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Papillary contours can be classified with the Jemt index:33
| Jemt Index Category | Description of papillary appearance |
|---|---|
| Index 0 | Absence of interproximal dental papilla |
| Index 1 | Presence of gingival papilla, measuring less than half the distance between the imaginary line and the interdental contact point |
| Index 2 | Presence of gingival papilla, measuring at least half the distance between the imaginary line and the interdental contact point, but without filling the entire interdental space |
| Index 3 | Presence of gingival papilla filling the entire interdental space |
| Index 4 | Hyperplastic gingival papilla, covering part of the crown or prosthetic crown adjacent to the studied area. |
Papillary fill that completely fills the space from the interdental contact point to the level of the surrounding gingival tissues (Jemt index 3) is considered most esthetic. Papillary overfill (Jemt index 4), seen in cases of significant gingival inflammation, and missing or blunted gingival papillae (Jemt index 0-2) are both considered suboptimal esthetically.32 Incomplete papillary fill is sometimes referred to as a “black triangle” and may be caused by interproximal bone loss, triangular tooth form, root divergence, open interdental contacts, or because of inflammatory periodontal disease and/or its treatment with resective periodontal surgery. It is well-established that papillary fill is related to the distance from the interdental contact point to the crest of the interproximal bone. When the distance from the contact point to the crest of the alveolar bone is ≤ 5mm, papillae are present 100% of the time, but when the distance between the contact point and the interproximal crest is 6mm is papillae are only present 56% of the time.34
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