Int erpr o ximal Enamel Reduction

Martinho L. R. Moreno Pinheiro, DMD1

Aim: To describe in detail the stripping technique, or interproximal enamel reduction. Material and Methods: Following a careful literature review, this article discusses the interproximal enamel reduction techniques currently available and presents two clinical cases. The indications, contraindications, advantages, disadvantages, and precautions of interproximal enamel reduction are discussed. Results and Conclusion: Orthodontists can effectively use interproximal enamel reduction techniques in many aspects of clinical practice. There is no evidence that, when utilized correctly and in selected clinical situations, interproximal enamel reduction causes harm to the dental hard tissues or soft tissues. World J Orthod 2002;3:223232.

COPYRIGHT 2002 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. NO PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.

nterproximal enamel reduction (IER) is understood to be the clinical act of removing part of the dental enamel from the interproximal contact area. The aim of this reduction is to create space for orthodontic treatment and to give teeth a suitable shape whenever problems of shape or size require attention. In the literature, this clinical act is normally referred to as stripping, although other names can be found, such as slandering, slicing, Hollywood trim, selective grinding, mesiodistal reduction, reapproximation, interproximal wear, and coronoplastia.13 IER is a critical procedure. Therefore, planning and execution need to be carefully assessed. This treatment should be considered as an exact reduction of interproximal enamel and not just as a simple method to solve problems.

HISTOR Y OF INTERPROXIMAL ENAMEL REDUCTION

Interproximal dental stripping has been used by orthodontists for many years.2,3 It was initially used to gain space when correcting mandibular incisor crowding or to prevent such crowding.
1Private

Practice of Orthodontics, Portalegre, Portugal.

REPRINT REQUESTS/CORRESPONDENCE Dr Martinho Pinheiro, Av. Pio XII n2 r/c DTO, 7300-073 Portalegre, Portugal. E-mail: martinhopinheiro@hotmail.com

In 1944, Ballard4 recommended a careful stripping of the interproximal surfaces, mainly from the anterior segment, when a lack of balance is present. In 1954, Begg5 published his study of Stone Age mans dentition, where he referred to the shortening of the dental arch over time, which occurred through abrasion. Although the degree of shortening of the dental arch found by Begg was contested, the existence of this natural reduction led to the publication and development of the technique for interproximal enamel reduction. In 1956, Hudson6 stated that mesiodistal reduction of the mandibular incisors is only occasionally referred to in the literature, and listed just three previous articles with direct reference to the mesiodistal reduction of mandibular incisors. In his study, Hudson stated that stripping should be carried out with medium and fine metallic strips, followed by final polishing and topical application of fluoride (to the authors knowledge, this is the first description of a stripping technique). He stated that it was possible to gain 3 mm of space between mandibular canines, and presented an enamel thickness table for incisor and mandibular canine contact points. In 1958, Bolton 7 published his seminal study titled Disharmony in tooth size and its relation to the analysis and treatment of malocclusion. This study, together with Ballards study, supported the need, in dental dimension discrepancy problems, to use interproximal stripping to correct problems of dental balance.
223

Pinheiro

WORLD JOURNAL OF ORTHODONTICS

In 1969, Kelsten 8 recommended the use of mechanical means to carry out stripping and recommended prior alignment of teeth. He posited that only after alignment could stripping be simply and accurately achieved. That same year, Rogers and Wagner9 described an in vitro study that used teeth extracted for orthodontic reasons. These extracted teeth were subjected to stripping and polishing. It was found that if the extracted teeth were treated with fluoride after stripping, they offered greater resistance to acid attacks, mainly in the 48 to 96 hours after the procedure. This scientifically justified the impor tance, already highlighted by Hudson,6 of topical fluoride application after stripping and polishing. In 1971, Paskow10 published an article that recommended the use of mechanical methods of IER. In 1973, Shillingbourg and Grace11 wrote an article entitled Thickness of enamel and dentin, which was an important study on enamel and dentin thickness. The results of this study later served as the scientific basis for work on stripping and allowed the amount of enamel that could be safely removed from each dental face to be accurately determined. Also in the 70s, Peck and Peck published articles12,13 on crowding of the mandibular incisors and presented the Peck index. They advised stripping whenever the mesiodistal dimension of the mandibular incisors did not fall within acceptable figures calculable from their index. They claimed that anything in excess would constitute predisposition toward crowding. In 1980, Tuverson14 published Anterior interocclusal relations: Part 1, which presented a highly detailed description of the stripping technique using a back angle and abrasive disks. In 1981, Doris, Bernard, and Kuftinec15 concluded that one of the strongest determining factors for dental crowding is the dimension of teeth in the arch. In 1981, Betteridge16 presented the results of stripping on the anterior and inferior segment after 1 year without retention. She observed some relapse, but concluded that esthetics were clearly acceptable after observation by a panel of three dentists, three orthodontists, and three non-dentists. In 1985, Sheridan published his article Air-rotor stripping 17 and, in 1987, Air-rotor stripping update.18 These articles totally revolutionized the technique and aims of interproximal enamel reduction. He recommended: 1. Use of a turbine with carbide drill, instead of diamond disks and strips. 2. Stripping on buccal sectors; in other words, distally on canines or mesially on the second molars
224

on both arches. This achieves greater space and allows the preservation of incisors. 3. Use of stripping procedures to achieve space (up to 8 mm per arch) for the correction of moderate dentomaxillary disharmony, without recourse to extraction or excessive expansion. In 1986, Zachrisson19 proposed a new direction for stripping: improvement of the shape of the teeth, mainly for incisors and reduction of the black triangular space above the papilla.

COPYRIGHT 2002 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. NO PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.

INDICATIONS
The IER technique has evolved over the years; it was first used only for stripping mandibular incisors, with the aim of preventing and correcting crowding. Areas of application have continued to grow: 1. Tooth size discrepancy. In 1944, Ballard recommended careful stripping of the proximal surfaces of the anterior teeth when there was imbalance.4 2. Crowding of mandibular incisors. Stripping was first used6 to obtain space for the correction and prevention of crowding. 3. Tooth shape and dental esthetics. Stripping can and should be used for the reshaping of enamel on some teeth, thus contributing to an improved finishing of orthodontic treatment and dental esthetics.19 4. Normalization of gingival contour and elimination of triangular spaces above the papilla, thus greatly improving esthetics and smile.19,20 5. Moderate dentomaxillary disharmony. This is a primary area of application for interproximal enamel reduction in the technique developed by Sheridan in 1985 and 1987, which allowed space to be obtained for the correction of moderate dental crowding; up to 8 mm per arch could be achieved without the need for extraction or excessive expansion.17,18 6. Reduced expansion and premolar extraction. 7. Camouflage of Class II and III malocclusions. The use of mandibular stripping can be beneficial in camouflaging slight to moderate Class III conditions and overjet. In orthodontic treatment to camouflage Class II with the extraction of two maxillary premolars, correcting the crowding and inclination of the mandibular incisors with stripping is an ideal solution. 8. Correction of the curve of Spee. For the correction of an exaggerated curve of Spee, it is necessary to create a few millimeters of space in the arch. This can be achieved through moderate stripping.

VOLUME 3, NUMBER 3, 2002

Pinheiro

CONTRAINDICATIONS
There are several contraindications for the approximation technique: 1. Severe crowding (more than 8 mm per arch). With application of IER, it would be hazardous to carry out orthodontic correction. There would be risk of excessive loss of enamel and all of the ensuing consequences. 2. Poor oral hygiene and/or poor periodontal environment. IER should not be used when there is active periodontal disease or lack of dental stability. Although little scientific evidence exists linking IER and increased dental mobility, it is prudent to avoid this technique in these situations. In addition, IER should not be used when there is poor oral hygiene; the orthodontist could be held responsible for all subsequent iatrogenic activity. Vanarsdall has called attention to the potential deleterious consequences.20 3. Small teeth and hypersensitivity to cold. Stripping should not be used in these situations, as the risk of the appearance of or an increase in dental sensitivity is great. 4. Susceptibility to decay or multiple restorations. There is a risk of causing imbalance in unstable oral situations, although the stripping of restorations, instead of enamel surfaces, is an option to consider. 5. Shape of teeth. Stripping should not be carried out on square teethteeth with straight proximal surfaces and wide basesas these shapes produce broad contact surfaces, and could potentially cause food impaction and reduced interseptal bone.

COPYRIGHT 2002 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. NO PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.

Fig 1 Holding device with metallic strips used for the manual method of IER.

Mechanical method
This technique greatly reduces working time. The tools for its use mainly consist of disks for handpieces or contra-angles8,10,14,19 (Fig 2a), high-speed handpieces,17 and mechanical files for contra-angle heads with shuttle movement (Figs 2b and 2c) A new generation of perforated disks was recently tested by Zhong and colleagues24 (Fig 3). In Zurich, van Waes and Matter have developed an orthostrips system (Intensiv; GAC International, York, PA, USA) of flexible strips for contra-angle shuttle heads composed of four small metallic strips of decreasing grain size (Fig 4).

Techniques
Initially, stripping was done as described by Hudson,6 with metallic strips (Fig 5). Hand disk contra-angles were introduced later, and are recommended by a number of authors8,14,19,23 (Fig 6). In 1985, Sheridan17 advised the use of carbide fissure drills for turbines, cutting from a horizontal position and parallel to a 0.022-inch wire, called an indicator wire, which was previously positioned at the gingival margin (Fig 7). For the shaping and finishing of the tooth, Sheridan recommended a finegrain diamond drill.18 Other authors have recommended very fine diamond drills, used vertically, which facilitate the shaping movement and reduce the risk of causing the formation of steps (Fig 8). Zhong and colleagues 24 have concluded that stripping executed with perforated disks, followed by polishing with fine and ultra-fine Sof-Lex disks (3MUnitek, St Paul, MN, USA), proved to be efficient and provided good results in final polishing (Fig 9).
225

MATERIAL AND METHODS

Correct IER is composed of four stages: reduction, reshaping, polishing, and protection of the enamel. There are two main techniques for IER, depending on whether manual or mechanical methods are used.

Manual method
This method consists of metallic strips, impregnated with abrasive metal oxides, and numerous holding devices (Fig 1). This method was first described in the literature by Hudson.6 The technique is seldom used for three reasons: (1) it is time consuming; (2) there is technical difficulty in working on posterior teeth; and (3) it causes much deeper grooves on the abraded enamel than those caused by mechanical instrumentation.22,23

Pinheiro

WORLD JOURNAL OF ORTHODONTICS

COPYRIGHT 2002 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. NO PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.

Fig 2 Tools for the mechanical method of IER. (a) Disks for handpieces, (b,c) mechanical files for contra-angle heads with shuttle movement.

Fig 3

Perforated disks for IER.

Fig 4 The ortho-strips system developed by van Maes and Matter. (a) Metallic strips of decreasing grain size for (b) contra-angle shuttle head. Fig 5 (Left) Manual stripping with small metallic strips. Fig 6 (RIght) Stripping with disks.

Fig 7 (a) Indicator wire and (b) the Sheridan stripping technique.

Fig 8 Stripping technique with a very fine diamond drill, used vertically.

Fig 9 (a) Stripping with perforated disks, followed by (b) polishing with Sof-Lex disks.

226

VOLUME 3, NUMBER 3, 2002

Pinheiro

COPYRIGHT 2002 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. NO PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.

Fig 10 (a) Ortho-strips system technique and (b) its adaptation to the shape and convexity of the tooth.

Fig 11 heads.

Files for use with shuttle

The four metallic strips in the van Waes and Matter ortho-strips system, with grains between 15 and 90 m for cutting and polishing, can be adapted to a 36position shuttle head with oscillation movement of 0.8 mm. They have the advantage of being flexible and adapt well to the shape and convexity of the tooth, especially at the contour of cervical area (Fig 10). Files for use with shuttle heads are available in several different grains (15 to 125 m) for cutting and polishing, They are also practical for shaping teeth (Fig 11).

Treatment sequence
The following treatment steps are described in more detail below. 1. Complete treatment planning, with accurate measurement of study casts. 2. Ensure that no contraindications to IER exist. 3. Place orthodontic appliances and correct rotation. 4. Place elastic or spring separators. 5. Carefully do the IER (carried out sequentially). 6. Shape and polish the stripped surface. 7. Measure and control the obtained space. 8. Check posterior anchorage. 9. Reduce friction and perform the progressive distalization. 10. Apply fluoride. 11. Align anterior teeth. 12. Retain properly to maintain optimal results. For sound practice of this technique, the first step should be to plan the treatment and accurately measure, on the study casts, the amount of space required18 for the desired correction (Fig 12). No contraindications to stripping should exist for the patient. A few days before stripping, separators are placed in position (Fig 13a) or, as Sheridan18 recommends, a spring is placed (Fig 13b) to separate each tooth at the contact area. This has the advantage of allowing stripping to be carried out individually on each tooth.
227

However, this also necessitates the prior measurement of the space opened up by the elastic (or spring) for optimal reduction (Fig 13c). Using one or more of the techniques previously described, IER and polishing are then carried out on the mesial surface of the last tooth to be stripped and on the distal surface of the penultimate tooth. The space obtained is measured with the instrument recommended by Sheridan25,26 or with calibrated wires, as recommended by Philippe27 (Figs 14a and 14b). Anchorage of the posterior teeth is then prepared, which can be done with stops (Fig 14c), bends in the arch, or through the prior fitting of palatal and lingual bars. Distalization should be carried out tooth by tooth to avoid any loss of space.18 The archwire should slide freely in the brackets, so round steel arches are recommended (Fig 15a). Brackets with a ball hook can also be used, which allows the fitting of a metallic ligature to the bracket and force application at that point (Fig 15b). At the end of each stripping and polishing session, a topical application of fluoride should be performed6,9,17,23,28 (Fig 16). Initially, Sheridan recommended the use of sealants,29 but he later withdrew these recommendations because remineralization might spontaneously occur.22 When distalization of the tooth is finished, the whole process is repeated in the next contiguous space (Fig 17). When the stripping and distalization stages are complete, a nickel-titanium or thermoactive arch is placed, followed by alignment of the anterior teeth. Figures 18 and 19 illustrate, with pre- and posttreatment photographs, the results achieved with proper IER technique in two patients with Class I malocclusion and moderate crowding.

Advantages of IER
The following are the main advantages of the IER technique:

Pinheiro

WORLD JOURNAL OF ORTHODONTICS

Fig 12 Measurement of the teeth on the cast.

COPYRIGHT 2002 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. NO PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.

Fig 13 A few days before stripping (a) separators are placed in position or (b) spring is used to separate teeth, and (c) measurement of the space is obtained with the spring or separator.

Fig 14 (a) Calibrated wires, as recommended by Julien Philippe. (b) Instrument recommended by Sheridan (Raintree Essix, Metairie, LA, USA). (c) Anchorage of the posterior teeth with stops.

Fig 15 (a) Distalization elastic placed on bracket and (b) distalization elastic placed on a ball hook.

Fig 16 Fluoride ready for topical application.

Fig 17

Treatment progress.

228

VOLUME 3, NUMBER 3, 2002

Pinheiro

COPYRIGHT 2002 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. NO PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.

Fig 18 Young adult female patient with Class I malocclusion and moderate crowding, treated with IER. (a to e) Pretreatment and (f to j) posttreatment.

The space obtained can be continuously monitored to adjust it to the space needed to achieve the treatment goals. Overexpansion of the dental arch is avoided. Extraction of teeth is greatly reduced. The need for excessive tooth movement, as well as the possible loss of bone and of root cementum, is reduced due to the fact that the iatrogenic potential is considered less than with extraction. Treatment time is reduced.
229

The quality of treatment is significantly improved in patients with crowding and contraindications for extraction, as in the case of closed bites. Esthetics are improved, as is the final health of the gingival papilla, which adapts better to a reduction of interdental space than to the space left by extraction. Treatment of adults with slight or moderate crowding is possible, without the need for extraction. Greater posttreatment stability is possible.

Pinheiro

WORLD JOURNAL OF ORTHODONTICS

COPYRIGHT 2002 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. NO PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.

Fig 19 Young adult male patient with a Class I malocclusion and moderate crowding, treated with IER. (a to e) Pretreatment and (f to j) posttreatment.

Disadvantages of IER
It is a time-consuming treatment.

Does stripping increase the risk of decay? Does stripping cause periodontal damage? How much enamel can be stripped? A perusal of the literature offers some answers. Radlanski and colleagues30,31 demonstrated that even with thorough polishing it was impossible to totally remove grooves left by stripping and that after 1 year, such grooves are still microscopically visible at the contact point, where there is natural abrasion. They also found that even after careful cleaning,
230

RESER VATIONS OR POTENTIAL IATROGENIC SEQUELAE

In 1956, Hudson already questioned whether IER could have adverse consequences on oral health. It is legitimate that some issues arise:

VOLUME 3, NUMBER 3, 2002

Pinheiro

COPYRIGHT 2002 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. NO PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.

including flossing, bacterial plaque was evident. They concluded, however, that no study has demonstrated that this roughness suggested predisposition to decay. In 1980, Boese,32 in a 9-year retrospective study, concluded that it was not possible to find adverse effects. Zachrisson,19 in 1986, considered polishing and treatment of the stripped surface unnecessary. In 1990, Crane and Sheridan,33 in a retrospective study conducted on patients who had been subjected to stripping between 1985 and 1988, found 4.6% of new caries lesions on stripped areas and 4.1% of new caries lesions on unstripped areas. This difference was statistically insignificant. In 1991, El-Mangoury et al,28 in an in vivo study, concluded that the roughness produced by stripping does not increase propensity to decay, and that after 9 months, the natural remineralization of the stripped area is complete. However, the application of fluoride is advised. In 1991, Joseph et al23 recommended a mixed technique of polishing with strips and treatment with 37% phosphoric acid. This provided an excellent polish, which was then followed by topical application of fluoride. It can be concluded from these studies that stripping itself is not a factor that enhances the decay process. In addition, the preponderance of evidence suggests that stripping does not predispose patients to periodontal deterioration. In 1980, Boese,32 in a 9year retrospective study carried out on patients subjected to stripping and fiberotomy, concluded that there was no significant reduction of the osseous crest in these patients. Sadowsky and BeGole,34 in a study conducted in 1981 comparing a group of patients that received orthodontic treatment during adolescence with a control group, concluded that this treatment did not have any effect on long-term periodontal health. In 1981, rtun et al35 concluded that the approximation of roots through orthodontic treatment did not predispose patients to faster periodontal destruction. In 1990, Crain and Sheridan,33 in a study on premolars and molars in patients subjected to stripping, found no alterations of the osseous crest when comparing stripped areas to non-stripped areas. Finally, several authors have conducted studies on the thickness of dental enamel (Fig 20, see WJO website at www.quintpub.com).6,11,36 On the basis of these studies, several possibilities regarding the amount of enamel that can be stripped were described, but it is now widely accepted that 50% of existing enamel is the maximum amount that can be stripped without causing risk to dental and periodontal health.17 In most situations, this corresponds to a maximum of 0.5 mm per dental surface or, in other words, 1 mm33,37 per mesial contact area of second molars to the distal of the canines.
231

ADMONITIONS
Always carry out IER with new instruments. Carefully protect soft tissues. Never carry out IER until dental rotation has been corrected, so that it can be done at the correct contact areas. In cases of Class I malocclusions, without tooth size discrepancy, always carry out IER on both arches. Take into consideration that IER on anterior teeth may detract from their esthetic appearance. When using IER in adolescents, consider extraction of third molars, since many clinicians feel that they could cause new crowding and need for additional treatment.

KEY POINTS
Carry out stripping sequentially. Limit stripping to 0.5 mm per contact surface or, in other words, 1 mm per mesial contact area of second molars to the distal of the canines. Measure space accurately. Parallel stripped contact areas. Shape dental surfaces to their original configuration, without abraded grooves. Carefully polish the stripped surface. Topically apply fluoride after stripping. Reduce, as much as possible, inadvertent loss of space obtained, by using anchorage on posterior teeth and reducing friction through the use of round arch and metallic ligatures.

CONCLUSION
It has been shown that orthodontists can effectively use the IER technique in many aspects of their practices. There is no evidence that IER conducted within recognized limits and in appropriate situations causes harm to teeth or gingiva.

REFERENCES
1. Fillion D. Apport de la sculpture amlaire irterproximal lorthodontie de ladulte (prmiere partie). Rev Orthop Dento Facial 1992;26:279293. Ritto AK. Remodelao Dentria Interproximal. Revista de Sade Oral 1997;2:107118. Ritto AK. Remodelao Dentria Interproximal. Revista de Sade Oral 1998;3:3344. Ballard ML. Asymmetry in tooth size: A factor in the etiology, diagnosis, and treatment of malocclusion. Angle Orthod 1944;14:6771.

2. 3. 4.

Pinheiro

WORLD JOURNAL OF ORTHODONTICS

COPYRIGHT 2002 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. NO PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.

5. Begg PR. Stone Age mans dentition. Am J Orthod 1954;40: 298312,373383,462475,517531. 6. Hudson AL. A study of the effects of mesio-distal reduction of mandibular anterior teeth. Am J Orthod 1956;42:615624. 7. Bolton WA. Disharmony in tooth size and its relation to the analysis and treatment of malocclusion. Angle Orthod 1958; 28:113130. 8. Kelsten LB. A technique for realignment and stripping of crowded lower incisors. J Pract Orthod 1969;3:8284. 9. Rogers GA, Wagner MJ. Protection of stripped enamel surfaces with topical fluoride applications. Am J Orthod 1969; 56:551559. 10. Paskow H. Self-alignment following interproximal stripping. Am J Orthod 1970;58:240249. 11. Shillingbourg HT, Grace CS. Thickness of enamel and dentin. J So Calif Dent Assoc 1993;41:3354. 12. Peck H, Peck S. An index for assessing tooth shape deviations as applied to the mandibular incisors. Am J Orthod 1972;61:384401. 13. Peck H, Peck S. Crown dimensions and mandibular incisor alignment. Angle Orthod 1972;42:148153. 14. Tuverson DL. Anterior interocclusal relations: Part I. Am J Orthod 1980;78:361370. 15. Doris JM, Bernard BW, Kuftinec MM. A biometric study of tooth size and dental crowding. Am J Orthod 1981;79:326336. 16. Betteridge MA. The effects of interdental stripping on labial segments evaluated one year out of retention. Br J Orthod 1981;8:193197. 17. Sheridan JJ. Air-rotor stripping. J Clin Orthod 1985;19:4359. 18. Sheridan JJ. Air-rotor stripping update. J Clin Orthod 1987; 21:781787. 19. Zachrisson BU. Zachrisson on excellence in finishing. Part 2. J Clin Orthod 1986;20:536556. 20. Vanarsdall RL Jr. Periodontal/Orthodontic Interrelationships. In: Graber TM, Vanarsdall RL Jr (eds). Orthodontics: Current Principles and Techniques (ed 3). St Louis: Mosby, 2000:801838. 21. Frvig E, Zachrisson BU. Effects of mandibular incisor extraction on anterior occlusion in adults with Class III malocclusion and reduced overbite. Am J Orthod Dentofacial Orthop 1999;115:114124. 22. Fillion D. Apport de la sculpture amlaire irterproximal lorthodontie de ladulte (deuxime partie). Rev Orthop Dento Facial 1993;27:189214.

23. Joseph VP, Rossouw PE, Basson NJ. Orthodontic microabrasive reapproximation. Am J Orthod Dentofacial Orthop 1992; 102:351359. 24. Zhong M, Jost-Brinkmann PG, Radlanski RJ, Miethke RR. SEM evaluation of a new technique for interdental stripping. J Clin Orthod 1999;33:286291. 25. Ballard R, Sheridan JJ. Air-rotor stripping with the essix anterior anchor. J Clin Orthod 1996;30:371373. 26. Sheridan JJ, Hastings J. Air-rotor stripping and lower incisor extraction treatment. J Clin Orthod 1992;26:1822. 27. Philippe J. A method of enamel reduction for correction of adult arch-length discrepancy. J Clin Orthod 1991;24:484489. 28. El-Mangoury NH, Moussa MM, Mostafa YA, Girgis AS. In-vivo remineralization after air-rotor stripping. J Clin Orthod 1991; 25:7578. 29. Sheridan JJ, Ledoux PM. Air-rotor stripping and proximal sealant. An SEM evaluation. J Clin Orthod 1992;26:1822. 30. Radlanski RJ, Jger A, Schwestka R, Bertzbach F. Plaque accumulation caused by interdental stripping. Am J Orthod Dentofacial Orthop 1988;94:416420. 31. Radlanski RJ, Jager A, Zimmer B. Morphology of interdentally stripped enamel one year after treatment. J Clin Orthod 1989;23:748750. 32. Boese LR. Fiberotomy and reapproximation without lower retention, nine years in retrospect. Angle Orthod 1980;50: 8897,169178. 33. Crain G, Sheridan JJ. Susceptibility to caries and periodontal disease after posterior air-rotor stripping. J Clin Orthod 1990; 24:8485. 34. Sadowsky C, BeGole E. Long-term effects of orthodontic treatment on periodontal health. Am J Orthod 1981;80:156172. 35. rtun J, Kokich VG, Osterberg SK. Long-term effects of root proximity on periodontal health after orthodontic treatment. Am J Orthod Dentofacial Orthop 1987;91:125130. 36. Stoud JL, English J, Buschang PH. Enamel thickness of the posterior dentition: Its implication for nonextraction treatment. Angle Orthod 1998;2:141146. 37. Sheridan JJ. The physiologic rationale for air-rotor stripping. J Clin Orthod 1997;31:609612.

232

VOLUME 3, NUMBER 3, 2002

Pinheiro

WEB ONLY

COPYRIGHT 2002 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. NO PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.

Average Total Tooth

Central incisor Lateral incisor Canine Fig 20a 5.00 5.83 6.58

Greatest Total Mesial Distal mm

0.522 0.683 0.900 5.88 6.50 8.53 0.88 1.05 1.11 0.70 0.98 1.80 4.40 4.95 5.27

Least Total Mesial mm

0.37 0.47 0.38 0.36 0.50 0.55

Mesial Distal mm
0.544 0.650 0.763

Distal

Hudsons enamel thickness table.6

Central Incisor M
Maxillary Mandibular Fig 20b 0.85 0.75

Lateral incisor M D

Canine M
1.19 0.88

First premolar M D

Second premolar M D

First molar M D

D
0.91 0.77

D
1.31 1.16

0.96 0.80 0.75 0.77

1.48 1.54 1.41 1.51

1.27 1.21 1.38 1.80

1.34 1.41 1.46 1.47

Shillingbourgs and Graces enamel thickness table; contact point values selected by Didier Fillion.11,22

Fig 20c Stoud, English, and Buschangs enamel thickness table.38

1.29 M2 1.28 1.41 1.18 1.22 0.98 1.07 0.8 0.9 1.0 1.1 1.2 1.3 1.4 1.5 1.6 Mesial Distal PM1 1.48

M1

PM2