Assessment of parameters affecting the presence of the central papilla using a non-invasive radiographic method

This study was performed to assess the relationship between radiopaque landmarks and central papilla presence and height. The probability of the presence of a central papilla has been related to the bone crest-contact point distance. Papilla height has been measured by inserting a dental probe under local anesthesia, but this method is invasive. It would be desirable to assess the influence of other dental landmarks on the presence and height of the papilla and to use a non-invasive method for measurement of papilla height that is simple, accurate, and accepted readily by patients.

Periapical radiographs were obtained in 310 adults with fully erupted permanent dentition, healthy gingiva (plaque and gingival indexes of 0 to 1), and well-aligned maxillary central incisors. Semisoft radiopaque material was placed to fill the space coronal to the papilla tip, which enabled it to be visualized without probing. Vertical and horizontal distances were measured with an electric ruler.

The presence of a full central papilla was related significantly to age, papillary height, and distances from the bone crest to the contact point, the buccal cemento-enamel junction, and the proximal cemento-enamel junction. When confounding factors were controlled using multifactorial logistic regression, the distance from the bone crest to the proximal cemento-enamel junction was the strongest determinant of papilla presence.

Standard periapical radiography is a non-invasive method that can be used to study determinants of the presence of a central papilla. The factors linked to papilla recession were age, bone crest-contact point distance, bone crest-proximal cemento-enamel junction distance, and papilla height. Bone crest-proximal cemento-enamel junction distance, the strongest predictor of the probability of papilla recession, might be used to predict this probability after prosthetic or orthodontic interventions.