Dr. Beatrice Leung Dentistry Professional Corporation

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The Unaesthetic Black Triangle

When I first started practising dentistry many years ago, I didn’t know how much people hated the black triangle.  The black triangle that can develop as a result of gingival recession leading to the loss of the interdental papilla.  So much research has been around to determine what contributes to supporting the interdental papilla.  All I can remember hearing at the dental meetings 20 years ago was everyone quoting Dr. Dennis Tarnow’s work on the critical distance between the interdental bone and the apical  aspect of the contact area.

Prosthetically, the only way to minimize the black triangle is to create long broad proximal contacts making the teeth more square in shape than triangle.  This may or may not upset the width height proportion but this is often what can be done to minimize the unaesthetic black triangle.

This patient had veneers done more than twenty years ago.  I always tell her that these veneers were done very well.  But over the years, you can see the change in the gingival margin creating the much hated black triangle.  The patient really disliked these spaces.  On top, some of the veneers have debonded and there has been  tooth wear on the lingual aspect.  For awhile, the patient has been managing with selective bonding to protect some of the tooth structure.

Finally this patient has decided to redo these veneers.  I started replacing the maxillary veneers and changing them into emax crowns.  I will be working on replacing the mandibular veneers later.

You will see that I have not tried to change much the length or the shape of the teeth.  There has been minor incisal changes as requested by the patient.  The only thing the patient really wanted was to eliminate the black triangle.  Because these teeth already have veneers, bonding using Bioclear matrix  will not be possible.  The only way is to replace these veneers with full coverage crowns or another set of veneers.  I decided to convert these to full coverage crowns to further protect the lingual wear that was evident.  I find the if I have to change the proximal shape so much, the preparations have to be extended quite palatally so proper emergence profile can be developed more naturally.  In this case, there was also wear on the lingual aspect so naturally full coverage crowns to me would be a more appropriate treatment plan for the patient.

Would you have done this any differently?

Thanks for reading.