Factors associated with the interdental papilla height between two maxillary central incisors: a radiographic study

Various factors affect the central maxillary incisor papilla height (PH) and central clinically observable PH (COPH) such that a study of these factors and their interactions is needed. This study reports on an investigation of the factors associated with PH and COPH in patients with and without papilla recession.

The central papilla was visually assessed in 450 adults using standardized periapical radiographs of maxillary central incisors. Various vertical and horizontal distances were measured including the lengths from the proximal cemento-enamel junction (pCEJ) to apical contact point (CP), bone crest (BC) to CP (BC-CP), BC to pCEJ (BC-pCEJ), and papilla tip (PT) to CP (PT-CP) and the interdental width at the pCEJ level (IW), width at the BC level (crest width [CW]), and width at the PT level (PTW). PH was defined as the length from the PT to BC, and COPH was defined as the length from the PT to pCEJ. Simple analyses for PH and COPH were performed, and significant variables were entered into multiple linear regression models.

Among all study patients, papilla recession status and PT-CP were significant independent predictors of PH (both P <0.001). Age, papilla recession status, PT-CP, and BC-pCEJ were significant independent predictors of COPH (all P <0.001). Among patients with papilla recession, CW and PT-CP independently predicted PH (both P <0.001). All variables tested (except sex and CW) were significantly associated with COPH in patients with papilla recession, especially IW, PTW, PT-CP, and BC-pCEJ (P <0.001 for these variables).

The effects of age and BC-pCEJ on COPH change differed in patients without and with recession, suggesting that the initial change in COPH was large but later slowed after recession occurred while there was no severe interdental bone loss progression. However, additional clinical study is needed to find out other variables that may decrease or ameliorate the severity of central papilla recession by restorative/prosthetic or orthodontic intervention and to confirm this possibility.