This month, Cosmetic Dentistry Specialist, Manrina Rhode, discusses everything you need to know about black triangles and the different ways to treat them.
Today I will talk to you about black triangles.
Do you know what a black triangle is? They are small black areas that you find between the teeth very close to the gum line.
A black triangle could be present for many different reasons, but they are usually present due to loss of papillae in the area. Papillomas could soften due to gingivitis, recession, periodontal disease, etc.
It could also be eased due to post-orthodontic treatment, so where the teeth were potentially crowded before then they straighten out and the gums don’t get used to filling that gap.
You can tell after the treatment if it will fill properly by measuring the sound of the bones. If the contact point – the highest point of your contact point between two teeth – is five millimeters from the top of the bone, then, very likely, it will actually fill in and that black triangle will disappear.
It’s worth putting some numbing gel on the gums, taking a probe and popping it until you hit the bone and get some feeling so you can feel a little more reassured.
Close up of black triangles
Black triangles are something I always note on my new patient exams before starting any treatment plan or treatment. In the case of smile makeovers, the black triangle is the last of a patient’s concerns. Then you spend time doing orthodontics, teeth straightening, whitening, veneers, bonding, whatever, and they end up with that perfect smile.
But then their one concern in life will be that little black triangle. So you really want to 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, trying to close the dark triangle with the cosmetic work you do, ends up with a worse result than what you would end up with leaving it.
Important things to consider
First, the black triangles cannot be repaired by gluing or veneering. With a protrusion, you don’t want to leave trapped plaque that the patient can’t clear. Your restorations should always come together in a truly comfortable way.
But sometimes by elongating that contact point so that you’re pushing the nipples or having a tooth there to close the black triangle, that can make the tooth look quite bulky. So there might be some aesthetic benefits to leaving a black triangle there.
The other thing to consider when doing restoration work is that sometimes there is no black triangle. You can place temporaries where you know your teeth are stuck together while they are in temporaries. For example, on porcelain veneers all ten teeth tend to be bonded together in plastic while their temporaries go through.
Sometimes the plastic from the temporaries can temporarily soften the papillae. So when you fit your porcelain, there could initially be a black triangle, but you need to make sure that there wasn’t one before and that the gum will slowly build back into that space.
Using gum fillers to restore black triangles
What about black triangles caused by gingivitis or periodontal disease causing recession? You can get quite advanced black triangles, particularly around the lower incisors.
One treatment I am well known for is gum fillers. I brought the treatment to the UK from the US. I was there learning and hearing about the treatment – I believe I was the first practitioner to bring it. This involves taking filler that we use on the face and placing it in the papillae of the gums to fill in that black triangle.
It will only give you a very small amount of filling. It’s not like a lip where you can actually get a good milliliter of filler in it once a month and expand to these ridiculous sizes that some people go to. The nipples are quite tight, so you are limited in the enhancement you can achieve with gum filler.
It’s great for those really tiny black triangles though – you get a little expansion of the gum and that looks great.
Using welding to restore black triangles
Let’s say the gum filling was not enough and you had to restore the black triangle with bonding, the bonding should always be placed on two teeth. (Seems obvious, but just in case it wasn’t.)
The bond should be placed in the middle of one tooth and the distal of the other so that the patient can still floss, mimicking the natural boundaries of the tooth. This is so the patient can floss and clean and you don’t create additional problems by doing this.
Using orthodontic treatment to correct black triangles
And then, of course, if you’re going to move the teeth orthodontically and there’s going to be some IPD involved, if there’s a black triangle, you might want to place your IPD in areas where the triangle is.
This means you can bring the two closer together and minimize that black triangle.
I hope that helped and I hope it was an interesting discussion or summary about dealing with black triangles.
Have a nice day!
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Visit Manrina’s website here: www.drmrlondon.co.uk.
