The ‘Dark Triangle’ Space Between Dental Implants or Teeth

The ‘dark triangle’ between dental implants or teeth is both an aesthetic as well as hygienic issue. It occurs when the papilla (the gum tissue between teeth) recedes due to either periodontal disease or tooth loss with bone resorption. Either way, it creates an unsightly space particularly when it occurs in the smile zone. Several surgical procedures and techniques have been suggested to restore the papilla although it has been generally not predictable. In an article in 2010 by Garber, Salama, & Salama, the authors described certain parameters in predictable regeneration of papilla in different circumstances. The various dimensions between implants and adjacent implants or natural teeth and distance between the bone and contact points offered a valuable reference which can be used during treatment planning.

This patient was treated with a single dental implant in the aesthetic zone with adjacent natural tooth on one side and a dental implant on the other. Initially, patient presented with loss of papilla and development of the ‘dark triangles’. However, the implant position, diameter, depth, bone level, and restoration design was carefully planned with certain parameters and dimensions in mind. The papilla spontaneously regenerated itself over the next 18 months with the result shown 4 years later. Biologically-driven and evidence-based treatments should be the pillars for every treatment decision we make.

Dr. H. Ryan Kazemi is a board-certified oral and maxillofacial surgeon in Bethesda, MD