Black triangles: An increasing problem with adult orthodontic aesthetics
Monday, September 11, 2017
According to information published by the American Association of Orthodontics, adult orthodontics are on the rise. Since 1996, the use of adult orthodontics has risen around 40 percent. Additionally, the British Orthodontic Society saw a 10 percent increase in adult patients in the last 10 years.
Middle-aged patients claimed they sought treatment for aesthetic reasons, primarily to improve the look of their smiles. However, the black triangle dilemma can negate these effects and negatively impact the way patients view themselves.
What is black triangle?
"Black triangle" — also known as gingival embrasures — is a problem rarely seen as a result of pediatric orthodontics, but it can occur in adult patients.
When teeth develop into adulthood, the bone follows and adapts as well. Because children and teenagers are still growing, their jaws respond to changes enacted by orthodontic systems. Gums grow to fill the gaps in teeth to the gum line and create an overall pleasing appearance.
Adults, however, have set bone structure. They also tend to lose bone strength and formation over the years. When this happens, the gums follow. This means when an adult's teeth are fixed with orthodontics — with problems ranging from overcrowding to malalignment — the gums will recede if needed.
When the gums recede, there may not be sufficient bone between teeth, so the normally pointed gum area between each tooth — papilla — remains flat. This creates the dreaded "black triangle" appearance that plagues so many patients, and it isn't noticeable until the removal of the brace systems.
Image: Bioclear Matrix
What can be done?
Jihyon Kim, DDS, and David J. Clark, DDS, detail potential solutions in their recent article "Full-Mouth Black Triangle Treatment Protocol" in Dentistry Today. Often, expensive, conventional solutions suggested for black triangles range from interproximal bone grafts to soft-tissue grafts, and even removable prosthesis in cases of significant damage.
These answers can be expensive and unpredictable for many patients.
The pair urges dentists to not simply view this problem as merely visual. Doing so makes it easier for dentists to ignore the problem overall, which isn't in their patients' best interests.
There are many functional problems with black triangles as well, let alone the negative impact on a patient's quality of life. Black triangles make it easier for debris and biofilm to accumulate, increasing the chances of potential tissue inflammation. This, in turn, can also increase the need for scaling to remove plaque buildup.
A new solution
Rather than focusing on gum loss in black triangles, Kim and Clark emphasize there is an added benefit to focusing on white space restorations. These solutions are often more cost-effective with predictable outcomes, unlike many soft-tissue restorative efforts.
The doctors stress an added benefit to using the Bioclear Method in lieu of traditional white composite techniques. Full disclosure: Clark is the inventor of Bioclear, and Kim is co-director of Bioclear Learning Center.
With the Bioclear Method, a rubber dam is used to isolate the area to be treated. Then, a biofilm staining is performed, using a two-tone disclosing solution followed by its removal with aluminum trihydroxide spray. The dam is used to mold papilla embrasure space to fill areas.
A heater is used to heat flowable, paste composites to 155 degrees F. Excess composite is quickly removed before final polish is complete for a stain-resistant smile that matches the patient's existing tooth color.
Completing a patient's treatment with the Bioclear Method is rising in demand and offers a relatively cost-effective method for patients to get the smile they've always wanted. Dentists and orthodontists can learn more about the Bioclear Method as a viable solution for those in their care on the company's website.
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