A Case of the Dreaded Black Triangle

Consequences of gum disease

A Case of the Dreaded Black Triangle

Problem: a cosmetic challenge of acquired spacing between teeth and in the form of ‘black triangles’. This is caused by the loss of bone and shrinkage of gum tissue following gum disease. The patient did not wish for braces or any invasive forms of treatment.

Solution: now that the gum disease had been stabilised, this patient was referred to us to improve the appearance of this smile. Use of composite resin to redistribute spacing across a number of teeth so as to avoid making them look too large (wide) without use of drills, braces or surgery. Note how the upper black triangle has now had gum in-fill improving the overall appearance.

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Discussion Points: a relatively small task but not without multiple considerations and a difficult aesthetic balance to maintain. Certainly a more ‘perfect’ outcome was possible, with options such as tooth whitening, orthodontic alignment, or indeed sculpting the composite additions to deliberately ‘straighten’ the teeth out, or even through use of veneers. Nevertheless, careful shade (colour) selection and application of composite resin fulfilled the patient’s request for an instant improvement to her smile without resorting to more complicated solutions. The calculated position and contour of the restorations are designed to encourage the gum to fill in the unsightly black triangles (of space) while maintaining a more natural appearance.  However the more significant deficit of tissue loss between the lower front teeth was harder to mask within the limitations of this approach (addition of more composite would have resulted in over-contoured and unnatural looking teeth). The options to straighten and/or whiten the teeth are always available as future interventions should the patient so wish (although it is worth noting that any restorations would need revision for any colour changes as a result of whitening treatments at a later date).