Relationship of Papilla Fill and Peri-Implant Esthetic Parameters with Radiographic Findings in Anterior Single-Tooth Implants

Objectives: To evaluate the relationship between papilla fill, peri-implant esthetic outcomes, and radiographic parameters in anterior single-tooth implants, and to assess the clinical applicability of the Complex Esthetic Index (CEI). Materials and Methods: This cross-sectional study included 38 systemically healthy adults (28 females and 10 males; 18–65 years) with 45 anterior single-tooth implants functioning for at least one year. Clinical parameters, including plaque index, gingival index, bleeding on probing, and probing depth, were recorded. Esthetic outcomes were assessed using the CEI. Interproximal bone levels and apicocoronal implant position were measured on standardized periapical radiographs using ImageJ software, version 1.53 (National Institutes of Health, Bethesda, MD, USA). Results: Plaque index and gingival index values were significantly lower around implants than whole-mouth averages (p < 0.001 and p = 0.018, respectively), whereas probing depth was significantly greater at implant sites (p < 0.001). Bleeding on probing did not differ significantly between implant and natural tooth sites. Interproximal bone level was significantly associated with papilla fill, with complete papilla fill decreasing when the contact point-to-bone crest distance exceeded 5 mm (mesial p = 0.005; distal p = 0.003). Apicocoronal implant position was significantly associated with vertical soft-tissue level (p < 0.001). Conclusions: Interproximal bone support is significantly associated with papilla fill in anterior single-tooth implants. Nevertheless, peri-implant esthetic outcomes are influenced by a combination of hard- and soft-tissue characteristics, surgical factors, and prosthetic design. The CEI is a useful clinical tool for comprehensive esthetic evaluation.