This month, the Aesthetic Dentistry Expert, Manrina Rhode, discusses everything you need to know about black triangles and the different ways of treating them.
Today I’m going to talk to you about black triangles.
Do you know what a black triangle is? They are little black areas that you get interproximally between teeth quite close to the gum margins.
A black triangle could be there for many different reasons, but they’re usually there due to loss of papillae in the area. Papillae could be blunted because of gum disease, recession, periodontal disease etc.
It could also be blunted due to post-orthodontic treatment, so where teeth were potentially crowded before and then they are straightened up and the gingiva is not used to filling in that gap.
You can tell after the treatment if it will properly fill in by measuring by bone sounding. If the contact point – the highest point of your contact point between two teeth – is five millimetres from the crest of bone, then, more than likely, that really will fill in and that black triangle will disappear.
It’s worth popping some numbing gel on the gum, taking a probe and popping it up until you hit bone and having a little feel so you can feel a little more reassured.
Closing black triangles
Black triangles are something that I always make a note of in my new patient exams before starting any treatment plans or treatments. In the case of a smile makeover, the black triangle is the last of a patient’s concerns. You then spend time doing some ortho, straightening teeth, whitening, veneers, bonding, whatever it is that you’re doing, and they end up with this perfect smile.
But then their one concern in life will be that small black triangle. So you really want to make a note and let them know, ‘look, that black triangle was there before we started, and so it’s still there now, but look how amazing everything else is’.
Sometimes, by trying to close the black triangle with the cosmetic work that you’re doing, you end up with a worse result than you would end up with by leaving it.
Important things to consider
Firstly, black triangles can’t be closed restoratively with bonding or with veneers. With a ledge, you don’t want to leave any plaque trapped that the patient can’t clean. Your restorations always needs to meet in a really comfortable way.
But sometimes, by elongating that contact point so that you’re squeezing the papillae, or you’ve got tooth there to close the black triangle, that can make the tooth look quite bulky. So, there can be some aesthetic benefits to leaving a black triangle there.
The other thing to consider when you’re doing restorative work is sometimes there is no black triangle. You might place temporaries where you know your teeth are stuck together while they’re in a temporary phase. For example, in porcelain veneers all ten teeth tend to be stuck together in plastic while they go through their temporaries.
Sometimes the plastic from the temporaries can temporarily blunt the papillae. So, when you come to fit your porcelain, initially there could be a black triangle, but you need to be reassured that it wasn’t there before and the gum will slowly build back into that space.
Using gum fillers to restore black triangles
What about black triangles that are caused by by gingivitis or periodontal disease causing recession? You can get quite advanced black triangles particularly around lower incisors.
A treatment that I’m known well for are gum fillers; I brought the treatment to the UK from the United States. I was over there learning and heard about the treatment – I believe I was the first practitioner to bring it over. What this involves is taking filler that we use in the face and placing that into the papillae of the gum to fill out that black triangle.
It will only give you a very small amount of filling. It’s not like a lip where you can really get a good amount of one millilitre filler in it once a month and expand to these ridiculous sizes that some people go to. The papillae is quite tight so you’re limited in the improvement you can get with gum filler.
However, it’s lovely for those really tiny black triangles – you get a little bit of expansion of gum and that looks great.
Using bonding to restore black triangles
Say gum filler wasn’t enough and you needed to restore the black triangle with bonding, bonding always needs to be placed on two teeth. (It seems obvious, but just in case it wasn’t.)
The bonding needs to be placed on the mesial of one tooth and on the distal the other so the patient can still floss, mimicking natural tooth margins. This is so the patient is able to floss and clean, and you’re not creating extra problems by doing that.
Using orthodontic treatment to restore black triangles
And then, of course, if you’re going to orthodontically move the teeth and there’s going to be some IPR involved, if there’s a black triangle, you may want to position your IPR in areas where the triangle is.
This means you can bring the two closer together and minimise that black triangle.
I hope that helped and I hope it was an interesting discussion or synopsis on the treatment of black triangles.
Have a good day!
Catch up with previous Aesthetic Dentistry Expert columns:
- The bright side of whitening
- Balancing ethics and expectations
- The importance of aesthetic dentistry training
- The ‘dark side’ of crowns
- The dark side of composite bonding.
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Visit Manrina’s website here: www.drmrlondon.co.uk.