Black triangles, gaps, or spaces between teeth
This Libertyville, IL patient was unhappy with the "black triangles" between her teeth, her tooth shapes, the heavy wear, and the uneven color. She wanted a better tooth alignment and to replace the tooth structure lost due to her bruxism (night grinding) habit. It is difficult to get rid of black triangles. Gum surgery will not fix or fill these dark triangular spaces between the teeth. The restorative dentist and ceramist must collaborate with special techniques to close these spaces down. The dentist has to follow a specific drilling design which varies based on certain anatomical variations of your bone between the teeth and the technician will adjust the contours of the porcelain restorations based on specific measurements provided by the dentist.
Seven conservative porcelain veneers were used on the upper front teeth to fill the "black triangles".
The veneers served several goals including improving the tooth alignment, changing her bite (occlusion), replacing lost tooth structure from nighttime grinding, and the other patient directed agendas. The designation of "conservative veneers" means that the amount of tooth drilling or preparation was conservative or limited. Special attention was directed to the shape of the veneer porcelain between the teeth to close the dark spaces between the teeth.
Missing gum between teeth – black triangles, spaces or gaps between teeth
Black triangles and spaces between teeth are common problems that can be difficult to fix well. The triangular dark open spaces are caused by gum recession, periodontal disease, or abusive dentistry. Some people are genetically more prone to these unattractive triangular openings or spaces which normally would be filled with gum tissue. Natural teeth come in all different shapes. When the tooth root is significantly more narrow than the width of the exposed clinical crown, then there is a predisposition to having these spaces between the teeth after dental treatment. This problem is more likely when the dentist does not pre-plan for this going into treatment. When creating veneers, the dentist often will drill between the teeth. When black triangles are likely, the dentist needs to drill in certain ways so that these large open spaces can be minimized. The laboratory design can also be altered to mask these unesthetic spaces. There are specific preparation designs that can help minimize post-operative disappointments.
Types of tissue most prone to “black spaces” or “black triangles” between crowns and veneers
There are normal variations in the thickness of and the resistance to recession of gum tissue. Some people have a “Thick Biotype”, which is very unlikely to recede or to lose the gum papillae between the teeth. Others have a “Thin Biotype” that is very susceptible to recession and loss of the gingival papillae between the teeth. When doing cosmetic bonding, porcelain veneers, or crowns on teeth with the thin biotype, extreme atraumatic care is necessary to prevent or limit loss of tissue.
If the tissue is already lost, the spaces can still be closed by a well-trained prosthodontist or cosmetic dentist partnering with a higher end laboratory technician. It is very difficult to close the space and still render restoration shapes that don’t appear square. The tooth preparations may be less conservative and the shapes of the restorations are subtlely modified to fill the spaces without margin overhangs and avoiding the “square tooth” look. Very specific tooth preparation design and planning are required to aesthetically fill the black spaces with a natural appearance that is cleansable.