Black triangle - Ravis Dental Care

With increasing demand for esthetic in dentistry, patients are more concern about beautiful smile. Interdental papilla that fills the triangular space (embrasure) between teeth is key component for esthetics. Loss of this interdental papilla between teeth due to various reasons leads to formation black triangular spaces which are unesthetic. These black triangles also pose problems with speech and plaque accumulation.

These black triangles can occur in about 67 % of people above 20 years of age. Due this high prevalence, even dentist should be aware of various techniques to correct these black triangles and restore esthetic smiles. But its unfortunate many dentists are not aware of recent techniques and their predictability in correcting black triangles.

Causes of Black Triangles

Plaque associated lesions - gum inflammation, attachment loss leads to underlying bone loss. This may turn into loss of interdental papilla.
Traumatic oral hygiene procedures- improper and aggressive brushing techniques may lead to black triangle.
Abnormal tooth shape- abnormal tooth shape may lead to improper gingiva pailla architecture which increase the incidence of black triangle.
Improper contours of the restoration- improperly contoured restoration can lead food accumulation, inflammation and loss of papilla.
Spacing between teeth-
Loss of teeth

Factors contribute to black triangle formation

Underlying bone support to interdental papilla- lack of underlying bone leads to collapse of interdental papilla leading to black triangle.
Gingival biotype- thinner gingival biotype have more risk of black triangle
Periodontal bioforms- high scalloped gingiva poses more risk of black triangle following implant or restorative procedures.
Diverging roots and post-orthodontic treatment- correction of crowded anterior teeth, orthodontically may lead to diverging roots and stretch the interdental papilla, increasing the risk of black triangle.
Tooth morphology- triangular shape teeth with high gingival scallop have higher incidence of black triangle.

Treatment options for black triangle

Surgical approach:

Periodontal plastic surgery by bone grafting and papilla reconstruction is one treatment option for black triangle. But due to limited blood circulation to papilla, its reconstruction is less predictable.

Tissue engineering:

Combing periodontal surgical procedure with injection of periodontal cells with regenerative capacities is one technique of treating black triangle.

Tissue volumizing:

Hyaluronic acid injection into papillary tissue is used to reduce the black triangle.

Reshaping and restoring tooth shape

Reshaping or restoring the shape of teeth or restoration improves the shape of papilla that fills the embrasure space. This helps to reduce the black triangles.

Pink restorative materials:

Interdental space should be restored with pink coloured restorative material. Bioclear restorative system is recent matrix system is used treat black triangle in more predictable manner.

BioClear restoration technique: This is recent injection moulding technique used for filing black triangle space. This is non-invasive and predictable method. This technique provides more aesthetic recontouring of teeth and filling space with healthy papilla.

Veneers: ceramic or composite gingival veneers can help to reduce black triangle.

Orthodontic correction: closure of the interdental space with orthodontic treatment be attained with a bodily movement of the two adjacent teeth.

Ravi Kumar

MDS, CONSERVATIVE DENTISTRY AND ENDODONTICS