When considering the many aspects to dental aesthetics that can contribute to an ideal smile, it’s essential to not underestimate the impact of of open gingival embrasures, commonly known as black triangles.
The absence of interdental papilla creates spaces within the dentition, posing both functional and aesthetic complications.[i] These small gaps facilitate the retention of food debris – obviously detrimental to the health of the periodontium[ii] – and smiles with multiple large black triangles are seen to be less attractive than a conventionally healthy smile.[iii]
There is a consensus that demand for cosmetic dentistry is rapidly growing, and social media (including the likes of Instagram, Facebook, and Snapchat) is one driving factor behind the surge.[iv] As such, patients may be presenting at your practice looking for treatments for black triangles more often moving forward.
Understanding how to effectively aid these individuals with minimally invasive solutions is key, and could help you expand your everyday treatment offerings too.
A developing problem
Black triangles, sometimes referred to as open gingival embrasures, are by no means uncommon. They are particularly common within the elderly population, but some estimates put incidence rates at 67% for individuals over the age of 20.[v] For younger patients, this is only 18%.v
A multitude of factors could contribute to the development of black triangles. These include aging, periodontal disease, the loss of height of the alveolar bone relative to the interproximal contact, root angulations, triangular-shaped crowns, and so much more.ii Fixed orthodontic treatments can increase the development of open gingival embrasures by approximately 58%.[vi]
With an older population that is expected to grow in the coming years[vii] and the established rise in aesthetic dentistry demand, including orthodontic treatment, it can be postulated that the prevalence of black triangles will also develop with time.
Advising patients on how to avoid the development of black triangles can be simple: engage in a sustained oral hygiene routine. This will help to prevent the development of periodontal diseases that cause gingival recession and bone loss, and brushing gently will avoid abrasion to the gingiva.[viii] However, with some factors such as aging, crown shape, and root angulations being largely out of an individual’s control, even the most diligent of patients may have concerns.
Minimally invasive solution
Providing a highly functional and, importantly, aesthetic solution to patients in these cases is key.
Veneers, orthodontics, and surgical interventions such as papilla re-contouring, preservation and reconstruction have each been discussed as potential solutions in the literature.i However, none of these fulfil the demand of predictability with a minimally invasive approach, a combination that is understandably attractive to many clinicians.
This is where the Bioclear® Method presents as an effective treatment option. With the utilisation of injection moulding the Bioclear® Method involves using flowable composite and heated conventional composite within anatomical clear mylar matrices, and has the advantage of creating a homogenous monolithic restoration that is stronger than composite layering, whilst retaining aesthetics.[ix]
With matrices of differing sizes and individualised shapes, clinicians can eliminate black triangles whilst establishing the appropriate height of a contact zone, as well as an emergence profile that will perfectly support the soft tissue.ix These are essential to achieve an aesthetic result whilst respecting the gingiva.
The Bioclear® Method is notable for being entirely additive. Heated flowable and paste resin composite materials fill a Bioclear® matrix in a manner that allows for an ideal transition to the tooth structure, thanks to the solutions’ viscosity. It can then be moulded into a thin layer, requiring a simple etch-and-rinse protocol for effective adhesion, and preserving the entirety of the healthy tooth structure.[x]
Where other approaches are unappealing due to their complex nature and demand for extensive clinical expertise,ix such as for the use of conventional celluloid matrices,x the Bioclear® Method is simpler to implement whilst promising brilliant results.
Materials make the difference
Alongside the clinician’s technique, the chosen flowable and conventional composite solutions will make all the difference in providing an aesthetic and functional result through the Bioclear® Method. For black triangle restorations in the anterior dentition, consider solutions like the Filtek Supreme Flowable Restorative and Filtek Supreme XTE Universal Restorative composite materials from Solventum, formerly 3M Health Care. The award-winning* Filtek Supreme Flowable Restorative offers exceptional adaption and versatility, and is made with TRUE nanotechnology from Solventum for excellent polish retention and wear resistance. Used in conjunction with the Filtek Supreme XTE Universal Restorative, which is available in 36 shades for optimised aesthetics, black triangles can be a concern of the past.
Black triangles are as much of an aesthetic concern as they are a functional problem, and a risk for the health of oral tissues. By implementing non-invasive and predictable approaches to restorative care, such as the Bioclear® Method, clinicians can approach this common problem with confidence, and provide restorations that patients love.
©Solventum 2024. Solventum, the S logo and Filtek are trademarks of Solventum and its affiliates. 3M and the 3M logo are trademarks of 3M.
*Dental Advisor Research Award 2024 winner: https://www.dentaladvisorawards.com/products/3m-tm-filtek-tm-supreme-flowable-restorative
About Solventum
At Solventum, we enable better, smarter, safer healthcare to improve lives. As a new company with a long legacy of creating breakthrough solutions for our customers’ toughest challenges, we pioneer game-changing innovations at the intersection of health, material and data science that change patients’ lives for the better while enabling healthcare professionals to perform at their best. Because people, and their wellbeing, are at the heart of every scientific advancement we pursue. We partner closely with the brightest minds in healthcare to ensure that every solution we create melds the latest technology with compassion and empathy. Because at Solventum, we never stop solving for you.
[i] Kajal, D. P. A., Bali, S., Garg, A., & ArunaNautiyal, D. V. R. S. (2022). Management Of Black Triangles–A Review. Journal of Pharmaceutical Negative Results, 1861-1868.
[ii] Al-Zarea, B. K., Sghaireen, M. G., Alomari, W. M., Bheran, H., & Taher, I. (2015). Black triangles causes and management: a review of literature. British Journal of Applied Science & Technology, 6(1), 1.
[iii] Al-Omiri, M. K., Atieh, D. W. A., Al Nazeh, A. A., Almoammar, S., Bin Hassan, S. A., Alshadidi, A. A. F., … & Lynch, E. (2024). Relationships between perception of black triangles appearance, personality factors and level of education. Scientific Reports, 14(1), 5675.
[iv] Abbasi, M. S., Lal, A., Das, G., Salman, F., Akram, A., Ahmed, A. R., … & Ahmed, N. (2022, October). Impact of social media on aesthetic dentistry: General practitioners’ perspectives. In Healthcare (Vol. 10, No. 10, p. 2055). MDPI.
[v] Nagaraj, E., Kondody, R. T., Kalambettu, A., Rao, S. M., Nambiar, M., & Nair, S. G. (2022). Multidisciplinary Consideration for Managing Gingival Black Triangles in Aesthetic Dentistry: A Review.
[vi] Rashid, Z. J., Gul, S. S., Shaikh, M. S., Abdulkareem, A. A., & Zafar, M. S. (2022, July). Incidence of gingival black triangles following treatment with fixed orthodontic appliance: a systematic review. In Healthcare (Vol. 10, No. 8, p. 1373). MDPI.
[vii] Centre for Ageing Better (2023) Our Ageing Population. In: State of Ageing 2023-24. (Online) Available at https://ageing-better.org.uk/our-ageing-population-state-ageing-2023-4 (Accessed May 2024)
[viii] Archibald, J., Stanborough, R. J., (2020). What to Do About Black Triangles Between Your Teeth, Healthline. (Online) Available at: https://www.healthline.com/health/dental-and-oral-health/black-triangles-teeth [Accessed May 2024]
[ix] Ferrando Cascales, Á., Agustín Panadero, R., Amengual Lorenzo, J., Sauro, S., Mendoza Rodríguez, A., Ferrando Cascales, R., … & Clark, D. (2024). Minimally Invasive Cosmetic Restoration of Teeth Associated with Open Gingival Embrasures. Descriptive Case Series. Journal of the California Dental Association, 52(1), 2313244.
[x] Hussien, A. O. T., Ibrahim, S. H., Essa, M. E. S., & Hafez, R. M. (2023). Restoring black triangle with bioclear matrix versus conventional celluloid matrix method: a randomized clinical trial. BMC Oral Health, 23(1), 402.
