This document discusses the black triangle disease, which refers to the loss of interdental papilla that can create cosmetic deformities. It outlines factors that influence the presence of papilla like underlying bone support, periodontal biotype, and tooth morphology. Causes of papilla loss include plaque, trauma from oral hygiene, abnormal tooth shapes, and spacing between teeth. The document discusses surgical and non-surgical techniques for reconstructing lost papilla, including pedicle flaps, composite veneers, and gingival prosthetics. It provides examples of using gingival prosthetics to restore black triangles non-surgically.

1. DR VIKRAM KUMAR
BHU
Black triangle and its management
in esthetic dentistry

2.  White esthetics” is the natural dentition or
the restoration of dental hard tissues with
suitable materials.
 “Pink esthetics” refers to the surrounding
soft-tissues, which includes the interdental
papilla and gingiva that can enhance or
diminish the esthetic result.

3. BLACK TRIANGLE
 The loss of papilla can lead to cosmetic
deformities (so-called “black triangle
disease”),
 Reconstruction of the lost interdental papilla
is one of the most challenging
 Restoration and maintenance of these tissues
are a real challenge in modern esthetic
dentistry.

4. Problem associated with
“blackholes”
 phonetic problems (space allows passage for
the air or saliva),
 lateral food impaction
 Altered sound
 Low confidence
 Social unaccepted

5. FACTORS INFLUENCING THE
PRESENCE OF PAPILLA
 Availability of underlying osseous support:
positive architecture”
 Periodontal biotype: thin biotype( suseptible)
: thick type
 Periodontal bioforms :high,
: normal
: flat( suseptible)
 Tooth morphology: triangular shape teeth form
more suseptible

6. LOSS OF INTERDENTAL PAPILLA
 Absence or loss of interdental papillae
 Plaque associated lesions
 Traumatic oral hygiene procedures
 Abnormal tooth shape
 Improper contours of the restoration
 Spacing between teeth
 Loss of teeth.

7. RECONSTRUCTION OF LOST
INTERDENTAL PAPILLA
 Correction of traumatic oral hygiene
procedure
 Non-Surgical
 Surgical
 Orthodontics
 Prosthodontics

8. SURGICAL TECHNIQUES
Surgical approaches included following three treatment
modalities
 Papilla re-contouring-in gingival enlargement
 Papilla preservation.
-Modified papilla preservation flap
- Simplified papilla preservation flap:
 Papilla reconstruction
-Pedicle flap:
-Semilunar coronally repositioned flap:
-Envelop type flap:
-Autogenous osseous and connective tissue grafts:
-Microsurgery

9. Non Surgical
Prosthodontics Implication

10.  Dentists repaired “black triangles” and gaps
with porcelain veneers. A method for
restoring function and appearance, veneers
are thin layers of ceramic that adhered to the
teeth.
 In Crown height ratio gingival ceramic cover
recession area

11. Implant supported prosthesis

12.  Gingiva-colored composites to restore the
defects and aid in visualizing the possible
result may need surgery as future option.
 Monitor the composites for failure and
replace as necessary.
 It is minimally invasive and cost effective
treatment

15. Indications for gingival
prosthesis

Gingival recession with root exposure and open interdental spaces due
to loss of papillae after periodontal disease or post-periodontal
treatment therapy.
 Provisional coverage prior to definite restorations.Temporary splint.
 As a gingival augmentation for implant supported prosthesis.
 When there is proclination of teeth along with mild recession.
 As an interim measure in cases where final treatment planning is
delayed.

16. CASE -1

17. Black triangle between 11
and 21

18. Palatal impression with
addition silicone

19. Labial impression with
polyether

20. Assembled impression

21. Final prosthesis made in
gingiva colored composite

22. Intraoral view of final
prosthesis

23. CASE-2

25. CASE-3

27. bibliography
 Gingival prosthesis: A treatment modality for
recession
 Use of different concentrations of hyaluronic
acid in interdental papillary deficiency
treatment: A clinical study
 Black triangle dilemma and its management
in esthetic dentistry