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The Triangle of Gums Between Teeth and Implants

The little triangle of gums between your front teeth.  Did you ever notice it? Look closely. Between each tooth should be a little triangle of gum called a papillae.

That little tiny triangle of gum is of ultimate importance when having an implant in the front of the mouth.

When you smile big you probably see these triangles. When an implant is ideal it should have a triangle of gum on each side. If it does not, it may look funny. In fact, it may be missing all together leaving a black hole.

There are ways to regenerate these papilla but the best way is to

prevent them from receding. I go through an extensive work up to predict the outcome before surgery ever begins.

The health of your real teeth around the implants is of utmost importance. If the adjacent teeth have even slight bone loss, this could prevent the formation of the papilla or it may not be as big as it is suppose to be.

This triangle of gum should be discussed with you should you elect to have implants for the front teeth. It is especially important if there are multiple dental implants next to each other.

The following pictures show what I call cosmetic failures.  I did NOT treat these patients.  These are dental implants that do not have the papillae:

Image01 DSC_0788
These pictures are samples of my work:

Frontal Close up #9

Although this little tiny triangle of gum may be insignificant to you now, it is of paramount importance to me. It makes all the difference!

Let me know if I can help avoid this problem!



114 thoughts on “The Triangle of Gums Between Teeth and Implants

  1. Hi Dr Amin,
    I had an extraction and immediate implant on an upper front middle tooth one month ago. I just learned that my other middle front tooth has resorption and will also need to come out. My dentist wants to extract it, place an immediate implant, and have me wear a flipper for 3 more months while both missing front teeth heal. He said immediate loading is too risky and so I’m worried that the triangles in between the middle front teeth will recede during the 3 months I’m wearing the flipper. The teeth loss is from an accidental fall and I’m otherwise healthy and compliant. Is immediate loading that risky for both upper front teeth, and wouldn’t it help with no black triangle happening? Thank you, your site is great and very informative!

    1. Bad idea in most case. You need to see an high level implant dentist for this. The flipper will smash the triangles down.

  2. Hi Dr. Amin,
    I have an implant replacing tooth #10, placed a few years ago. Now the adjacent #9 is failing and needs to be extracted. I’ve been told by my dentist and the surgeon he works with that it’s a very tricky situation in terms of implant placement because of aesthetic concerns.
    I went to see another, very highly regarded, perio-surgeon. He did some 3D scans and, while he agreed that it’s a challenging situation, he is confident that he can achieve a good aesthetic result by placing the implant a certain way + doing connectice tissue and bone grafts at the same time.
    What is your opinion? Is it possible to achieve a nice looking result in my situation? I have a gummy smile, unfortunately.
    Thank you,

  3. Im just after a little bit of advice I’m starting to get a back triangle in my bottom front teeth I think I may have receding gums as one of my bottom teeth is a bit bigger then the rest I can feel that tooth its not pain but its just annoying that I can feel the tooth:/ I’m scared its going to fall out before I see the dentist or them even telling me they have to remove it I’m only young and dont really want a missing front tooth as its making me so uncomftable within my self I hardly leave the house I had a really bad fear of dentists so I hadn’t visited one in quite a few years and its seems now I’ve been to the dentist they seem to be getting worse… I just want them sorting out now just hoping they can be fixed:(((

    1. not sure if you’re talking about teeth or implants. Very different. You should look into having IV sedation for dental work…that way you can sleep through it!

  4. Hello Dr. Amin,

    I recently had an implant placed and the permanent crown was placed this week. Now that the work is done I have the dreaded black triangles on both sides of the implant. The implant replaced the tooth next to my front tooth on my right side. Prior to the implant I had had a post with crown. My real tooth hasn’t been in place for 13 years.
    The outcome is a tooth much longer than that on the other side, looks like a horse tooth to me and sits higher than my other teeth. I feel like if the triangles could be fixed it may help some. During the process I did have a bone graft and small gum graft to bulk the tissue above the tooth. Nothing was done in the triangle area. Is this likely to grow back? What can I do? My gums show when I smile and I use to love my smile. I’m a mid 30s female who is pretty down about this

  5. Hi Dr. Amin,

    I knocked out my front left tooth and the one to the left of that a few years ago. I had one implant placed in the spot of the front tooth and a crown with both teeth on it was attached to the implant. Things were fine until a few months ago when my regular noticed a lot of sensitivity with my gums in that area. I went back to my oral surgeon and he said a small pocket had formed which trapped food in between the crown and my gum and led to a small amount of bone loss in the front. He performed a bone graft, but it didn’t take completely and now my gums have receded a lot and I have a black hole that continues to get bigger every day. My oral surgeon wants to wait to weeks to brainstorm ideas of how to fix this, but I’m getting more and more anxious because I’ve heard horror stories about this being unfixable and getting drastically worse in a short period of time. I get married in three months and I’m not sure what to do. Can you please advise? Is this fixable? What should I do? Thank you in advance for your help.

    1. You might not want to do anything before the wedding. You might want to seek out several different opinions and for sure have a 3-D scan done. It sounds like you may have some thinning bone and/or peri-implantitis
      Sorry for the bad news

  6. I had adult braces a couple years ago. I had had braces as a teen, but since I didn’t wear my retainer, my teeth shifted. Now I look at my lateral incisors, and from the side view they are angled toward my centrals. They look OK from the front view, but a little strange from the side. And I now have small holes between my front teeth and laterals where the papillae used to be full and plump. It is apparent that angled laterals are standard in orthodontics, but I don’t understand why. It looks strange from the side view, and it lessens the papillae… which I believe to be a very important part of the smile.

    1. Hmm. Interesting observation. That is not normal. Good ortho will place the laterals in ideal positions. Some orthodontists are much better than others.

  7. I currently have veneers, I have taken very good care of them for 10 yrs.the papilla seems to be thinnout,will this grow back in?my dentist wants to make a mouth guard to turn the tooth in.can that be possable with already haveing a veneer? I’m afraid of getting my veneer destroyed.

    1. Should be fine. The veneer does not prevent orthodontic movement. The papillae is no likely to come back.

  8. I currently have veneers, I have taken very good care of them for 10 yrs.I have some a small gap from gum loss.my dentist wants to make a mouth guard to turn the tooth in.can that be possable with already haveing a veneer?

  9. Hello wonderful Dr Amin. Hope you are well. I am enquiring about gum flap procedures and lost gum/papilla I recently had a cyst removed above an old apico at UR2. The space was too narrow so the surgeon had to create a gum flap and go in at the top. The cyst was smaller than xrays were showing and my bone was healthier than it showed and no infection, just a lot of scar tissue. He placed an implant at the time with a cover screw and padded out with some putty as well as padding out my buccal defect. He pulled my upper lip down to help with the gum flap. I have a little denture in there now as a temp.

    My face did swell quite a lot and I had bruising after the procedure but a week on I noticed that the gum is trench like above the tooth/crown where the line of gum flap went to at UR1 like its pulled up or just disintegrated as well as the papilla? I presume ill be having my implant abutment and crown in about six months.

    The surgeon said mother nature may take care of it as there will still be swelling – but two weeks on its not doing anything and ive read gum does not ever grow again once gone? I do feel tension where the lip has been pulled down and wondered could this cause the gum flap to have split and caused it.

    Ive sent pics of the swelling five days after procedure and a couple of pics now just over two weeks after procedure.

    Hope you can help

    1. The ability of the gums to grow back is going to depend on the presence of bone on the teeth on either side. If good bone is present, the gum will likely return in a few months after a fixed temporary is placed.
      If there is even the slightest amount of bone loss, the gum will not grow back fully.

    2. I have receded gums i want to get them to grow back. I am told by my dentist that I do not have peridontal disease. How and what can I use to get the tissue to grow back. I heard there was a drink with liquid collagen that helped . Is this true and if so where can I get it and what other products can I use to help the tissue grow back. I visit my dentist usually regularly.

      My teeth are not loose and I don’t want to lose my teeth. Please advise

      1. unfortunately there is no magic. Slight recession of the gums as normal as it age especially if you have thin gum and bone tissue.

  10. I had one of my tooth extracted and prepped for an implant. While my bone is healing for the 2nd and third state of the implant procedure, i have partial dentures in place. However, I’ve noticed that the papilla on both sides of the tooth in question has disappeared. Will the papilla regenerate after the implant get put in place?

    1. This will mostly be determined by the health of the adjacent teeth. If the bone is excellent of those teeth and there is only one tooth missing, the triangle will likely re-make itself. If this is a front tooth, the tissue will need to “groom” with a temporary order to grow back this triangle to the right height and shape. This process usually takes about three months to occur with a temporary on the implant if this is a front tooth.

  11. Can the papillae be replaced or repaired after a bone graft? There was no implant done…there is a crown there. It’s in the front on the lower bottom.

    1. Sometimes, but mostly not…. I would need to see an x-ray and a photograph plus examine you in person.
      The best thing would be to wait 6 months to 1 year after the bone graft. Oftentimes it spontaneously corrects on its own to avoid another surgery and additional expense.

      Ramsey Amin DDS

  12. 2 months ago i had a surgery. my gum was detached between 4rth and 5th tooth (upper ones) The dentist shaved my epitillium through laser. he did 3,4,5. now i have a black triangle between 3 and 4. between 4 and 5 there is also a small space.

    my question is, can it be filled through surgery? i think he removed papilla. he says it’s because of the surgery. im so worried. im only 24. it feels like something is stuck in between my 3 and 4 tooths when i swallow saliva or water. im sure its because of the space but can the space be filled through surgery? my dentist say it cant be 🙁

    1. Hi Anna,

      It really boils down to what you’re risk factor is for staying on the blood thinner during surgery versus being removed off of the blood thinner. Some blood thinners require several days of being off of it while some only just 1 or 2. There are more contemporary blood thinner such as Plavix, Xarelto, Pradaxa that are sometimes difficult to manage. If your surgery is extensive, coming off the blood thinner is probably suggested. I have treated many 100s of patients that have had, stents, strokes, pulmonary embolism, heart attacks and the one commonality is I always speak to the patient’s physician can write a letter to them stating what are the risks versus benefits. Together, the patient, their physician and myself will make that decision. I recently treated a 90-year-old man for bilateral sinus bone grafts and he was on blood thinners. It comes down to the comfort level of the dental implant surgeon also. I see no reason why you cannot have dental implant.

      A high quality dental implant that is made of a titanium alloy will not be rejected by your body. Even though it is a foreign substance, your body does not see as foreign because your immune system really doesn’t recognize it.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

    2. I also had treatment with laser and lost papilla between 4 and 5 upper teeth. I worry a lot as feel huge hole in between teeth and I can see root of one tooth and root of inplant. Is it any chance that I can safe both teeth and how can I clean it meanwhile. I feeling tingling and swelling of both gums. can I use salted water or bicarbonate soda?
      I will be grateful for your advice

      1. Bone loss around and dental implant can be progressive and even take out a tooth next to it. If you have advancing bone loss on the implant I would remove it ASAP.

  13. Hello.
    On June 2015 I had an implant on my left front tooth (21). I think so is a good implant but it have not a papillae between the 21 and the 22 tooth. It look like you say a black hole and my dentist told me that this has not solution, but i want to recover my smile.
    I would like to know if my case could be solved. I’m living in Uruguay now but i’m willing to improve my smile and can make a trip until to you to solve this. Thanks.

    1. give it until at least June 2016 which will be 1 year. If the black triangle is small it may close on its own in the first year

      Ramsey Amin DDS

  14. On August 27, 2014 I had an implant on my right front tooth due from a fall. I wore a flipper for seven months before I got the crown. On March 27, 2015 I had the crown put on and have been in complete agony every since. The dentist has adjusted it as far as the top to get the shelf part off so food want be ever where. My biggest problem is the triangle of hole between the right front tooth and the one next to it. My mouth is continuously squishing saliva with my tongue against the back of my front teeth. When I plug the whole with my fingernail it stops. The dentist looks at me as it I’m crazy. He says it habit. I didn’t not do this the whole time I wore the flipper. Is this due to no papillae there? I really could use some suggestions! Thanks, Phyllis

    1. It is very possible that missing the papilla is causing this. Unfortunately I would need to see you to be able to determine this.


  15. Hi I’ve always had a thin gap between my front teeth and in the last 5 years the triangle piece of gum has got larger and comes down more.

    Is the anything that can be done to fix this?

  16. I am hoping you can help me. I am an oral surgery assistant of 14 years. I recently had 7 and 8 removed due failing rct( I had an accident as a child). I had socket preservations preformed at time of ext. it is now 6 months later and am ready for implants. I have NO papilla between 7,8 area. Can you help guide me as to how I could regain some papilla-like tissue? I am a 34 year old healthy female. I would be happy to supply photos if that will help. I love to laugh and smile and just want to reclaim my smile. I am so scared of the black triangle! Any products or techniques you could recommend would be amazing! Thank you so much for your valuable time!

    1. Ohhh…. So sorry Liz.
      I treat a lot of dentists and dental staff as patients. Just the other day I did a huge bone graft on a dentist’s wife. The problem is you know way too much!

      The combination of missing a lateral incisor #7 and a central incisor #8 is the most difficult implant reconstruction in the entire mouth. This is because the area lacks symmetry and the papilla between #7 and 8 must be carefully managed in order for to look like the opposite side between #9 and 10. Your case must be evaluated very closely through photography, 3-D scan, clinical examination and extremely precise planning. Sometimes developing a papilla between these 2 particular teeth is impossible and a decision is made to place only one implant with a cantilever depending on how much gum you show when you smile. Other compromises can be tissue color pink ceramic porcelain done very well to hide the lack of symmetry. Be sure the implant diameters are very small and there is a lot of space between the 2 implants should you decide to have 2 implants put in. Be sure your oral surgeon works extremely closely with a very skilled implant restorative dentist. The restorative implant dentist should be guiding your boss on how to place the implants. I would highly suggest a computer surgical guide for placement on such a critical location.
      Good luck


      Ramsey Amin DDS

  17. Hi,
    I had two dental implants done two weeks ago, the teeth either side of my front ones. Initially I had a problem with the papilla triangle disappearing between my right front tooth and the implant beside it. Now that side has grown back but in the last day or so one has opened up between my left front tooth and the new implant. I’m 21 years old and have no loss of bone on that side. Do you think it is simply healing and needs time?
    Thank you.

    1. Hi Holly,

      It is probably a little bit too early to tell. Give it more time. As long as the adjacent teeth have no bone loss, the papilla triangle should fill in. If you have an implant next to another implant, and that is a different story. That has a lot to do with how close the implants are to each other and the depth of placement. It will take a good 3-6 months for to fill in completely especially if you did not have teeth there to begin with. If you did not have teeth there to begin with, it is very likely that you have some degree of existing bone loss. You could have 90% of the bone, but that final 10% is the final frontier.

      Keep me posted in a few months and please reference this particular post so that I know who you are.

      here are some photos of cases that I have done:
      Smile Gallery

      Very Respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  18. Hi,
    I am 37 y/o and have always taken care of my teeth with regular brushing, flossing, dental check ups every 6 months. Never have any cavities. Pockets are always one’s and two’s the couple of time they’ve been checked. Since my last cleaning, I noticed triangle spaces between my lower front teeth. The dentist or hygienist didn’t say anything about it. They said everything was good. I really do floss regularly and take great care of my teeth. I really don’t like those spaces and don’t understand why they are there. I would understand this if i didn’t floss and do all the other things necessary to maintain healthy teeth and gums. Any advice/

    1. This blog is intended for those that have dental implants or are considering dental implants.

      That being said I can give you some basic information and still try to help! Unfortunately we cannot change our parents. 😉

      Genetically we are given either thick or thin gums and bone that surround our teeth. We called this the genetic bio type of our teeth and gums.

      Women in general have thinner genetic bio type and often have more problems with recession of the gums and crestal bone which leads to a slight triangular opening between your teeth at the base.

      Have an extensive evaluation with a full mouth set of x-rays done with your dentist as soon as possible.

      Very respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  19. Hi,

    I am 19, I had braces and after my braces I brushed my teeth really hard and now between my premolar and my molar I keep getting food stuck in my teeth. So after I eat I get a piece of floss to get the food particles out. I’m not sure if I’m using the floss properly. But I’m really scared that I’m just pushing up the food particles and all that bacteria into my gums even more. I am insecure and feel depressed about my teeth in general. Would a gum gaft help prevent food from getting inbetweeen my teeth?

    1. This blog website is intended for dental implant and bone graft reconstruction questions. I will direct you to another link on my website for wisdom tooth information that may help you. 😉

      a gum graft is not likely to work…. You should have a full evaluation done with a really good dentist to figure out the problem. Don’t ever be afraid to floss all the way to the bottom…. Do this every day for the rest of your life

      Good luck,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  20. Hi,

    I am missing the tip of the gum triangle between my top two front teeth! I’ve had braces before and I have a lot of spaces between my teeth. I started putting my retainer back on at night but I still have a lot of spaces between my teeth. Any suggestions for filling the gum triangle and making my teeth closer together?
    Thank you!

    1. Hello Tiffany,

      This website is intended for patients that have questions about dental implants.

      Gum triangles between your natural teeth often have to do with potential bone loss and or the angulation of your roots to each other. You need to have an x-ray and evaluation in order to tell whether your triangle of gum will regenerate. Your teeth must be touching each other without gaps in order for the gum triangle to fill in.

      Very Respectfully,

      Ramsey Amin DDS
      Diplomate of the American Board of Oral Implantology/Implant Dentistry
      Fellow of the American Academy of Implant Dentistry
      Burbank, California

  21. Hello Dr. Amin,

    I came across your article about this papilla triangle issue while searching for my solution to that exact problem. Unfortunately I have 3 implants on the very front teeth and have the missing triangles that you described as cosmetic failure. My gum is similar to those 2 photos that you have, only far worse…

    Is there anything that could be done to restore my gum? It’s pretty bad…

    I greatly appreciate your insight!

    1. Hi Minh,

      Wow… It sounds like you have pretty bad situation if it is worse than these photos. There are not a lot of good options besides trying to mask the black triangles by connecting the 3 teeth together with a bridge utilizing pink, gum colored ceramic.

      Complex Case Example–Tilted Dental Implant Used To Bypass Impacted Tooth and Bone Expansion for Missing Front Teeth

      Alternatives To Bone Grafting For Dental Implant Teeth: A Unique Approach by L.A Dentist Ramsey Amin, DDS

      Cosmetic and Restorative Smile Gallery: Porcelain Fixed Bridges

      If you don’t show a lot of gums when you smile that will be helpful in hiding the pink tissue porcelain. If you have a high smile line, and everything shows, you may want to consider removing everything and starting all over with bone grafting.

      Very respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, California

      1. Thank you Dr. Amin! While it’s not an answer I was hoping to hear, but you have saved me thousands of dollars paying dentists who claimed to be able to fix it.

        Greatly appreciate!’


  22. I recently got dental crowns on my 8 front teeth on top. How long does it take for the gums to grow to fill in the black triangles in between? It has only been a week since I got them. They are not big spaces but noticable.

  23. Dr. Amin,

    I am getting implants on teeth 7 and 8. Tooth 8 was only recently extracted from the root but 7 has been out for years therefore, I had to have bone grafting ( only on tooth 7) before I can get my implants placed. Do you think it is possible to get the triangle between these two teeth (7 and 8)? After placing the implants, will my gums simply heal around them thus forming the triangle?

    1. hello Yolanda,

      The situation you described of tooth #7 and 8 being replaced with dental implants is the most complex replacement of any in the entire mouth. The reason why is the lack of symmetry. The triangle of gum between tooth #7 tooth #8 can be predicted prior to execution of any surgical procedure. Your dentist must carefully measure the bone and degree of scallop of your gum. Your bone tissue bio type is super important in this situation. None of this can be left to chance.

      You should know prior to even starting treatment whether or not this papilla or triangle of gum will be present after everything is done. If not, there are options to mask it with other restorative technique such as gingival colored ceramics, bonding or other surgical techniques.

      I would suggest a consult with an expert implant dentistry for your situation. Please see this link with examples of all of which I describe.


      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  24. Six months ago I had an implant on a tooth next to my upper left front tooth. It is still very much in my smile line.

    My gum grew back fine – but the oral surgeon seemed to have taken off part of my gum on my front tooth–I had fine gums over my front teeth prior to any surgery. Although I am 51 I have had great gums, bones and even hair.

    I think the gum across my front tooth will grow back but my dentist says it wont. He is not a gum man by any means so I hope he is wrong. I asked him if any therapy may speed its growth. It is hairline-but definitely showing that I have a crown on my front tooth. Since the implant area grew back faster than they believed..I am hoping same for my front?

    1. Hello Deborah,
      It is not uncommon for gum to shrink after surgical procedures. Anytime you open the gum and place it back there is a risk for it to shrink slightly.

      If the gum is right over the outside of the tooth, your dentist is right, it will not likely grow back on its own.

      It is easy enough to do a tunnel gum graft root coverage procedure in order to slide the gum back over the top. This is a procedure I do routinely in my office to move the gum line back to its original position. You do not always need to have gum taken from your palate in order to slide the gum line back. This will highly depend on how much of your gum is attached and how much needs to be moved.


      Thin Receding Gums And Dental Implants – What’s Important? Video by Ramsey Amin, DDS

      Very respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, California

  25. Hello! My name is Andrea and I’m 22 years old.

    2 or 3 months ago my gums got inflamed, but I waited a whole month to see the dentist, because I had to find a new one, and also because I didn’t think it was so serious. By the time I went to the dentist, my papillae have already receded a little, and the inflammation had gotten a little milder. After seeing me, the dentist said I have a form of aggressive periodontitis and prescribed me antibiotics for a week (Metronidazole and Amoxicillin). She then proceeded to do a quick clean of all of my teeth and then made an appointment in a month (which is due today).

    The antibiotics have really helped with keeping the inflammation at bay, but I don’t see any improvement regarding the gum recession. The gums aren’t all that receded, hardly even noticable, but what bothers me are the papillae, the black spaces between the teeth. Do you think there is any chance that my papillae will regrow, or is there some kind of procedure that could help rebuild them?

    1. Also, none of my dentists in the past had ever told me I had any form of gingivitis, and then this happens all of a sudden.

      The dentist also looked shocked and surprised, and said that my teeth look healthy and there isn’t even that much to clean. I’m still not sure what is actually going on inside of my mouth.

      P.S. I have all of my teeth. I have also worn braces for a year and a half when I was 12. Never had any major problems, except for a root canal on my upper left first molar. I’ve had a problem with tooth grinding since I was a child, and it still persists. None of my former dentists ever suggested a dental guard, but this one did. Interesting thing is that the tooth I had a root canal on is the tooth that takes the most pressure when I grind my teeth.

      I hope this additional information can help you.

      1. Hello Andrea,

        The papilla between teeth is very difficult to regrow. In your case the aggressive gum disease needs to be treated first. Teeth that have root canals tend to have a little bit more recession also. The treatment of using metronidazole is excellent if you have something as aggressive as what it sounds. Also if your bite is off and you only touch on that one tooth, it will cause inflammation which will result in recession of your gum on that same tooth.

        The ability to rebuild the gum in that area is going to be dependent on how much bone you have underneath it.

        You might require an antibiotic culture and sensitivity to make sure that the antibiotics being used are actually killing off the bacteria that are present in your mouth. Of course excellent home care on your part is going to be a necessity. Ask the dentist to actually show you how to floss your teeth properly. Most people don’t know how.

        Ramsey A. Amin, D.D.S.
        Diplomate of the American Board of Oral Implantology /Implant Dentistry
        Fellow-American Academy of Implant Dentistry

  26. i will finish my orthodontics treatment in a short time. but i have black triangles between both my right and left lateral incisors and canine. i would like to know if it is possible to close it my gum graft. i dont like the idea of veneers or anything that will remove my healthy teeth. if i can send u my pic, i will do so. thanks.

    1. Hi syiriel,

      This would be a great question for your orthodontist. In order to determine whether or not the black triangle will fill in the by itself, small dental x-rays need to be taken to determine how high the crest of your bone is in relation to where your teeth touch in between. We called this the contact point. Photos alone cannot determine this.

  27. Hello, My name is Nancy Ruiz, I recently finished my invisalign trays and got my gums lasered to raise them and show more teeth, unfortunately in between 2 of my teeth there was a small black triangle left. At first i didn’t know what it was but i felt a little air bubble every time i chewed gum or food, now that I know its there it is very uncomfortable and food always gets stuck in there. I was wondering if there is a way to fix that or if the gum will grow back!?

    1. Hello Nancy,

      This would be a better question for your orthodontist. This blog is related to dental implants.

      My guess is used likely have some pre-existing bone loss between those teeth. If you don’t, it should grow back!

      Good luck!

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  28. Hi Dr. Amin,
    Im in Iowa, and our new young Dentist in town does not impress with his constant referrals, for my son and I, (it really seems like he just examines) Well in November 2012, I had a Hospital procedure done and they chipped two teeth 12 and 31. No problems with 31 as of yet and it chipped big time. Well 12 became festered, and he suggested having it pulled. I had it pulled Mach 2013, and 12 root was surprisingly long almost half inch if not more (oral surgeon would not let me keep it) but due to how long the root it had caused my sinus cavity (correct?) above to sink in to the empty root. Now I get sinus pain in that area. Would an implant be able to fix that in the future? Also I have noticed since the loss of 12 by bite has change and my teeth are moving more and have gotten more cavities (in a shorter time then when I had braces) I lost a flap of papilla years ago between the 25 and 24, now it has receded so low I have gotten a black hole and tooth 25 is tilting and pushing into 24. I wonder if a “spacer” would help it to remain more up right as the “black hole” heals. When I use flossing stick I pull the floss between the teeth slightly moving it back and it helps with the pain of them moving.
    Thank you.

    1. Hi Melissa,

      Sorry to hear about your dental problems. Before having an implant to replace that area I would consider finding out what the source of the pain is. The dental implant will not take away whatever sinus pain you have, so I would definitely not be in pain while having the implant. The source of the pain must be figured out beforehand. You might want to consider seeing an ear nose and throat medical doctor called an ENT.

      The sinus is not usually painful after a tooth extraction but it is normal for bone loss to occur because the sinus expands.

      Once you lose a tooth it sets up a chain reaction of other problems like you described such as cavities and papilla shrinking. It sounds like he really needs to be seen by an excellent dentist and figure out these problems.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  29. Hello,
    I have 80% bone loss in my lower front teeth, deep recession, and a very thin front jaw bone. I had tissue grafting about 5 years ago, I have a wire behind my teeth to stabilize them (they are mobile), and I have regular periodontal cleanings. I also have very healthy gums abd I take exceptional care of my teeth. In spite of all this, they continue to worsen. I have large black triangles and am recently developing triangles of black on my top front teeth. I have also developed slight pain on my front left tooth by the gum line(the worst one). I am a 50 yr old female and believe my condition is largely genetic. I do not think I have enough bone or tissue in front for implants. What would you think is my best option? What could be causing the pain? What will happen if all my teeth continue looking bone and tissue? Thanks for your help.

    1. Hi Nancy,

      80% bone loss is not sustainable in the long-term. Even though you have lost bone ‘around’ each tooth it doesn’t mean that you have lost the main volume of jaw bone to support an implants. The pain comes from the roots being exposed. They have pores that allow bacteria to enter the roots since they have no enamel.

      I would consider a Prettau full arch implant bridge if you are going to lose all of your teeth.

      Look at the featured case on this page for a sample: https://www.burbankdentalimplants.com/smile-gallery/

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, CA

      1. Thankyou. Is this something that should be considered right away, or should I try to keep my own teeth for as long as possible? Also, in the meantime, is there a cosmetic procedure to hide the growing “black triangles” between my upper front teeth? Will bonding hide the spaces?

        1. Hi Nancy,

          Without seeing you it is near impossible to be able to give you a solid answer.


          Ramsey A. Amin, D.D.S.
          Diplomate of the American Board of Oral Implantology /Implant Dentistry
          Fellow-American Academy of Implant Dentistry

        2. Nancy,

          You really should be examined by a dentist in your area as soon as possible. There is no way that I can answer this question without having seen you. X-rays and a thorough dental examination is going to be the most helpful. Look for somebody very skilled and implant dentistry, preferably a diplomate of the American Board of Oral Implantology or dental implant specialist.

          Ramsey A. Amin, D.D.S.

  30. Dear Dr,
    I lost my front tooth, but I still have a root inside. I saw my DDS today, and she wants to do a bridge instead of implant. Her concern is that despite even a successful implant procedure, she has only 50% assurance rate that she will be able to preserve my papilla. She said that its easier to remove the root, do the grafting (placing material inside of my gum to keep it from falling), and do the bridge.
    Do you think she is right, I really had my heart settled on implant?
    Thank you

    1. Hi Natalie,

      If you have bone loss on the adjacent teeth, have black triangle spaces are inevitable if an implant is placed in between those teeth. If this is the case, the bridge will look way better. Unless you have a really low lip line and don’t show the area, the bridge would be better. Are you more than 30 years of age?

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  31. Hello Doctor,

    I had a tooth removal & implant #19 & 20. The extracted tooth was packed with grafting material & stitched. I am 17 days post op & I am experiencing a nasty taste & discharge. The incision site is now open. The gums are mushy & I pushed on the side last night & a blob of yellow yuck with a stitch came out. I had just seen the oral surgeon 4 days before & he said it looked fine. I told him that I was still experiencing some pain around the extracted tooth site. He did not seem concerned. Am I rejecting the graft material or is it infected?

    Thank you

    1. Hi Judith,

      It sounds like you have an infection. Go see your dental implant dentist ASAP.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  32. You mentioned in the article that the papilla can be regenerated. What needs to be done in that case? Should the implant be replaced in order to fix them or is there a better solution? I had a front implant about 3 months ago. Then the papillae went away only on one side of the tooth. There is a black hole as you said. What should be done?

    Thank you.

    1. Hi JP,

      If the gum triangle opened after the implant it is NOT likely to come back. 🙁

      This likely means you are missing bone on the tooth next to the implant or the implant is very deep.

      Without seeing you though it is really impossible for me to give you advice.


      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  33. I am 29 years old and just had my braces removed a few ago. I noticed a black triangle and was wondering if my gum will regenerate to fill in this gap. I have never had a problem with my gums in the past. Thanks!

    1. Hi Lindsey,

      Braces are a totally different story than dental implants.

      The triangle of gum is much more likely to come back! Give it a bit of time.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  34. Recently I underwent through Flap Surgery. Because of the severe Bone loss my 4 Upper front teeth are in very bad condition and the bone loss is reached almost 80- 95 percent. Two teeth are removed at present and they are fixed temporarily, while RC has been done for the other two. My doctor has recommended to go for a bridge of 6 teeth with the support of canine. Can you please suggest in this context.

    1. Hi Raj,

      You can rebuild the bone in the area of the four front teeth and not grind down the natural teeth for a bridge. The bridge will be replaced every 5-15 years, even if it is well done.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  35. Dr Amin
    I needed two root canals and two crowns on teeth 29 & 30,my question is my dentist lasered off my interdental papillas completely between teeth #29 & #30 and on the other side of tooth #30,on tooth #30 she did have to do crown lengthening,why would she have lasered off my papillas when she never worked under the gums beneath the papilla area,I now have a large triangle gap between my crowns,that she states will grow back, the papillas are not growing

    1. I feel my dentist lasered my papillas off two get them out of the way so she could work on the post for the teeth

    2. Hi Russell,

      The triangle of gum between natural teeth and implants are COMPLETELY different. If the bone is healthy, they will likely grow back. It sounds like you had some deep pockets, so the dentist is helping you to keep these compromised teeth. If you have none loss, they won’t fully grow back, but you are more likely to keep the teeth.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      1. I really don’t understand your answer Dr Ramsey, I had my interdental papilla’s lasered off, now I have a large gap that traps food, the trapped food will increase crown failure. there never was any work done beneath the interdental papilla.

  36. DEAR DR. AMIN,

    1. Hi Sandy,

      Is the triangle of gum missing now? Is your pain absent now?


      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  37. I just recently had jaw surgery and my mouth is wired shut. Since its wired shut I can only eat liquid foods. I blend all my meals and will be doing so for 4 weeks until i get the wires removed. Since I can’t open my mouth to eat, anytime im eating im sucking in the liquid food. I noticed that the gum in between my 2 front teeth is missing now and i think its due to all the “sucking”. Theres a black hole instead of gum that i never noticed before. I can also tell that this is new because there is a slight burning sensation around that area as if there is damage to the gums. Will this grow back? if not how can i get it back??

    1. Hi Adrian,

      The broken jaw is no fun. It sounds like you had a bad break to have to be wired shut instead of plating the fracture.

      Keep your gums as healthy and clean as you can while the arch bars are on. If your teeth were really healthy before the fracture, the triangle will likely recover.

      Hang in there!

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, California

  38. Dr.Amin,
    I am 13 years old and just got my braces off. I noticed that on my bottom 2 middle teeth the gum part is missing and is leaving a black whole. I asked my orthodontist about it, and he said that it would grow back. I am very concerned and your repy would be greatly appreciated.

    1. Hi Brin,

      At your age the hole should fill in


      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, California

      1. What about if i am a 19 year old who just removed his braces 19 year old this year. Can my one and only small black hole between 2 teeth be filled naturally by my gum tissue?

        1. Hi Samuel,

          It is likely that in your situation it will fill in automatically! Good luck!

          Dr. Amin 🙂

  39. Dr. Amin,
    I have a space between my lower front teeth and I’ve noticed that the pink triangle between them has disappeared. Both teeth look quite long. I thought that I could possibly have a gum graft but it seems that I need papilla to have any chance of success. I’ve just recently set my mind towards investing in orthodontic treatments to correct my teeth. Is it too late for that?

    1. Dental implants and teeth can have space that results in a black triangle. This is usually due to bone loss. Since you don’t have an implant, you should consult with your dentist.

      My special training is in implant dentistry not in orthodontics.


      Dr. Amin

    2. It is never to late for orthodontics. It always helps!

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  40. Dear Dr.Armin

    I have a question regarding your column. I had done my Orthodontic treatment for year and a half. I started to notice my papillae are missing about half a year. But I didn’t really care about them until recently. I am not sure when it started missing actually, maybe even before I’m done with the Orthodontic treatment? Could the treatment be the cause?
    Right now I have few places of papillae missing, they’re not major yet. Noticeable if look closely. I am afraid that it’s going to get worse. Would it get better if I keep my teeth clean and healthy, or at least not getting worse?

    Thanks for your comment in advance,

    1. Hi Chatdanai,

      The most likely scenario is you have some degree of pre-existing bone loss between youor teeth. The bone crest between each tooth supports the gum triangle. Now that the teeth have moved from being crooked, the black triangles show because the teeth don’t overlap.

      Are you over 35 years old?

      Ramsey A. Amin, D.D.S., D.A.B.O.I.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      UCLA and Western U. Dental School Faculty

      1. Hi Dr.Amin

        Thank you for your reply.

        No I am about to turn 24 this year.
        I am still thinking that it maybe the side-effect of my Orthodontic treatment. I am also having gum receding on my mandible. I am worrying that it’s going to cause sensitivity and so on.

        Is it normal after Orthodontic treatment to have this problem? Do you have any suggestion on my case?

        Thank you,

  41. Dear Doc.,
    I just got done with my Orthodontic treatment. Now my teeth are nice and aligned, and my smile never looked better. The only problem is the small triangles between the teeth and gums. I find that this is the place where the food particles get stuck, etc. Also having these triangles filled would make my smile even better.
    Is is possible? If Yes, what would be the costs involved as a rough ball park estimate?

      1. Thanks for the reply Dr. Amin.
        I’m 27. I’m not quite sure but I think I might have a slight bone loss.
        I am curious to know your opinion.

        1. Hi Ro,

          If you have all of your teeth (no implants) then the slight bone loss is more than likely causing this. Often, veneers or bonding are used to fill the spaces if it is truly due to bone loss.
          It would be best to get into the hands of someone in your area to evaluate and diagnose the problem then discuss treatment. Are you local to southern California?

          Dr. Amin

          1. I do have all my teeth. Sorry I live in Texas. I guess I will visit a dentist to see what options do I have.
            Thanks for the advice.

  42. Hello Dr Amin,
    I just came back from my periodontist in tears because this is going to be an issue with my implants.
    You see, I was born without my lateral incisors and as a result my adult cuspids grew-in in their places. So, 2 years ago, he referred me to an orthodontist. I had my primary incisors pulled and the braces have been moving the cuspids over about 6.5mm to make room to implant the lateral incisors.
    Today he tells me that my teeth are triangular and my gum has flattened next to my central incisors and that my options are to graft the gum, pull my central incisors down (which will in turn pull “a bit” of gum down), or square off my central incisors.
    I’ve finally stopped crying and don’t know what to do. I’m not too keen on them pulling my front teeth down as I fear this may create MORE problems.
    I would be grateful if you can make any recommendations.
    Thank you.

  43. Excellent post on the issue. I have also seen very few people care about Triangle of Gums Between Teeth and Implants. Thanks for this nice concern.

  44. Hello Dr. Amin,
    Thank you for your reply.
    Unfortunately, I do not live nearby. I can definitely e-mail you pictures before and after the accident.
    Can you please let me know on which e-mail I can send them.

  45. Hi Sara,
    I know how you feel.
    A gum graft will almost ALWAYS help thin gums but MAY not put the “triangle” back. Do you have any pictures of you in a full, big smile that you can email me?
    That will really help me to give you a better idea. Do you live nearby?
    Dr. Ramsey Amin

  46. Hello Dr Amin
    I am a 22 yr old female. I have lost my 4 upper front teeth after an accident and plan on getting two implants with a bridge.
    My problem is that my gum line is uneven, even though before the accident very little gum would show when I smile I still feel that it made a difference and I feel uncomfortable smiling now.
    My dentist said that due to my gum being thin a gum graft may be unsuccessful. Pink porcelain over crowns was suggested.
    I would be grateful if you can make any recommendations.

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Dr. Ramsey Amin has extensive experience in surgical and restorative implant dentistry. As one of only less than 400 Diplomates of the American Board of Oral Implantology/ Implant Dentistry (ABOI/ID) he is considered an expert, and board-certified in dental implants. He is a former instructor at the UCLA School of Dentistry.