How to Treat Black Triangles?

Diagnosis and Treatment Planning

A 40-year-old male patient (and fellow dentist) presented with minimal restorative history, stable periodontal status, and excellent home care. His chief complaint was the generalised black triangles present between all inter-proximal contacts following orthodontic treatment.

A stated secondary concern of his was the generalised mild/moderate tetracycline staining of all dentition.

The treatment goal was to minimise or eliminate the open gingival embrasures, while also minimising the amber colour gradation present in the gingival half of the anterior teeth.

The only tooth preparation involved was the removal of an old incisal composite restoration on the left central incisor (tooth No. 9).

The facial aspect then had to be prepped with a functional aesthetic bevel. All other treatment was completely additive.

The result was a significant improvement that satisfied the patient’s aesthetic goals.

The radiographs show the smooth sub-gingival restorative contours that result in a favourable tissue response...

  • The preoperative photos demonstrate an ideal width-to-height ratio of the maxillary central incisors and the aesthetic presentation of the smile.
  • The tapered crown form and incisally positioned point proximal contacts are clear, contributing to the large interdental embrasure spaces.
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Even if the arch form allowed for interproximal reduction and closer orthodontic positioning of roots, it would have compromised tooth proportions and smile perspective, while the black triangles would have been merely minimised rather than eliminated.

In addition, the impact on Bolton ratios could potentially compromise interarch relationships.

Bioclear Clinical Protocol

The Bioclear Method is simple and prescriptive. One of the pillars of this method is biofilm removal, using rubber dam isolation (Hygenic 6”x6” Heavy Gauge Dental Dam).

It is important to note the sub-gingival extension of the matrices.

  • The teeth were treated using the total-etch technique, then rinsed and dried.
  • Next, a universal adhesive (Scotchbond Universal Adhesive [3M]) was applied.
  • This was followed by heated flowable composite, which was chased with heated paste composite.
  • 3M Filtek Supreme XTE Flowable paste composite (shade B1 Body) was then used and cured.
  • After the matrix removal, excess buccal and lingual composite was quickly removed and shaped with large coarse discs (Sof-Lex [3M]). This was completed while avoiding marring the smooth Mylar finish left by the matrices.
  • Initial polishing was carried out using Magic Mix (Bioclear) applied with a rubber cup, then rinsed.
  • Finally, a Jazz Polisher (SS White Burs) achieved a stain-resistant high shine.

Following the treatment, the patient commented that Bioclear had made him a much happier person.

The patient first notices black triangles between tooth Nos. 23 and 24, at the age of 17. This was not a significant concern however, as it was not visible when smiling or speaking.

It was only when further posterior black triangles appeared and the central papilla disappeared, that the patient became extremely self-conscious. Yet multiple periodontist consults yielded no solution. Then he came across the Bioclear Method...

Bioclear: The Facts

The Bioclear Method offers many benefits to every level of clinician, who can learn and apply this approach to black triangle treatments very easily:

Simple and predictable: the technique can be learned and applied by the average clinician.

Smooth subgingival contours for tissue adaptation and health.

Mylar finish for minimal calculus accumulation and easy removal, minimizing iatrogenic root contouring with repeated scaling.

Protective coverage of root surfaces, reducing sensitivity.

Broad incisal-gingival and buccal-lingual contacts, leading to orthodontic stability.

Our free Bioclear guide addresses the problem of unnecessarily aggressive restorative treatments, presenting a range of conservative solutions for treating black triangles, Class II restorations and peg laterals, as well as closing diastemas.

*This case was originally presented by Dr David Clark and Dr. Jihyon Kim in Minimally Invasive Dentistry.

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