Angularis nigra

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Angularis nigra between mandibular central incisors Angularis Nigra.png
Angularis nigra between mandibular central incisors
Angularis nigra between maxillary central incisors Angularis nigra 2.png
Angularis nigra between maxillary central incisors

Angularis nigra, Latin for 'black angle', also known as open gingival embrasures, and colloquially known as "black triangle", is the space or gap seen at the cervical embrasure, below the contact point of some teeth. The interdental papilla does not fully enclose the space, leading to an aperture between adjacent teeth. [1] This gap has many causes including gingival recession, and gingival withdrawal post-orthodontic work. [2] Interdental "black triangles" were rated as the third-most-disliked aesthetic problem below caries and crown margins. [3] Treatment of angularis nigra often requires an interdisciplinary approach, involving periodontal, orthodontic and restorative treatment.[ citation needed ] Possible treatments to correct angularis nigra include addition of composite resin in the space, [4] veneer placement, or gum graft. [5] Angularis nigra is generally only treated based on the aesthetic preference of the patient [6] (although serious gum recession may warrant periodontal treatment).

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Previously, lack of proper terminology to report this condition was an issue, often colloquially termed the "black triangle"; angularis nigra has been proposed as a term to describe the appearance.

There are several risk factors leading to the development of black triangles. Papillae dimension can be changed due to any of the following reasons:

1. Inter-proximal space between teeth; diverging roots can result in the presence of an interproximal space when the contact point between the two clinical crowns is situated too incisally, diverging roots may also be a result of orthodontic treatment. [7]

2. The increased distance between inter-proximal contact position to bone crest, example to that is the naturally occurring diastema. [8]

3. Gingiva biotype; thick and thin tissues often respond differently to inflammation and trauma, [9] [10] thin gingiva is more liable to recession following restoration / crown preparation / periodontal or implant surgery.

4. Patient's age; the gingiva recede with aging which can cause an open gingival embrasure.

5. Periodontal disease and loss of attachment, resulting in recession.

6. Tooth morphology and abnormal crown and restoration shape; a clinical crown that tends to be triangular in shape can also result in partial interproximal space. [11]

Related Research Articles

<span class="mw-page-title-main">Dental floss</span> Cord of thin filaments used in interdental cleaning

Dental floss is a cord of thin filaments used in interdental cleaning to remove food and dental plaque from between teeth or places a toothbrush has difficulty reaching or is unable to reach. Its regular use as part of oral cleaning is designed to maintain oral health.

<span class="mw-page-title-main">Gums</span> Mouth anatomy

The gums or gingiva consist of the mucosal tissue that lies over the mandible and maxilla inside the mouth. Gum health and disease can have an effect on general health.

<span class="mw-page-title-main">Dental implant</span> Surgical component that interfaces with the bone of the jaw

A dental implant is a prosthesis that interfaces with the bone of the jaw or skull to support a dental prosthesis such as a crown, bridge, denture, or facial prosthesis or to act as an orthodontic anchor. The basis for modern dental implants is a biological process called osseointegration, in which materials such as titanium or zirconia form an intimate bond to the bone. The implant fixture is first placed so that it is likely to osseointegrate, then a dental prosthetic is added. A variable amount of healing time is required for osseointegration before either the dental prosthetic is attached to the implant or an abutment is placed which will hold a dental prosthetic/crown.

Periodontology or periodontics is the specialty of dentistry that studies supporting structures of teeth, as well as diseases and conditions that affect them. The supporting tissues are known as the periodontium, which includes the gingiva (gums), alveolar bone, cementum, and the periodontal ligament. A periodontist is a dentist that specializes in the prevention, diagnosis and treatment of periodontal disease and in the placement of dental implants.

<span class="mw-page-title-main">Oral irrigator</span> Dental care device

An oral irrigator is a home dental care device which uses a stream of high-pressure pulsating water intended to remove dental plaque and food debris between teeth and below the gum line. Regular use of an oral irrigator is believed to improve gingival health. The devices may also provide easier cleaning for braces and dental implants. However, more research is needed to confirm plaque biofilm removal and effectiveness when used by patients with special oral or systemic health needs.

<span class="mw-page-title-main">Gingival recession</span>

Gingival recession, also known as gum recession and receding gums, is the exposure in the roots of the teeth caused by a loss of gum tissue and/or retraction of the gingival margin from the crown of the teeth. Gum recession is a common problem in adults over the age of 40, but it may also occur starting in adolescence, or around the age of 10. It may exist with or without concomitant decrease in crown-to-root ratio.

<span class="mw-page-title-main">Crown lengthening</span> Dental procedure

Crown lengthening is a surgical procedure performed by a dentist, or more frequently a periodontist, where more tooth is exposed by removing some of the gingival margin (gum) and supporting bone. Crown lengthening can also be achieved orthodontically by extruding the tooth.

Gingivectomy is a dental procedure in which a dentist or oral surgeon cuts away part of the gums in the mouth.

The interdental papilla, also known as the interdental gingiva, is the part of the gums (gingiva) that exists coronal to the free gingival margin on the mesial and distal surfaces of the teeth. The interdental papillae fill in the area between the teeth apical to their contact areas to prevent food impaction; they assume a conical shape for the anterior teeth and a blunted shape buccolingually for the posterior teeth.

Dental pertains to the teeth, including dentistry. Topics related to the dentistry, the human mouth and teeth include:

A gum lift is a cosmetic dental procedure that raises and sculpts the gum line. This procedure involves reshaping the tissue and/or underlying bones to create the appearance of longer or symmetrical teeth, thereby making the smile more aesthetically pleasing. This procedure is typically done to reduce excessively gummy smiles or to balance out an asymmetrical gum line. The procedure, also known as crown-lengthening, has historically been used to treat gum disease. It is only within the past three to five years that dentists have commonly used this procedure for aesthetic purposes. The practice of cosmetic gum lifts was first developed in the late 1980s, but there were few oral surgeons and dental practitioners available to perform the procedures. Gum lifts can also include bone shaping to reduce the prominence of the upper jaw and even out the tooth and gum ratio. This method provides permanent results, while simple gum contouring may result in relapse or regrowth of the gingiva.

Height of curvature in the tooth can be defined as the line encircling a tooth at its greatest bulge to a selected path of insertion. The height of curvature is the same as the height of contour.

In dentistry, numerous types of classification schemes have been developed to describe the teeth and gum tissue in a way that categorizes various defects. All of these classification schemes combine to provide the periodontal diagnosis of the aforementioned tissues in their various states of health and disease.

Gingivoplasty is the process by which the gingiva are reshaped to correct deformities. Gingivoplasty is similar to gingivectomy but with a different objective. This is a procedure performed to eliminate periodontal pockets along with the reshaping as part of the technique. This procedure is followed to create physiological gingival contours with the sole purpose of recontouring the gingiva in the absence of the pockets.

Interproximal reduction (IPR) is the practice of mechanically removing enamel from between the teeth to achieve orthodontic ends, such as to correct crowding, or reshape the contact area between neighboring teeth. After reducing the enamel, the procedure should also involve anatomic re-contouring and the protection of interproximal enamel surfaces.

Laser gingivectomy is a dental procedure that recontours or scalpels the gingival tissue to improve long term dental health or aesthetics. Compared to conventional scalpel surgery, soft-tissue dental lasers, such as Laser diode, Nd:YAG laser, Er:YAG laser, Er,Cr:YSGG laser, and CO2 lasers, can perform this procedure, offering a precise, stable, bloodless, often less painful, and accelerated healing experience. However, the Laser diode gained more popularity due to its versatility, less interaction with hard tissue, ease of use, and the less expensive set up.

<span class="mw-page-title-main">Gingival grafting</span>

Gingival grafting, also called gum grafting or periodontal plastic surgery, is a generic term for the performance of any of a number of periodontal surgical procedures in which the gum tissue is grafted. The aim may be to cover exposed root surfaces or merely to augment the band of keratinized tissue.

Interdental cleaning or interproximal cleaning is part of oral hygiene where the aim is to clean the areas in between the teeth, otherwise known as the proximal surfaces of teeth. This is to remove the dental plaque in areas a toothbrush cannot reach. The ultimate goal of interproximal cleaning is to prevent the development of interproximal caries and periodontal disease. The combined use of tooth brushing, and mechanical and manual interdental cleaning devices has been proven to reduce the prevalence of caries and periodontal diseases.

Periodontal surgery is a form of dental surgery that prevents or corrects anatomical, traumatic, developmental, or plaque-induced defects in the bone, gingiva, or alveolar mucosa. The objectives of this surgery include accessibility of instruments to root surface, elimination of inflammation, creation of an oral environment for plaque control, periodontal diseases control, oral hygiene maintenance, maintain proper embrasure space, address gingiva-alveolar mucosa problems, and esthetic improvement. The surgical procedures include crown lengthening, frenectomy, and mucogingival flap surgery.

References

  1. Burke, S; Burch, J; Tetz, J (1994). "Incidence and size of pretreatment overlap and posttreatment gingival embrasure space between maxillary central incisors". American Journal of Orthodontics and Dentofacial Orthopedics. 105 (5): 506–11. doi:10.1016/S0889-5406(94)70013-3. PMID   8166102.
  2. Ikeda, T; Yamaguchi, M; Meguro, D; Kasai, K (2004). "Prediction and causes of open gingival embrasure spaces between the mandibular central incisors following orthodontic treatment". Australian Orthodontic Journal. 20 (2): 87–92. PMID   16429878.
  3. Cunliffe, Joanne; Pretty, Iain (December 2009). "Patients' ranking of interdental "black triangles" against other common aesthetic problems". The European Journal of Prosthodontics and Restorative Dentistry. 17 (4): 177–181. ISSN   0965-7452. PMID   20158060.
  4. Lenhard, M (2008). "Closing diastemas with resin composite restorations". The European Journal of Esthetic Dentistry. 3 (3): 258–68. PMID   19655542.
  5. De Castro Pinto, RC; Colombini, BL; Ishikiriama, SK; Chambrone, L; Pustiglioni, FE; Romito, GA (2010). "The subepithelial connective tissue pedicle graft combined with the coronally advanced flap for restoring missing papilla: A report of two cases". Quintessence International. 41 (3): 213–20. PMID   20213022.
  6. Clark, D (2008). "Restoratively driven papilla regeneration: Correcting the dreaded 'black triangle'". Texas Dental Journal. 125 (11): 1112–5. PMID   19180945.
  7. Cho, Hae-Sung; Jang, Hyun-Seon; Kim, Dong-Kie; Park, Joo-Cheol; Kim, Heung-Joong; Choi, Seong-Ho; Kim, Chong-Kwan; Kim, Byung-Ock (October 2006). "The Effects of Interproximal Distance Between Roots on the Existence of Interdental Papillae According to the Distance From the Contact Point to the Alveolar Crest". Journal of Periodontology. 77 (10): 1651–1657. doi:10.1902/jop.2006.060023. ISSN   0022-3492. PMID   17032106.
  8. "Portuguese Abstract Translations". Implant Dentistry. 23 (5): e87–e93. October 2014. doi:10.1097/id.0000000000000164. ISSN   1056-6163. S2CID   220586634.
  9. Houston, W. J. B. (1984-08-01). "Textbook of clinical periodontology. Author: Jan Lindhe. Publisher: Munksgaard International Publishers Ltd., Price: D.kr. 460.00". The European Journal of Orthodontics. 6 (3): 234. doi:10.1093/ejo/6.3.234. ISSN   0141-5387.
  10. SANAVI, FARSHID; WEISGOLD, ARNOLD S.; ROSE, LOUIS F. (May 1998). "Biologic Width and its Relation to Periodontal Biotypes". Journal of Esthetic and Restorative Dentistry. 10 (3): 157–163. doi:10.1111/j.1708-8240.1998.tb00351.x. ISSN   1496-4155. PMID   9759032.
  11. "Portuguese Abstract Translations". Implant Dentistry. 23 (5): e87–e93. October 2014. doi:10.1097/id.0000000000000164. ISSN   1056-6163. S2CID   220586634.

Further reading