Is It Possible to Do a Bone Graft in Order to Close Black Triangle Between the Teeth?

I believe I recall your case from a previous question a few days ago.  As mentioned previously, a gum graft would not close this space completely, but if a surgeon could even close it by 50 percent we could close the rest with veneers.  It would be challenging, but should be able to be accomplished.  I think that the orthodontist has accomplished everything possible, and your only choice would be what I mentioned.  Good luck.

A bone graft won't close the triangle, but veneers would do it.  Probably need to do at least four.

It is possible to take a tissue graft from the maxillary tuberosity that is very dense and grafting it under a coronally repositioned flap.  A bone graft would be my last choice of treatment unless bone pockets were present.

It is also possible to super-erupt 8 and 9 to grow more bone and esthetically reshape the crowns. 

From the picture it looks like you are a candidate to remove mesial tooth and move the teeth closer but a radiograph is needed to evaluate the bone, how extensive is the bone loss.

Another suggestion is to do reverse vestibuloplasty to prevent exposure of the black triange when smiling.  This is usually done to cover a gummy smile.

Bonding is the easiest alternative.

Yes, the black triangle is dreaded by both the patient and the doctor. We are now using cosmetic filler's like Juvederm to plump the tissue and fill the black triangle; particularly for patients that are opposed to bonding. Bonding is a more conservative approach than veneers and doesn't lock you into a particular treatment modality, the same goes for cosmetic filler's.  

I recommend gum grafting over one or two procedures. You could also try bone regeneration which could give more support to the gums. Different experts do it differently. Some say you need to increase the amount of gum first, which is relatively easy, then as a second procedure after a few months, do a bone graft (a small one!). Results will never be perfect though and you can get a bit of scarring in the area.

Dentistry has come up with many amazing solutions over the years, but when the papilla is lost treatments to add gum and/or bone to restore the papilla to the original size and shape have been disappointing. 

The most predictable and commonly used approach to eliminate the black triangle is to place crowns or veneers on the adjacent teeth.  The new dental restorations would be made much fuller near the gum line, meant to obscure the lost of papilla and black triangle.  Although most cosmetic dentists favor doing veneers over crowns, the crowns will most likely give you dentist more control over getting the shape of the restoration that will best hide the black triangle.

If you visit the web link below you will see several examples where crowns or veneers were used to close the space and hide the black triangle.

Black triangles can be permanently and comfortably eliminated by correcting the shape of the front teeth, This can be done with bonding, veneers or crowns with excellent results A black triangle is simply a space where two teeth contact one another. Therefore, two teeth require treatment to eliminate one black triangle. This is accomplished by making the teeth slighly wider in the triangle area. Closing black triangles can dramatically improve your smile. I think veeners or crowns would be a great procedure for this problem.  I would explore this area with a good cosmetic dentist.

This is actually a very tough question and answer. As you ahve seen, there are a few ways to proceed and the results vary with each.  With the amount of visual bone and gum tissue loss, it will be difficult to get the results you may be looking for.  Can the results be good - YES; can they be great- Well, not sure.  The surgical route of placing some bone or gum tissue may be the best start and then when healing is complete, if some length has been gained, then veneers is the answer for you. I see you have braces, so you obviously care what your smiles appearance is.  You are a good candidate for any of these procedures simply because you are motivated and will do what it takes to ensure success.  This is a great question and tough to answer because in past, the results have varies so much. Dentistry has came a long way and results are more predictable.  Make sure you are seeing a dentist and periodontist who do this work often! You should be in good shape if you do.  I woudl also say that both of theses professionals will not give you a definite guarantee of the outcome because of the items each of the dentists have already spoken of.  But confidently, you can have a good omprovement which will most definitely enhance your smile! 

Hey Anka,

Thanks for posting the picture, it makes it much easier to answer your question.  I would strongly recommend gum grafting to improve the appearance of the black triangle.  I work with a very competent periodontist in the city who performs these procedures rourtinely.  You may want to look him up; Dr. Baruch Tetri.  After the gums heal then you need a competent dentist using a very good lab to hide the defects and make things look their best. Good Luck!

This is really hard to address without seeing the xrays and a full assessment.  Having said that I wish to summarize the solutions to this problem, there may be something in this that may help find the best solution to your condition.

Black triangles between teeth are formed because the bone level is too low to support the gum or the space between the teeth is too large and the gum can't fill that in. 
 

1) We can move the teeth closer together and this may force the contact of the teeth closer to the bone and thus help in the reduction of the black space.

2) We can move the roots of the teeth closer together.  When the roots of the teeth are spaced the teeth have an inclination toward one another and thus the space in the gum seems larger, in your case i can almost see that but can't be sure without more info.

3) We can place dental bonding or porcelain veneers and again make the contact area of the teeth closer to the gum therefore reducing the space between the teeth.

4) Do nothing!  This may seem harsh but most of us have a black triangle between the teeth if its small enough its considered normal in an aging dentition.  Dentistry can solve many problems very predictably but this one is a little elusive!!

Bottom line, bone grafting is not predictable in this situation and can actually make things worse, talk to your orthodontist again, this may be partially corrected by torquing the roots.