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
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
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
13.
14.
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.
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