Treatment Planning Papilla Esthetics
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.
What is your favorite part of treatment planning a case? We’d love to hear your thoughts in the comments!
Related Course
E4: Posterior Reconstruction and Completing the Comprehensive Treatment Sequence
DATE: February 27 2025 @ 8:00 am - March 3 2025 @ 2:30 pmLocation: The Pankey Institute
CE HOURS: 44
Dentist Tuition: $ 7400
Single Occupancy with Ensuite Private Bath (per night): $ 345
THIS COURSE IS SOLD OUT The purpose of this course is to help you develop mastery with complex cases involving advanced restorative procedures, precise sequencing and interdisciplinary coordination. Building on…
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About Author
Dr. Lee Ann Brady is passionate about dentistry, her family and making a difference. She is a general dentist and owns a practice in Glendale, AZ limited to restorative dentistry. Lee’s passion for dental education began as a CE junkie herself, pursuing lots of advanced continuing education focused on Restorative and Occlusion. In 2005, she became a full time resident faculty member for The Pankey Institute, and was promoted to Clinical Director in 2006. Lee joined Spear Education as Executive VP of Education in the fall of 2008 to teach and coordinate the educational curriculum. In June of 2011, she left Spear Education, founded leeannbrady.com and joined the dental practice she now owns as an associate. Today, she teaches at dental meetings and study clubs both nationally and internationally, continues to write for dental journals and her website, sits on the editorial board of the Journal of Cosmetic Dentistry, Inside Dentistry and DentalTown Magazines and is the Director of Education for The Pankey Institute.