Etiological factors of black triangles: A cross sectional study

Background: In recent years, esthetic demand in dentistry have increased rapidly, driven by an enhanced awareness of beauty and esthetics. Loss of the interproximal dental papilla may cause formation of black triangle and in maxillary anterior region cause functional, phonetic and esthetic impairment. There are number of factors affecting the papilla fill in embrasure space, they are periodontitis, abnormal tooth shape, history of orthodontic treatment etc. Black triangle may be present when distance from contact point to alveolar crest is more than 5mm. It is important to know the cause of black triangle so that appropriate treatment can be planned. Aim: To determine factors causing the black triangle. Amount of papilla fill in embrasure space. Materials and Methods: A total of 200 sites were examined for amount of papilla fill & the presence of black triangle in 6 maxillary anterior teeth. The distance from contact point to alveolar crest was evaluated using Cone Beam Computed Tomography(CBCT) Clinically, the plaque index was recorded. Individuals were divided into 2 groups: Group A - Patients having 100% papilla fill and Group B - Patients having black triangle. Results: The most common factor causing black triangle is poor oral hygiene. Patients with poor oral hygiene 73.5% of total sites had black triangle whereas in the patients maintaining good oral hygiene, only 2.5% of total sites had black triangle then followed by patients with thin gingival biotype and triangular tooth morphology showed the occurrence of black triangle with 67.5% and 57.5% of total sites respectively. There was no significant difference found in gender for presence of black triangle. 100% papilla fill is present when the distance from CP - AC was ≤ 5mm. Conclusion: The most common factor causing black triangles is poor oral hygiene followed by thin gingival biotype, and triangular tooth morphology. It is commonly seen in older age i.e. 35 -50 yr. In the present study, it was also found that when the distance from CP - AC was ≤ 5mm, a complete papilla fill was present.