Australasian Dentist Magazine Nov Dec 2021
Category 48 AustrAlAsiAn Dentist t he interdental papilla is an important component in an aesthetic smile and its loss may result in a gingival black triangle (GBt), resulting in phonation problems (space allows passage for the air or saliva) and lateral food impaction. the interdental area is composed of, u contact area u interproximal embrasure u interproximal dentogingival complex (gingival tissue supported and created by two adjacent teeth in contact and the underlying bone beneath this tissue). u open gingival embrasures – known as black triangles. Aetiology the absence or loss of interdental papillae can be due to several reasons. u Abnormal tooth shape/crown form u improper contours of the restoration u loss of teeth due to extraction u Gingival biotype u Aging of the patient u loss of bone as the result of periodontal disease or the loss of the contact alters the support of the interdental tissue, which can lead to the loss or reduced height of the papilla. u Plaque-associated lesions and traumatic oral hygiene procedures. u During orthodontic alignment, midline diastema closure, decrowding and diverging roots during extraction space closure, root angulations following orthodontic treatment u inter-proximal space between teethand the distance between inter-proximal contact position to bone crest can be due to – loss of periodontal ligaments due to recessions, reduced alveolar bone height, length of embrasure area, distance between roots and triangular crown. Management of Black Triangles Black triangles in adults may arise from loss of gingival tissue related to periodontal disease, but when crowded and rotated maxillary incisors are corrected orthodontically in adults, the connector moves incisally and black triangles may appear, especially if severe crowding was present. For that reason, both actual and potential black triangles should be noted during the orthodontic examination, and the patient should be prepared for reshaping of the teeth to minimize this aesthetic problem. the presence of a black triangle or embrasure space can be analysed with the iOPA radiographs. the following microaesthetic factors can be of real significance in the management of black triangles: tooth shape and proportions (height and width proportions of the teeth): incisor height tends to be more variable than incisor width because of the variability of soft tissue biotypes and in adolescent stages of active and passive eruption. the ideal ratio should be 8:10 of width to height. Shape: Determined by the contact relationships between the teeth, the width of the proximal tooth surfaces and the course of the cemento-enamel junction. tooth contacts and connectors: Vertical positioning of the contact is important and the connector is “where the teeth appear to touch”. long axis: inclination of the anterior teeth should be tipped slightly to the distal aspect. incisal embrasure: Central incisor embrasure should be smallest, while the Management of Black Triangle liniCal By Dr Geoffrey Hall, specialist orthodontist BDsc ( Mel) Cert Orth( uni of Penn) MrACDs ( Orth) Founder and Director of OrthoeD, smilefast and CAPs Figure 1 Figure 2 Figure 4 Figure 5 Figure 3 Dr Geoffrey Hall
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