Discussion
trauma
The objective of this retrospective study was to explore the influence of different incision designs on papilla height. Results showed that for second stage surgery, intrasulcular incisions result in enhanced papillary recession compared with papilla-sparing techniques. However, in implant placement surgery no statistical difference was observed (Figs. Punch techniquesU-shaped techniqueSplit finger technique (mesial)Split pedicle roll envelope techniqueAchieving optimal gingival esthetics around dental implant is always considered challengeable. One of the factors that are heatedly discussed is incision designs in implant surgery. Castro-Calderón et al. In this study, gingival recessions after crown restoration were observed in all groups compared with preoperative measurements, indicating that implant surgeries can cause damage to soft tissue and adversely affect gingival papilla height to various degrees. Implant surgery impair the stability of soft tissue, leading to lack of blood supply. Inadequate blood flow largely affects alveolar bone remodeling, and may further influence gingival contour. Therefore, to minimize surgical damage is of great importance in obtaining good esthetic outcomes.Our results indicate that incision methods for implant placement surgery did not significantly affect papilla height. Results after implant placement surgery revealed that changes in gingival height among the 3 groups were not statistically different. Hutchens et al. We also found that intrasulcular incisions in second stage surgery significantly decreased the gingival height. ΔVβ of group A was significantly higher than group B and C, indicating that minimizing surgical trauma in second stage surgery is of great importance in sustaining papilla height. Phadke et al. Based on the results above, we recommend using papilla-sparing techniques in the second stage surgery. For implant placement surgery, papilla-sparing techniques are not necessary, especially when GBR is performed. Also, healing abutments of 3 mm height are recommended in the implant placement surgery, on the premise that the wound is completely closed.There are several limitations in this study. The observation period in this study terminates at the time of crown placement. The papilla height of included cases may change with time, and we will continue to follow up. Also, this is a retrospectives study. Randomized controlled trials are needed to further investigate this issue.