How to Treat Black Triangles

Black Triangles in teeth are basically the black spaces in the form of triangles in contact between the teeth. They are prone to accumulate food debris, as well as excessive plaque due to the size of the void space in the triangle. According to research, more than a third of the adults suffer from black triangle disorder, (also referred to as gingival embrasures). The black triangles mainly appear as a consequence of a bracket malpositioning of the teeth, with respect to a tooth inclination. Hence when observed by a periapical X-ray, it will show that the roots are not parallel.

Patient Attitudes

According to research, most patients have been found to be dissatisfied with the ranks, especially with the ranks on black triangle, which have been found to be quite high, especially among the aesthetic effects, ranking third after the carious lesions and dark growth margins. Thousands of questions have also been posted online in forums pertaining the black triangle forums, where the patients complain and post lawsuits about adult orthodontic cases as well as post-periodontal therapy papilla loss. These are dilemmas that have been found out to require high attention from the dentists or specialists profession. There has however not been an invasive approach for the treatment of the disorder.

Main Challenges

The main teeth that have the challenges of restorative dentistry are mainly the lower teeth. This is because the lower incisor teeth have their unique restorative challenges. Many dentists may often overlook, or simply ignore the lower incisors and just treat the upper incisors as brought up by patient complaints from various dentists. The incisal edge is usually broad and thin. The root is also broad buccolingually. It resembles an instance of a knife which has been bent at 90 degrees in the middle of the blade. A lower incisor tooth with significant recession may lead to a multilatory teeth preparation for porcelain.

Treatment Procedures

One of the forms of treatment procedures for this kind of ailment is slenderizing. This is where the volume is removed through the closure of the excess space. It is only the quantity necessary for the teeth alignment that is removed. The slenderizing treatments are however only recommended to patients with good oral hygiene to avoid the risk of caries. It can also result in wide interproximal contact areas for patients who have multiple teeth rotations.Patients who require the treatment need also to be informed about the treatment processes to be carried out and even be given a written consent if possible.

How it Works

Progressive slenderizing can be done in three ways;

  •     Total progressive slenderizing (for all teeth)
  •     Posterior slenderizing (for molars and premolars)
  •     Anterior slenderizing (for canines and incisors)

Depending on the cases available, this process will be carried out in different zones. This will involve;

Before alignment, in order to avoid protrusion, (ligated archwire will be passive).

  • Starting from distal towards mesial.
  • Simultaenous in both sides of an arch. Indicated in both jaws, and also carried out simultaneously.
  • Without anaesthesia
  • With irrigation and rinsing between the use of files
  • -Appropriate burs

Clinical Procedure

It is also possible to carry out direct or indirect bonding of the labial or lingual brackets as well as tubes. (It is not advisable to use bands with slenderizing). Slenderizing should also not be started before bonding as this would reduce the bracket positioning precision. The clinician can also use a figure-of-eight ligature between the first molars on the right and the left side. The second molar can be moved 1 millimetre distally. The separation is usually achieved within 24-48 hours. You can also use a brass wire to protect the gingiva. The wire will depress and protect the gingiva tissues and it serves as a guide and support for slenderizing bur.

A continuous 0.016 inch archwire, or 0.016*0.016 stainless steel sectional wire can be used. An omega loop will be inserted on the mesial side of the second side of the second molar tube which will prevent the forward movement of the incisors. An elastic separator between the second pre-molar and the first molar will be used to move the first molar towards the distally. Once the first molar is distalized, slenderizing is carried out on the mesial surface of the first molar.

The first premolar will then be moved distally using an elastic chain from the second premolar to the first molar and maintain the anchorage using figure-of-eight ligature.

When posterior slenderizing is carried out, the canines are the last teeth to be stripped. If anterior slenderizing is carried out, the elastic separator should be placed between the canine and the first premolar.

While performing slenderizing in the anterior segment, aesthetics, symmetry and midline discrepancies should be taken to account. Progressive slenderizing will also require the client to have 8-10 appointments in total, at least one in every 15 days.

How much Enamel can be Stripped?

The minimal enamel thickness and not the minimal values must be taken into account when determining the enamel quantity that is going to be removed, since it is not possible to know the teeth present in minimal thickness. There is also no relation between the teeth size and the thickness of the enamel layer, thus, macrodontic teeth should be removed.

Slenderizing is usually followed by polishing in order not to leave rough surfaces. A fluoride vanish should also be applied before slenderizing. The patient/client should be encouraged to brush his/her teeth using a toothpaste that has a high fluoride content.

Cast Retainers

Cast retainers are strongly recommended to be used for patients with severely reduced periodontal support and consequence increased tooth mobility, mainly on the upper anterial teeth. This approach is used for the need to create a situation where the remaining periodontium is loaded in an optimal way. This is only achieved if the retainer is constructed with a build-up of palatal surface, so that the group function of the upper anterior teeth can be established. In the procedure for a bonded bridge, the palatal surface for such a retainer should be modeled for an individual articulator.


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