I have 2 anterior implant cases coming up next month that I intend to do fully guided. I’ve done several anterior immediate cases with adjacent natural dentition but never with an adjacent implant. One of the cases is to replace horizontally fractured #9 with an existing implant at site #8. What measurements do you use to ensure papilla survival between #8 & 9?
Our Answer:
I use this rule of thumb: 3mm apical the gingival zenith of the adjacent natural tooth, and at least 3mm horizontally from the adjacent implant.
Also, I don’t do cases that are not thick bio type. I refer those out to periodontists. Also, I use the same old dimensions as usual. The bone must have 7mm mesio distal and bucco-lingual volume.
The biggest advice for the anterior to keep the papilla is to not damage the papilla initially.
Atraumatically extracting the tooth is key. That way the soft tissue and bone levels are not compromised and will make your life a whole lot easier when it comes to esthetics. If you lay a full thickness flap— I would use a papilla sparing incision so that you don’t even elevate it. This will also decrease the chances you’ll have papilla reduction.
Another helpful thing is to get a custom healing abutment so the transition to a provisional is much easier with the soft tissue.
Here is another article worth looking at on the subject: