International Journal of Prosthodontics and Restorative Dentistry

Register      Login

VOLUME 11 , ISSUE 4 ( October-December, 2021 ) > List of Articles


A Trichotomous Relation between Papilla Proportion, Gingival Zenith, and Facial Profile

Shivanand Aspalli, S Gomathi Sai Krishna, Reetika Gaddale, Susan Abraham, Prerana Mahapatra, VR Monisha

Keywords : Facial profile, Gingival zenith, Papilla height, Papilla proportion

Citation Information : Aspalli S, Krishna SG, Gaddale R, Abraham S, Mahapatra P, Monisha V. A Trichotomous Relation between Papilla Proportion, Gingival Zenith, and Facial Profile. Int J Prosthodont Restor Dent 2021; 11 (4):173-177.

DOI: 10.5005/jp-journals-10019-1343

License: CC BY-NC 4.0

Published Online: 04-04-2022

Copyright Statement:  Copyright © 2021; The Author(s).


Aims and objectives: Gingival morphology, that is, the contour, thickness, height of the papilla, proportion of the papilla, plays a vital role in smile designing and esthetics. These anatomical landmarks may vary based on race, gender, and ethnicity, so understanding, evaluating, and correcting these variations is the utmost important aspect when planning for smile designing as well as in anterior teeth rehabilitation. The main objective of this study was to evaluate papilla height and papilla proportion as a useful parameter for treatment planning in different facial profile subjects (concave, convex, straight). Materials and methods: Diagnostic casts were made using alginate impressions for 32 periodontally healthy subjects including males and females (age range 18–50 years) having sound anterior teeth. Gingival zenith was marked by using the method described by Chu and Stappert. Papilla height was measured and papilla proportion was calculated by the mathematical equation given by Chu and Stappert. The data obtained were subjected to statistical analysis. Results: Papilla height and papilla proportion were higher in concave profile subjects when compared to convex as well as straight profile subjects. The mean papilla proportion of right central incisor among various facial profiles (convex, straight, and concave) was 34.93% ± 5.40, 34.64% ± 7.38, and 37.58 ± 8.27, respectively and for the left central incisor were 34.74% ± 5.56, 34.05 ± 7.59, and 37.21 ± 8.37, respectively. Conclusion: Facial, dentogingival, dentofacial, and dental are the factors involved in the esthetic analysis. Multidisciplinary approaches are often required to increase the treatment predictability.

  1. Magne P, Belser U. Bonded porcelain restorations in the anterior dentition: a biomimetic approach. Carol Stream (IL): Quintessence 2002;58–64.
  2. Cohen ES. Atlas of cosmetic and reconstructive periodontal surgery. Shelton: PMPH-USA; 2007.
  3. Chu SJ, Tan JHP, Stappert CFJ, et al. Gingival zenith positions and levels of the maxillary anterior dentition. J Esthet Restor Dent 2009;21(2):113–120. DOI: 10.1111/j.1708-8240.2009.00242.x
  4. Nordland WP, Tarnow DP. A classification system for loss of papillary height. J Periodontol 1998;69(10):1124–1126. DOI: 10.1902/jop.1998.69.10.1124
  5. Takei H, Yamada H, Hau T. Maxillary anterior esthetics. Preservation of the interdental papilla. Dent Clin North Am 1989;33(2):263–273.
  6. Takei HH. The interdental space. Dent Clin North Am 1980;24(2):169–176.
  7. Ahmad I. Anterior dental aesthetics: gingival perspective. Br Dent J 2005;199(4):195–202. DOI: 10.1038/sj.bdj.4812611
  8. Bhatsange A, Mehetre V, Waghmare A, et al. A quantitative evaluation of gingival zenith position of maxillary central incisors in different facial forms. IOSR J Dent Med Sci 2015;14(1):62–65. DOI: 10.9790/0853-14116265
  9. Frizzera F, Tonetto M, Cabral G, et al. Periodontics, implantology, and prosthodontics integrated: the zenith-driven rehabilitation. Case Rep Dent 2017;2017:1070292. DOI: 10.1155/2017/1070292
  10. Legan HL, Burston CJ. Soft tissue cephalometric analysis for orthognathic surgery. J Oral Surg 1980;38(10):744–751.
  11. Magne P, Belser U. Bonded porcelain restorations in the anterior dentition: a biomimetic approach. Chicago: Quintessence Publishing; 2002. 57–98.
  12. Singhal M, Singhal R. A CAD–CAM prosthodontic option and gingival zenith position for a rotated maxillary right central incisor: an evaluation. Indian J Dent Res 2012;23(1):112–115. DOI: 10.4103/0970-9290.99053
  13. Chander GN, Damodaran A, Balasubramanium M. Evaluation of proportion between incisal edge to gingival zenith distance and interdental papilla in maxillary anterior dentition of Indian population. J Clin Diagn Res 2016;10(3):40–41. DOI: 10.7860/JCDR/2016/16271.7449
  14. Patil VA, Desai MH, Assessment of gingival contours for esthetic diagnosis and treatment: a clinical study. Indian J Dent Res 2013;24(3):394–395. DOI: 10.4103/0970-9290.118005
  15. Chu SJ. Range and mean distribution frequency of individual tooth width of the maxillary anterior dentition. Pract Proced Aesthet Dent 2007;19(4);209–215.
  16. Cho HS, Jang HS, Kim DK, et al. The effects of interproximal distance between roots on the existence of interdental papillae according to the distance from the contact point to the alveolar crest. J Periodontol 2006;77(10):1651–1657. DOI: 10.1902/jop.2006.060023
  17. Martegani P, Silvestri M, Mascarello F, et al. Morphometric study of the interproximal unit in the esthetic region to correlate anatomic variables affecting the aspect of soft tissue embrasure space. J Periodontol 2007;78(12):2260–2265. DOI: 10.1902/jop.2007.060517
  18. Tarnow DP, Magner AW, Fletcher P. The effect of the distance from the contact point to the crest of bone on the presence or absence of the interproximal dental papilla. J Periodontol 1992;63(12):995–996. DOI: 10.1902/jop.1992.63.12.995
  19. Ganji KK, Alam MK, Alanazi AF, et al. Facial profile based evaluation of gingival zenith position in maxillary central incisors among Saudi, Indian & Bangladeshi population. Saudi Dent J 2018;30(4):342–347. DOI: 10.1016/j.sdentj.2018.05.008
  20. Bendahmash M, Dhafr F, Awwad A, et al. Evaluation of Saudi population perception of the proportion of maxillary anterior teeth width ratio to the dental papilla position. EC Dental Sci 2020;19(3):01–06.
  21. Nanal N, Shetty M, John N. A study to evaluate age and gender as determinants of papillary proportions in the esthetic region. J Osseointegr 2021;13(2). DOI:
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.