Still missing interdental papilla after gum and bone grafts 2 years ago - what is causing this? (photos)

Hi,Your case is a massively difficult one to get right! It looks like your upper right lateral incisor is an implant tooth, and the canine is a new crown, is this right? You have what we call a thin bio type, this means the gum on your bone is thin, and the amount of bone on the roots of your teeth is thin, you can see this because you can almost see the roots of the teeth through the bone. The problem with thin bio types is that the gum quickly shrinks after the tooth is removed! Your question is about the papilla, and not the gum height, so I assume you have been advised about how hard your case is to get perfect! The papilla is related to the level of bone in the area, and the distance between this and the contact point between the teeth. If this distance is too much, then the gum may not fill in. Your best option is usually to change the crown contact point - but it looks like you already tried this! Another option might be to use a dermal filler (something people use to get bigger lips etc), and fill the gum between the teeth. This is quick and easy, but you will need to redo it, as its not permanent. If you can avoid it, you should not change the abutment on the implant, as this can lead to bone loss, and hence reduce papilla's.If these things do not work, you may be best off seeking the advise of an experienced dental surgeon who may be able to do some soft tissue surgery to build up the papilla. I hope this helps! Gurs