Development of natural soft tissue architecture and interdental papillae between adjacent implants in the aesthetic zone.

A classification of predicted vertical height of the interdental papillae has been developed based on whether a papilla has a tooth, a pontic, or an implant on either side of it. Based on this classification, it may be prudent to avoid the placement of adjacent implants in multiple-unit restorations. To further enhance the aesthetics of multiple-unit restorations, endodontically retained roots may be submerged between implant sites. Some patients, however, require adjacent implants due to limited bone support. Others request them for personal reasons. In these cases, additional efforts must be made to create naturally appearing soft tissue architecture with full and symmetrical papillae.