Implant-Based Strategies for Interdental Papilla Preservation and Regeneration in Single-Tooth Edentulous Spaces of the Esthetic Zone: A Narrative Review

Background/Objectives: Loss of the interdental papilla in a single-tooth edentulous site within the esthetic zone is a frequent clinical issue with functional and psychosocial impact. This literature review aimed to appraise and synthesize the published clinical evidence on implant-based strategies for regenerating and preserving the interdental papilla in single-tooth edentulous spaces within the esthetic zone, with emphasis on methodological quality, esthetic outcomes over time, and patient satisfaction. Methods: A structured search was performed across PubMed/MEDLINE and Scopus, complemented by gray-literature sources including Semantic Scholar, complemented by gray-literature sources, resulting in 498 papers. The studies included adult patients with single-tooth edentulism in the anterior maxilla, reported at least one esthetic parameter, and followed up patients for a minimum of 6 months. Data analysis included study characteristics, surgical and prosthetic techniques, esthetic results, complications, and patient satisfaction. Results: A total of 27 studies fulfilled the inclusion criteria. The short-term studies (<12 months) showed favorable interdental papilla fill with immediate flapless implant placement followed by provisional restoration. Mid-term results (12–36 months) indicated stable interdental papilla presence, alongside Pink Esthetic Score/White Esthetic Score values with ridge preservation and augmentation increasing predictability. In the long-term studies (>36 months), minimal recession was reported after 12 months. Conclusion: Immediate implant placement with provisional restoration, minimally invasive approaches, and connective tissue grafting in thin gingival phenotypes are the strategies most consistently associated with favorable interdental papilla preservation outcomes in the available observational evidence; causal efficacy under controlled conditions remains to be established by adequately powered randomized trials.