One of the major factors contributing to esthetic success in the anterior maxilla is the location or height of interproximal bone crest. The height of the interproximal bone crest significantly impacts interproximal papilla formation as well as the type of placement protocol to utilize. In evaluating height of bone crest measured from the contact point to bone crest, Tarnow and colleagues noted that while a distance of 5mm or less resulted in complete papilla formation, a distance of 6mm or more resulted in complete papilla fill only about 55% of the time. 

As a result, having distance of bone crest that is 6mm or more requires that an alternative technique be utilized from immediate implant placement because of the possibility of causing incomplete papilla formation and dark triangles with the implant restoration. Typically, a delayed or early placement approach with bone and possibly soft tissue augmentation is needed. 

Additionally, to allow for adequate development of interproximal papilla, they recommend that the distance between dental implants and adjacent teeth should be at least 1.5mm, and the distance between adjacent dental implants should be at least 3mm to prevent bone loss inter-proximally and allow adequate papilla formation. 

Reference: 

Tarnow DP, Cho SC, and Wallace SS. The effect of Inter-implant distance on the height of inter-implant bone crest. Journal of Periodontology 2000(April); 72(4): 546-540. 

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