Int erpr o ximal Enamel ReductionMartinho 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;3:223–232. 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. I 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.”1–3 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 nº2 r/c DTO, 7300-073 Portalegre, Portugal. E-mail:
[email protected] 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 man’s 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 author’s 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 Ballard’s study, supported the need, in dental dimension discrepancy problems, to use interproximal stripping to correct problems of dental balance. 223 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. already highlighted by Hudson. up to 8 mm per arch could be achieved without the need for extraction or excessive expansion. INDICATIONS The IER technique has evolved over the years. Paskow10 published an article that recommended the use of mechanical methods of IER. mainly for incisors and reduction of the black triangular space above the papilla. The use of mandibular stripping can be beneficial in camouflaging slight to moderate Class III conditions and overjet. That same year. This is a primary area of application for interproximal enamel reduction in the technique developed by Sheridan in 1985 and 1987. Stripping on buccal sectors. These extracted teeth were subjected to stripping and polishing. correcting the crowding and inclination of the mandibular incisors with stripping is an ideal solution. thus contributing to an improved finishing of orthodontic treatment and dental esthetics. Betteridge16 presented the results of stripping on the anterior and inferior segment after 1 year without retention. 2. thus greatly improving esthetics and smile.17. He recommended: 1. it is necessary to create a few millimeters of space in the arch. they offered greater resistance to acid attacks. In 1980. Correction of the curve of Spee. Shillingbourg and Grace11 wrote an article entitled “Thickness of enamel and dentin. COPYRIGHT © 2002 BY QUINTESSENCE PUBLISHING CO. and Kuftinec15 concluded that one of the strongest determining factors for dental crowding is the dimension of teeth in the arch.19 4.18 6. but concluded that esthetics were clearly acceptable after observation by a panel of three dentists. Also in the ‘70s. Peck and Peck published articles12. INC. in other words. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. which allowed space to be obtained for the correction of moderate dental crowding. Sheridan published his article “Air-rotor stripping” 17 and. This can be achieved through moderate stripping. in 1987. She observed some relapse. instead of diamond disks and strips. In 1981. Ballard recommended careful stripping of the proximal surfaces of the anterior teeth when there was imbalance. For the correction of an exaggerated curve of Spee. 8.4 2. mainly in the 48 to 96 hours after the procedure. Stripping was first used6 to obtain space for the correction and prevention of crowding. it was first used only for stripping mandibular incisors. without recourse to extraction or excessive expansion. Rogers and Wagner9 described an in vitro study that used teeth extracted for orthodontic reasons. In 1944. Tuverson14 published “Anterior interocclusal relations: Part 1. They advised stripping whenever the mesiodistal dimension of the mandibular incisors did not fall within acceptable figures calculable from their index.20 5. In 1986.” which presented a highly detailed description of the stripping technique using a back angle and abrasive disks. Use of stripping procedures to achieve space (up to 8 mm per arch) for the correction of moderate dentomaxillary disharmony. Tooth size discrepancy. Reduced expansion and premolar extraction. with the aim of preventing and correcting crowding. Tooth shape and dental esthetics. Stripping can and should be used for the reshaping of enamel on some teeth. Moderate dentomaxillary disharmony. Camouflage of Class II and III malocclusions. Crowding of mandibular incisors. He posited that only after alignment could stripping be simply and accurately achieved. In 1981. . This achieves greater space and allows the preservation of incisors. Zachrisson19 proposed a new direction for stripping: improvement of the shape of the teeth. Normalization of gingival contour and elimination of triangular spaces above the papilla. Kelsten 8 recommended the use of mechanical means to carry out stripping and recommended prior alignment of teeth.13 on crowding of the mandibular incisors and presented the Peck index. It was found that if the extracted teeth were treated with fluoride after stripping. In orthodontic treatment to camouflage Class II with the extraction of two maxillary premolars. Bernard. In 1971. 3. They claimed that anything in excess would constitute predisposition toward crowding. and three non-dentists.Pinheiro WORLD JOURNAL OF ORTHODONTICS In 1969. In 1985. 3. three orthodontists. Doris. In 1973.”18 These articles totally revolutionized the technique and aims of interproximal enamel reduction. distally on canines or mesially on the second molars 224 on both arches. “Air-rotor stripping update. Use of a turbine with carbide drill.” which was an important study on enamel and dentin thickness.19. Areas of application have continued to grow: 1. This scientifically justified the impor tance. NO PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER. 7.6 of topical fluoride application after stripping and polishing. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.VOLUME 3. Vanarsdall has called attention to the potential deleterious consequences. cutting from a horizontal position and parallel to a 0. Mechanical method This technique greatly reduces working time. it would be hazardous to carry out orthodontic correction. called an “indicator wire. INC. and (3) it causes much deeper grooves on the abraded enamel than those caused by mechanical instrumentation. GAC International. IER should not be used when there is poor oral hygiene.20 3. Stripping should not be used in these situations. NO PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER. is an option to consider. Stripping should not be carried out on “square” teeth—teeth with straight proximal surfaces and wide bases—as these shapes produce broad contact surfaces. instead of enamel surfaces. Sheridan17 advised the use of carbide fissure drills for turbines. In Zurich. Poor oral hygiene and/or poor periodontal environment. 2002 Pinheiro CONTRAINDICATIONS There are several contraindications for the approximation technique: 1. There are two main techniques for IER.19 (Fig 2a). Zhong and colleagues 24 have concluded that stripping executed with perforated disks. reshaping. depending on whether manual or mechanical methods are used.23 . high-speed handpieces. stripping was done as described by Hudson. Sheridan recommended a finegrain diamond drill.14.19. 4.10. PA. 5.17 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 1985. and numerous holding devices (Fig 1). impregnated with abrasive metal oxides. as the risk of the appearance of or an increase in dental sensitivity is great. St Paul. followed by polishing with fine and ultra-fine Sof-Lex disks (3MUnitek. and protection of the enamel. and are recommended by a number of authors8.18 Other authors have recommended very fine diamond drills. York. Susceptibility to decay or multiple restorations. van Waes and Matter have developed an “orthostrips system” (Intensiv. and could potentially cause food impaction and reduced interseptal bone. COPYRIGHT © 2002 BY QUINTESSENCE PUBLISHING CO. (2) there is technical difficulty in working on posterior teeth. With application of IER. In addition. 2. USA). Severe crowding (more than 8 mm per arch). Small teeth and hypersensitivity to cold. This method was first described in the literature by Hudson. although the stripping of restorations.022-inch wire. Although little scientific evidence exists linking IER and increased dental mobility.” which was previously positioned at the gingival margin (Fig 7). There is a risk of causing imbalance in unstable oral situations. proved to be efficient and provided good results in final polishing (Fig 9). polishing. For the shaping and finishing of the tooth. Manual method This method consists of metallic strips. it is prudent to avoid this technique in these situations. Fig 1 Holding device with metallic strips used for the manual method of IER. which facilitate the shaping movement and reduce the risk of causing the formation of steps (Fig 8). the orthodontist could be held responsible for all subsequent iatrogenic activity. used vertically.14.6 The technique is seldom used for three reasons: (1) it is time consuming. Hand disk contra-angles were introduced later.6 with metallic strips (Fig 5). MN. The tools for its use mainly consist of disks for handpieces or contra-angles8. Shape of teeth. IER should not be used when there is active periodontal disease or lack of dental stability. There would be risk of excessive loss of enamel and all of the ensuing consequences. 225 MATERIAL AND METHODS Correct IER is composed of four stages: reduction. NUMBER 3. USA) of flexible strips for contra-angle shuttle heads composed of four small metallic strips of decreasing grain size (Fig 4).22.23 (Fig 6). Techniques Initially. a b c Fig 2 Tools for the mechanical method of IER. Fig 7 (a) Indicator wire and (b) the Sheridan stripping technique. a b a b Fig 8 Stripping technique with a very fine diamond drill. Fig 9 (a) Stripping with perforated disks. (a) Metallic strips of decreasing grain size for (b) contra-angle shuttle head. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. 226 . (b. Fig 6 (RIght) Stripping with disks. followed by (b) polishing with Sof-Lex disks. (a) Disks for handpieces.c) mechanical files for contra-angle heads with shuttle movement. Fig 5 (Left) Manual stripping with small metallic strips.Pinheiro WORLD JOURNAL OF ORTHODONTICS COPYRIGHT © 2002 BY QUINTESSENCE PUBLISHING CO. INC. NO PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER. b Fig 3 Perforated disks for IER. a Fig 4 The “ortho-strips system” developed by van Maes and Matter. used vertically. Using one or more of the techniques previously described. No contraindications to stripping should exist for the patient. so round steel arches are recommended (Fig 15a). with grains between 15 and 90 µm for cutting and polishing. Anchorage of the posterior teeth is then prepared. Brackets with a ball hook can also be used. Treatment sequence The following treatment steps are described in more detail below. NO PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER. Measure and control the obtained space. a spring is placed (Fig 13b) to separate each tooth at the contact area. the first step should be to plan the treatment and accurately measure.29 but he later withdrew these recommendations because remineralization might spontaneously occur. Fig 11 heads. 7. This has the advantage of allowing stripping to be carried out individually on each tooth.23. They are also practical for shaping teeth (Fig 11). with pre. Reduce friction and perform the progressive distalization. A few days before stripping. The space obtained is measured with the instrument recommended by Sheridan25. Place elastic or spring separators. 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. 6. 1. followed by alignment of the anterior teeth. Files for use with shuttle The four metallic strips in the van Waes and Matter ortho-strips system. Files for use with shuttle heads are available in several different grains (15 to 125 µm) for cutting and polishing. a topical application of fluoride should be performed6. Complete treatment planning. 9. separators are placed in position (Fig 13a) or. Apply fluoride. the amount of space required18 for the desired correction (Fig 12).8 mm. the whole process is repeated in the next contiguous space (Fig 17). Sheridan recommended the use of sealants.26 or with calibrated wires.9. 2002 Pinheiro COPYRIGHT © 2002 BY QUINTESSENCE PUBLISHING CO. 4.VOLUME 3. Check posterior anchorage. Figures 18 and 19 illustrate. which can be done with stops (Fig 14c).28 (Fig 16). a b Fig 10 (a) Ortho-strips system technique and (b) its adaptation to the shape and convexity of the tooth. When the stripping and distalization stages are complete. or through the prior fitting of palatal and lingual bars. Align anterior teeth.22 When distalization of the tooth is finished. especially at the contour of cervical area (Fig 10). this also necessitates the prior measurement of the space opened up by the elastic (or spring) for optimal reduction (Fig 13c). 227 However.and posttreatment photographs. 3. on the study casts. as recommended by Philippe27 (Figs 14a and 14b). For sound practice of this technique. as Sheridan18 recommends. Shape and polish the stripped surface. 2. Ensure that no contraindications to IER exist. bends in the arch. Advantages of IER The following are the main advantages of the IER technique: .17. 8. Initially.18 The archwire should slide freely in the brackets. INC. 11. Place orthodontic appliances and correct rotation. At the end of each stripping and polishing session. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. a nickel-titanium or thermoactive arch is placed. 10. NUMBER 3. Distalization should be carried out tooth by tooth to avoid any loss of space. They have the advantage of being flexible and adapt well to the shape and convexity of the tooth. Retain properly to maintain optimal results. 5. can be adapted to a 36position shuttle head with oscillation movement of 0. which allows the fitting of a metallic ligature to the bracket and force application at that point (Fig 15b). the results achieved with proper IER technique in two patients with Class I malocclusion and moderate crowding. with accurate measurement of study casts. 12. Carefully do the IER (carried out sequentially). Metairie. as recommended by Julien Philippe. Fig 16 Fluoride ready for topical application.Pinheiro WORLD JOURNAL OF ORTHODONTICS Fig 12 Measurement of the teeth on the cast. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. a b c Fig 13 A few days before stripping (a) separators are placed in position or (b) spring is used to separate teeth. LA. a b Fig 15 (a) Distalization elastic placed on bracket and (b) distalization elastic placed on a ball hook. 228 . (b) Instrument recommended by Sheridan (Raintree Essix. COPYRIGHT © 2002 BY QUINTESSENCE PUBLISHING CO. USA). a b c Fig 14 (a) Calibrated wires. NO PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER. INC. and (c) measurement of the space is obtained with the spring or separator. a b Fig 17 Treatment progress. (c) Anchorage of the posterior teeth with stops. NO PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER. a b c d e f g h i j Fig 18 Young adult female patient with Class I malocclusion and moderate crowding. without the need for extraction. as is the final health of the gingival papilla. as in the case of closed bites. •Treatment time is reduced. which adapts better to a reduction of interdental space than to the space left by extraction. •The space obtained can be continuously monitored to adjust it to the space needed to achieve the treatment goals. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. INC. •Overexpansion of the dental arch is avoided. •Greater posttreatment stability is possible. NUMBER 3. •Treatment of adults with slight or moderate crowding is possible. 229 •The quality of treatment is significantly improved in patients with crowding and contraindications for extraction. . •Extraction of teeth is greatly reduced. 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. treated with IER. •The need for excessive tooth movement. 2002 Pinheiro COPYRIGHT © 2002 BY QUINTESSENCE PUBLISHING CO.VOLUME 3. •Esthetics are improved. (a to e) Pretreatment and (f to j) posttreatment. 230 RESER VATIONS OR POTENTIAL IATROGENIC SEQUELAE In 1956. treated with IER. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. •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. a b c d e f g h i j Fig 19 Young adult male patient with a Class I malocclusion and moderate crowding. where there is natural abrasion. Disadvantages of IER •It is a time-consuming treatment. Hudson already questioned whether IER could have adverse consequences on oral health.31 demonstrated that even with thorough polishing it was impossible to totally remove grooves left by stripping and that after 1 year. It is legitimate that some issues arise: . (a to e) Pretreatment and (f to j) posttreatment.Pinheiro WORLD JOURNAL OF ORTHODONTICS COPYRIGHT © 2002 BY QUINTESSENCE PUBLISHING CO. INC. such grooves are still microscopically visible at the contact point. NO PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER. Radlanski and colleagues30. They also found that even after careful cleaning. Joseph et al23 recommended a mixed technique of polishing with strips and treatment with 37% phosphoric acid. NUMBER 3. see WJO website at www. by using anchorage on posterior teeth and reducing friction through the use of round arch and metallic ligatures.33 in a retrospective study conducted on patients who had been subjected to stripping between 1985 and 1988. This difference was statistically insignificant. NO PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER. Revista de Saúde Oral 1997. •Take into consideration that IER on anterior teeth may detract from their esthetic appearance. •In cases of Class I malocclusions. In 1991. Asymmetry in tooth size: A factor in the etiology. 2002 Pinheiro COPYRIGHT © 2002 BY QUINTESSENCE PUBLISHING CO.quintpub. In 1990. Ballard ML. 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. •Topically apply fluoride after stripping. •Limit stripping to 0. Crain and Sheridan. Remodelação Dentária Interproximal.36 On the basis of these studies. concluded that this treatment did not have any effect on long-term periodontal health. 1 mm33.17 In most situations. including flossing. 2. CONCLUSION It has been shown that orthodontists can effectively use the IER technique in many aspects of their practices. REFERENCES 1. 4. •Carefully protect soft tissues. concluded that there was no significant reduction of the osseous crest in these patients. El-Mangoury et al. in other words. Crane and Sheridan. several possibilities regarding the amount of enamel that can be stripped were described. this corresponds to a maximum of 0.26:279–293.11. bacterial plaque was evident. 231 ADMONITIONS •Always carry out IER with new instruments. Revista de Saúde Oral 1998. found 4. Årtun et al35 concluded that the approximation of roots through orthodontic treatment did not predispose patients to faster periodontal destruction. diagnosis.3:33–44. several authors have conducted studies on the thickness of dental enamel (Fig 20. This provided an excellent polish. In 1981. In addition.32 in a 9-year retrospective study. always carry out IER on both arches. Apport de la sculpture amélaire irterproximal à l’orthodontie de l’adulte (prémiere partie). In 1980. Sadowsky and BeGole. found no alterations of the osseous crest when comparing stripped areas to non-stripped areas. however. •Measure space accurately. Finally. Boese. concluded that the roughness produced by stripping does not increase propensity to decay.6% of new caries lesions on stripped areas and 4.34 in a study conducted in 1981 comparing a group of patients that received orthodontic treatment during adolescence with a control group.14:67–71. Zachrisson. Ritto AK.5 mm per contact surface or. Boese. Angle Orthod 1944. KEY POINTS •Carry out stripping sequentially. •Carefully polish the stripped surface. •Reduce. 1 mm per mesial contact area of second molars to the distal of the canines. •When using IER in adolescents. Remodelação Dentária Interproximal. Ritto AK.5 mm per dental surface or. inadvertent loss of space obtained. •Never carry out IER until dental rotation has been corrected. without abraded grooves. without tooth size discrepancy. INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. which was then followed by topical application of fluoride.19 in 1986. Rev Orthop Dento Facial 1992. In 1980. •Parallel stripped contact areas. However. 3. Fillion D. since many clinicians feel that they could cause new crowding and need for additional treatment. There is no evidence that IER conducted within recognized limits and in appropriate situations causes harm to teeth or gingiva. the application of fluoride is advised.6. the preponderance of evidence suggests that stripping does not predispose patients to periodontal deterioration.28 in an in vivo study. consider extraction of third molars.com).VOLUME 3. so that it can be done at the correct contact areas.32 in a 9year retrospective study carried out on patients subjected to stripping and fiberotomy. concluded that it was not possible to find adverse effects. and treatment of malocclusion. They concluded.33 in a study on premolars and molars in patients subjected to stripping. the natural remineralization of the stripped area is complete. In 1990.2:107–118. It can be concluded from these studies that stripping itself is not a factor that enhances the decay process. and that after 9 months. . as much as possible.37 per mesial contact area of second molars to the distal of the canines.1% of new caries lesions on unstripped areas. •Shape dental surfaces to their original configuration. In 1991. that no study has demonstrated that this roughness suggested predisposition to decay. in other words. considered polishing and treatment of the stripped surface unnecessary. Zachrisson BU. 16.517–531. Orthodontics: Current Principles and Techniques (ed 3).50: 88–97. 29. Air-rotor stripping and lower incisor extraction treatment. 30.115:114–124. Sheridan JJ. nine years in retrospect. Sheridan JJ. A biometric study of tooth size and dental crowding. Morphology of interdentally stripped enamel one year after treatment. The effects of interdental stripping on labial segments evaluated one year out of retention. Am J Orthod 1981. Fillion D.30:371–373. Kuftinec MM. Am J Orthod 1972. Am J Orthod 1956.33:286–291. Air-rotor stripping and proximal sealant. Schwestka R. 33. INC. Am J Orthod 1970.24:484–489. 32. J So Calif Dent Assoc 1993. J Clin Orthod 1992. In: Graber TM. Doris JM. Philippe J. J Clin Orthod 1990. Paskow H. Crown dimensions and mandibular incisor alignment. Begg PR. Sheridan JJ. Crain G. Ballard R. Miethke RR. 9. Mostafa YA. 7. Peck H. Sheridan JJ.42:615–624. Årtun J.94:416–420. Hastings J. Protection of stripped enamel surfaces with topical fluoride applications. 28. Rogers GA. Radlanski RJ. 20.26:18–22.58:240–249. Ledoux PM. Zachrisson on excellence in finishing. J Clin Orthod 1989. 232 .2:141–146. Grace CS. Susceptibility to caries and periodontal disease after posterior air-rotor stripping.61:384–401.41:33–54. Rev Orthop Dento Facial 1993. Peck H. Anterior interocclusal relations: Part I. Am J Orthod Dentofacial Orthop 1992. 17.3:82–84.20:536–556. Osterberg SK.31:609–612. 27.79:326–336. Am J Orthod Dentofacial Orthop 1999. Orthodontic microabrasive reapproximation. Long-term effects of root proximity on periodontal health after orthodontic treatment. Joseph VP. 11. 102:351–359.26:18–22. Fiberotomy and reapproximation without lower retention. 5. Jager A. El-Mangoury NH. 56:551–559. 23. Angle Orthod 1998. Sheridan JJ. Apport de la sculpture amélaire irterproximal à l’orthodontie de l’adulte (deuxième partie).80:156–172. Wagner MJ. Air-rotor stripping. Thickness of enamel and dentin. Rossouw PE. Sheridan JJ. 25. 2000:801–838.Pinheiro WORLD JOURNAL OF ORTHODONTICS COPYRIGHT © 2002 BY QUINTESSENCE PUBLISHING CO. Basson NJ. Girgis AS. J Clin Orthod 1986. Air-rotor stripping update. Jäger A. Air-rotor stripping with the essix anterior anchor. Jost-Brinkmann PG. Shillingbourg HT. Sheridan JJ. 19. 34. Enamel thickness of the posterior dentition: Its implication for nonextraction treatment. Radlanski RJ. 10.40: 298–312.8:193–197. Zhong M. Angle Orthod 1980. J Pract Orthod 1969. J Clin Orthod 1991. 25:75–78. 21. 18. J Clin Orthod 1999. Zimmer B. An SEM evaluation. Stoud JL. 22. A method of enamel reduction for correction of adult arch-length discrepancy. 26. 28:113–130. Periodontal/Orthodontic Interrelationships.19:43–59. J Clin Orthod 1997. 24:84–85. Tuverson DL. Part 2.27:189–214. Am J Orthod 1954.91:125–130. 14. Moussa MM. Angle Orthod 1958. 24. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. Vanarsdall RL Jr. Vanarsdall RL Jr (eds). A study of the effects of mesio-distal reduction of mandibular anterior teeth.42:148–153. A technique for realignment and stripping of crowded lower incisors. Am J Orthod 1969. Am J Orthod 1981. 36. Br J Orthod 1981. Bolton WA. Boese LR. Am J Orthod 1980. An index for assessing tooth shape deviations as applied to the mandibular incisors. J Clin Orthod 1991. Færøvig E. 21:781–787. SEM evaluation of a new technique for interdental stripping. 12.373–383. 31. Angle Orthod 1972. 6. Disharmony in tooth size and its relation to the analysis and treatment of malocclusion. NO PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER. Bernard BW.78:361–370. Bertzbach F. 8. Zachrisson BU. BeGole E. Peck S.169–178. Buschang PH. Am J Orthod Dentofacial Orthop 1987. Radlanski RJ. Kokich VG. J Clin Orthod 1985. 13. Plaque accumulation caused by interdental stripping.462–475. English J. In-vivo remineralization after air-rotor stripping. J Clin Orthod 1987. Effects of mandibular incisor extraction on anterior occlusion in adults with Class III malocclusion and reduced overbite. Kelsten LB. J Clin Orthod 1996. 35. J Clin Orthod 1992. Long-term effects of orthodontic treatment on periodontal health. 37. Stone Age man’s dentition. Hudson AL.23:748–750. Am J Orthod Dentofacial Orthop 1988. The physiologic rationale for air-rotor stripping. Sadowsky C. 15. St Louis: Mosby. Betteridge MA. Peck S. Self-alignment following interproximal stripping. NO PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.41 1.38 1.38 0.27 1.VOLUME 3. NUMBER 3.83 6.55 Mesial Distal mm 0.88 6.51 1.80 0.47 0.37 0.6 Central Incisor M Maxillary Mandibular Fig 20b 0.50 0.31 1.6 Mesial Distal PM1 1.77 1.48 1.34 1.41 1.70 0.96 0.75 0.27 Least Total Mesial mm 0.58 Greatest Total Mesial Distal mm 0.98 1.00 5.05 1.36 0.88 1.11 0. and Buschang’s enamel thickness table.9 1.80 4.80 1.77 D 1.0 1. 2002 Pinheiro WEB ONLY COPYRIGHT © 2002 BY QUINTESSENCE PUBLISHING CO. Average Total Tooth Central incisor Lateral incisor Canine Fig 20a 5.522 0.22 Fig 20c Stoud.3 1.16 0.50 8.1 1. English.29 M2 1.650 0.98 1.40 4.900 5.95 5.28 1.53 0.5 1.22 0.763 Distal Hudson’s enamel thickness table.683 0.91 0.544 0.07 0.19 0.75 Lateral incisor M D Canine M 1. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.47 Shillingbourg’s and Grace’s enamel thickness table.48 M1 PM2 .88 First premolar M D Second premolar M D First molar M D D 0.2 1.11. contact point values selected by Didier Fillion.8 0.4 1.46 1. INC.41 1.54 1.18 1.85 0.38 1.21 1.