Black Triangle Concerns, Esthetics, Bone Loss - 30 year old male

51 Rating(s).


Posted on By Mike Jones In Esthetic Therapy (General)

Previous orthodontic treatment with extraction of all first bicuspids Class I malocclusion, anterior crowding, tight anterior overjet?
Black triangle between #24/25 (CC)?Distal root tip #24/25
triangular teeth?, Lower anterior horizontal localized bone loss due to previous periodontal disease Lower anterior mild facial bone loss?

Patient is concerned with Black Triangle and has asked about ortho or bioclear matrix composite, in addition wants to know if LANAP will regenerate bone???




Add to Favorites
Add a comment to the discussion on Black Triangle Concerns, Esthetics, Bone Loss - 30 year old male


Upload photos
1.  Photo Title:

2.  Photo Title:

Would you like to follow this post?
Case has been added to your favorites.
Case has been removed from your favorites.
Thank you for your input. Your comment has been posted.
You are now following this member. You will get notified on any new topics posted by this member.
You are no longer following this member. You will not get notified on any new topics posted by this member.
Edit Comment
1.  Photo Title:
Current Image:   Delete Image
2.  Photo Title:
Current Image:   Delete Image
Comment has been updated.

16 Comments

Hi Mike;
You have two choices:
1. Strip the MIL corners of 24 and 25 and orthodontically move the teeth together
2. Restorative dentistry which can be accomplished with direct resin or with porcelain veneers. I have done this many times with resin.
Regards,
gerald


Reply

Thank you, would you using general bonding and believe it's safe for the gums to not cause further bone loss or go with bio clear matrix?

In addition, would you recommend Invisalign or conventional braces?


Reply

I agree with Gerald. The mesial incisal area can be reshaped, move the teeth closer together and evaluate for resins.
Bioclear matrix's will absolutey give this area closure if ortho is denied.

60+ year old female did not want ortho and elected to start with these 2 spaces first
utilized Bioclear matrix just last week. Not perfect but she was very happy the space was closed in a very conservative manner


Reply

Mike; I agree with Benjamin here. Bond her or ortho following IPR. No hope of bone regrowth with LANAP or anything else as it is a zero wall defect. Dr. S


Reply

Thank you, would you using general bonding and believe it's safe for the gums to not cause further bone loss or go with bio clear matrix?

In addition, would you recommend Invisalign or conventional braces?

In addition, in the future if teeth become mobile, would dental implants be an option with the patient having a thin biotype?


Reply

Hi Mike;
It depends on how good your resin skills are...I have bonded resin to correct black triangles many, many times with great results and no gingival inflammation. I would suggest using only a Microfill such as Renamel (Cosmedent). Your fees must be high enough to allow you to spend time to do this well.
Hope this helps.
Regards,
gerald


Reply

Thank you makes sense, in regard to the ortho, would you recommend Invisalign or traditional braces? In addition, do you see an increase in bone loss in any similar cases like mine when doing ortho?


Reply

Mike; Standard bracket orthodontics allows for better root control than Invisalign IMHO. As for continued bone loss with ortho ONLY if movement occurs with uncontrolled inflammation and/or trauma. Good luck Dr. S


Reply

Thank you very much, last but not least, if this was your patient would you bond or ortho? There are no financial constraints, patient wants to achieve aesthetics and teeth for lifetime.


Reply

Hi Mike,
Dr. Salama knows a lot more about this than I do.
Regards,
gerald


Reply

Any additional opinions?

Thank you


Reply

Mike, I have closed many similar black triangles with a microfill composite as Gerald mentioned. However, you do need to get a 'perfect' gingival margin. I use a thin mylar strip and hold it very tight at the gingival area even overbuilding the interdental space which I will then cut back to the proper dimension. One warning to the patient...If your patient creates a great deal of calculus on the lingual surfaces of the lower incisors it will be difficult to keep the composite surfaces clean. Therefore I suggest having the patient in for prophylaxis at 2 months for the first time and monitor the buildup before you let the patient go for 3 to 4 months in between cleanings.


Reply

Thank you for the reply, so through your experience in practice, would you do a combination of IPR stripping and orthodontics followed by composite, or just strictly composite with NO Ortho involved?


Reply

Hi Mike;
Instead of using a thin Mylar strip as Dr. Goldstein recommends, an easier technique is to use a Greater curve with the Toffilmeier retainer on the lingual.
Regards,
gerald


Reply

In recent years, clinician and dentist's esthetic demand in dentistry have increased rapidly, driven by an enhanced awareness of beauty and esthetics. The ultimate goal in modern restorative dentistry is to achieve "white" and "pink" esthetics in esthetically important zones. "White esthetics" is the natural dentition or the restoration of dental hard tissues with suitable materials. "Pink esthetics" refers to the surrounding soft-tissues, which includes the interdental papilla and gingiva that can enhance or diminish the esthetic result. Reconstruction of the lost interdental papilla is one of the most challenging and least predictable problems. Restoration and maintenance of these tissues with adequate surgical and prosthetic techniques are a real challenge in modern esthetic dentistry. Treatment of marginal tissue recession, excessive gingival display, deficient ridges, ridge collapse, and esthetic defects around teeth and implants are some of the esthetic problems associated with the interdental papilla that have to be corrected in todays scenario which has been discussed in this review.


Reply

In recent years, clinician and dentist's esthetic demand in dentistry have increased rapidly, driven by an enhanced awareness of beauty and esthetics. The ultimate goal in modern restorative dentistry is to achieve “white” and “pink” esthetics in esthetically important zones.
The absence or loss of interdental papillae can be due to several reasons, viz.

Plaque associated lesions
Traumatic oral hygiene procedures
Abnormal tooth shape
Improper contours of the restoration
Spacing between teeth
Loss of teeth.


Reply


DoWell Dental Products
Hu-Friedy