Comparing the Perception of Periodontists, General Dentists, and Lay People to Inter-Dental Papilla Discrepancies: “The Black Triangle Disease”

Signature Grand, Davie, Florida, USA

Objective. To determine the size of a “black triangle” perceived as unaesthetic to Periodontists, General Dentists and Lay People. Background. Dental implant rehabilitation is no longer merely a vehicle to restore lost masticatory and phonetic function. With advances in bone augmentation and soft tissue management patients have expect aesthetically pleasing restorative treatments and have questioned the disappearance of inter-dental papilla resulting in the so-called “black triangle disease.” Methods. A smile photograph was digitally altered with varying heights of inter-dental papilla deficiencies (“black triangles”). A total of 16 images were created. The black triangles ranged in height from 0 to 2mm in 0.25mm increments and were equally divided between the central and lateral papillae. Subjects from the three testing groups (20 Periodontists, 20 General Dentists and 20 Lay People) were presented with the images to determine the smallest papilla deficiency which was considered unaesthetic. Results. The mean size at which an unaesthetic black triangle was discernable ranged from 1.06mm to 0.45mm and varied depending upon the group. At the central papilla position papilla discrepancies were detected by Lay People at 1.06mm; General Dentists at 0.65mm; Periodontists at 0.55mm. Lateral papilla position: Lay People at 0.625mm; General Dentists at 0.575mm; Periodontists at 0.45mm. Conclusion. Periodontists were the most perceptive in detecting inter-dental deficiencies and were able to discern the smallest deficiencies, followed by General Dentists and finally Lay People. All groups were able to detect small discrepancies and discrepancies at the lateral papilla were more readily detected than at the central papilla.