Gingival black triangles (GBTs) are generally considered to be aesthetically unacceptable, have a multifactorial aetiology and a range of treatment options. This review covers the surgical and non-surgical management of GBTs. Surgical methods address recontouring, preserving or reconstructing the soft tissue including the interdental papilla as well as the alveolar bone. Non-surgical approaches include restorative techniques (including the use of prostheses and gingival-coloured materials), orthodontic movement, tissue engineering and tissue volumisers. This review covers the aetiology and management of GBTs, highlighting the importance of considering the options currently available when treating a lost dental papilla. A lack of longitudinal studies investigating the long-term outcomes of the options in management of GBTs presence is identified.