Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

November 10, 2016

Looking for a lab that makes gingival masks


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Dr. Hall,
Hi. We have a couple of patients who are in need of a gingival mask; but no labs in our area fabricate them. Can you please give me the name of a lab that we could work with that makes them?

Thanks!
– Diana from a dental office in Mt. Shasta, California

Diana,
For background for our visitors who may not know about the gingival mask, it’s a prosthesis for replacing gum tissue that is lost from severe gum disease, or after periodontal surgery. It is flexible and pink, and it snaps between the teeth to cover the black triangles left by severely receded gums. It’s usually made out of silicone, but I’ve heard some labs talk about making it out of soft denture liner material such as Molloplast.

A lot of dental labs make these, so I thought you’d have several choices, but then I looked up Mount Shasta and I see that you’re in a relatively remote area of northern California. So I can see where you would have problems maybe finding a lab that would make this.

In other parts of the country, you may want to consider Glidewell Dental Lab in Newport Beach, California, where they are used to shipping cases all over the country. They are fairly familiar with gingival masks. While just about any dental lab that makes dentures would be able to make one of these, if you have to explain to the technician what a gingival mask is, that wouldn’t inspire you with confidence. That won’t happen with Glidewell.

Thanks,
– Dr. Hall

Question and answer go here.

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

July 7, 2016

I had bonding to close black triangles, and it looks awful


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Dr. Hall,
I had dental bonding done to close two tiny black triangles I had on the teeth next to my front teeth, and it looks awful. I went back today to see if he could fix it and it still looks bad.

I thought my dentist was a cosmetic dentist but come to find out he’s not certified which I had no idea and the job looks terrible. Looks like whitish material lodged between my teeth and I am sad and regretting even doing it. Just thought if he said he would do it, it was an easy fix that would look nice. He said give it a couple weeks to get used to but he will refund me since I am not happy. I can’t even floss between the teeth except above the bonding.

He wants me to come back tomorrow to try and fix it. I am afraid to have him do anything else. And researched more and found that certain dentists are actually certified for this. Is this something I can get fixed and done correctly? I just wish he would have said this isn’t something he specializes in. I just want my teeth back to where they were before this now and want my gums to settle down. What do I do???

– Angie from St. Louis

Dear Angie,
Closing black triangles is really tricky. Fortunately, you a couple of excellent cosmetic dentists in the St. Louis area, and either of them could do a fine job on this for you.

Black triangles are usually caused by receding gums. Here is a photograph of a case where that occurred.

Black triangles from receding gums

Black triangles from receding gums.

In your case yours showed up after straightening your teeth with Clear Correct invisible braces. Now you said that they are tiny. Not seeing a photograph of your teeth, I can’t tell you my opinion about whether or not you need these areas bonded—you can figure that out, if you want to just have the bonding sanded off and go back to the way your teeth looked, or if you want the black triangles filled in somewhat.

If you have them filled in, I’ll let you know several issues that make fixing these black triangles tricky.

The first is that their shape can adversely affect the health of the gums. Simply adding bonding material to fill in the hole left by the gum–that will just create a food trap which will cause plaque and calculus to accumulate beneath it. This will cause gum disease. So the added composite has to be shaped skillfully so that there is no such trap created and then polished carefully to make it plaque-resistant. The best test of whether or not the shape is healthy is to floss between the teeth. If you can push the floss into the sulcus under the gum and then when you pull it up it pulls smoothly, that is a strong sign that the shape and the polish are excellent. In your case, you’re saying that you can’t even get the floss past the bonding material. This is a serious problem and needs to be resolved to avoid gum disease on these teeth.

The second issue is that this is a difficult area to bond anything. To get the final result shaped properly, the dentist should be working some slightly under the gumline. Gum tissue oozes fluids. And if the gum tissue isn’t healthy, this oozing is very difficult to control. Those fluids contaminate the bond between the composite and the tooth, making it so the composite doesn’t stick. There are techniques for retracting the gum and controlling this oozing during the procedure, and those techniques have to be meticulously applied.

The third issue is the esthetics of the case, and there are a couple of dimensions to esthetics at play here. You mentioned color. Teeth are quite a bit darker at the gumline than they are at the incisal edge, and many dentists won’t use a dark enough shade of composite here. Family dentists may not even stock appropriate shades, because they only stock general purpose composites that are used for fillings. Composites for esthetic work are different. And then the shape is another dimension. Just putting a blob of composite on the teeth to plug the hole isn’t good enough. The end result has to look natural, and it can’t be done in such a way as to compromise the health of the gums, as I mentioned above.

I respect your dentist for his honesty in acknowledging his inadequacy here. I would recommend that you have him remove all the bonding material, refund your money as he has offered, and then, if you want this fixed, go to someone who knows what they are doing. There are sandpaper strips that can be used to polish off all of the bonding. After it is removed, you should be able to floss easily, get the floss under the gum, and the surface will feel smooth as you rub the floss up and down on the tooth surface.

– Dr. Hall

Do you have a comment or a question or anything else to add? We’d love to hear from you. Enter your comment below.

Click here to ask Dr. Hall a question of your own.

About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

February 18, 2016

Finding a dentist who can make a gingival mask for me

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Dr. Hall,
I am suffering from periodontal disease. I have searched for a cosmetic dentist that does gingival masks in my area and haven’t found one. Would you have any idea what I should search for?

My gums have receded a lot, so I have large black triangles between my front teeth. And then I and am scheduled for gum surgery in the near future which is going to make them look worse. It’s a very unsightly thing and seems to be getting worse, and I think a gingival mask would help a lot.

Also, have you seen gums come back to fill these triangles in after gum surgery, seems the future of my once nice smile is in jeopardy. I just want to be able to smile confidently again, any help would be greatly appreciated.
Thank you,
Mike from Michigan

Mike,
Here’s the thing on gingival masks. Even cosmetic dentists who do a lot of appearance-related dentistry don’t get calls for them very often, so they’re very unlikely to mention them on their websites. And if you call the office, the receptionist is likely to not know what you are talking about. But any dentist who is seriously into aesthetic dentistry is going to be able to do this for you and do a nice job.

The concept of a gingival mask is fairly simple. It’s simply a piece of silicone shaped to fit over these black triangles between your front teeth and colored to look like gum tissue. It has little tags that slip through those black triangles and help anchor it into place.

gingival mask prosthesis

Gingival mask photo courtesy of Chromeworks Lab, Chico, CA

Silicone is used in dentistry for several purposes—soft denture liners for one. So any dental lab that does dentures can make them. And all the dentist has to do is send a good plaster model to the dental lab. So any dentist who is really into cosmetic dentistry should be able to make this.

So my suggestion would be to simply make an appointment with any cosmetic dentist that I recommend on this website, and I’m confident they could do this for you.

And no, your gum is not going to grow back. Even trying to correct this surgically isn’t really going to work. The gingival mask prosthesis is the only real way to address the aesthetics of your situation, if you have a high lip line that shows your gums.

Do you have a comment? We’d love to hear from you. Enter your comment below.

Click here to ask Dr. Hall a question of your own.

About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

September 6, 2012

Sometimes you just have to trust your dentist

This is a follow-up to a question from Jamie from California about Fixing a Black Triangle.

So I went to a cosmetic dentist your site recommends about my black triangle between the 23 and 24. he said it was small and should not bond it because the gum in that area will be hard to keep clean and could become inflamed and not healthy in the long run. If he doesn’t want to do the bonding, should I go to another dentist? I’d really like to reduce the black triangle. He recommended getting veneers in twos for the space, but I’d really rather not ruin perfectly good healthy teeth for veneers at this point.

– Jamie from California

Jamie,
You’re saying that this black triangle is between teeth #s 23 & 24? Those are the lower right central and lateral incisors. I was thinking you were talking about UPPER teeth.

Does this actually show during conversation?

Now I need to be careful here, because maybe this space is really ugly, but I’m skeptical. I don’t have a photograph of your face, so I don’t know, and I’m going to need to make some assumptions in answering your question.

Having black triangles between lower teeth is not really abnormal, and I wouldn’t be inclined to treat them. Some people have them when they are young, and almost everyone has them as they age. I have them, and I have received numerous compliments about my smile. The lower teeth tend to be covered by your lower lip, and even when they aren’t completely covered, people’s attention is naturally focused on your upper teeth.

Have you had other people notice this black triangle? Or is this just something you’re looking at and you have an idea in your mind of how this is supposed to look and how it looks doesn’t measure up to that ideal?

I’d suggest getting a friend or two you can trust, and position them at a normal conversational distance, and have a little conversation with them. And ask them if they notice anything unattractive about your smile. Urge them to be honest with you, and hopefully you can trust them to be honest. And make a judgment from that about whether this black triangle needs treating.

A good cosmetic dentist addresses the cosmetic needs of the patient as the patient perceives them. But there are limits of reasonableness to this approach. I remember hearing Dr. Ronald Goldstein, who is considered by many to be the father of modern-day cosmetic dentistry, discuss the unreasonable obsession some patients have with the details of the appearance of their teeth. Patients, he said, should evaluate the appearance of their teeth at a conversational distance, and when they use a mirror to evaluate their teeth, should hold the mirror at arm’s length, so that they see themselves as others see them. Then he joked that when they would hold the mirror up close, he would adjust the fee to be inversely proportional to the distance between their face and the mirror. That brought a big laugh from the audience of cosmetic dentists, because they all are familiar with patients who have an inordinate obsession with tiny details in the appearance of their teeth that no one else notices.

And the dentist you went to mentioned functional problems with bonding – that you will create an area that will be difficult to clean. Essentially, from what he is saying, he would create a food trap. He is to be commended for his honesty and integrity. But I have a question for you. You said you don’t want to “ruin” perfectly healthy teeth by putting porcelain veneers on them. Why, then, would you want to ruin them by creating gum disease around them? A food trap is far more damaging to the health of your teeth than placing porcelain veneers, and could lead to the eventual loss of those teeth.

Getting good dental care is a matter of being able to accurately judge whether you can trust your dentist. It appears to me that this dentist is trustworthy – as a recommended dentist on our list he has to be esthetically sensitive. And he is pouring cold water on your idea, saying that the damage that would be caused by the treatment you want would outweigh any esthetic benefit. You could just trust him, which is what I think you should do, or you could shop around until you find an untrustworthy dentist who will actually do what you want.

Dr. Hall

We thank our advertisers who help fund this site.

About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

August 13, 2012

Fixing a black triangle

Filed under: Braces — Tags: , , — mesasmiles @ 8:00 am

I had a spring retainer made and then the orthodontist shaved 2mm off the side of my tooth and its created this black triangle because he didn’t make the spring retainer right. I still question whether the 2mm needed to be shaved because I had braces before and everything was fine before the tooth shifted. Anyway, is there a way to help the gum grow and cover this black triangle? .
– Jamie from California

Jamie,
About this black triangle – I feel like I would need to understand more about your case to say whether or not this is easily fixable. I would suspect that the orthodontist is planning on closing this space, but I don’t know. I general, these black triangles can be tricky. Preventing them or treating them is all in the shaping and positioning of the teeth on either side. It doesn’t really work to graft in gum tissue to cover these. The position and shape of the gums is a natural response to the positions and shapes of the teeth on either side, and if you surgically re-shaped the gums, within a few weeks they would go back to their natural contours.

We occasionally see complaints of people who have had braces and then have some associated gum recession and get black triangles between their teeth. If this does happen and the teeth are straight and touching each other, then the solution has to be some type of dental bonding to add to the sides of the affected teeth near the gumline.

To address this you need an expert cosmetic dentist. Please don’t make the mistake of going to your family dentist for a solution to this. This is way beyond the basic education dentists get in dental school.

Read a post with Jamie’s follow-up question, where Dr. Hall begins to question whether or not Jamie is becoming obsessive over a small defect: Sometimes you just have to trust your dentist.

We thank our advertisers who help fund this site.

About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

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