Multifactorial Contributions to Central Incisor Tooth Morphology and the Presence of Black Triangles: A Case Study

Steven E. Kohane, Katelyn C. Means

Abstract


Abstract: Dentists are often faced with patient concerns of smile esthetics in addition to oral health and should be equipped to help patients manage both.  Black triangle disease, or a lack of interdental papilla, is esthetically displeasing particularly in the central incisor region and has a hoard of etiologies ranging from gum disease to inherited tooth morphologic features.  Addressing patients’ esthetic concerns must first be met with understanding the causation of the black triangles before treatment can be rendered.  Genetic contributions are multifactorial, and this case report provides evidence for a case of a central incisor black triangles without other affected family members.

Background:   Black triangles are a prominent feature for those experiencing a lack of interdental papilla between central incisors and may dramatically affect the presentation of a person’s smile.  The aim of this case report is to convey the importance of managing patients’ esthetic chief complaints while addressing the etiology of the esthetic concern.

Case Description:  A 24-year-old man presented to his dental colleague with concern of his black triangle spaces.  The patient does not have gingival recession in the area of interest, and his biological mother and brother do not have black triangle spaces.  Pathology is not an issue, but instead inadequate length of the central incisor mesial contact area prevents the interdental papilla from reaching the contact.  Esthetics are a concern, but the patient is not interested in irreversible treatment for his healthy tissue.

Practical Implications: Dentists should be aware of the multifactorial contributions to patients’ esthetic concerns. Dentists should also be aware that meeting a patient’s expectations may require a more complex treatment plan than the patient expected.


Keywords


black triangles; multifactorial inheritance; cosmetic dentistry; esthetics; gingival embrasures; interdental papilla; contact point; tooth morphology; odontometry

Full Text:

PDF

References


The Influence of the Smile on the Perceived Facial Type Esthetics. Batwa W. Biomed Res Int. 2018;2018:3562916. eCollection 2018. PMID: 30112381.

Black triangle dilemma and its management in esthetic dentistry. Singh VP, Uppoor AS, Nayak DG, Shah D. Dent Res J (Isfahan). 2013 May;10(3):296-301. Review. PubMed PMID: 24019795.

Maxillary anterior papilla display during smiling: a clinical study of the interdental smile line. Hochman MN, Chu SJ, Tarnow DP. Int J Periodontics Restorative Dent. 2012 Aug;32(4):375-83. PubMed PMID: 22577642.

Clinical studies on the appearance of natural anterior teeth in young and old adults. Hartmann R, Müller F. Gerodontology. 2004 Mar;21(1):10-6. PMID: 15074535.

Open gingival embrasures after orthodontic treatment in adults: prevalence and etiology. Kurth JR, Kokich VG. Am J Orthod Dentofacial Orthop. 2001 Aug;120(2):116-23. PMID: 11500652.

An analysis on the factors responsible for relative position of interproximal papilla in healthy subjects. Kim JH, Cho YJ, Lee JY, Kim SJ, Choi JI. Journal of Periodontal & Implant Science. 2013 Aug 31; 43(4): 160-167. PMID: 24040568.

Esthetics: the orthodontic-periodontic restorative connection. Kokich VG. Semin Orthod. 1996 Mar;2(1):21-30. Review. PubMed PMID: 9161280.selct

Incidence and size of pretreatment overlap and posttreatment gingival embrasure space between maxillary central incisors. Burke S, Burch JG, Tetz JA. Am J Orthod Dentofacial Orthop. 1994 May;105(5):506-11. PubMed PMID: 8166102.

Significance of crown shape in the replacement of a central incisor with a single implant-supported crown. Gobbato L, Paniz G, Mazzocco F, Chierico A, Tsukiyama T, Levi PA Jr, Weisgold AS. Quintessence Int. 2013 May;44(5):407-13. PMID: 23479574.

Risk factors associated with open gingival embrasures after orthodontic treatment. An SS, Choi YJ, Kim JY, Chung CJ, Kim KH. Angle Orthod. 2018 May;88(3):267-274. Epub 2018 Jan 16. PMID: 29337634.

Factors influencing the presence of interproximal dental papillae between maxillary anterior teeth. Chen MC, Liao YF, Chan CP, Ku YC, Pan WL, Tu YK. J Periodontol. 2010 Feb;81(2):318-24. PMID: 20151812.

Age-related changes in crown and root length in Sri Lankan Sinhalese. Jayawardena CK, Abesundara AP, Nanayakkara DC, Chandrasekara MS. J Oral Sci. 2009 Dec;51(4):587-92. PubMed PMID: 20032612.

Intrusive luxation in primary teeth - Review of literature and report of a case. Gupta M. Saudi Dent J. 2011 Oct;23(4):167-76. Epub 2011 Sep 16. PubMed PMID: 23960512.

Genome-wide association analysis identifies 20 loci that influence adult height. Weedon MN, Lango H, Lindgren CM, Wallace C, Evans DM, Mangino M, Freathy RM, Perry JR, Stevens S, Hall AS, Samani NJ, Shields B, Prokopenko I, Farrall M, Dominiczak A, Johnson T, Bergmann S, Beckmann JS, Vollenweider P, Waterworth DM, Mooser V, Palmer CN, Morris AD, Ouwehand WH, Zhao JH, Li S, Loos RJ, Barroso I, Deloukas P, Sandhu MS, Wheeler E, Soranzo N, Inouye M, Wareham NJ, Caulfield M, Munroe PB, Hattersley AT, McCarthy MI, Frayling TM. Nat Genet. 2008 May;40(5):575-83. Epub 2008 Apr 6. PubMed PMID: 18391952.

Short and tall stature: a new paradigm emerges. Baron J, Sävendahl L, De Luca F, Dauber A, Phillip M, Wit JM, Nilsson O. Nat Rev Endocrinol. 2015 Dec;11(12):735-46. Epub 2015 Oct 6. Review. PubMed PMID: 26437621.




DOI: https://doi.org/10.5195/d3000.2021.101



Copyright (c) 2021 Steven E. Kohane, Katelyn C. Means

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.