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
(See Dr. Hall’s answer below.)
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Dear Angie,
Closing black triangles is really tricky. Fortunately, you have 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.
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
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About David A. Hall
Dr. David A. 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 advanced internet marketing for dentists.