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Mother of All Dental Black Triangle Cases

by Dr. David Clark Nov 01, 2013 Aesthetics Not tagged yet...

"Black Triangles" a relatively new hot topic about an age old problem.


More and more we are hearing from patients about the unwanted space or "dental black triangles" that are developing between their teeth. This dark space, unfortunately, is what our human eye is drawn to.  It leaves the teeth looking old and dark.  This isn't because your teeth are dark, it is just the contrast between your white teeth, pink gums and dark space.    

There are several reasons that these black triangles form.  The first is just simply the shape of some teeth. When your teeth take on more of a triangle form, they connect with one another at the chewing surface but not near the gum line, leaving a larger gap between teeth. Another common cause is gum recession. If the gums surrounding your teeth begin to recede due to gum disease or bite-related problems, you may notice these black triangles begin to appear. If left untreated, they will grow larger over time.

Dentists using the Bioclear Matrix System can offer an alternative to veneers or crowns that provide unparalleled results with a minimally invasive process that will close these black triangles and dramatically improve your smile.  The space is filled with a glassy smooth and anatomically shaped composite material.  This process will not only close the space but will also dramatically brighten your smile.  

Using anatomically correct matrices and injection molding the composite, your dentist can achieve a rich, healthy smile restoration that will last, and help to preserve, and restore the papilla or gumline.  In many cases it is the only long lasting solution, especially on lower teeth.  

Intro to The Mother of All Black Triangles.

Sometimes a particular case comes along that appears, at first glance, overwhelming.  This case fits that description. (Fig1-3)  However, when this patient emailed my office and inquired regarding flying across the country to have me treat him, I had fortunately done many cases involving hundreds of teeth using the Bioclear Matrix system to treat dentitions afflicted with black triangles, albeit none of this magnitude. I felt absolutely confident that we could achieve a good outcome.  The trick was to disassemble the case into bite sized pieces. This case presents many excellent questions and the additional challenge of severe facial abrasions.  I will first review background of black triangles and of lower incisor complications and then proceed with the presentation of the clinical procedures used to treat this particular patient.

Dental Black Triangles Fig 1

 Fig 1) Preoperative view of black triangle case.  Notice the pursing of lips and forced smile of a patient who is embarrassed of the aesthetics of the lower teeth

 Dental Black Triangles up-close Fig 2 Crop

Figure 2) The receded papilla height of the anterior teeth was not significantly lower than that of the posterior teeth, ruling out a surgical approach

Dental Black Triangles Bottom Teeth Fig 3

 Figure 3) This view demonstrates the unique “twisted butter knife” anatomy of the lower incisor tooth

Black Triangles: Prevalence and Patient Attitudes

One-third of adults suffer from black triangles or more appropriately referred to as open gingival embrasures. 1   Besides being unsightly and prematurely aging the smile, black triangles are prone to accumulate food debris and excessive plaque. 2  A recent study of patient attitudes found patient dissatisfaction with black triangles to rank quite highly among aesthetic defects ranking third following carious lesions and dark crown margins. 3  If you go online and Google “dental black triangles”,  you will view hundreds of patient black triangle questions and of patient complaints and lawsuits resultant from adult orthodontic cases and post-periodontal therapy papilla loss.  This clinical and esthetic dilemma demands more attention from our profession.  The caveat is that until now, there has been no easy, minimally invasive approach for treatment.  



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