Papillae loss: How to manage?

That looks better than most!

If planning this case I would have gone with a wider implant as the mesial distal space width is wide and getting emergence profile with this implant can be challenging. I would have no matter what implant placed (and it may have been done) placed a connective tissue graft at implant placement to bulk up the tissue. Then at uncovery made an incision to the palatal and pushed the tissue facially and shaped it with a screw retained provisional crown. So what to do now. I would make an undercontoured screw retained provisional crown (concave subgingivally) place that and do a connective tissue graft trying to thicken the tissue and move it move incisally position the tissue more incisal then you ideally want as you will get some shrinkage as it heals in the apical direction. let that site for 2 months before moving to a final crown so the tissue is stable. vertical releasing incisions should be made between 7-8 and 10-11

Remove healing cap and replace with cover screw. Let the tissue to heal over, perform connective tissue graft to build bulk of tissue, wait for 2 to 3 months, place temporary crown over temporary abutment to form a shape, then replace with permanent. Another think you have to look at is what angulation this implant has, if implant to buccal then your best will be to make crown with pink porcelain, if implant place with correct angulation then follow steps I described above. Good luck.

There are two problems to overcome with this case: 1) The gingival height at the zenith of the implant crown will need to be plumped up and moved incisally. The best way to achieve this would be with a vascularized CT pedicle graft from the palate by covering over the implant and cover screw. Uncovering would be done with a lingualized incision to push the soft tissue to the buccal. Also creating a concave facial surface on the abutment and crown will decrease pressure on the soft tissue and diminish any recession as noted in the comments above. This type of CT graft will have far less shrinkage than a conventional CT graft. 2) the other issue is the actual papilla height (especially on the lateral incisor). No amount of grafting will bring the papilla more incisally. The only way to resolve this problem is to do slow orthodontic extrusion of the lateral incisor to bring the bone and papilla with it more incisally. (Additionally the mesial papilla of the central incisor is more apical than ideal. This may be able to be camouflaged since it is in the midline and does not have a balancing papilla to match). We have successfully corrected papilla issues next to implants using these techniques with good results at Midwestern University Dental School in Glendale, Arizona but it does take a cooperative patient since the fix is not quick. (As a side bar...when treatment planning implants in the anterior where the patient has a high smile line, we have found it very helpful to maintaining papilla height next to pontic sites by performing RCT on the adjacent teeth to the implants and then root banking them...this makes a significant improvement in papilla maintenance in highly esthetic areas...these teeth are hopeless but not useless)

Dear Dr. Elijah Arrington III, thank you for posting that very impressive video.