Black Triangles and its Management- A Review

In the modern, fast-paced world the concept of aesthetics is very important to all people. The degree of aesthetic value may vary from person to person but the basic idea of it is more or less equivalent in all people. Similarly, in dentistry, the value of aesthetics is very high. Open gingival embrasures or black triangle cause complex functional and aesthetic problems. Management of such problems requires careful evaluation of the underlying causes. In today’s aesthetic environment where both the dentist and the patient are aware of aesthetic value, the real challenge was to reconstruct this lost papilla and moreover to obtain stable and sustainable results. This review was carried out after electronic searches in databases such as PubMed, PubMed Central, MEDLINE, Google Scholar, and MeSH. Manual searches of hard copies were also done. Studies included ranged from a time period of 1992–2016 and included clinical trial researches. A total of 19 articles were chosen for this review. These articles satisfied the various inclusion criteria and were taken after a detailed assessment of the full-length articles. Black triangles pose multiple problems both to the dentist and patients. The causes of Black triangles are multifactorial and they can occur after various dental therapies. A strong connection is found between their occurrence and post-orthodontic treatment patients. Various methods to treat these problems are present. The clinician and the patient should discuss these problems and solutions in depth before starting the treatment. Key-words: Aesthetics, Black triangles, Open gingival embrasure, Periodontal treatment, Patient satisfaction INTRODUCTION The importance of aesthetics in modern dentistry is paramount. Aesthetics has its different values and perceptions, which may be different from the eyes of the patient and those of the clinician . It is dependent on the socio-economic status and the upbringing and mentality of each individual person. In spite of this, there are certain universal standards of aesthetics that must be maintained while performing any dental procedure . How to cite this article Roy A, Kashyap B, Nakra P Black Triangles and its ManagementA Review. SSR Inst. Int. J. Life Sci., 2019; 5(3): 2278-2283. Access this article online https://iijls.com/ Various aesthetic factors have to be considered while performing dental treatment which include shade of teeth, contour of teeth, positioning of appliances, occlusal level, and absence of high points, gingival color and contour, contour of lips, outline of mouth and smile line. One of the factors that hamper proper aesthetics is the presence of “Black Triangles” . It is referred to as the gap seen at the cervical embrasure, below the contact point of some teeth, which are cervically located with respect to the interproximal contact point and not occupied with gingival tissue . This gap has many causes including gingival recession and periodontal disease. Hence, these areas present some unique aesthetic and functional problems . These problems include the fact that they are noticeably unaesthetic which negatively affects the smiling profile. They also Review Article SSR Inst. Int. J. Life Sci. ISSN (O): 2581-8740 | ISSN (P): 2581-8732 Roy et al., 2019 DOI:10.21276/SSR-IIJLS.2019. 5.3. 2 Copyright © 2015 2019| SSR-IIJLS by Society for Scientific Research under a CC BY-NC 4.0 International License Volume 05 | Issue 03 | Page 2279 lead to retention of food debris and also to the aggregation of dental plaque . Prevalence– One third people were affected by black triangles . Some studies reported that the preponderance of black triangles were  >67% of people above 20 years  <= 18% of people under 20 years A recent study conducted by Geld et al. [4] of patient attitudes found patient displeasure with black triangles to rank quite high among aesthetic flaws, ranking 3 following cariogenic lesions and dark crown margins. Fig. 1 depicts the aesthetic concerns caused by black triangles. Fig. 1: Black Triangles in incisors Interdental Papilla The interdental papilla is formed by a dense connective tissue covered by oral epithelium and it occupies the physiological space between the teeth. Interdentally, the gingiva that occupies the space coronal to the alveolar crest is known as interdental gingiva . It presents as a pyramidal shape in the interdental area with the tip located immediately below the contact point, is narrower and called as dental papilla. It is broader in the posterior region. In the absence of a contact point or when interdental papilla migrates apically as a result of inflammation, the contouring disappears and interdental papilla takes on a pyramidal shape, which is dysfunctional and unaesthetic. Loss of interdental papilla leads to different problems, which include aesthetics, enunciation and food lodgement . Etiological FactorsThere are multiple causes as to the etiology of open gingival embrasures. These include aging, periodontal disease, loss of height of alveolar bone relative to interproximal contact, length of embrasure area, root angulations, interproximal contacts and triangular-shaped crowns . However, black triangles may also arise following periodontic and orthodontic therapy . Its management varies depending on the etiological factor but is favourably managed by teamwork usually including restorative, orthodontic and periodontic treatment. Sometimes, the correction of these problems is not straightforward and may increase both the complexity and duration of treatment. [1,2,5,16] Sometimes, the decision to close the embrasures or not is difficult especially when the open embrasures are small, as displayed in Fig. 2. Fig. 2: Small embrasure openings affecting the smile