Black triangles occur when there is a loss of gum between the teeth. This can occur when there is a loss of bone due to disease, crooked teeth, or poor hygiene, among other reasons. These little "triangles" of "black" space (pictured below) tend to catch more food and plaque in the middle, along with being unaesthetic!  When closing a black triangle space, we can't just stuff a filling in the middle and call it a day. Front teeth require specific anatomy and gentle curves not just for esthetics, but for ease of flossing and cleansing. The purpose of this anatomy makes it harder for plaque to catch in between and, thus, prevent bacterial growth which can lead to further gum loss. To remedy this, we place fillings between the teeth with a device called a Bioclear Matrix (below).  Sample photo provided from https://www.aegisdentalnetwork.com/id/2011/05/the-bioclear-matrix-and-peg-lateral-treatment This plastic Bioclear matrix template allows us to bond a filling that has all the right shapes and curves to give us an aesthetic AND cleansible restoration.  Note how the unesthetic black triangle spaces are now filled with aesthetic restorations that have all the right shapes and sizes. The teeth and gums are easily cleansible and will significantly reduce the amount of plaque trapping between the teeth. This patient's smile now looks many years younger!
This was such a fun case! This patient was very insecure about his smile and his underbite. After much time, planning, patient compliance - everything is now complete! Happy patient means a happy dentist, which means a happy blog post.
This patient's severe crowding is now resolved. He has a smile he can be proud of!
Overall thoughts: Invisalign is such a powerful tool for Class 3 (underbite) orthodontics. It was thought before that Invisalign could only treat simple cases. However with solid treatment planning COMBINED with a patient who follows all the easy directions, orthodontic treatment can be more predictable.
With this in mind, a case like this does not have to be scary or difficult. Instead, it is very rewarding and most of all - absolutely fun! Our 5 year old patient’s parents were concerned about her loud grinding at night and were asking about what to do so she’s not grinding her teeth away before the adult set comes in. While other dentists or pediatricians may say bruxism or teeth grinding is “normal” and that their child will eventually grow out of it, it is not normal and is actually a sign of an underlying airway disorder. Teeth grinding is the body’s physiological response to an airway problem and is considered sleep disordered breathing or (SDB). With SDB, airflow is interrupted and oxygen levels drop, and the body’s response is grinding or clenching their teeth to help open up the airway. Once the teeth are ground down, this can further lead to TMJ issues down the line which can be extremely painful. The main point is to intervene with a myofunctional appliance before this even has a chance to occur. The myofunctional appliance promotes the natural growth and development of the upper and lower jaws to promote nasal breathing, as well as expanding the airway and straightening teeth. As the jaw and airway develop, symptoms of SDB disappear. With an adequate airway, the body gets the oxygen it needs to help kids grow to their full potential. Myofunctional appliances not only address the root cause of SDB, they simultaneously straighten your child’s teeth (no need for braces!). Appliances help expand the arch to allow for proper spacing for adult teeth to grow in, while guiding the adult teeth to grow straight. Think of this as an interceptive appliance to straighten teeth, as opposed to braces doing the work after the teeth already grew in crooked.
“I like that smile better!” The patient was a great candidate to start wearing a myofunctional appliance to address her grinding. She looks forward to her dental appointments, and immediately points out which smile she likes better. The patient and her parents are ecstatic with her results after only 3 months. As seen in her pictures, her upper teeth almost completely covered her bottom teeth. Her jaw was also visibly shifted back, decreasing her airway space, and causing a crease to develop above her chin. After only 3 months, her jaw positioning and teeth positioning are ideal, the crease above her chin has disappeared, and the patient is thrilled with her new smile. Her facial development is apparent after having started treatment.
Pictures posted with permission from patient's Mom. :)
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Photo used under Creative Commons from Michael Dunn~!
