Black Triangles Research Articles

Investigating the efficacy of hyaluronic acid in minimizing black triangles: A comprehensive analysis

In the anterior area of the mouth, the interdental papilla is important for dental hygiene and appearance. When it disappears, unpleasant “black triangles” form, which affects patients’ self-confidence in their smiles and makes oral hygiene more difficult. The loss of interdental papilla is caused by several variables such as tooth shape, periodontal disease, and aging. Although surgical treatments have been utilized to restore or retain missing papilla, their predictability remains unknown. In response, researchers have investigated non-invasive procedures, such as the use of fillers such as hyaluronic acid (HA). Owing to its capacity to increase tissue volume and bind water, HA, a naturally occurring polysaccharide with special rheological qualities, has become a popular choice for use as a dermal filler. It shows promise when used to cure interdental papilla loss; the effects usually last for six–12 months. This review article explores the development and history of papilla rebuilding methods, emphasizing hyaluronic acid as a cutting-edge and successful method for regaining both periodontal health and aesthetics.

Progress of the study on factors related to orthodontic treatment and the formation of black triangles

Black triangles can be formed due to the defect or absence of the gingival papilla, which increases the risks of food impaction, caries, and periodontal disease, and affects the esthetics of anterior teeth. The incidence of black triangles after orthodontic treatment is from 38% to 58%. The formation of black triangles is influenced by patient-related factors and factors related to orthodontic treatment. This article discusses the factors related to orthodontic treatment and the formation of interdental black triangles and provides reference for preventing the formation of this problem.

Multidisciplinary Consideration for Managing Gingival Black Triangles in Aesthetic Dentistry: A Review

The importance of aesthetics in modern dentistry is paramount. Aesthetics has its different values and perceptions, which may be different from the eyes of the patient and those of the clinician [1]. It is dependent on the socio-economic status and the upbringing and mentality of each individual person. Open gingival embrasures or black triangle cause complex functional and aesthetic problems. Management of such problems requires careful evaluation of the underlying causes. In today’s aesthetic environment where both the dentist and the patient are aware of aesthetic value, the real challenge was to reconstruct this lost papilla and moreover to obtain stable and sustainable results. asure area, root angulations, interproximal contact position, triangular-shaped crowns and aging. Treatment of black triangles often requires an interdisciplinary approach, involving of periodontal; orthodontic and restorative treatment. In this review, the authors highlighted the important etiological factors that predispose to the occurrence of the black triangles. In addition to the common biological factors, dimensional changes of papilla during orthodontic alignment, the relevant consequences of periodontal disease treatment and iatrogenic treatment mishaps such as poor veneers and crowns are factors have also been discussed as factors that may lead to black triangles.

Cosmetic Makeover of Periodontally Compromised Patients using Flexible Gingival Mask and Porcelain Laminate Veneers: Report of Two Cases

Chronic periodontal disease can lead to advanced gingival tissue loss that can result in problems with esthetics, phonetics, food impaction and tooth sensitivity. One of the most difficult problem encountered in the management of periodontal disease is loss of interdental papillae which leaves unsightly “black triangles” between the teeth. The first step in the management of these problems is surgical correction of the defect. In cases where mucogingival surgery is unpredictable due to generalized recession and loss of large volume of gingival tissue, removable gingival prosthesis is an excellent alternative to correct the deformities remaining after the control of destructive periodontal disease specially in the maxillary anterior region. Gingival prostheses may be fixed or removable. It can be made from a range of materials like acrylic, silicones, porcelain- based materials and flexible resin denture material. This report describes two clinical situations in which combined periodontal/prosthodontic rehabilitation was done for patients with advanced periodontal disease. Accurately fitting flexible gingival prostheses and porcelain laminate veneers were fabricated to restore advanced gingival tissue loss in esthetic area following periodontal flap surgery. The flexible gingival masks not only help to achieve excellent cosmetic results but also reinstate the functional and psychological wellbeing of the patient.

The knowledge regarding the impacts and management of black triangles among dental professionals and laypeople

This study aimed to assess the knowledge regarding impacts, causes and management of black triangles (BT) among participants from different educational backgrounds including dental students, dentists and laypeople. This descriptive cross-sectional observational research included 435 participants who comprised 4 groups: pre-clinical (3rd year) dental students, clinical (4th and 5th year) dental students, dentists, and laypeople. A constructed self-reported questionnaire was utilized to assess participants’ demographic data and their knowledge of the impacts, causes and management of BT. The VAS scale was used to assess participants’ ratings for the impacts of BT on esthetics, with 0 meaning no impact and 10 meaning very severe negative impacts. The most reported treatments for BT were “cannot be treated” 99.3% and “non-surgical periodontal treatment” 67.1%. Meanwhile, the least reported was “modify the porcelain” 41.8%. The most reported cause of BT was “periodontal disease” 85.1%. However, the least reported were “parafunction” and “deep implants” 33.1% each. Dental professionals had better knowledge of the causes (t = 8.189, P < 0.001) and management (t = 8.289, P < 0.001) of BT than the non-dental participants. The dentists had the best knowledge, while the laypeople had the least knowledge of the causes (F = 62.056, P < 0.001) and treatment (F = 46.120, P < 0.001) of BT. The knowledge of the causes (t = 0.616, P = 0.538) and treatment (t = 1.113, P = 0.266) for BT was not significantly different between males and females. Age was not significantly related to the total knowledge about the causes (r = −0.034, P = 0.475) or treatment (r = −0.034, P = 0.482) for BT. Dental professionals had better knowledge of the impacts, causes and management of BT than the non-dental participants. The dentists were the best, while the laypeople were the worst in this regard. Age and gender had no relationships with the knowledge of causes or management of BT.

Management of Ankyloglossia Using Conventional Surgical Technique: A Case Series

Periodontal plastic surgery is a more conservative and precise technique practised to create more functional and aesthetic results for the treatment of mucogingival problems. The presence of an aberrant frenum is one of the aetiological factors associated with the persistence of a midline diastema. Inadequate dental plaque removal, poor oral hygiene, bifid tongue, impaired speech, and mucogingival problems like recession and black triangles need more attention. Ankyloglossia, or tongue-tie, is a congenital anomaly with an abnormally short lingual frenulum. The aberrant frenum can be treated with surgical removal of the frenum using either frenectomy or frenotomy procedures. In the present case series, frenectomy was performed using a conventional scalpel technique for the treatment of tongue tie.

THE USE OF A MODIFIED DEEPITHELIALISED FREE GINGIVAL GRAFT IN THE TREATMENT OF GINGIVAL RECESSIONS ASSOCIATED WITH INTERPROXIMAL BONE LOSS. CASE REPORT

The prevalence of gingival recessions is very high, and it increases with age. The gingival recessions occur frequently in populations both with high and low standards of dental care. Gingival recessions are surgically treated to improve aesthetics, reduce root hypersensitivity. Recently, the coronally advanced flap is more frequently used, displacing the free gingival graft and the laterally positioned flap. Connective tissue graft or a deepithelialised free gingival graft is often used in combination with coronally advanced flap. It has been stated, that periodontal plastic procedures may predictably determine complete root coverage in multiple Miller class I and II recessions. According to the treatment of multiple Miller class III recessions, there is lack of evidence by clinical trials in the literature. It should be considered, that dealing with multiple recessions can be associated with different limitations in the same surgical area, such as interproximal bone loss, larger avascular surface, position of the teeth, high muscle and frenulum attachments, etc. There is a quite big difference in the literature according to the data of complete root coverage percentage. Another problem is dealing with black triangles because of interproximal bone loss. Of course, patients expect not only recession closure, but also papillary reconstruction. But it is very hard to predict a complete root coverage at Miller class III recession and papillary reconstruction at the same time. The purpose of this clinical report is to evaluate the effectiveness of the coronally advanced flap in combination with modified deepithelialised free gingival graft (MDFGG). The scalloped form of the deepithelialised free gingival graft in combination with the coronally advanced flap helped to solve two problems simultaneously: recession closure and papillary reconstruction. The results lead to further researches for the treatment of Miller class III and IV recessions, and also papillary reconstruction techniques.

Relationships between perception of black triangles appearance, personality factors and level of education

This analytical cross-sectional study evaluated the perception of black triangles (BT) and examined the relationships between the perception of BT, personality factors, different educational backgrounds and demographic factors. 435 participants were included and divided into four groups: dentists, clinical (4th and 5th year) dental students, pre-clinical (3rd year) dental students, and laypeople. Participants’ perception of the attractiveness of smile profiles of maxillary and mandibular anterior dentition with BT was rated using a ten-point VAS scale with 0 being the least, and 10 being the most attractive smile profile. The personality was assessed using the NEO-FFI personality questionnaire. The smile profile with multiple large BT was rated the least attractive for the maxillary (mean = 3.6) and mandibular (mean = 3.9) tested profiles. The smile profile without BT was rated the most attractive for the maxillary (mean = 9.1) and mandibular (mean = 8.8) tested profiles. The dental professionals perceived the maxillary smile profile with multiple large BT as less attractive than the non-dental participants (t = − 2.715, P = 0.007). Being a male, having dental education, having lower Neuroticism scores, as well as having higher Openness, Agreeableness, Conscientiousness, and Extraversion scores predicted and contributed more towards perceiving various tested smile profiles as more attractive. These findings show that black triangles negatively impacts the perception of smile attractiveness, and that personality traits and having dental education impact the perception of smile attractiveness for smiles with black triangles.

Author Correction: Aldo-keto reductase 1C2 (AKR1C2) as the second gene associated to non-syndromic primary lipedema: investigating activating mutation or overexpression as causative factors.

Correction to: Eur Rev Med Pharmacol Sci 2023; 27 (6 Suppl): 127-136-DOI: 10.26355/eurrev_202312_34697 After publication and following some post-publication concerns, the authors have applied the following corrections to the galley proof. - The conflict of interest section has been amended as follows: J. Kaftalli and G. Marceddu are employees at MAGI EUREGIO. K. Donato is employee at MAGI EUREGIO and MAGISNAT. M. Bertelli is president of MAGI EUREGIO, MAGISNAT, and MAGI's LAB. G. Bonetti, K. Dhuli, A. Macchia, and P.E. Maltese are employees at MAGI's LAB. M. Bertelli, P.E. Maltese, K. Louise Herbst, Sa. Michelini, Se. Michelini, and P. Chiurazzi are patent inventors (US20220362260A1). M. Bertelli, P.E. Maltese, G. Marceddu are patent inventors (US20230173003A1). M. Bertelli, K. Dhuli and P.E. Maltese are patent inventors (WO2022079498A1). M. Bertelli, P.E. Maltese, Sa. Michelini, Se. Michelini, P. Chiurazzi, K. Louise Herbst, J. Kaftalli, K. Donato, and A. Bernini are patent applicants (Application Number 18/516,241). M. Bertelli, K. Donato, P. Chiurazzi, G. Marceddu, K. Dhuli, G. Bonetti and J. Kaftalli are patent applicants (Application Number: 18/466.879). M. Bertelli, G. Bonetti, G. Marceddu, K. Donato, K. Dhuli, J. Kaftalli, Sa. Michelini, and K. Louise Herbst are patent applicants (Application Number 63/495,155). The remaining authors have no conflict of interest to disclose. - Figure 5 has been modified as follows to better distinguish outliers: - The legend of Figure 5 has to be modified as follows: Relative expression of AKR1C1 and AKR1C3 in different groups (CTR = non affected controls, L = lipedema patients without overexpression of AKR1C2, L-over = Lipedema patients with overexpression of AKR1C2), showing that lipedema patients expressed AKR1C1 and AKR1C3 levels similar to the control group. Outliers are reported as black triangles. There are amendments to this paper. The Publisher apologizes for any inconvenience this may cause. https://www.europeanreview.org/article/34697.

The Use of Injectable Platelet-Rich Fibrin As an Alternative Treatment for Interdental Papilla Reconstruction in Black Triangle Case

Introduction: Interdental papilla is triangular soft tissues that fill the gaps between teeth andfunction as protective periodontal tissues and are important in terms of aesthetics, ifinadequate, they will form black triangles, which are blackish areas between teeth. Non-surgical treatment of black triangle is preferred by patients as it is painless. Injectable Platelet-Rich Fibrin (i-PRF) is a platelet concentrate derived from the patient&amp;#39;s blood that does notcause immunological reactions and contains growth factors for remodeling the interdentalpapilla. Case Report: A 20-year-old female patient, systemically healthy, came to Prof.Soedomo UGM Dental Hospital with complaints that the gums of the middle part of her upperteeth had a blackish area and disturbed her confidence. An objective examination was carriedout including, gingival biotype, black triangle area, and radiographs, so it was concluded thatthe black triangle was classified as class I Nordland and Tarnow and interdental papillareconstruction to correct the black triangle could be planned. The patient refused surgery so i-PRF can be used as an alternative non-surgical treatment. The black triangle closed completelyafter the i-PRF injection was given. Discussion: I-PRF has the ability to accelerate cellproliferation and migration as well as angiogenesis so that it can modulate fibroblastregeneration in the interdental papilla area. Conclusion: The use of i-PRF can be an alternativenon-surgical option for the treatment of interdental papilla reconstruction.

Orthodontic Risk Perspectives among Orthodontists during Treatment: A Descriptive Pilot Study in Greece and Slovakia.

This study explores orthodontists' perspectives on risks associated with orthodontic treatment, as described by Greek and Slovak orthodontists. Informed by the foundational importance of effective communication of risk perspectives in health sciences, particularly in facilitating valid consent and shared decision-making, this research addresses gaps identified in the literature concerning the consistent communication of potential treatment risks based on demographic and cultural characteristics. This study identifies 15 potential critical risks during orthodontic treatment. These risks include root resorption; temporary undesired changes to the occlusion; sleep difficulties; not achieving an ideal result; development of black triangles between teeth; taking additional X-rays; speech difficulties; using a protective splint during sports; duration of treatment; number of visits; transmission of infectious diseases; and swallowing orthodontic appliances. A questionnaire, distributed electronically to orthodontists in Greece (N1 = 570) and Slovakia (N2 = 210) from September 2022 to December 2022, aimed to assess risk communication practices, taking into consideration socio-demographic factors, such as country, gender, age, and academic-degree-related variations. A total of 168 valid questionnaires (91 from Slovakia and 77 from Greece) were obtained, indicating significant disparities in the risks emphasized and preferred forms of consent. The Greek orthodontists focused more on the risks involved, such as relapse, root resorption, temporal occlusal changes, and failure of desired movement, while the Slovak practitioners tended to be more interested in sleeping difficulties, temporal occlusal changes, and not achieving an ideal result. They also obtained written or digital consent from patients or their parents/guardians more frequently than the Greek team. Male orthodontists discussed specific risks more frequently, including relapse and extractions, whereas females preferred written or digital consent. PhD-trained orthodontists prioritized certain risks, indicating the need for tailored approaches. This study underscores the dynamic nature of risk assessment in orthodontic practice, emphasizing its ethical and strategic dimensions. The findings advocate for tailored risk communication strategies that recognize individual, contextual, and cultural factors, and the need for an orthodontic informed consent protocol for a tailored communication approach for patients to elevate the standard of care in European orthodontics. The reliance on digital tools reflects contemporary trends in enhancing patient understanding, thereby supporting ongoing innovation in orthodontic practices.

Smile esthetics perception by the general population among different age groups in tiruchengode

To evaluate the smile esthetic perception on varying gingival display and black triangles among individuals aged between 18-35 and 36-50 using a visual analog scale (VAS). To evaluate the two variables (gingival display and Black triangle), a photo album is created that consist of two sets of photos which included six different photographs in each set. The frontal view of young adult female smile was selected for evaluating the esthetic perception. The smile features in the photographs is digitally altered using Adobe Photoshop CS6. Black triangles images are created using 0.5-mm increments. The gingival display by decreasing (−) the distance (2.0 and 4.0 mm) and increasing (+) the distance (2.0, 4.0, and 6.0 mm). The photographs are printed on photographic paper to create a photo album and coded from 1 to 6 and the scoring was done using a 10 cm visual analog scale (VAS). The participants are asked to mark the VAS score according to the attractiveness of each smile image separately with individual ratings.The comparisonofsmile esthetic perception among age groups was done using the Mann-Whitney U test. On comparing, the results revealed that laypeople with 18-35 yrs have given more scores for 0 mm Black triangle and for 2 mm gingival display which showed statistically significant results. Comparison of images among different age groups does not show significant results. The impact on the perception of smile esthetics vary among different age groups in terms of gingival display and black triangle.

Hemolasertherapy - A Novel Approach to Reconstruct the Interdental Papilla: A Case Report

Black triangles are considered a nightmare by Periodontists as their treatments have been associated with high failure rate. There is a continuous quest for novel techniques that could restore the normal interdental papilla lost due to the periodontal disease process. In recent times a novel procedure called hemolasertherapy has been introduced that has led to papilla regeneration. Hence we reported a case of a 20-year-old female with a black triangle between the lower central incisors which was treated with hemolasertherapy. Photobiomodulation therapy was carried out with the help of a Sunny diode laser wavelength 650 nm where each of the nine bleeding points were irradiated for 30 seconds. A total of two sessions were conducted at one-week interval. Complete regeneration of the lost interdental papilla was observed by the end of three months. It can be concluded that hemolasetherapy is a non-invasive convenient modality that can be used for regenerating the interdental papilla.

应用弧形成型片与条状聚酯薄膜成型片进行树脂修复黑三角临床效果对比分析

应用弧形成型片与条状聚酯薄膜成型片进行树脂修复黑三角临床效果对比分析

Enamel interproximal reduction and periodontal health

Enamel interproximal reduction (IPR), also known as stripping, is an orthodontic procedure used by many clinicians, especially in non-extraction cases. It aims to reduce the mesiodistal diameter of teeth by removing interproximal enamel. This therapeutic option allows to obtain space in the dental arch to achieve tooth alignment, in case of mild or moderate crowding, and to preserve the papilla avoiding the onset of black triangles. IPR is an irreversible procedure, and it requires an accurate case examination to avoid damage, such as demineralization of the enamel or periodontal complications, that can compromise both aesthetics and oral health. When performing IPR, orthodontists can change the contact point between the teeth and move it closer to the alveolar crest, thus improving esthetics by reducing the black triangles. However, there is also a risk for worsening periodontal health due to root proximity although, according to the literature, periodontal indices, such as clinical attachment loss (CAL) and bleeding on probing (BOP), seem to be not significantly affected by IPR.

Effect of hyaluronic acid application on gingival black triangles– A systematic review

Interdental papilla loss, also known as “black triangles,” is a prevalent issue that both patients and dentists worry about. According to Singh and Vandana (2019a), the gingival black space is the loss of the papillary height. One of the most difficult periodontal issues to address is this one. According to V. P. Singh et al. (2013), tooth loss, incorrect restoration contouring, traumatizing oral hygiene practices, and dental spacing all play a role. Dentistry has paid a lot of attention to the use of hyaluronic acid (HA) injections for papilla regeneration in cases of interdental black triangles (BTs). The discussion here highlights the various strategies and results connected with employing HA injections for papilla regeneration.

Non-surgical periodontal treatment for black triangle

Objective: This case report aims to introduce the black triangle therapy in Miller’s Class IV gingival recession. Methods: The patient complained of spacing between the upper and lower teeth causing food accumulation, “long teeth”, and receding gums which were unaesthetic during speaking. Clinical examination of the maxillary and mandibular anterior revealed Miller Class IV gingival recession, large black triangles, no tooth mobility nor pocket probing, and no gingival inflammation signs. Based on clinical and radiograph examination, nonsurgical therapy using gingival mask was the best option. Nonsurgical therapy using gingival mask was made using indirect technique with an elastomeric impression. An extra-soft soft liner was chosen for gingival mask materials. Results: The black triangle was covered. The “long teeth” appearance and hypersensitivity were reduced. Conclusion: Gingival masks is a good and predictable nonsurgical treatment option for treating black triangle in Miller Class IV gingival recession.

The use of radiographs to assess the impact of the distance between the contact area and the crest of the bone to predict the presence or absence of interdental papilla: an in vivo study.

Introduction Black triangles (interdental papilla) pose an aesthetic problem for both the patient and the clinician. They also can have an impact on phonetics and periodontal health. It is useful to predict the presence of a black triangle to inform the patient of potential aesthetic compromises. The aim of this study to assess whether the risk of black triangle formation can be predicted using radiographs.Material and methods In total, 404 interproximal sites from 80 random patients attending for a periodontal assessment were measured after radiographs were digitised. The percentage of black triangles within the range of measurements of the crestal bone to the contact area from <5 mm up to 8 mm and over was then calculated.Results At a distance of 5 mm or less, the papilla was present 87.5% of the time. At 6 mm, a black triangle was present 51.4% of the time, and at 7 mm or greater, a black triangle was present 72.7% of the time. When these results were compared to other studies that had different criteria and methods, they were all very similar.Conclusion Using radiographs appears to be useful in assessing the presence or absence of a black triangle in patients who are assessed for periodontal disease, prosthetic replacement, implants in the aesthetic zone, or cosmetic treatment.

Application of Hyaluronic Acid for Treatment of Interdental Papillary Deficiency: A Systematic Review and Meta-Analysis.

Objectives: The focused question of this systematic review was "does hyaluronic acid (HA) injection in areas of interdental papillary deficiency reduce black triangles?" Materials and Methods: A systematic literature search was performed to find clinical studies on human patients with a minimum of 6-month follow-up, published in English from 2005 to May 2020. There were two outcome variables: black triangle area (BTA) change after treatment at different measurement time points compared with baseline, and patient reported outcome measures (PROMs), when available. Results: Of eight eligible articles (2 randomized clinical trials (RCTs) and 6 non-randomized, non-placebo controlled clinical studies), seven reported that HA injections had a positive impact on reduction of BTA and subsequent papillary augmentation. Six studies were included in meta-analysis and showed that the intervention led to a pooled reduction percentage of 57.7% in BTA after 6 months. Although there were clinical diversities between the studies, all the studies applied the same concentration of HA (approximately 2%), 2-3 mm apical to the papilla tip in several intervals. Some degrees of relapse were reported in some studies. Conclusion: Within the limits of this study, this systematic review and meta-analysis showed that HA injection can serve as an efficient minimally-invasive treatment for small interdental papillary deficiencies. It is essential to conduct further randomized clinical studies with prolonged follow-ups in order to support this conclusion.

Management of an adult patient with severe crowding using lingual appliances and mini-screw anchorage: A case report

At present, more adult patients seek orthodontic treatment so orthodontists are more likely to face periodontal patients and esthetic appliance demand increases. This case report presents the management of an adult patient with mild periodontitis and severe crowding using lingual appliances and mini-screw anchorage. Interproximal stripping was performed to create space and correct the triangular tooth shape and gingival black triangles. Four mini-screws were implanted in the palatal alveolar bone and mandibular buccal shelf to distalize the entire upper and lower arch. According to the case report, interproximal stripping in combination with mini-screw-assisted entire arch distalization and lingual appliances may be an effective space-creation approach in patients treated with non-extraction way.