Tooth and gingival appearance have gradually become an important issue in dentistry, especially in patients with high smile lines. Insufficient fill of the papilla in the interproximal area can cause ”black triangles” between the teeth, thus compromising esthetics. There are numerous causes of papillary loss and also some factors that we may alter to increase the possibility of the presence of interdental and inter-implant papilla. Various methods have been developed in aim to preserve and reconstruct the interproximal papilla. However, the outcomes are not predictable. Further studies on how the papilla may be regenerated could provide a resolution to unesthetic situations. (J Taiwan Periodontol 17:99-109, 2012)