As seen on Oprah and EXTRA 
FROM THE DESK OF ALAN M. MELTZER DMD MScD
In this third monograph, I will explore the subject of the interdental papilla with focus on the single tooth implant.
How close can a dental implant be placed to a natural tooth root? It is well documented that an implant should be placed no closer than 1 millimeter from a natural tooth root (green arrow) or the implant will compromise the bone support on the adjacent natural tooth. The generally accepted distance is approximately 1.5millimeters.
What is the minimal width of an interdental space required for implant placement? The average width of most standard sized dental implants is about 4 millimeters. Therefore, the minimal width is 7 millimeters.This allows 4 millimeters for the implant and 1½ millimeters mesially and distally for root clearance.
What about the use of narrow diameter implants? Most dental manufacturers produce narrow diameter implants. Most have a prosthetic platform in the 3.4 millimeter range (3.25 mm implant with a 3.4 mm prosthetic seating surface). This would reduce the interdental minimal width requirement to 6 millimeters. There are some narrower implants (3 millimeter range) but the potential risk of metal fatigue and implant fracture must always be taken into consideration. These specialized narrow implants should only be used in areas of minimal occlusal stress such as upper lateral incisors or lower incisors.
How can the loss of papillary tissue be predicted? Once again, it is a well-documented fact that this aesthetic dilemma can be evaluated preoperatively.
The key measurement involves evaluating the periodontal health of the adjacent natural teeth. If one measures the distance from the contact point to the crest of bone on the adjacent teeth (red arrow) this will accurately give you the ability to predict the chances of maintaining or regenerating the papilla.
If the distance from the contact point to the crest of bone on the teeth adjacent to the proposed implant site is 4 to 5 millimeters, you have an almost 100% chance of regaining the papilla. If the distance is 6 millimeters you have about a 50% chance of getting the papilla back. If the distance measures 7 millimeters the odds fall to roughly 25%.
Note: Papillae either stay the same over time or improve. The mid-facial either stays the same over time or worsens. The mid-facial dilemma will be the subject of my next monograph.
