How do you know when your multi-unit implant restoration will need prosthetic gingiva? This is a challenging situation for many providers but understanding several key concepts should ease your apprehension. 1) Lip position in full smile, 2) presence of existing papilla and 3) the size of the defect being restored are the main guidelines to help understand when prosthetic gingiva will be needed.
A beautiful smile possess both esthetic and proportional white and pink components. Even patients with a low smile line usually have papilla that are present. Despite having fantastic prosthetic teeth, missing gingiva results in a cosmetic failure. The average central incisor is about 10.5-11.5 mm long. If the alveolar ridge has not experienced resorption or trauma, then most likely you only need to replace the missing teeth and prosthetic gingiva will not be required.
If you designed your restoration and you notice it takes 12+mm of tooth length from alveolar ridge to ideal incisal edge position, you probably will benefit from prosthetic gingiva so you don't end up with long piano key looking teeth. If you don't have a natural papilla, that's another indication when the restoration could benefit from prosthetic gingiva. And lastly, a low smile line may mitigate the need for prosthetic gingiva, but medium to high smile lines will increase your chances of needing some pink if the defect if large.
"Prosthetic Gingival Reconstruction in a Fixed Partial Restoration. Part 1:" Coachman, C. Intern Jour of Perio and Rest Dent. Vol 29, Number 5, 2009.
"Papilla Proportions in the Maxillary Anterior Dentition" Chu, S. Intern Jour of Perio and Rest Dent. Vol 29, Number 4, 2009