During esthetic treatment planning one of the critical factors is assessing and managing the papilla. This is a common conversation when anterior implants are being planned, but sometimes gets less than the optimal attention when the treatment plan is all on natural teeth. The tips of the papilla, unlike the gingival margin show in an astounding majority of our patients up into their sixties and seventies, making it an essential element of their smile esthetics. Their are two pieces I look for in diagnosing the papilla esthetics. The first is symmetry. Much like with gingival esthetics we want the papilla heights to be symmetric across the midline. Some patients will have papilla tips that when connected create a straight line, others the line will tip up toward the canines. We want to see that the left and right sides mimic one another, so if the papilla tip is slightly shorter between the canine and lateral, it does this the same way on both sides.
Second, is papilla height as compared to contact length. Ideally the papilla tip should take up 45-50% of the total length of the tooth from the gingiva to the end of the contact, with the contact using up the remaining 50-55% of this distance. Once you have looked at the existing papilla symmetry and height it allows you to know decide if this is acceptable and our goal will be to maintain it. If it is currently esthetic, you also now have a reference to assess the impact that treatment like crown lengthening, ortho, and restorative procedures will have to impact the papilla esthetic in a negative way. If the current esthetics of the papilla is not acceptable using these parameters as a goal you can evaluate treatment options to improve them.