Black triangles, or open gingival embrasures, can be a major aesthetic concern following orthodontic treatment. These spaces result from inadequate papilla fill, and their management requires a combination of orthodontic, restorative, and soft tissue approaches.
A. Revise and review: Managing Black Triangles in Orthodontics: A Focus on Treatment Orthodontic Strategies
1. Proximal Enamel Reduction (IPR)
• Reduces interdental space by increasing the contact point length.
• Should be performed in increments to allow gingival adaptation (Jahangiri et al., 2012).
2. Tooth Movement Adjustments
• Torque Control: Adjusting incisor inclination can improve contact point position (Tarnow et al., 1992).
• Extrusion of Teeth: Controlled extrusion can bring the papilla coronally, reducing the triangle (Zachrisson, 2003).
3. Customised Retainers
• Thermoplastic retainers with composite additions can gradually shape interproximal areas (Mandelaris & Rosenfeld, 2018).
B. Restorative Approaches
1. Composite Bonding
• Alters tooth shape to optimise the contact point (Tay et al., 2014).
• Effective for mild-to-moderate black triangles.
2. Veneers or Crowns
• Suitable for cases requiring significant aesthetic enhancement (Jahangiri et al., 2012).
C. Soft Tissue Management
1. Hyaluronic Acid (HA) Injections
• Provides temporary papilla volume restoration (Tay et al., 2014).
2. Papilla Augmentation Surgery
• Subepithelial connective tissue grafting can regenerate papilla in severe cases (Han & Takei, 1996).
3. Laser or Electrosurgical Contouring
• Gingivoplasty can reshape gingival margins for better aesthetics (Kurth & Kokich, 2001).
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