Papillary Contours

Papillas can make us or break us in esthetic dentistry. We all have those cases out there where that papilla didn’t fill in all the way, and now we’re staring at a black triangle.

How do we prevent them?

Well, let’s think about the biology of a papilla. They’re delicate, but what supports them? The interproximal bone. The famous Tarnow study talks about the contact point of a restoration to the interproximal bone needs to be a distance of five millimeters or less. This gives us the greatest chance that that papilla will fill in.

How do we even test that?

Well, we apply a little bit of local anesthetic to the patient. We can take a perio probe and go right in between the teeth into that interproximal area. We align the probe with the long axis of the tooth and press until we find the bone. By doing this, we can communicate that measurement to the lab, and they can establish the porcelain to be within that five-millimeter range. From there, we’re hoping that we’ll get a predictable papilla fill-in, and then we don’t have to worry about that dreaded black triangle coming back to ruin the case at the end.