Introducing Dr. Bill Cho

Perhaps not as entertaining as photos of Dr. Bell break dancing, dentistry is still our passion and profession and one of our jobs is to educate you. In previous posts we have been discussing gum recession so we have enlisted Dr. Bill Cho a periodontist we work with to provide information on how to deal with unsightly black triangles between the teeth that occur because of gum recession. He provides a description of the causes and options on how to prevent and restore the defects. We have provided  pictures of cases where we have used some of these solutions to restore a smile and function.

As with all the specialists we use Dr. Cho is one of the best of the best, a caring professional who does great work helping our patients with his expertise.

Why do I have a black triangle between my teeth?

A gum/gingival black triangle is an unsightly space beetween the teeth that appears dark because you can see the darkness of the mouth behind the teeth. Sometimes the space is irratating because you feel like air passes between your teeth or bubbles form when you talk. Normally, this space is filled with a triangular shaped gum tissue called a papilla. However, due to various reasons, the papilla tissue is lost. Known reasons for the black triangles include:

• Gum disease – where bone loss has occurred
• Trauma-acute accidental injury to the gum
•  excessive toothpicking, overly aggressive flossing, nail picking
• Poorly fitting dental work
• Anatomy – Malpositioned teeth
• Periodontal treatment/surgery

Problems with having black triangles:

Not only do black triangles pose a cosmetic concern, but they can also lead to poor gum health. Black triangles allow greater retention of food and debris, and no one likes the look of lettuce stuck in their teeth. This leads to an area where bacteria can flourish and cause greater gum inflammation. Prolonged gum inflammation eventually leads to bone loss around the teeth.

 The problems created by gum recession are not always as unsightly or dramatic as above and often can be solved in several ways

Ways to correct black triangles: 

Restorative Dental Corrections of  Black triangles

Adding to the teeth

There are various restorative techniques available to correct the black triangle. These techniques include composite bondings (white filling material that bonds to teeth), veneers (shell like tooth covers that are bonded to the teeth), and crowns. The restorations are made to fill in the dark spaces created by the loss of papilla tissue. This technique is the most common way to treat black triangles and at this time, the most predictable. This is not as easy as it seems as you have to  extend the tooth into the space and at the same time not make it appear larger or misshapen. 

 

From Bell Family Dentistry:  This is a case we recently treated.  The patient had cosmetically maligned teeth that  resulted in gum recession.  In realigning and whitening the teeth with bonding and a veneer we also also closed the black triangles. 

 

 

 

Creating fake gum: The Gingival Mask

Also known as dummy gums, these are pink  removal appliances that fill the black triangles. Similar to a denture, the gums can be removed at anytime. Most patients will wear these when going into public and remove them when they feel it is appropriate. This is the cheapest alternative to cover the black triangles.  Unfortunately this solution can be at times uncomfortable and awkward as it is removable.

Periodontal treatment of black triangles

 The filler technique

With the use of dermal fillers, the tissue can be plumped to fill in the black triangle space. An injection of the filler material is injected into the gum tissue until the space is filled in. However, much like facial fillers, this is a short term fix. It is shown that 6 months post-filler injection, the black triangle is back to its original form. This may be a good way to fill the space temporarily without having extensive dental work on the teeth.

Periodontal surgery to restore the lost gum

Many periodontal surgical techniques have been developed to augment the papilla tissue. However, none has been proven to be very effective. Gum grafting has proven to be successful in building gum tissue on the outer surface of teeth, but has not been successful in building tissue between teeth. In the future, a predictable technique will be developed that will that will provide as a long term solution..  When the technique is suceesful and proven we will be recommending it to our patients.

The best solution

Prevention, Prevention, Prevention. Good home care, routine dental care by your dentist, and the elimination of any traumatic injury to the tissue is the best medicine.