Closing black triangles?

black triangle with Bioclear

Black triangle teeth treatment options

Black triangle teeth treatment choices will vary from dentist to dentist and the method that we choose depends on the reason for the black triangle, the patient’s desires, and the dentist’s experience.

Closing tooth black triangle options

The main options for treating teeth black triangles are restoratively, orthodontically, prosthetically, or surgically.

  1. The restorative option means with fillings or veneers and is the most common and almost always the best choice.
  2. Closing the spaces with braces is possible but would never be the primary reason for getting braces.
  3. Prosthetically means with a removable appliance, called an epithesis.
  4. Surgical closure is tricky and unpredictable.

Closing a black triangle with composite and Bioclear.

Black triangle teeth treatment restorative option

Bioclear is a company that makes great products for closing black triangles with composite. This and closing them with dental veneers is common and easy for most cosmetic dentists.

Tooth black triangle removal with Bioclear composite.
Teeth with a black triangle and an immediate post picture, which is why the gums are a little red and inflammed.

To close black triangles in the gingival embrasure when restoring teeth with veneers or crowns, there are clinical and technical design procedures required before preparing the tooth or manufacturing the restoration. Preparation design is a very important factor in closing a black triangle.

  1. We must extend the tooth preparation subgingivally. The depth will depend on the volume of space that needs to be closed. The larger the space, the deeper we need to place that margin intracrevicular. The maximum depth should not exceed one-half of the measured sulcus depth.
  2. We must extend the interproximal finish line palatal past the interproximal contact. The larger the space, the further the preparation will extend toward the palatal aspect of the tooth. We prefer a slice prep.
By designing the tooth preparation as above, the technician can design the final restoration with a convex morphology to close the space and create a cleansable restoration.

Restorative tricks for dental implants

Tarnow research shows that dental implants need to have 5mm from bone height to IP contact to get 100% closure. A trick you can use to hide a black triangle is how you rotate the teeth if you are doing multiple teeth next to each other. A soft rotation will open a black triangle whereas a hard rotation will help hide or eliminate one.
How to rotate teeth to hide a black triangle.
This is a great photo from a Lane lecture.

Treatment options using orthodontics

Using braces to close black triangles is doable. However, that is not a reason to get braces and the only way to do it with braces is to shave away tooth structure in-between the teeth. If the black triangle is larger then we would need to remove too much tooth structure to make this work. The times this is useful is very rare.

Black triangle teeth treatment prosthetic option

The epithesis is a removable appliance that mimics gums and you will also see the term “gingivamol” or party gums online. It is better than nothing but is not highly esthetic. Usually the product is made of silicone. It is best for people with a lot of expensive bridge work that would require a major investment to fix without this option.

Black triangle teeth treatment surgical option

This option requires extreme skill, perfect patient care after surgery, and a bit of luck. There are both surgeries which I will not even cover in this post and then there are fillers, I cover the fillers elsewhere.

Black triangle in-between teeth after braces

This is a fairly common issue with adults. Typically the person is upset and feels the braces or the dentist is to blame. Really what happens is as the crowding disappears as the teeth move farther apart and the black triangles then appear. The person will either have black triangles or crowding and that’s just the way they are. There is no sure way to determine who is at risk of this, although those with or prone to gum disease are more likely. Some of the black triangles will get better over the next 6 months but only time will tell to what extent. All the individual can do is floss and maintain excellent oral hygiene to encourage optimal gingival rebounding.