JM, Maekawa S, Yao Y, et al. Regenerative medicine technologies to treat dental, oral, and craniofacial defects[J]. Front Bioeng Biotechnol, 2021, 9: 704048.
[55] Ebrahimi R, Khorshidi H, Boroumand R, et al. Eva-luation of the effect of hyaluronic acid injection on the reconstruction of reduced interdental papillae in patients referred to Shiraz school of dentistry[J]. J Dent, 2023, 24(3): 305-311.
[56] Becker W, Gabitov I, Stepanov M, et al. Minimally invasive treatment for papillae deficiencies in the esthetic zone: a pilot study[J]. Clin Implant Dent Relat Res, 2010, 12(1): 1-8.
[57] Bertl K, Gotfredsen K, Jensen SS, et al. Can hya-luronan injections augment deficient papillae at implant-supported crowns in the anterior maxilla? A randomized controlled clinical trial with 6 months follow-up[J]. Clin Oral Implants Res, 2017, 28(9): 1054-1061.
[58] Bertl K, Gotfredsen K, Jensen SS, et al. Adverse reaction after hyaluronan injection for minimally invasive papilla volume augmentation. A report on two cases[J]. Clin Oral Implants Res, 2017, 28(7): 871-876.
[59] McGuire MK, Scheyer ET. A randomized, double-blind, placebo-controlled study to determine the safety and efficacy of cultured and expanded autologous fibroblast injections for the treatment of interdental papillary insufficiency associated with the papilla priming procedure[J]. J Periodontol, 2007, 78(1): 4-17.
[60] Wu DT, Munguia-Lopez JG, Cho YW, et al. Polymeric scaffolds for dental, oral, and craniofacial regenerative medicine[J]. Molecules, 2021, 26(22): 7043.
[1] Sifan Chen,Yingying Zhuo,Yao Chen,Xing Jiang,Zhiqiang Zheng,Jie Lin. Research progress on the application of resin-ceramic composites in crown restoration of posterior dental implants [J]. Int J Stomatol, 2026, 53(5): 711-718.
[2] Jieyu Zhou,Lei Zhao,Yafei Wu,Yong Li,Huan Zhao. Vascularized interpositional periopel connective tissue flap combined with crown restoration for reconstruction of esthetic gingival papillae: a case report [J]. Int J Stomatol, 2025, 52(3): 323-332.
[3] Meilin Zhao,Yiqiong Zhao,Jiao Huang. Treatment of gingival papilla loss with gingival recession in orthodontic patients with stage Ⅲ grade C periodontitis: a case report [J]. Int J Stomatol, 2025, 52(3): 333-340.
[4] Mei Wu, Yanjing Liang, Xuepei Peng, Weihong Chen, Xingtong Guo, Lili Hou. Current status of speech function after oral cancer surgery and analysis of influencing factors [J]. Int J Stomatol, 2025, 52(1): 42-49.
[5] Jiazhen Jiang,Xiaoge Jiang,Song Chen. Influencing factors of the success rate of mini-implants in the infrazygomatic crest [J]. Int J Stomatol, 2024, 51(6): 677-686.
[6] Mengyuan Zhang,Hongye Lu,Qianhui Li,Ping Sun. Autophagy and its role and mechanism in osseointegration of oral implants [J]. Int J Stomatol, 2024, 51(6): 742-748.
[7] Han Chong,He Dongning,Yu Feiyan,Wu Dongchao. Research progress on the mechanism and treatment of pain after oral implants [J]. Int J Stomatol, 2024, 51(1): 99-106.
[8] Liu Yang,Yin Deqiang. Introducing a novel digital articulation workflow with high precision [J]. Int J Stomatol, 2023, 50(5): 499-505.
[9] Wu Jiaxin,Cheng Xingqun,Wu Hongkun.. Clinical application and research progress on hyaluronic acid in the repair of papillary height loss [J]. Int J Stomatol, 2023, 50(3): 347-352.
[10] Wang Taiping,Shi Xinglian,Li Zhezhen,Liu Mei,Jiang Jianhong. Analysis of psychological factors and intervention in patients with oral cancer [J]. Int J Stomatol, 2023, 50(2): 203-209.
[11] Liu Jiamei,Wu Yanmin. Application of periodontal plastic surgery in the preservation and reconstruction of gingival papilla [J]. Int J Stomatol, 2020, 47(3): 318-327.
[12] Cai Xiaoxiao. Digital planning strategies in aesthetic areas [J]. Int J Stomatol, 2019, 46(6): 621-630.
[13] Kun Cao,Jiafeng Li,Yuhua Sun,Qiang Bao,Qiuning Lu,Wei Tang. Evaluating of the submandibular fossa by cone beam CT [J]. Inter J Stomatol, 2019, 46(2): 209-212.
[14] Zhou Jinru, Chen Xiwen, Li Xin, Li Ziyan, Zhu Zhimin, Chen Wenchuan. Exploring the necessity of aesthetic education for prosthodontic postgraduates [J]. Inter J Stomatol, 2016, 43(3): 263-267.
[15] Wang Xiaona, Zhao Jinghui, Chu Shunli, Zhou Yanmin. Effect of bone substitutes in oral implants on bone formation [J]. Inter J Stomatol, 2016, 43(1): 113-.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!