The appearance of your teeth is heavily impacted by the position of the surrounding gum tissue. In a normal situation, two teeth that are side by side in your mouth have contact with each other. Below this contact, the area is filled in with gum tissue in the shape of a triangle. This triangular-shaped gum tissue is called the papilla. It is not uncommon to have an empty space in the area where the papilla is supposed to be. If this occurs, the result is perceived as a black space.
They are caused by a loss of the gum tissue itself or by the shape and/or position of the teeth. For any black space that is present, the first thing that needs to be done is to diagnose what caused it to occur. Once this is done, the restorative dentistry treatment choice can be made. The best decision will be the most conservative treatment that corrects the black space.
One of the most common causes of loss of gum tissue is due to the gum disease known as periodontitis. This gum disease acts on the supporting bone around the teeth, causing a loss of bone. This loss of bony support causes the papilla to slump and flatten, creating a black space between the teeth. The first step in treating the resulting black space in this situation is to treat the cause. Once the gum disease is under control, the black spaces can then be addressed with restorative dentistry.
To remove the black spaces, the teeth need to have restorations placed that will change the shape of the teeth and fill in this space. The type of restorative dentistry can vary depending on whether or not there are any other problems with the teeth. The simplest and most conservative restoration is composite, a tooth-colored filling material. It can be bonded directly on the tooth in the area of the black space. Since it is placed only in the affected area, the situation where this is used requires that the overall appearance of the tooth is acceptable and does not need to be changed.
If the overall appearance of the tooth needs to be altered, then a different type of restorative dentistry needs to be used. The choice is either a dental veneer or a dental crown. The choice between the two depends on both the appearance and the structural changes that need to be done. Usually, to correct a black space, both teeth on either side need to be restored. In doing this, the symmetry between the teeth will remain the same. If you restored just one tooth, you would end up with one tooth being wider than the other. The advantage of using restorative dentistry to correct black spaces is that it usually results in a shorter treatment time.
Another cause of the black space is due to the position of the teeth themselves. One example is teeth that are tilted towards each other. When this occurs, the area for your gum tissue to fill becomes too large for the amount of tissue you have. This same concept may occur with certain types of tooth shapes. In these instances, the restorative dentistry treatment of choice is to use orthodontics (braces) to align the teeth. The advantage of doing this is that the black space will disappear without having to do any restorations on the teeth.
By Greggory Kinzer, DDS, MSD