Identifying Key Factors in Papilla Growth Around Implants: Focus on Intraoral Negative Pressure

The absence of interdental papillae in dental prosthetics often leads to unsatisfactory esthetic outcomes, such as black triangles and elongated clinical crowns. While previous research has demonstrated that papillae can regenerate in a coronal direction, the underlying mechanisms remain incompletely understood. Several theories have been proposed to explain this phenomenon, but no clear cause-effect relationship has been established among the various factors involved in spontaneous papilla growth around implants. This study aims to identify and classify the factors influencing this process. Various potential contributors were analyzed, including adjacent elements, buccal-lingual papilla width, contact point position, convergent neck design, crown overcontour, intraoral negative pressure, and others. To systematically organize these factors, a modified Overton Window and a mind map were employed. The factors were categorized as cause-related, essential, or influencing based on the collective opinion of the research group following a comprehensive review of the relevant literature. In the absence of clear evidence supporting a definitive cause-effect relationship, Occam's Razor (the principle of parsimony) was applied to identify the most plausible cause-related factors.