Inclusion criteria  Good general health, no chronic systemic diseases. All subjects included in this study needed to have one missing premolar or molar teeth with adjacent natural teeth. All subjects included in this study had been treated with one bone-level implant insertion in the premolar or molar region. The patients had insufficient gingival papilla height (referred to contralateral natural tooth which also had insufficient gingival papilla height) and at least 2 mm of keratinized tissue width around the implant.  Exclusion criteria  Active periodontal infections. Heavy smoking (> 10 cigarettes per day).