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Black triangles, or open gingival embrasures as they’re referred to by dentists, are the small triangular-shaped gaps or spaces that can be seen between the teeth and the gum line.
They’re a very common problem and many people find these triangular black spaces aesthetically displeasing. As food and plaque can get trapped in them (it’s not a great look) it increases your chances of developing gum disease.
Those looking to improve their smile and oral health often ask “Can gum grafting fix my black triangles?”.
There’s good news! Gum grafting is available as a fix for these triangular shapes but it isn’t suitable for all patient groups and may show limited success. If you’re not suitable for this treatment there are alternative treatment options and ways that you can prevent the spaces from getting worse.
This post aims to explain what causes black triangles, treatment with gum grafting, and alternative solutions.
What Are Black Triangles Between The Teeth?
Black triangles between the teeth and gums are caused by a lack of gum tissue and often appear triangular.
You may surprised but more than one-third of all adults have them and they are more frequent in adult patients who suffer bone loss (1). However, some online sources have suggested that the number is as high as 67% in certain ethnic groups.
What Causes Black Triangles to Form?
The main reason these small gaps develop is bone loss around the tooth socket. This bone loss causes gum recession. Whilst this can naturally occur as we get older, it’s exacerbated by tooth loss and periodontitis, a form of gum disease that’s very common in the adult population. In less severe cases small gaps form between the teeth as they drift forwards or sideways.
Another cause is adult orthodontics. Approximately 38% of adult orthodontic cases result in black triangles after their treatment. (2).
Tooth shape, thin gums, aggressive tooth brushing, and oral piercings can also accelerate gum recession and their development.
What’s The Problem With Black Triangles
Aesthetically the small black gaps are not visually pleasing and they have a negative effect on the smile.
However, they also affect oral health as food debris can become stuck within the gap. This food debris and plaque are challenging to clean from the area which can lead to the development of periodontal disease, which can cause further bone loss and more loss of gum tissue.
Some people may also find that it affects the way they speak.
Can Gums Grow Back Into Black Triangles?
Sadly, gum tissue can’t grow back. However, there are several solutions that can be used to disguise the problem.
Gum Grafting for Black Triangles
Gum grafting is a surgical procedure where tissue is taken from elsewhere in the mouth or a donor and used to cover the gum recession. The procedure covers the gaps as well as any exposed roots.
The Treatment Process
There are several approaches used. These include free gingival grafts, connective tissue grafts, and pedicle grafts. New techniques tried recently involve using enamel matrix proteins to increase protein production in the ligament cells holding the teeth to the bone. The procedure used will depend on your unique and individual situation.
If periodontal disease has caused significant bone loss you may need a bone graft before the tissue graft.
Disadvantages of Gum Grafting for Black Triangles
Gum grafting sounds like a superb way to replace missing tissue but is unsuitable for those with extreme gum recession. If gum recession is not the cause of your black triangle, gum grafting may not be the most suitable solution.
Whilst gingival grafting has been employed for over 30 years the procedure has not yet been perfected. It is often unpredictable in large or hard-to-access areas and these cases may require repeated maintenance. Often poor blood supply to the gum means that the gum grafting procedure offers limited success.
If you’re not a candidate for a gum grafting procedure you can prevent the triangles from getting any worse with self-care treatments at home – see below for more details.
Other Solutions
Several other treatment options are available to fix the gaps.
Tissue Engineering
Advances in the field of tissue engineering have been promising in the treatment of black triangles. Regenerative cells are injected into the gum to help regrow the missing tissue.
Hyaluronic Acid Treatment
Similar to tissue volumizing employed in facial tissue Hyaluronic Acid, a natural substance found in the fluids in the eyes and joints is used to volumize the gum tissue around the teeth, filling the gaps. This is a painless procedure that has a high level of patient satisfaction during trials.
Porcelain Veneers
Artificial gum made of acrylic or silicone can be used to mask any triangular gaps. There are multiple names for these removable devices including flange prosthesis, gingival veneer prosthesis, acrylic gingival veneer, removable gingival extension, and gingival mask (3)
These veneers are removable and can be used to cover exposed root surfaces in those with advanced bone loss. They can be useful to prevent food from becoming stuck to exposed surfaces and help correct problems in people’s speech that sometimes occur with black triangles.
This technique has some disadvantages – mainly poor oral hygiene which can lead to gum disease, further bone, and tissue loss, and make the triangular gaps bigger.
Tooth Restorations
This non-invasive and affordable method uses resins or composite to make the teeth appear bigger and fill in the black triangle. Pink-coloured resins such as that used by BioClear, a flowable composite, can be used to rebuild the teeth. Because it is pink it looks like the original gum tissue. Some sites online refer to this treatment as injection molding.
Invisalign Can Reposition Teeth
Whilst orthodontic treatment is a known cause of black triangles, it can strangely be used as a treatment to close the gaps and fix them as well.
The technique referred to as interproximal reduction (IPR) involves removing up to 0.5mm of enamel from the sides of teeth and then using braces to move the teeth closer together. An additional benefit of this treatment is that it can alter the location of tooth roots, adding additional support to the gum tissue underneath.
Due to the risks involved in the procedure, you should seek advice from dental experts and avoid DIY braces according to the British Orthodontic Society.
Preventative Measures
Knowledge is power where beating gum disease is concerned. Gum Disease: Solved online education tool arms you with the information to understand why you have gum disease and how you can beat it in only 10 minutes per day at home, without the need for costly and ineffective dental visits.
Self-care treatments involve developing and maintaining good oral hygiene – brushing the teeth twice a day with a fluoride toothbrush and carefully cleaning the space between the teeth with a gum pocket brush, interdental brushes, and/or floss.
Some changes to lifestyle choices such as smoking cessation, controlling blood sugars, reduction in sugar consumption, and sipping water throughout the day can also be beneficial.
Newer treatments such as LANAP and other methods of treating periodontal disease in the early stages can help prevent triangular gaps from forming.
References
- Tarnow DP, Magner AW, Fletcher P. The effect of the distance from the contact point to the crest of bone on the presence or absence of the interproximal dental papilla. J Periodontol. 1992;63(12):995-996. Available at https://pubmed.ncbi.nlm.nih.gov/1474471/. Accessed 14th July 2022
- Tanaka OM, Furquim BD, Pascotto RC, et al. The dilemma of the open gingival embrasure between maxillary central incisors. J Contemp Dental Pract. 2008;9(6): Available at https://pubmed.ncbi.nlm.nih.gov/18784864/. Accessed 14th July 2022.
- Alani A, Maglad A, Nohl F . The prosthetic management of gingival aesthetics. Br Dent J 2011; 210: 63–69. Available at https://pubmed.ncbi.nlm.nih.gov/21252883/. Accessed on 14th July 2022
Sources
- British Orthodontic Society – InterproximalReductionMarch2019 – Page 1
- Ziahosseini, P., Hussain, F. & Millar, B. Management of gingival black triangles. Br Dent J 217, 559–563 (2014). Available at https://doi.org/10.1038/sj.bdj.2014.1004. Accessed on 15th July 2022
- Al-Zarea, K & Sghaireen, Mohd & Alomari, W. & Bheran, H. & Taher, Ibrahim. (2014). Black Triangles Causes and Management: A Review of Literature. British journal of biomedical science. 6. 10.9734/BJAST/2015/11287. Available at Research Gate. Accessed on 14th July 2022.
