Black Triangle Management in Orthodontics Using Hyaluronic Acid: A Case Report

The presence of interdental papillary deficiency, commonly termed a black triangle, is a frequent aesthetic and functional concern encountered during or after orthodontic treatment. Although orthodontic tooth movement aims to improve alignment and occlusion, it may inadvertently lead to loss of interdental papilla, compromising smile aesthetics and patient satisfaction. Black triangles are multifactorial in etiology and are strongly influenced by periodontal status, tooth morphology, root angulation, and the relationship between the contact point and the alveolar bone crest. Traditional management strategies include orthodontic space modification, restorative reshaping, and periodontal surgical reconstruction; however, these approaches may be invasive, irreversible, or associated with patient morbidity. Recently, minimally invasive injectable hyaluronic acid (HA) has emerged as a promising adjunctive modality for the management of black triangles. This article presents a comprehensive review of the etiopathogenesis, diagnosis, and management of black triangles, followed by a detailed clinical case report describing the successful closure of a post-orthodontic black triangle using HA dermal filler. The clinical protocol, measurement technique, postoperative care, and outcomes are discussed in detail. The findings suggest that HA is a safe, effective, and patient- friendly option for mild to moderate interdental papilla deficiencies.