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J Periodontol. 2016 May;87(5):511-8. doi: 10.1902/jop.2015.150441. Epub 2015 Dec 14.

Evaluation of Hard and Soft Tissue Dimensions Around Zirconium Oxide Implant-Supported Crowns: A 1-Year Retrospective Study.

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Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Aachen, Aachen, Germany.
Private practice, Munich, Germany.
Department of Oral and Cranio-Maxillofacial Surgery, Hightech Research Center, University Hospital Basel, University of Basel, Basel, Switzerland.
Department of Reconstructive Dentistry and Gerodontology, University of Bern, Bern, Switzerland.
Department of Anatomy Munich, Ludwig-Maximilians University Munich, Munich, Germany.



This study aims to evaluate the effect of the distance between the alveolar crest of a full-ceramic implant to the lowest point of the contact area of the crowns on the interdental papilla. Therefore, the authors proposed a new concept of linear measurements for the reproducible and metric evaluation of distances relevant for the assessment of hard and soft tissue changes around dental implants.


A total of 216 sites were examined in 87 patients. In a radiographic and clinical evaluation, four relevant distances were evaluated. In the x-ray image, the tip of the papilla was marked with a radiodense mixture of tungsten powder and temporary cement. In a clinical photograph, the lowest point of the interdental contact zone of the crowns was visualized by a metallic interdental ligature.


Using the proposed measuring methodology, four different papilla-deficit situations around ceramic implants could be reproducibly distinguished. When the measurement from the bone crest at the implant was ≤5 mm, the papilla was completely present in 100% of cases. When this distance was 10 mm, the papilla was still present in 67% of the cases, without any cosmetically apparent deficit.


A close relationship is observed between the distance from the contact point to the bone and the presence of the papilla. Using a combination of radiographically and clinically visible landmarks allows the reproducible measurement of these distances.


Crown; dental implants; esthetics; gingiva; radiography; zirconium

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