Elsevier

Dental Abstracts

Volume 60, Issue 3, May–June 2015, Pages 138-140
Dental Abstracts

Hands On
Gingival black triangles

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Background

The esthetics of a smile can be compromised by the loss of interdental papillae, causing gingival black triangles (GBTs). Patients may experience phonation problems or have issues related to food and plaque accumulation. GBTs are the third most disliked esthetic problem affecting teeth after caries and crown margins. Techniques are available to manage GBTs, but the approaches and results have been inconsistent. Low blood supply to the papillae makes them fragile and sensitive to recession. As a

Causes of GBTs

Several factors contribute to the development of GBTs. These include the interproximal space dimensions between teeth, the distance between interproximal contact position and bone crest, gingival biotype, patient age, periodontal disease and loss of attachment, diverging roots after orthodontic treatment, and tooth morphology and abnormally shaped crowns and restorations.

A wider interdental width may permit better blood supply to the papilla tip, but a very wide width increases the risk for a

Management

Treatment can involve surgery, tissue engineering, tissue volumizing, tooth shape modification, restorative materials, or orthodontic movement. Among the surgical techniques are that that release, reflect, and stabilize the papillae. The most recent techniques use a modified papilla preservation flap (MPPF) and a simplified papilla preservation flap (SPPF) combined with enamel matrix proteins (EMPs) and acellular dermal matrix allografts.

Tissue engineering contributes to less invasive

Discussion

GBTs are caused by a reduction in the interdental papillae and develop in association with a multitude of factors. Orthodontic treatment can both cause and treat GBT development. Many treatment options are available, so the dentist should evaluate each case to determine the best approach.

Clinical Significance

Patients really dislike those dark triangles between their teeth and want them to go away. Dentists have numerous approaches they can use to minimize or eliminate GBTs. Management is

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Ziahosseini P, Hussain F, Millar BJ: Management of gingival black triangles. Br Dent J 217:559-563, 2014

Reprints available from BJ Millar, King’s College London Dental Inst, Bessemer Rd, London, SE5 9RW; e-mail: [email protected]

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