Interdental Papilla: Esthetic Considerations 

By: Lee Ann Brady DMD
Topic originally appeared on Dr. Brady allowed permission for igniteDDS to share with our readers

Interdental papilla is the part of the gingiva that fills the space between teeth. It has a triangular shape in the anterior region and a concave col in the posterior region of the tooth, which is particularly determined by the adjacent teeth, the width of the interproximal tooth surfaces, and the cementoenamel junction.

Interdental papilla has a functional and esthetic importance, it protects the periodontium during eating since it is compromised of masticatory mucosa and connective tissue.

Furthermore, the esthetic is mostly why patients are concerned and seek help because when the interdental papilla is lost, they start seeing the black triangles. That’s why it’s so important that before starting to treat any case, plan the treatment by keeping in mind also the esthetic considerations for the soft tissues and the papilla.

Assessing and managing the papilla is particularly important when we are treatment planning esthetic cases. Usually, we pay attention to the papilla when planning anterior implants and are less focused on this when we are treatment planning natural teeth.

The papilla is valued in cosmetic dentistry because it is an essential element of smile esthetics. If we want patients to be truly happy with their results, we must include it in our early considerations.

Papilla Tips and Why They Matter

Many of our patients who are in their sixties and seventies will still show the tips of the papilla. This isn’t the case for other aspects such as the gingival margin. Because of this, it’s critical that we don’t ignore them when treatment planning a smile.

Two main aspects to focus on when diagnosing papilla esthetics are symmetry and papilla height compared to contact length.

Papilla Symmetry

Papilla heights should be symmetric across the midline. Papilla tips will vary for patients, with some creating a straight line when connected and others having a line that tips up toward the canines. Regardless, the left and right sides should mimic one another. For example, if the papilla tip is shorter between the canine and lateral, it should do this on both sides.

Papilla Height

Papilla height compared to contact length is also important. The papilla tip should take up 45-50% of the total length of the tooth from the gingiva to the end of the contact. Then the contact should use up the remaining 50-55% of this distance.

Looking at the existing papilla symmetry and height enables you to decide if the esthetics are acceptable. Your goal will be to maintain them optimally. If they are where you want them to be esthetically already, then you have a reference to determine the positive or negative effect treatments like crown lengthening, ortho, and restorative procedures could have. If papilla esthetics are not where you want them to be, you can use these parameters to evaluate treatment options and improve them.

Key Takeaways

To gain a deeper understanding of treatment planning for cases and the intricacies of anterior aesthetic form and function, as well as the nuances of papilla esthetics in treatment planning, ensuring confidence in meeting patients’ aesthetic needs aligned with their journey toward health, explore our advanced courses at The Pankey Institute.

Join us at Pankey, where you’ll learn from experienced lecturers from around the world. We look forward to welcoming you!

Keep Reading: Predictable Veneers: The Art of Shrink Wrap Provisionals

Dr. Lee Ann Brady

Dr. Lee Ann Brady

Dr. Lee Ann Brady lives in Phoenix, Arizona with her husband Kelly and three children Sarah, Jenna and Kyle. She owns Desert Sun Smiles Dental Care, a private restorative practice in Glendale, Arizona. Outside of her private practice, Dr. Brady is the Director of Education for The Pankey Institute, recognized for hands-on education programs focused on occlusion and restorative dentistry. She is the founder and lead curator of Restorative Nation, a supportive learning community for dentists.