Modern Anterior Composite Restorations & Black Triangle Closure
A contemporary approach to direct composite dentistry using anatomical matrices and the Bioclear Method.
Developments in composite materials and adhesive dentistry have expanded the possibilities for conservative anterior restorative treatment.
However, achieving natural interproximal contours, appropriate emergence profiles and polished restorative surfaces can remain challenging with traditional freehand layering techniques.
In this published Dental Update article, Dr Claire Burgess and Professor Dominic Hassall introduce the principles of the Bioclear Method and demonstrate its application to anterior restorations and black triangle closure.
The article explains the Five Pillars of the Bioclear Method, clinical techniques, matrix selection and illustrated treatment cases.
Professor Dominic Hassall
Original publication: Dental Update, February 2023
Journal reference: Volume 50, pages 117–125
Article: Part 1 – Anterior Composite Restorations and Black Triangle Closure
An Introduction to a Modern Procedure for Anterior Composite Restorations and Black Triangle Closure
Using a Novel Matrix System: Part 1
Why Rethink Traditional Composite Dentistry?
Composite materials have developed substantially since their introduction in the 1960s, but clinical technique remains central to restorative success.
The Evolution of Composite
Developments in adhesive systems, filler technology and composite handling have expanded the use of direct composite restorations.
The article discusses the contributions of Buonocore's acid-etch technique and Bowen's resin developments.
Limitations of Traditional Layering
Conventional layered composite restorations can experience chipping, marginal staining and surface deterioration.
Their performance is influenced by restoration design, tooth position, material selection and operator technique.
A Systematic Restorative Approach
The Bioclear Method brings together preparation design, surface cleaning, anatomical matrices, composite placement and finishing.
The aim is to simplify complex restorative procedures and improve control of final anatomy.
The principle behind the Bioclear Method:
Restorative success
depends on the
complete procedure,
rather than simply
choosing an
appropriate composite.
The Five Pillars of the Bioclear Method
First developed by Dr David Clark in 2007, the Bioclear Method combines five complementary principles for direct composite restorative treatment.
Biofilm Removal
Disclosure and thorough cleaning of bonding surfaces before adhesive procedures.
Modern Cavity Preparation
Conservative preparation design using appropriate bevels and restorative geometry.
Anatomical Matrices
Purpose-designed matrices to guide contours, contacts and emergence profiles.
Heated Injection Moulding
Matrix-guided composite placement using suitable warmed restorative materials.
Rockstar Polishing
Systematic finishing and polishing to develop smooth, highly polished restorative surfaces.
Why the Five Pillars Work Together
The article explains that controlling shade, marginal adaptation and anatomical form simultaneously can be challenging with traditional layering.
The Bioclear Method uses anatomical matrices to help guide restoration shape, while the other clinical stages address bonding, material handling and final surface finish.
The intention is to create a repeatable restorative workflow that can be applied across different clinical situations.
Anatomical Matrices: A Different Approach to Tooth Shape
One of the central developments discussed in the publication is the replacement of traditional flat Mylar strips with anatomically shaped matrices.
Anterior & Diastema Closure Matrices
Designed for anterior restorative procedures including Class III and IV restorations, diastema closure and tooth reshaping.
The article discusses different matrix thicknesses and their use according to the presence or absence of existing contacts.
360° Composite Veneer Matrices
Designed to wrap around the tooth when positioned mesially and distally.
These matrices are used for selected anterior reconstructions, including fractured teeth, peg laterals and changes in tooth length.
Bioclear Black Triangle Matrices
Specifically shaped to help develop cervical contours and interproximal emergence profiles when closing open gingival embrasures.
The original Bioclear BT system uses a measuring gauge and corresponding colour-coded matrices.
Why matrix design matters:
The matrix helps
control the
restorative contour
in areas that
can be difficult
to shape and
polish freehand,
particularly near
the gingival margin.
Heated Composite Injection Moulding
Rather than building restorations through extensive freehand incremental layering, the Bioclear approach uses an anatomical matrix to guide composite placement.
Combining Flowable and Paste Composite
The article describes the use of flowable and warmed paste composite within the anatomical matrix system.
Appropriate warming temporarily reduces the viscosity of suitable composite materials, helping facilitate controlled placement and adaptation.
The paste composite is injected following the flowable material, with the matrix controlling the intended restorative contours.
The authors describe the objective of achieving a restoration composed predominantly of paste composite, rather than a large volume of flowable material.
The original paper illustrates this technique using Filtek materials and the Bioclear HeatSync heater.
Why Use Heated Composite?
- Reduced viscosity of suitable warmed composites.
- Easier injection through the matrix system.
- Controlled placement around anatomical contours.
- Potential for improved material adaptation.
- Less reliance on extensive freehand sculpting.
- Integration with a systematic finishing and polishing protocol.
Material-specific protocols:
The 2023 article
describes particular
Filtek composites
and warming conditions.
These are the
materials and
protocols discussed
in that publication,
not a universal
heating recommendation
for every composite.
Current manufacturer
instructions should
always be followed.
Finishing & Rockstar Polishing
The publication places particular emphasis on the relationship between finishing, surface smoothness and restorative aesthetics.
Shape & Marginate
Following matrix removal, excess composite is removed and the restoration is shaped.
The published protocol includes burs, discs and Shofu Brownies.
Surface Refinement
The article describes the use of Bioclear Magic Mix to refine the composite surface before final polishing.
Final High-Gloss Polish
A diamond-impregnated polishing cup is used to develop the final high-gloss surface.
The objective is a smooth finish that retains a polished appearance when dry.
Black Triangle Closure: A Conservative Restorative Option
Open gingival embrasures can be an important aesthetic concern, particularly following orthodontic treatment or changes in periodontal tissues.
Understanding the Challenge
Black triangles become visible when the interdental papilla does not completely fill the space beneath the contact area.
The appearance may be influenced by tooth shape, contact position, gingival recession and periodontal attachment levels.
Traditional composite placement can make it challenging to develop smooth cervical contours without creating bulky restorations or overhangs.
The article presents the Bioclear Method as an alternative for selected black triangle cases, particularly where teeth are already appropriately aligned.
Important Treatment Objectives
- Preserve healthy tooth structure where possible.
- Select an appropriate matrix for the size of the embrasure.
- Develop natural cervical and interproximal contours.
- Create an appropriate contact area.
- Avoid restorative overhangs and unnecessary plaque-retentive areas.
- Maintain good periodontal health and accessibility for cleaning.
Upper Anterior Black Triangle Closure
The article illustrates a detailed clinical sequence for black triangle treatment following orthodontics.
Reconstructing Anterior Tooth Contours
The patient presented with upper anterior black triangles following orthodontic treatment.
The Bioclear Black Triangle Gauge was used to determine the appropriate matrix size.
Corresponding colour-coded matrices were selected and tried in to assess the planned emergence profiles and space closure.
Where necessary, interproximal contacts were adjusted using Bioclear Tru-Contact Saws to allow appropriate matrix seating.
The teeth were isolated with rubber dam and the biofilm removal protocol was completed.
The restorations were then completed using anatomical matrices and composite injection overmoulding.
The published photographs document treatment through to the one-week review.
An important clinical detail:
The publication describes
completing and finishing
each tooth before
proceeding to
the next restoration.
Once the restorations
were completed,
the final shapes
were assessed
together and
polished systematically.
Black Triangle Treatment: The Clinical Sequence
The published technique follows a structured restorative workflow, from assessment and matrix selection through to final polishing.
Assessment & Measuring
Assess the size of the embrasure and select the corresponding matrix using the Bioclear BT Gauge.
Matrix Try-In
Confirm matrix seating and emergence profile. Adjust tight contacts where clinically necessary.
Isolation & Biofilm Removal
Isolate the teeth and clean the bonding surfaces before adhesive treatment.
Composite Injection
Position the anatomical matrices and restore the selected tooth using the injection-moulding technique.
Repeat & Refine
Complete the next restoration, removing gross excess and refining contours as the treatment progresses.
Finish, Polish & Review
Assess the final tooth shapes and occlusion, complete polishing and arrange appropriate maintenance.
Explore the Published Clinical Photographs
The original Dental Update publication includes detailed clinical photographs covering matrix placement, black triangle treatment and follow-up outcomes.
Complete Black Triangle Treatment Sequence
Includes the pre-treatment appearance, BT Gauge, matrix selection, rubber dam, injection overmoulding, finishing and postoperative views.
Long-Term Black Triangle Follow-Up
Dr David Clark's published black triangle case includes pre-treatment, immediate postoperative and six-year follow-up photographs.
Black Triangles After Periodontal Disease
The publication illustrates treatment of black triangles following periodontal disease, with a four-year postoperative photograph.
About the clinical images:
These links open
the original
illustrated publication,
preserving the
authors' figure
captions and
clinical context.
The figures
represent separate
clinical cases and
should not be
interpreted as
sequential photographs
of the same patient.
What Do the Follow-Up Cases Show?
The publication includes two particularly interesting examples of black triangle restorations reviewed several years after treatment.
Anterior Black Triangle Closure
Figure 14 presents a case treated with the Bioclear Method, including photographs taken six years and four months after treatment.
The images provide an individual example of the longer-term appearance of composite black triangle restorations.
Black Triangle Closure Following Periodontal Disease
Figure 15 shows a separate case involving black triangles following periodontal disease.
The four-year photograph illustrates the appearance of the restorations and surrounding gingival tissues at review.
Understanding the evidence:
These cases
demonstrate individual
long-term clinical
appearances.
They do not
establish an overall
survival rate or
prove that the
Bioclear Method
is superior to
all conventional
composite techniques.
Individual periodontal
health, restorative
conditions and
maintenance remain
important.
Beyond Black Triangles: Other Anterior Applications
The authors also demonstrate how the principles of the Bioclear Method can be used across a wider range of anterior restorative situations.
Diastema Closure
Anatomical matrices can help develop new proximal contours when closing selected spaces between anterior teeth.
Peg Lateral Reconstruction
Injection overmoulding can be used to reshape undersized teeth and improve anterior tooth proportions.
Replacing Existing Composites
The article illustrates replacement of chipped and discoloured composite restorations with new matrix-guided restorations.
Fractured Anterior Teeth
Anterior tooth reconstruction can be undertaken using anatomical matrices and direct composite techniques.
Class III & IV Restorations
Modern preparation design and matrix-guided composite placement can be applied to conventional and deeper anterior restorations.
Composite Veneers
The Bioclear approach can be used for selected direct composite veneers and 360° overmoulding procedures.
Clinical Considerations & Maintenance
The article emphasises that restoration design, periodontal health and ongoing maintenance all contribute to successful treatment.
Periodontal Compatibility
Black triangle restorations can extend towards the cervical tooth surfaces, making gingival emergence profiles particularly important.
The publication discusses treatment in patients with previous periodontal disease where periodontal health has been stabilised.
The restorative objective is to create smooth contours without plaque-retentive overhangs while maintaining access for appropriate oral hygiene.
Clinical suitability depends on tooth anatomy, periodontal stability and individual patient factors.
Maintenance Considerations
- Maintain excellent oral hygiene around restored interproximal areas.
- Review gingival health and restorative margins.
- Assess occlusion and functional loading.
- Check for staining, roughness or restorative deterioration.
- Re-polish restorations when clinically indicated.
- Consider retainer requirements following post-orthodontic restorative treatment.
Maintenance in the publication:
The authors suggest
review and
maintenance appointments
at approximately
12–18-month intervals,
with re-polishing
when required.
The appropriate
recall interval
should be tailored
to the individual
patient's risk
and clinical needs.
Read the Full Article by Dr Claire Burgess & Professor Dominic Hassall
An Introduction to a Modern Procedure for Anterior Composite Restorations and Black Triangle Closure Using a Novel Matrix System: Part 1
Dental Update, February 2023
Volume 50, pages 117–125
Nine-page illustrated clinical article
Includes the complete discussion of the Bioclear Method, anatomical matrices, composite injection moulding, clinical treatment sequences and references.
Frequently Asked Questions
Practical questions about anterior composite dentistry, Bioclear matrices and black triangle treatment.
What is the Bioclear Method?
The Bioclear Method is a systematic approach to direct composite dentistry developed by Dr David Clark.
It combines biofilm removal, contemporary preparation design, anatomical matrices, heated composite injection moulding and Rockstar Polishing.
Why use anatomical matrices instead of flat Mylar strips?
Anatomical matrices help guide restorative contours and contact areas, particularly towards the gingival margin.
This can reduce reliance on freehand shaping in areas where access and finishing are challenging.
Can Bioclear close black triangles without tooth preparation?
In suitable cases, black triangle closure can be performed using an additive composite approach with little or no removal of healthy tooth structure.
However, clinical preparation may be required depending on existing restorations, tooth anatomy and contact relationships.
How are Bioclear Black Triangle matrices selected?
The original Black Triangle matrix system uses a measuring gauge to assess the embrasure.
The gauge identifies a corresponding colour-coded matrix, which is then tried in to assess seating and the intended emergence profile.
Why is composite heated before injection moulding?
Appropriate warming can temporarily reduce the viscosity of suitable composite materials, making them easier to inject and adapt within the matrix.
Heating temperatures, duration and material compatibility must follow current manufacturer instructions.
Does injection moulding eliminate the need for finishing?
No. Anatomical matrices help control the restorative contours, but finishing and polishing remain important.
The Bioclear Method uses a systematic approach to shaping, refining and polishing composite restorations.
Can black triangles be treated following periodontal disease?
Selected patients with stable periodontal health may be suitable for restorative black triangle treatment.
The article includes a clinical example following periodontal disease, with a four-year postoperative review.
Periodontal assessment, restorative contours and oral hygiene remain important.
How long do Bioclear black triangle restorations last?
Restoration longevity depends on numerous factors including anatomy, occlusion, restorative technique, material selection and maintenance.
The publication includes individual cases reviewed after four years and after six years and four months.
These cases do not establish a universal restoration lifespan.
What other treatments can be completed using the Bioclear Method?
The publication describes applications including Class III and IV restorations, diastema closure, restoration replacement, peg lateral reconstruction, fractured teeth and direct composite veneers.
Where can dentists learn Bioclear black triangle closure?
Bioclear Matrix UK offers hands-on Black Triangle certification courses as well as Core Anterior training.
Training includes matrix selection, preparation principles, composite injection moulding and finishing techniques.
Continue Exploring Bioclear Clinical Publications
Discover more about contemporary composite techniques through related published clinical articles.
Posterior Composite Restorations
Dr Claire Burgess and Professor Dominic Hassall explore the Bioclear approach to posterior composite dentistry and Class II restorations.
Treatment of the Dreaded Black Triangles
Dr David Clark discusses black triangle closure using anatomical matrices and composite injection moulding.
Black Triangle Closure with Warmed Composite
Dr Michael Cai demonstrates a conservative anterior restorative procedure using Bioclear matrices, flowable and warmed composite.
Learn the Bioclear Method with Hands-On Training
Develop your skills in anatomical matrix selection, contemporary preparation design and composite injection moulding.
Bioclear Matrix UK offers structured clinical education including Black Triangle and Core Anterior certification courses.
Looking for Treatment for Black Triangles?
If you have black triangles between your teeth, the Bioclear Method may offer a conservative restorative option.
Find a dentist with relevant Bioclear training who can assess your teeth and explain the treatment options available.
Clinical educational overview based on An Introduction to a Modern Procedure for Anterior Composite Restorations and Black Triangle Closure Using a Novel Matrix System: Part 1 by Dr Claire Burgess and Professor Dominic Hassall.
Dental Update, February 2023, Volume 50, pages 117–125.
Clinical case photographs and treatment outcomes illustrate individual patients. Treatment suitability requires professional clinical assessment.