Injection of hyaluronic acid filler or silicone to close a black triangle.

Closing a black triangle can be very difficult if not impossible.  A newer technique being used is to inject hyaluronic acid filler or silicone into the area.

Steps to close a black triangle with filler

1. Insert small amount of filler into 1cc luer lock syringe
2. Remove the tip of a 27 g needle (creating a flat, end-discharging needle)
3. Insert 19 gauge or larger at least 5mm from papillary tip
4. Slow firm pressure no more than .2cc filler
5. While maintaining pressure on injection site, massage filler down
6. No flossing and light brushing only for 48 hours
7. Revisit in 4 weeks if needed

Tips

1. Only clear fillers
2. Higher concentration or larger molecule HA will last longer
3. Best for smaller black triangles in the range of 1-2mm

Reference Implant Practice article Volume 6 Number 3

Closing the black triangle via VITA

This is an interesting concept, similar to other tunneling grafting. Probably best for taking a really bad situation and making it not terrible. Saleh IJOI 2023 does a wonderful job of this technique and has great photos and illustrations.

Closing the space restoratively

This is the most predictable method but most damaging to the teeth. 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. This post focuses on the clinical portion of the preparation design.

1. Extending the tooth preparation subgingivally. The depth will depend on the volume of space that needs to be closed. The larger the space, the deeper that margin will need to be placed intracrevicular. The maximum depth should not exceed one-half of the measured sulcus depth.
2. Interproximal finish line must extend palatal to the interproximal contact. The larger the space, the further the preparation will extend toward the palatal aspect of the tooth.