Objectives: This prospective study was to investigate the papillae height and width of attached gingiva around single-tooth implants in the esthetic zone of maxillae after exposure of implant using crestal rotated flap. Methods: According to the inclusion criteria and exclusion criteria, 41 submerged implants of 39 patients were included. Impressions were taken before stage 2 surgery. All implants were uncovered according to the crestal rotated flap technique reported by P. Palacci. The first incision was more palatal in order to increase the amount of available tissue to be pushed buccally. The releasing incisions were made more mesial and distal in the apical portion of the elevated mucoperiosteal flap, thus allowing reflection of a thick, wide flap from which two pedicles can be disengaged. The mesial papillae was created with a pedicle rotated 90 degrees mesially, and the distally rotated pedicle created the distal papillae. Then impressions were taken 4 weeks later after stage 2 surgery, and stone models were used to evaluate the loss of papillae through dial calipers. The width of attached gingiva and papillae index around single-tooth implants were investigated before and after surgery. The papillae index designated four different levels indicating the amount of papillae present. The assessment was measured from a reference line through the highest gingival curvatures of the adjacent tooth. Results: The increase in papillae height and width of labial keratinized gingiva were a mean of 0.78 ± 0.28mm, 0.59 ± 0.38mm,which were statistically significant by analysis of a paired t test (P<0.05). The change of gingival index showed no significant by statistical analysis of rank sum test (P>0.05). Conclusions: The main advantages of the crestal rotated flap technique were simplicity, predictability and esthetics, it consistently provided a higher papillae and wider zone of keratinized gingiva in the labial aspect of the maxillary implants.

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