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Dental health assessed after interproximal enamel reduction: Caries risk in posterior teeth
Abstract
We investigated whether careful interdental enamel reduction (using extrafine diamond disks with air cooling, followed by contouring with triangular diamond burs and polishing) leads to increased caries risk in premolars and first molars.
Our subjects were 43 consecutive patients from 19 to 71 years of age who had received mesiodistal enamel reduction of anterior and posterior teeth 4 to 6 years previously. Dental caries were assessed on standardized bite-wing radiographs according to a 5-grade scale and with a fine-tip explorer catch. The incidence of interproximal caries was compared between reproximated and unground contralateral surfaces in the same patient. Patients were asked about their toothbrushing habits, use of dental floss and toothpicks, and regular fluoride supplementation after the orthodontic appliances were removed.
The overall clinical impression generally showed healthy dentitions with excellent occlusion. Only 7 (2.5%) new caries lesions (all grade 1) were found among 278 reproximated mesial or distal surfaces, in 3 patients. Among 84 contralateral unground reference tooth surfaces, 2 lesions (2.4%) were seen. On nonpaired premolars and molars that had not been ground, 23 surfaces had to be referred for caries treatment (grade 3 or occlusal caries). Eleven of these occurred in 1 patient. None of the 43 patients reported increased sensitivity to temperature variations.
Interdental enamel reduction with this protocol did not result in increased caries risk in posterior teeth. We found no evidence that proper mesiodistal enamel reduction within recognized limits and in appropriate situations will cause harm to the teeth and supporting structures.
... The procedure of IPR entails approximately 0.3-0.5 mm removal of the outer enamel on the interproximal surfaces of teeth [6]. It mainly allows gaining space to relief crowding and facilitate tooth movement and alignment when extraction is undesirable [7]. ...
... It mainly allows gaining space to relief crowding and facilitate tooth movement and alignment when extraction is undesirable [7]. Other claimed advantages include reduction in treatment time [6], providing greater contact point areas therefore greater stability [8] and reduction of open gingival embrasures (black triangles) [7]. IPR can further assist in reducing Bolton's disharmonies [9] and achieving treatment objectives without compromising the integrity of periodontal and dental tissues [10]. ...
... The amount of IPR performed clinically, implemented IPR (I-IPR), has to correspond to that P-IPR in the Clin-Check ® to achieve the desired tooth movements and enable the accuracy of implementing the 3D treatment plan [14]. However, the actual procedure of enamel reduction can be performed using several techniques: discs, strips, or burs, and is largely dependent on clinicians' skills and comfort [6,11,15]. Hence, the accuracy of implementing the P-IPR clinically might be influenced by the various IPR techniques and operators' skills. Consequently, it is crucial to assess the accuracy of implementing the P-IPR clinically. ...
Aim:
To evaluate the correspondence between the interproximal reduction (IPR) performed clinically and that programmed in ClinCheck® and further assess which teeth showed an amount of implemented IPR (I-IPR) that corresponds with that programmed in ClinCheck®.
Materials and methods:
Pre- (T0) and post-treatment (T1) ClinCheck® digital models for 75 subjects (30 males and 45 females), mean age (38 ± 15) years, were included. To calculate the amount of I-IPR, Ortho Analyzer software (3Shape, Copenhagen, Denmark) was used to measure the mesiodistal widths for the maxillary and mandibular teeth from second premolar to the contralateral second premolar on the initial (T0) and final (T1) STL models. I- IPR performed by tooth was obtained by comparing the mesiodistal width of each tooth at T0 and T1. The amount of programmed IPR (P-IPR) in ClinCheck® was compared to that implemented clinically using the following formula: IPR difference = (P-IPR) - (I-IPR).
Results:
Statistically significant differences were observed between the average value of digitally programmed and implemented IPR per tooth for both the maxillary (p < .0001) and mandibular (p < .0001) teeth. The mean P-IPR for the maxillary teeth was 0.28 ± 0.16 mm versus the mean I-IPR of 0.15 ± 0.15 mm. In the mandibular arch, the mean P-IPR was 0.31 ± 0.17 mm, while the I-IPR was 0.17 ± 0.16 mm. The mean I-IPR was consistently lower than the mean P-IPR regardless of teeth and sites (p < 0.0001). The difference between the P-IPR compared to the I-IPR was larger for mandibular anterior teeth than for maxillary anterior teeth (p = 0.0302) and larger for maxillary posterior teeth than mandibular posterior teeth (p = 0.0059).
Conclusion:
The amount of implemented-IPR in clear aligner therapy is less than that digitally programmed for most teeth. Regardless of the regions, I-IPR was consistently lower than that programmed. Mandibular anterior teeth and maxillary posterior teeth showed greater discrepancy between P-IPR and I-IPR than the maxillary anterior and mandibular posteriors. Further prospective studies are needed to determine the factors affecting the precision of IPR and the clinical implications of a significantly reduced I-IPR on treatment outcomes.
... In the control group, none of the participants had IPR at any time, but such group was inappropriate due to consisting of 16 undergraduate and postgraduate students, who probably were able to maintain better dental hygiene compared with ordinary orthodontic patients. Furthermore, only 3 of 16 control subjects had previously orthodontic treatment.Likewise, Zachrisson et al23 evaluated the caries incidence in patients treated with posterior IPR using the modified Tuverson technique. The split-mouth design was used in this study; this design improved its methodological quality. ...
... Zachrisson et al23 reported that 57 of 61 participants had no gingival retraction on the labial surfaces of their mandibular incisors. ...
... Besides, the finishing step is essential to prevent harm to the surfaces and it is recommended to use the 15µm grain finishing strip for obtaining a smooth and polished enamel.31,32 In the same sense, the findings of two included studies in the present systematic review performed by the same research group indicated that IPR does not increase tooth sensitivity.22,23 We did not find other studies carried out independently by others that confirm this result. ...
This systematic review aimed to determine the effects of the interproximal enamel reduction (IPR) techniques used in orthodontics. Six databases were searched: PubMed, Scopus, Web of Science, Dentistry & Oral Sciences Source, Science Direct, and Clinical Trials. Grey literature was sourced from Google Scholar. The risk of bias was assessed by Risk of Bias 2, Newcastle‐Ottawa Scale, and Robins‐I depending on the design of the evaluated study. Additionally, the quality of the included studies was determined using Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. This systematic review included randomized clinical trials, non‐randomized clinical trials, and observational studies with a control group that reported the effects of IPR for orthodontic purposes on the teeth and periodontium. Case reports, in vitro, and in vivo studies were excluded. Eight clinical studies match the eligibility criteria. As result, no demineralization of the enamel, no increase in caries incidence, no periodontal changes or dental sensitivity were found after IPR. Also, considering the duration of orthodontic treatment, IPR resulted in a quicker technique than dental extractions. At the risk of bias assessment, all observational studies showed low risk, the non‐randomized clinical trial had a critical bias, and all randomized clinical trials exhibited some concerns. The overall quality of the studies was found between low to very low. After the analysis of the data from included studies, it was concluded that the IPR procedures could be useful to treat dental crowding in orthodontic clinical practice without negative effects. However, more randomized controlled clinical trials with a longer follow‐up time and high‐quality studies are required to generate robust statements.
... 2,9,17,18 In addition, although IDS is a potential risk factor for caries development, reports have indicated that preventive procedures and patient motivation can overcome the associated risk. [19][20][21] We conducted a retrospective study to clarify the effectiveness of treatment in patients with borderline dental and skeletal Class I, II, and III malocclusions. The study aimed to determine the location of the jaw region and incisor positions in patients with Class I, II, and III malocclusions with mild-to-moderate crowding and nonsevere skeletal discrepancies who underwent nonextraction treatment. ...
... A few studies have described the in vivo performance of IDS, and several other studies have investigated the effect of enamel reduction on tooth structures. [9][10][11]19,20 However, the effect of IDS on the dentofacial structures and its relationship with these structures remains unclear. On the basis of these facts, we conducted an in vivo study on the relationship between the amount of IDS in the jaw region and the position of the incisor teeth in patients with different classification types of malocclusion undergoing nonextraction orthodontic treatment. ...
... 1,5,6 Previous reports indicated that the size difference between the teeth might cause orthodontic anomalies. 19,28,29 Bolton proposed that reproximation (IDS) could resolve the mismatch between the teeth, 29 and IDS procedure in combination with nonextraction treatment provided adequate results in patients with mild-to-moderate crowding. 2,6 In a study by Agenter et al, 30 it was reported that one of the methods that can be used for decreasing crowding large tooth masses in patients with large tooth sizes might be IDS. ...
Introduction
The study aimed to investigate the effect of a nonextraction treatment approach with interdental stripping (IDS) on the dentofacial structures in patients with dental and skeletal Class I, II, and III malocclusions.
Methods
A total of 60 patients with mild-to-moderate crowding of the teeth and nonsevere skeletal malocclusion were included and divided into 3 groups: Class I, Class II, and Class III groups (n = 20 per group). In all patients, nonextraction orthodontic treatment was administered, and those who underwent IDS at the jaw quadrants as needed were evaluated. For pretreatment and posttreatment evaluation, lateral cephalometric radiography and 3-dimensional dental model scans were acquired for each patient. For statistical analysis, paired-samples t test and 1-way analysis of variance with Tukey post-hoc test were used for parametric variables, whereas the Wilcoxon paired signed rank test and Kruskal-Wallis test with Dunn post-hoc test were used for nonparametric variables.
Results
An increase in the maxillary incisor angle was observed in patients with Class I and Class III malocclusions, whereas a decrease was observed in patients with a Class II malocclusion (P < 0.05). Mandibular incisor angles were significantly increased in the Class II malocclusion group (P < 0.05) but unchanged in the other groups. IDS was more frequently applied to the posterior aspect of the maxilla and mandible in patients with a Class II malocclusion than in patients with other malocclusion types, and the amount of IDS at the anterior aspect of the mandible was significantly higher in the Class III group.
Conclusions
Combined nonextraction orthodontic treatment and IDS yielded successful treatment outcomes. IDS application was localized to different jaw regions according to the different malocclusion types.
... One of the main concerns regarding IPR is the possible increase in caries risk due to the increased plaque accumulation on the roughened enamel surfaces. To date, several studies have shown no increase in caries susceptibility, 27,56 and some cases were followed for as long as 10 years after the procedure. 48 In an evaluation of patients who had IPR performed one to six years previously, no significant difference between the treated and untreated surfaces was found. ...
... This was investigated again, but with a shorter follow up period, in patients having received IPR only four to six years earlier. 56 Out of the 278 surfaces that were reduced in this study, only seven had new carious lesions (2.5%), and of the 84 untreated (control) surfaces, two had new carious lesions (2.4%). The patients were not categorised by their caries risk, and the seven new carious lesions had come from three patients, indicating that these patients may have had a higher initial caries risk. ...
... However, in the earlier study, two out of the 59 patients reported an increase in sensitivity; one who had sensitive teeth in general, and the other reported sensitivity in the lower anterior region only. 56,60 The conclusions drawn were that there was no increase in caries risk following IPR, and that it could be carried out safely if the correct technique was used within recognised limits. 27 A recent systematic review of IPR stated that no reliable conclusions could be drawn from the studies completed due to the diversity of the methodologies. ...
Interproximal reduction (IPR) is the deliberate removal of part of the dental enamel from the interproximal contact areas, which decreases the mesiodistal width of a tooth. This enamel may be removed for various reasons, but most commonly to create space during orthodontic treatment or to correct tooth-size discrepancies. Several authors have also encouraged its use as a method by which post-orthodontic stability might be enhanced, particularly in the lower anterior region. With the increased use of removable aligners for orthodontic treatment in which non-extraction therapy is often advocated, the use of IPR becomes a valuable tool to relieve crowding without over-expanding the dental arches.
It is possible that inaccurate IPR could result in the over-reduction of enamel, the creation of ledges and notches in the proximal surfaces, increased tooth sensitivity or damage to the surrounding soft tissues. However, carefully conducted IPR performed within the recommended guidelines may be used as a safe method to gain space for the relief of crowding, to correct tooth-size discrepancies and to improve aesthetics and long-term stability in selected orthodontic patients.
... 8,10 It has been found that IPR increased the surface roughness, regardless of the instruments used. 11 This roughness may increase the susceptibility of stripped enamel to bacterial adhesion and biofilm formation, which is then shielded from the mechanical clearance of salivary flow, brushing, or flossing, and thereby may promote demineralization and the buildup of plaque and calculus. Numerous studies have established that various dental materials with rough surfaces promote bacterial adhesion: eg, composite resin, 12,13 porcelain, 14 cobaltchromium alloy, 15 and dental implants. ...
... 16 However, other studies have found that IPR did not lead to an increased caries risk. 11,17,18 Whether IPR actually increases the susceptibility of the stripped enamel to caries is still a matter of debate. 11,19,20 This may be because roughness is only 1 parameter of surface topography (detailed surface features) that influences bacterial adhesion, or it may be because the changes in the enamel surface are not significant enough to progress to a clinical event. ...
... 11,17,18 Whether IPR actually increases the susceptibility of the stripped enamel to caries is still a matter of debate. 11,19,20 This may be because roughness is only 1 parameter of surface topography (detailed surface features) that influences bacterial adhesion, or it may be because the changes in the enamel surface are not significant enough to progress to a clinical event. Other topographic features of enamel surface after IPR are still poorly understood. ...
Introduction:
Interproximal reduction (IPR) removes enamel and leaves grooves and furrows on the tooth surface, which may increase the risk of caries. The aims of this study were to assess the nanotopography of enamel surfaces produced by the most commonly used IPR instruments and to evaluate the effect of polishing after IPR.
Methods:
Enamel slabs were cut from the interproximal surfaces of healthy premolars and then treated with diamond burs, strips, or discs, or Sof-Lex polishing discs (3M ESPE, St Paul, Minn). All samples were cleaned by sonication in distilled water. The control group had no IPR performed and was subjected only to cleaning by sonication. The enamel surfaces were assessed using atomic force microscopy.
Results:
The IPR instruments all produced surfaces rougher than the control sample; however, the samples that received polishing with Sof-Lex discs after enamel reduction were smoother than untreated enamel (P <0.05 for all comparisons). The larger grit medium diamond burs and medium strips generated rougher enamel surfaces than their smaller grit counterparts: fine diamond burs and fine strips (P <0.001). The difference in roughness generated by mesh and curved disks was not statistically significant (P = 0.122), nor was the difference caused by fine strips and mesh discs (P = 0.811) or by fine strips and curved discs (P = 0.076) (surface roughness values for medium bur, 702 ± 134 nm; medium strip, 501 ± 115 nm; mesh disc, 307 ± 107 nm; fine bur, 407 ± 95 nm; fine strip, 318 ± 50 nm; curved disc, 224 ± 65 nm). The smoothest surfaces were created by use of the entire series of Sof-Lex polishing discs after the enamel reduction (surface roughness, 37 ± 14 nm), and these surfaces were significantly smoother than the control surfaces (surface roughness, 149 ± 39 nm; P = 0.017).
Conclusions:
Different IPR instruments produced enamel surfaces with varied nanotopography and different degrees of roughness. Enamel surfaces treated with diamond-coated burs were the roughest, followed by diamond-coated strips and diamond coated discs. Polishing with Sof-Lex polishing discs after IPR reduced the enamel surface roughness, and this surface was even smoother than untreated enamel.
... 9 İnterproksimal mine aşındırması tek başına bir tedavi değildir, ortodontik tedavinin bir parçasıdır. 10,11 Ilk defa 1944 yılında Ballard 12 mandibuler anterior dişlerde arayüzeylerin aşındırmasını tanıtmıştır. Birkaç yıl sonra Hudson 13 metalik striplerle stripping ve ardından cila ve flor uygulama tekniğini tanıtmıştır. ...
... Böylece anterior dişler sıralandığında ortaya çıkan siyah üçgen interdental alanlar düzeltilmiş olur. İnterproksimal Mine Aşındırması Endikasyonları * 4-8mm arası çapraşıklık 10,11,[17][18][19][20][21][22] : ARS yöntemi sayesinde tek bir dental arkta yaklaşık olarak 9mm yer elde edilebilmektedir ki bu da 4-8mm çapraşıklığa sahip sınır vakalarda çekimli tedaviye alternatiftir 9,19,25,26 . * Bolton analizi sapması olan vakalar 10,11,[19][20][21][23][24][25] : Birçok ortodonti hastasında Bolton diş boyut uyumsuzluğu mevcuttur. ...
... İnterproksimal Mine Aşındırması Endikasyonları * 4-8mm arası çapraşıklık 10,11,[17][18][19][20][21][22] : ARS yöntemi sayesinde tek bir dental arkta yaklaşık olarak 9mm yer elde edilebilmektedir ki bu da 4-8mm çapraşıklığa sahip sınır vakalarda çekimli tedaviye alternatiftir 9,19,25,26 . * Bolton analizi sapması olan vakalar 10,11,[19][20][21][23][24][25] : Birçok ortodonti hastasında Bolton diş boyut uyumsuzluğu mevcuttur. Bu nedenle, tedavinin son aşamasında okluzal temaslarda sagittal veya transversal yönde uyumsuzluklar gözlenebilmektedir. ...
... 2,12,13 Long-term results of interdental stripping showed no iatrogenic damage: eg, dental caries, gingival problems, or increased alveolar bone loss. 2,3 It is still controversial whether a significant clinical relationship exists between stripping procedures and increased susceptibility to caries or periodontal disease. However, the use of polishing discs and some agents (fluoride products and sealants) has been recommended to prevent the undesirable side effects of interdental stripping by producing smoother enamel surfaces and enhancing remineralization. ...
... Interproximal enamel stripping is a common orthodontic procedure to correct tooth crowding and Bolton tooth-size discrepancies, and to eliminate black triangles between adjacent teeth caused by gingival recession. [1][2][3][4] Many dental specialists are not convinced that this application is a predisposing factor for caries and periodontal disease. 8,10 Although a direct relationship could not be detected between the stripping procedure and the increased susceptibility to caries and periodontal diseases, some preventive strategies have been recommended after enamel stripping to reduce possible detrimental effects. ...
... Although microhardness and surface roughness tests are suitable only on flat and highly polished surfaces, the microhardness and the surface roughness of intact enamel (group 1) were calculated with no grinding and polishing to reflect the clinical situation. The mean surface roughness values of the stripped enamel groups (2)(3)(4)(5) were lower than the values of the intact enamel group. The SEM photomicrographs also support this finding. ...
Introduction:
The aim of this study was to investigate the effects of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) application after interproximal stripping on enamel surface structures in vivo.
Methods:
Fifteen patients with a mean age of 15.8 years participated in this study. For each patient, the extraction of 4 first premolars was part of the orthodontic treatment plan. The patients were randomly divided into 5 groups of 3 patients. With the exception of group 1, the mesial and distal surfaces of all first premolars were stripped with a stripping disc (Komet; Gebr Brasseler, Lemgo, Germany) under air cooling and then polished with Sof-Lex polishing discs (3M Dental Products, St Paul, Minn). In group 1, no stripping was performed, and the teeth were removed immediately. In group 2, the teeth were removed immediately after the stripping. In group 3, the stripped teeth were extracted after exposure to oral conditions for 3 months. In groups 4 and 5, CPP-ACP (Recaldent Tooth Mousse; GC Europe, Leuven, Belgium) or fluoride varnish (Bifluoride 12; Voco, Cuxhaven, Germany) was applied to the stripped surfaces for 3 months, respectively, before the teeth were extracted. Surface roughness and microhardness values were evaluated with 1-way analysis of variance and Tukey HSD tests.
Results:
The CPP-ACP and the fluoride varnish applications increased the surface roughness and microhardness values that had been decreased by stripping. No statistically significant differences were found between groups 3, 4, and 5 for microhardness or between groups 4 and 5 for surface roughness (P > 0.5).
Conclusions:
The saliva and saliva plus remineralizing agents (fluoride varnish and CPP-ACP) increased the microhardness and surface roughness values of stripped enamel surfaces that had been decreased by stripping.
... Qualitative Scanning Electron Microscopy (SEM) evaluations showed that all the IER methods affect enamel morphology, leaving furrows and scratches and produce a significantly rougher surface compared to intact enamel (Zachrisson et al. 2007(Zachrisson et al. , 2011Koretsi et al. 2014). ...
... Although these irregularities might facilitate plaque and bacteria retention and abraded enamel appears to establish a favorable environment for caries development, many follow up studies indicated that there is not a significant clinical relationship between IER procedures and the increased susceptibility to caries (Zachrisson et al. 2007(Zachrisson et al. , 2011Koretsi et al. 2014) and that it is possible to prevent mineral loss and promote remineralization (Alessandri Bonetti et al. 2009Bonetti et al. , 2014Uysal et al. 2010). ...
... The results of this study allowed to consider saliva a valid healing aid, able to repair within 30 days early enamel lesions caused by IER, as already stated in longterm clinical studies (García-Godoy and Hicks 2008; Tschoppe et al. 2010;Alessandri Bonetti et al. 2011;Zachrisson et al. 2011). The present in vivo study confirmed the ability of CPP-ACPF to bind bacteria within the biofilm (Reynolds et al. 2003;Marchisio et al. 2010;Hegde and Moany 2012). ...
The study aimed to investigate the morphology and composition of the interproximal reduced enamel after exposition to saliva and casein phosphopeptide amorphous calcium phosphate with sodium fluoride (CPP-ACPF). Fourteen patients undergoing an orthodontic treatment with 4 premolars extractions participated to the study. Interproximal enamel reduction (IER) was performed on mesial surfaces of 3 extractive premolars for each patient while 1 served as untreated control. Premolars were assigned to 4 groups: No-S group, sound enamel as control; S-Ex group, stripped and immediately extracted enamel; S-Sal group, stripped and exposed to saliva enamel; S-CPP group, stripped enamel treated with CPP-ACPF. Teeth were extracted at different times, depending on the group they were assigned to and sliced into mesial and distal halves. Mesial surfaces were subjected to environmental scanning electron microscopy with energy dispersive X-ray spectrometry (ESEM/EDX) and to scanning electron microscopy (SEM) analysis. ESEM/EDX investigations showed no statistically significant differences in the content of calcium and phosphate between the 4 groups. SEM observations showed no difference in the morphological appearance of stripped enamel after 30 days of exposure to saliva and CPP-ACPF. Saliva and CPP-ACPF effects on stripped enamel in vivo showed no difference after 30 days.
... Interproximal reduction (IPR) of enamel involves the removal of outer enamel (0.3-0.5 mm) on the interproximal surfaces of teeth. 1 IPR is one of the techniques that may be used during orthodontic treatment to provide extra intra-arch space in patients with mild to moderate crowding and when extraction therapy is undesirable. 2,3 Other advantages of IPR include decreased treatment time 1 and prevention of interdental gingival retraction. ...
... Interproximal reduction (IPR) of enamel involves the removal of outer enamel (0.3-0.5 mm) on the interproximal surfaces of teeth. 1 IPR is one of the techniques that may be used during orthodontic treatment to provide extra intra-arch space in patients with mild to moderate crowding and when extraction therapy is undesirable. 2,3 Other advantages of IPR include decreased treatment time 1 and prevention of interdental gingival retraction. 4 The procedure can be performed using several methods: (1) air rotor stripping with fine tungsten-carbide or diamond burs, (2) the use of diamond-coated stripping disks, or (3) the use of hand-held or motor-driven abrasive strips. ...
... 4 The procedure can be performed using several methods: (1) air rotor stripping with fine tungsten-carbide or diamond burs, (2) the use of diamond-coated stripping disks, or (3) the use of hand-held or motor-driven abrasive strips. 1,[5][6][7] Widespread acceptance of IPR has been hindered by the overarching notion that abraded enamel may be more susceptible to caries formation, despite the lack of evidence demonstrating an increased risk of caries on reduced teeth. 1 In a clinical study that involved IPR followed by polishing, Zachrisson et al. 8 concluded that IPR does not negatively affect the health of the reduced teeth. Jarjoura et al. 9 supported this conclusion and demonstrated that the application of fluoride after IPR provided little additional benefit to the patient. ...
Objective:
To determine if interproximal reduction of teeth (IPR) is perceived differently by orthodontists and general dentists.
Materials and methods:
A Web-based survey containing statements about IPR was developed and randomly distributed to orthodontists and general dentists.
Results:
The majority of orthodontists and general dentists strongly agreed that IPR is a minimally invasive procedure that poses little risk for the development of interproximal decay. However, general dentists were more likely to perform post-IPR polishing and to apply topical fluoride than are orthodontists (P < .0001). A greater percentage of orthodontists strongly believed that the esthetic and occlusal benefits of IPR outweigh the potential risk of tooth decay when IPR was performed (P < .0001). A greater percentage of general dentists were hesitant to perform IPR, despite research supporting that IPR has little negative effect on the health of teeth.
Conclusions:
The results of this study disproved the null hypothesis that orthodontists and general dentists share similar views regarding the use of IPR during orthodontic treatment. General dentists were more conservative in their views of IPR and were less comfortable with performing IPR as a routine procedure. General dentists felt more strongly about the importance of post-IPR polishing and application of topical fluoride. Orthodontists were more likely to have researched the long-term effects of IPR on the health of teeth and therefore felt more comfortable performing IPR during orthodontic treatment.
... Treatments comprising tooth extraction and appliances that cause discomfort and social constraint are avoided and effectively overcome, for example, by interproximal stripping. Good occlusion and normal periodontal conditions, with intact gingival papillae between all teeth in the maxillary and mandibular arches, could be observed in follow-up examinations more than 3.5 years after orthodontic treatment 1 . Some authors 2 mention that enamel reduction in premolars using rotary instruments and appropriate technique does not damage dental pulp in most cases, even if dentin is slightly exposed and polished. ...
... Interproximal enamel stripping yields an alternative method to tooth extraction for solving mild to moderate crowding and has also been associated to short treatment duration [1][2][3][4][5][6] . Moreover, interproximal enamel stripping is not only useful for correcting tooth-arch discrepancies, but it also increases treatment stability [7][8][9] , and keeps the transverse dental arch dimensions and anterior inclinations constant 1,6,10 . ...
... Interproximal enamel stripping yields an alternative method to tooth extraction for solving mild to moderate crowding and has also been associated to short treatment duration [1][2][3][4][5][6] . Moreover, interproximal enamel stripping is not only useful for correcting tooth-arch discrepancies, but it also increases treatment stability [7][8][9] , and keeps the transverse dental arch dimensions and anterior inclinations constant 1,6,10 . ...
Estimating enamel thickness and planning the resultant optimal morphology of premolars are substantial steps before interproximal stripping. Aim: To analyze proximal enamel thickness and crown measurements in maxillary premolars. Methods: The mesiodistal, buccolingual and cervico-occlusal measurements of 40 human maxillary first premolars (20 right, 20 left) were registered with a digital caliper. The teeth were embedded in acrylic resin and sectioned mesiodistally at the level of the contact areas to obtain 1 mm-thick central sections. Enamel thickness on the proximal surfaces was measured using a perfilometer. Measurements were compared by the Student's t-test (α = 0.05). Results: The mean enamel thickness on the mesial surface was 1.22 mm for the right (± 0.17) and left (± 0.18) sides. On the distal surface, the corresponding values were 1.28 mm (± 0.19) on the right side and 1.39 mm (± 0.17) on the left side. Mean values, in millimeters, for the mesiodistal, buccolingual and cervico-occlusal measurements on both sides ranged from 7.03 (± 0.43) to 7.07 (± 0.48), 9.59 (± 0.48) to 9.65 (± 0.58) and 8.65 (± 0.66) to 8.85 (± 0.65), respectively. There were no significant differences between right and left teeth. However, enamel thickness was significantly greater (p<0.05) on the distal surface. Conclusions: In maxillary first premolars, considering the greater thickness of distal enamel, interproximal stripping during orthodontic treatment may be more pronounced on this surface. The greatest mean value was observed for the buccolingual crown measurement, followed by the cervico-occlusal and mesiodistal dimensions.
... Interproximal reduction (IPR) is a procedure commonly used to reduce the width of incorrectly proportioned (macrodontia) or misshapened (triangular) teeth. Interproximal enamel reduction also offers an attractive alternative to overcoming difficulty when extracting premolars and to resolve the instability of overexpansion in non-extraction cases [26], thereby, improving the stability of the arches [1]. ...
... Various IPR methods have been tested and gradually improved over the years [17,26]. The 3 most common techniques at present are the following: (A) the air-rotor stripping (ARS) technique with fine tungsten-carbide or diamond burs and diamond-coated strips (primarily in the posterior segments), (B) hand-piece or micromotor-mounted diamond-coated stripping disks, and (C) hand-held or motor-driven abrasive strips [3,10]. ...
... Regardless of which method is used, it is believed to weaken the enamel [2,16,24,26]. It is generally assumed that the finer the grain size used for removing enamel, the easier and quicker the subsequent polishing. ...
The aim of this in vitro study was to evaluate the stripping achieved on different teeth (incisors, canines, and premolars) by two grades of abrasive strips used for the first and tenth time. Our second aim was to test the efficacy of these strips by calculating the time necessary to perform interproximal reductions of 0.10, 0.20, and 0.30 mm.
Four models were constructed using extracted teeth affixed in wax. The upper and lower arches were set on plaster bases and fixed in wax, carefully creating contact points. All model mouths were treated with artificial saliva (Oral Balance®) in order to simulate the biological conditions in the oral cavity. We then tested specific air-rotor strips of different grades and degrees of wear (15-µm-grain and 25-µm-grain Orthofile® strips). Afterwards the teeth from all samples were cut lengthwise in half, and each mesial and distal portion was gold-plated and observed under SEM at incremental magnification (30, 60, and 100 µm).
The 25-µm-grain strip was more effective than the 15-µm-grain strip, irrespective of the tooth involved. Second, the finishing phase with specific polishing strips after interproximal reduction was fundamental in reducing the number of abrasions and irregularities created by stripping, in particular after using the 25-µm-grain strip. To achieve the best result, the entire abraded area must be polished.
This system permits a rapid and effective stripping procedure in direct proportion to the strip's grain and in inverse proportion to the wear from its use. Further research will enable us to compare this system with similar procedures.
... Sheridan [26] suggests in particular the use of water spray with the ARS technique to reduce any pain and dissipate the generated heat. Zachrisson [32] recommends, for greater visibility and optimal results, air stream cooling by a dental assistant while performing interdental enamel reduction with extrafine diamond disks. Several authors [19,26] recommended the use of new instruments for each stripping case to avoid discomforting thermal insults. ...
... Experimental results [16] showed that air-rotor stripping increased significantly the incidence of demineralization on human proximal enamel. Follow-up studies [2,32,37,38] with more than 5 years elapsed posttreatment time yielded contradictory evidence; overall low rates of new interproximal caries were observed ranging from 0 to 4.6 per cent [2,37]. The difference between teeth subjected to enamel reduction and control teeth was not statistically significant. ...
... The difference between teeth subjected to enamel reduction and control teeth was not statistically significant. It is likely that in clinical conditions remineralization from regular fluoride intake, and the natural interproximal enamel abrasion will restore the affected surfaces in the long term [32]. Observational studies [10,37] that investigated the periodontal health implications of interdental stripping up to 9 years after treatment demonstrated no significant differences in gingival index and alveolar crest height. ...
Artificial abrasion of interproximal surfaces has been described for almost seventy years as orthodontic intervention for achievement and maintenance of ideal treatment outcome. A variety of terms and approaches have been introduced throughout this period implying a growing clinicians' interest. Nevertheless, the widespread recognition of enamel stripping technique was initiated by the advent of bonded orthodontic attachments and a 2-article series of Sheridan in the 80's. Since then, experimental and clinical research has been focused on the investigation of instrumentation efficacy and potential iatrogenic sequelae related to interproximal stripping. This review discusses the evolution, technical aspects and trends of enamel reduction procedures as documented in the literature.
... Nowadays, it is clear that dentine hypersensitivity is a fairly rare long-term side effect of IER (7)(8)(9)(10), and root proximity caused by the reduced mesiodistal width of teeth after IER does not predispose one to an accelerated periodontal breakdown (11). It is well documented that cancellous bone along with laminae durae exists between adjacent tooth roots when the inter-root distance is at least 0.5 mm. ...
... A total of 32 fulltext articles were evaluated for eligibility. From these, according to the eligibility criteria, 18 studies were further examined and included in the systematic review; 14 assessing enamel roughness after IER (19,(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33) and four investigating caries incidence after IER (10,(34)(35)(36). The inter-reviewer reliability on eligibility assessment was j = 0.82. ...
... One of four studies focusing on caries incidence was excluded from the statistical evaluation because the term 'tooth' instead of 'surface' was used, making unclear the number of surfaces where caries developed (34). The mean followup time of the remaining three studies (10,35,36) is shown in Table 6. Meta-analysis of the findings of these studies showed no statistical difference in caries occurrence between tooth surfaces treated with IER and control tooth surfaces. ...
The aim of this study was to investigate the effect of interproximal enamel reduction (IER) on tooth surfaces regarding the level of enamel roughness after applying different IER methods and the caries risk of treated teeth. Seven electronic databases were systematically searched. Two independent reviewers rated the articles at every step according to predetermined eligibility criteria. Data on enamel roughness were pooled if the same IER method was used and arithmetic values were available. Data on occurrence of caries were suitable for the analysis if the same units for caries development were used. From 2396 citations initially identified, 18 articles met the inclusion criteria and were further considered (14 studying enamel roughness and four studying the risk of caries after IER). A meta-analysis of quantitative data regarding enamel roughness was not possible due to statistical heterogeneity; instead, the enamel roughness findings are only described. The meta-analysis of studies focusing on the incidence of caries revealed no statistical difference between treated and untreated enamel surfaces (p = NS) from 1 to 7 years after IER. Drawing reliable conclusions on enamel roughness after IER is difficult owing to the diversity of the available studies. Statistically, the occurrence of caries on surfaces previously treated with IER was the same as that on intact surfaces, indicating that IER does not increase the risk of caries on treated teeth.
... Recently, IPR has surpassed extractions as the most popular orthodontic procedure in cases of invisible non-extraction [13]. Correcting anterior crowding with IPR can avoid OGE because the ideal gingival apposition area can reduce or prevent retrusion of papillae [14,15], yet no evidence from clinical trials with large sample size have addressed this specific outcome. ...
... Researchers have also found that OGE may appear when the distance from the contact point to the alveolar crest is > 5 mm [27]; thus, IPR is an effective means with which to relocate the contact point [14,15], although there is no clinical evidence that IPR can prevent the occurrence of OGE. Interestingly, in the present study, we did not find a relationship between IPR and the occurrence of OGE, but we conjectured that IPR could reduce the severity of OGE. ...
Background
The incidence of open gingival embrasures (OGE) in patients after fixed appliance treatment is relatively high, while there are no detailed reports on patients after clear aligner therapy. Also, no clinical studies with large sample size have investigated whether interproximal enamel reduction (IPR) can actually avoid OGE. The purpose of this study was to determine the prevalence of OGE in adults after clear aligner therapy and to investigate the risk of OGE associated with IPR treatment and attachment design, focusing on the amount and distribution in mandibular anterior teeth.
Methods
Pre-treatment and post-treatment intraoral frontal photographs of 225 non-extraction patients were evaluated retrospectively for the occurrence and severity of OGE. The amount of IPR and the number of attachments in the anterior teeth from subjects after screening were recorded according to the first version of clear aligner software (Clincheck, San Jose, USA) and clinical medical documents. Logistic regression analysis was performed to identify the factors contributing to OGE.
Results
The incidence of OGE in non-extraction patients after clear therapy between maxillary and mandibular central incisors was 25.7% and 40.3%, respectively. IPR was not associated with the occurrence of OGE but was associated with severity ( P < 0.05). The number of attachments in the anterior teeth or central incisors was significantly related to the incidence of OGE ( P < 0.05) but was not associated with severity.
Conclusion
A high rate of OGE occurs after clear aligner therapy. Clinicians should be aware of the application of IPR and the design of attachments during clear aligner therapy.
... 5 Adequate polishing after IPR has the potential to leave treated enamel smoother than untreated enamel, [6][7][8][9][10] thereby reducing the risk of plaque accumulation and subsequent pathology. 5,[11][12][13][14] IPR has been indicated in the following circumstances: ...
... An investigation of the risk of developing dental caries after IPR has shown that there is no increased risk. 5,[11][12][13][14] Periodontal health is similarly reported as unaffected. 14,17,22,23 The performance of IPR demands precise clinical skills to achieve the desired reduction of tooth increments which may be as small as 0.1 mm. ...
Background
Interproximal reduction (IPR) is a treatment option for orthodontic space gain. The attainment of prescribed objectives in aligner treatment may require IPR that is accurately performed both qualitatively and quantitatively.
Objective
This study assesses the in vivo accuracy of IPR carried out in 10 orthodontic practices as a method of orthodontic space creation.
Methods
A comparison of proposed and achieved amounts of IPR completed (accuracy), the accuracy of IPR within and between upper and lower dental arches, and the accuracy of IPR within and between posterior and anterior arch segments were performed using 3-dimensional digital study models gained via Align’s ® ClinCheck.
Results
The findings indicated that IPR was routinely underperformed by all practices studied. On average, the amount of IPR achieved represented only 44.0% of the total prescribed per tooth in the sample assessed, with a mean discrepancy of 0.16 mm per tooth. There were statistically significant differences only between the overall anterior and posterior groups ( p < 0.01) and between maxillary anterior and maxillary posterior groups ( p < 0.01); however, these were not clinically significant. Significant differences in IPR performance were noted between different orthodontic practices.
Conclusions
This study demonstrates that the clinical performance of IPR in 10 orthodontic practices consistently fails to achieve the prescribed amount often by large variations. The effect of this under-performance on clinical outcomes remains to be quantified.
... 5 Adequate polishing after IPR has the potential to leave treated enamel smoother than untreated enamel, [6][7][8][9][10] thereby reducing the risk of plaque accumulation and subsequent pathology. 5,[11][12][13][14] IPR has been indicated in the following circumstances: ...
... An investigation of the risk of developing dental caries after IPR has shown that there is no increased risk. 5,[11][12][13][14] Periodontal health is similarly reported as unaffected. 14,17,22,23 The performance of IPR demands precise clinical skills to achieve the desired reduction of tooth increments which may be as small as 0.1 mm. ...
... Different stripping methods are available: abrasive strips, diamond discs and tungsten carbide or diamond burs [1]. However, scanning electron microscopy (SEM) observations have shown that regardless of the method used, all techniques affect the morphology of the enamel by leaving surface irregularities in the form of furrows and scratches [1,[4][5][6][7][8][9] that could promote bacterial adhesion and plaque accumulation [4,6,10,11]. Indeed, enamel is a tissue with a complex structure, the chemical composition and surface condition of which change over time. ...
... The latter constitute preferential retention sites for bacterial plaque. This aspect has been described by several authors who have confirmed that interproximal reduction damages the integrity of the enamel surface by increasing surface defects [1,[4][5][6][7][8][9]. Biochemical analysis of stripped enamel without exposure to the oral environment showed a decrease in the percentage of mineral elements (Ca = 4.09%, P = 2.55%) which is explained by the loss of mineral tissue when removing the protective outer aprismatic layer from the enamel and by the increase in the amount of carbon (C = 51.09%) in relation to bacterial colonization of striations and surface furrows caused by stripping. ...
Introduction
Interproximal enamel reduction (IPR) is a clinical procedure that has been in use since the advent of non-extraction orthodontic techniques. However, such a procedure affects the surface condition of the enamel and may predispose patients to cavities and hypersensitivity. The use of a remineralizing agent is recommended to prevent these side effects. The objective of our study was to evaluate the evolution of stripped proximal dental surfaces after exposure to the oral environment for 4 months with and without fluoride protection.
Materials and methods
Our sample consisted of 14 premolars (PM) from 6 patients of the Dentofacial Orthopaedics Department of the Consultation and Dental Treatment Centre of Rabat (CDTC) who required orthodontic treatment with PM extraction and had given their informed consent. The teeth were divided into 5 groups: group 1: intact enamel; group 2: intact enamel + fluoride varnish + 4-month oral exposure; group 3: IPR (manual and mechanized) + extraction; group 4: IPR (manual and mechanized) without varnish + 4-month oral exposure; group 5: IPR (manual and mechanized) + fluoride varnish + 4-month oral exposure. Proximal surfaces were subjected to qualitative analysis by scanning electron microscopy and quantitative analysis by Dispersive Energy Spectroscopy (DES) to quantify the percentage of mineral elements.
Results
Exposure of stripped dental surfaces to the oral environment for 4 months with or without fluoride protection showed the persistence of surface irregularities caused by stripping. We noted an improvement in the percentage of mineral elements for both groups with and without fluoride protection. However, the percentages of calcium (Ca) and phosphorus (P) were close to that of intact enamel in the fluoride varnish group.
Conclusion
Protecting stripped surfaces with fluoride varnish could help preserve the integrity of the enamel surface by restoring some of the mineral elements lost during stripping.
... The clinical conditions and malocclusions wherein proximal stripping are contraindicated are poor oral hygiene, crowding of teeth more than 8 mm per arch, enamel hypoplasia, hypersensitivity, multiple restorations, rectangular shaped anteriors, round premolars, and young patients with large pulp chambers. 30,31 Complications due to proximal stripping arise due to incorrect technique and inappropriate treatment plan. When it is used as an alternative to extraction treatment in borderline cases, it is important for the clinician to understand that overzealous stripping may cause hypersensitivity, irreversible pulp damage, increased incidence of caries, and periodontal disease. ...
... Zachrisson developed a technique for proximal stripping using a perforated diamond-coated disk (<30 µ grain size) with adequate air and water cooling followed by polishing with fine and ultrafine Sof-lex (3M ESPE) disks. 34 Scanning electron microscope studies by Zhong et al. 38,39 and long-term studies by Zachrisson et al., 30,40 which evaluated this technique confirmed that proximal stripping when done with Zachrisson's technique, does not predispose the enamel surface to caries. ...
Interproximal reduction, referring to the reduction of tooth structure in the proximal surfaces of anteriors or posteriors as required by the clinical scenario, has most often intrigued the orthodontist and the general dentist in particular in implementing it in contemporary orthodontics on a regular basis. The reduction of tooth structure as likelihood for the development of dental caries proximally, when the patient is undergoing orthodontic therapy, can in itself be a subject of debate between the conservative general dentists and the orthodontist. With recent treatment options for minimal space requirements in aligning teeth and others such as clear aligner therapy which involve the use of proximal stripping, this review aims to present the current concepts in interproximal reduction and its questionable role as an etiological factor in the development of caries.
... [3] The ideal preparation of tooth should spare the adjacent teeth from iatrogenic damage. Literature had documented an alarming incidence of iatrogenic damage to adjacent dental hard and soft tissue during the cavity preparation, [4,5] orthodontic stripping, [6][7][8][9] and crown preparation. [3,10] These resulted in roughness and grooving of enamel surface, and thus, making it susceptible to plaque accumulation which increased the risk of caries initiation or propagation. ...
... It was noted that iatrogenic damages were not always associated with the hazardous effects. [7,17] Nevertheless, every effort should be made to prevent these inevitable events from happening that includes the prudent use of interproximal barrier in the form of matrix bands or other metal shields that are made to prevent such iatrogenic damages. [14] Other methods that can be employed include the use of small diameter tapering burs and leaving the small enamel fin at proximal contact area and use of hand instruments to break the contact area, use of separators, and maintaining a high level of care. ...
Introduction:
Iatrogenic damage to the adjacent tooth during crown preparation is a frequent disastrous effect. The aim of the study was, therefore, to determine the frequency of different types, degree and location of iatrogenic damage to the adjacent tooth during crown and bridge preparations in a tertiary care setting that lead towards the morbidity of tooth.
Materials and methods:
A prospective study was conducted in Aga Khan University dental laboratory in two months period in which a total of 150 dental casts fulfilling the inclusion criteria were analyzed using non-probability convenient sampling technique. The casts were examined using 3.5x magnifying loupes for the location, degree and type of damage to the proximal surface adjacent to the prepared tooth using Moonpar and Faulkner criteria. Data were analyzed by using SPSS version 22. Chi square test was used to assess the association between the experience of practitioner and degree of damage to adjacent tooth. It was also used to determine the association between location of tooth and degree of damage to adjacent tooth. Inter-examiner reliability was assessed by using kappa statistics.
Results:
A high prevalence of damage to the proximal surface of adjacent teeth (78% on mesial tooth and 60.6% on distal tooth) was observed, with the majority (32.6%) belonging to the mild categories. There were statistically significant associations between the experience of practitioner and the damage to the surface mesial to the preparation. However, more severe damages occurred in mandibular teeth preparations as compared to maxillary teeth preparations.
Conclusions:
A high frequency of iatrogenic damage to the adjacent teeth had been found during crown and bridge work with the middle of the tooth as the most susceptible site. However, the majority of damages were of milder type including only abrasions.
... 14 Reduksi interproksimal pada email mencakup pengasahan pada email bagian luar (0.3-0.5 mm) pada bagian interproksimal dari gigi. 16 Reduksi interproksimal merupakan salah satu teknik yang dapat digunakan pada perawatan ortodonti untuk mendapatkan ruangan tambahan pada pasien dengan crowding ringan sampai sedang. 4,17,18 Keuntungan yang lain dari reduksi interproksimal mempersingkat waktu perawatan. ...
... 4,17,18 Keuntungan yang lain dari reduksi interproksimal mempersingkat waktu perawatan. 16 Beberapa metode dari prosedur ini adalah : (1) air rotor stripping menggunakan bor diamond atau bor tungsten-carbide yang halus, (2) diamond-coated stripping disk atau (3) strip abrasive yang dapat dikendalikan dengan tangan atau menggunakan mesin. 4,19 Indikasi dari perawatan reduksi interproksimal adalah untuk pasien dengan kebersihan mulut yang baik, maloklusi kelas I dengan arch-length discrepancies dengan profil ortognati, kelas II dengan crowding ringan atau pasien yang memiliki diskrepansi ukuran gigi Bolton. ...
Pendahuluan: Crowding merupakan maloklusi yang banyak terjadi dan dapat melibatkan satu atau lebih gigi pada masing-masing rahang. Adanya crowding dapat menyebabkan terganggunya estetik dan dapat menyebabkan tersangkutnya makanan sehingga bisa menyebabkan retensi plak. Penggunaan teknik reduksi interproksimal pada gigi dapat digunakan untuk mengkoreksi crowding.Tujuan penulisan laporan kasus ini adalah mengetahui hasil koreksi crowding anterior rahang bawah dengan teknik reduksi interproksimal. Laporan kasus: Seorang wanita usia 28 tahun datang ke klinik PPDGS Ortodonti RSGM Unpad dengan keluhan gigi yang berjejal. Hasil diagnosis memperlihatkan adanya maloklusi kelas 1 disertai dengan crowding pada rahang atas dan rahang bawah dengan profil muka cembung. Perawatan dengan reduksi interproksimal pada 6 gigi anterior rahang bawah dilakukan untuk mengkoreksi maloklusi menggunakan slicing strip. Kemudian dilakukan levelling dan alignment pada gigi rahang atas dan bawah dan dilanjutkan dengan artistic positioning. Crowding pada rahang bawah terkoreksi dalam kurun waktu 4 bulan dari awal perawatan. Simpulan: Reduksi interproksimal pada 6 gigi anterior rahang bawah berhasil dilakukan untuk mengkoreksi crowding pada anterior rahang bawah.
Kata kunci: Crowding, reduksi interproksimal, slicing strip.
ABSTRACT
Introduction: Crowding is a common malocclusion involving one or more teeth in both arches. Crowding can cause aesthetic disturbances and food retention thus causes plaque accumulation. The use of interproximal reduction technique can be used to correct crowding. This case report was aimed to describe the results of the correction of the mandibular anterior crowding with interproximal reduction technique. Case report: A 28-years-old woman presented to the Orthodontic Clinics of the Faculty of Dentistry Universitas Padjadjaran Dental Hospital with a chief complaint of dental crowding. Diagnosis results showed the class 1 malocclusion along with the maxillary and mandibular crowding, and a convex face profile. Treatment with an interproximal reduction in six mandibular anterior teeth was performed using the slicing strips to correct the malocclusion. Afterwards, the levelling and alignment were carried out on the maxillary and mandibular teeth continued with artistic positioning. Mandibular crowding was corrected within four months from the beginning of treatment. Conclusion: Interproximal reduction in six mandibular anterior teeth was successfully corrected the mandibular crowding.
Keywords: Crowding, interproximal reduction, slicing strip.
... None of the patients reported increased sensitivity to temperature variations. 5,6 Our aim of the study is to present and educate clinicians about the option of reshaping and IPR as a valid alternative to porcelain veneers. ...
... They suggest that the reduction should be performed according to the enamel thickness, fillings, and/or crowns. 1,2,[4][5][6] Interproximal reduction most of the time in orthodontics is thought of as a treatment modality for creating or gaining space. The IPR can change the shape, dental appearance, and improve gingival contour of teeth. ...
Background:
Clinicians often ask, "Veneer or no to veneer?" Clinicians usually think of porcelain veneers for cases in which patients are dissatisfied with their teeth shape. Interproximal reduction can change teeth's shape and appearance within the enamel to improve gingival contour, eliminate black gingival triangles, and correct the Curve of Spee.
Aim:
Our aim is to present to clinicians the option of reshaping and interproximal reduction (IPR) as a valid alternative to porcelain veneers.
Case report:
A male patient with round bulbous-shaped anterior maxillary teeth sought a better masculine smile. Interproximal reduction with thin bur size was performed to reshape the anterior teeth in order to achieve a proportional teeth width to height and give a more rectangular rather than square shape. Finally, the orthodontist closed the multiple diastemas using round wires in order to reduce anterior teeth proclination. The patient received bleaching treatment and minor composite fillings.
Conclusion:
Not every cosmetic case should be treated with veneers and crowns. Conservative minimal intervention, such as IPR was more than sufficient in treating such cases. It is the right of the patients to be informed and educated about all possible treatment options.
Clinical significance:
Minor reshaping and IPR preserving teeth structures can be helpful in achieving esthetic results and patients' confidence.
... Interproximal reduction (IPR) is a commonly used clinical technique to reshape tooth and obtain space 1) . It removes about 0.5 mm outer enamel on the interproximal surfaces of teeth 2) . A recent study found that 46% of the general dentists and 67% of the orthodontists routinely performed IPR 3) . ...
... The stripped enamel surface was found more susceptible to demineralization and more sensitive to hot and cold temperatures than intact surfaces 11,13) . Other studies, however on the other hand, suggested that IPR did not lead to increased caries risk in anterior and posterior teeth 2,14,15) . Although whether IPR increases the susceptibility of the abraded enamel to demineralization is still a matter of debate, it should be kept in mind that a reduction of a tooth's enamel coating might lead to impaired resistibility to acid, erosion, and attrition 5,9) . ...
To assess the effect of resin infiltration vs. fluoride varnish in enhancing enamel surface conditions after interproximal reduction (IPR). After IPR procedures, 84 human enamel specimens were divided into three groups, group A/ group B was treated by fluoride varnish/resin infiltration according to the manufacturers’ instructions, group C were treated with nothing. All the specimens were pH-cycled twice daily in 37°C bath for 30 days. Surface micro-hardness, density and mineral loss were measured before and after the pH cycling. The data were analyzed and compared using ANOVA. Both treatments A and B increased the surface microhardness of enamel after IPR (p<0.05). Both before and after pH cycling, the surface microhardness of A was significantly harder than B. The density of A was higher than B before pH cycling (p<0.05). Fluoride varnish and resin infiltration may provide an enamel protection from acid challenge.
... Dennoch zeigte sich selbst bei diesen Untersuchungen kein signifikant erhöhtes Kariesrisiko 13 . In anderen retrospektiven Studien wurden ebenfalls keine Nachteile in Form einer erhöhten Kariesinzidenz an mittels ASR behandelten Zähnen gefunden8,17,18 . Auch Untersuchungen, die sich mit möglichen Überempfindlichkeiten der Zähne beschäftigten, gelang es nicht, iatrogene Folgeschäden nachzuweisen17 . ...
... In anderen retrospektiven Studien wurden ebenfalls keine Nachteile in Form einer erhöhten Kariesinzidenz an mittels ASR behandelten Zähnen gefunden8,17,18 . Auch Untersuchungen, die sich mit möglichen Überempfindlichkeiten der Zähne beschäftigten, gelang es nicht, iatrogene Folgeschäden nachzuweisen17 . Es war kein Anstieg der Sensibilität gegenüber Temperaturunterschieden oder anderen Noxen erkennbar.Der letzte mögliche Nachteil, nämlich Wechselwirkungen auf die parodontale Situation, wird in der Literatur ...
... A nivel periodontal, las ventajas de la reducción interproximal son la prevención o reducción de retracciones de papilas, además del desarrollo de nichos gingivales abiertos y la provisión de adecuados conectores en la región incisiva. Todo lo anterior facilita el óptimo llenado de la papila gingival, lo cual genera mejor apariencia estética y evita problemas periodontales por retención crónica de alimentos, tema de especial importancia cuando se tratan pacientes adultos [42] (figura 6). ...
... Es importante tener en consideración que hay limitantes para la reducción del esmalte como su mor-Figura 6. Eliminación de triángulos negros y llenado papilar con la ortodoncia y el desgaste interproximal Fuente: [42] La recolocación del punto de contacto más apical y el aumento del área de los conectores también es lograda con el desgaste. Los conectores, diferentes al punto de contacto, se definen como las áreas donde los dientes anteriores se unen y son generalmente áreas más amplias (aproximadamente 2 x 2 mm) que ayudan a la estética de la región anterior. ...
Resumen. Durante los últimos años, el porcentaje de adultos que busca tratamiento ortodóncico ha ido en aumento. Con estos pa- cientes las demandas estéticas y las condiciones orales complican el tratamiento. El enfoque multidisciplinario con miras a realizar tratamientos más conservadores que eviten sacrificar dientes sanos es una de las metas en estos pacientes. La utilización de métodos como el desgaste dentario interproximal es una alternativa preventiva y terapéutica que, realizada con cuidado y conocimiento, no causa daño a los dientes y tejidos periodontales, facilita la corrección del apiñamiento y mejora las formas dentales y triángulos negros. Además, brinda resultados más estables, funcionales y estéticos para los pacientes.DOI: http://dx.doi.org/10.16925/od.v10i18.723
... Moreover, it has been shown that enamel surfaces that have undergone the procedure of enamel reduction using stripping in accordance with appropriate method protocols did not become more vulnerable to decay than teeth that had not undergone stripping, since new caries occurred in 2.5% of the teeth stripped as compared to 2.4% of intact enamel surfaces in a total of 43 patients 30 . This fact is supplemented by another research study indicating that stripping leads to enamel demineralisation followed by remineralisation over a period of 9 months 10 . ...
... However, the dentist should take into consideration caries and caries risk index of each patient. A local fluoride compound should be applied on surfaces that have been subjected to the procedure 28,30 . Other authors suggest application of sealants after interproximal enamel reduction 25 . ...
Interproximal enamel reduction is a technique used for creating space in cases of mild or moderate crowding. There are several indications and contraindications determined by the tooth shape and the percentage of the caries index. The instruments used for the technique are diamond-coated metal strips, diamond discs and burs, each with advantages and disadvantages. Another way of interdental enamel reduction is using chemical products such as orthophosphoric acid. There are opposite impacts on the enamel surface and the periodontal tissues, based on the literature review.
... Après que le disque diamanté a été utilisé sur les faces inter-proximales, les surfaces traitées sont souvent trop plates et leurs angles doivent donc être arrondis sur leurs faces linguales et vestibulaires, dans les régions antérieure et postérieure des arcades dentaires. Pour ce faire, une fraise diamantée triangulaire (n • 8833, Komet, Gebr, Brasseler) est idéale [47,48]. ...
... De nombreux cliniciens hésitent à utiliser la réduction amélaire inter-proximale, dont ils craignent qu'elle prédispose à un accroissement des risques carieux et parodontal. Les faits publiés, dont vos deux études consacrées à la réduction inter-proximale au niveau des dents antérieures [48] et postérieures [47], montrent que ces craintes sont non fondées. Pouvez-vous nous faire bénéficier des dernières données publiées à ce sujet ? ...
Bjørn U. Zachrisson est Professeur Émérite au sein du Département d’Orthodontie de l’Université d’Oslo (Norvège). Il conserve à Oslo une pratique libérale consacrée aux traitements de l’adulte.
Il a rédigé plus de 270 articles cliniques et scientifiques, publiés dans des revues internationales et dans des manuels d’orthodontie, de parodontologie, de traumatologie et de dentisterie générale.
Il a représenté l’orthodontie européenne à l’occasion de multiples congrès à travers le monde. Il a présenté de nombreuses conférences magistrales et donné des cours pendant les congrès internationaux.
Bjørn U. Zachrisson a reçu toutes les récompenses essentielles en orthodontie, y compris le prix Ketcham et Jaraback décerné par l’American Association of Orthodontics . Il est co-rédacteur du Journal of Clinical Orthodontics , rédacteur et auteur de «Ask an Expert» dans le World Journal of Orthodontics . Il collabore à l’ Editorial Board of the Seminars in Orthodontics , à l’ Angle Orthodontist , au World Journal of Orthodontics , à la Revista Dental Press de Ortodontia e Ortopedia and Revista Clinica de Ortodontia (Brésil), à l’Italian Journal of Orthodontics , ainsi qu’à l’ European Journal of Esthetic Dentistry.
... Surface roughness after stripping has been the subject of numerous experimental and theoretical investigations since surface irregularities may theoretically promote plaque adherence and induce iatrogenic damage, such as increased temperature sensitivity of the recontoured teeth, dental caries, periodontal tissue breakdown, gingival recession, and excessive root proximity (21, 22, 25,26). Some studies have shown that IPR may produce residual furrows and grooves and increase the susceptibility of proximal enamel to demineralization (17,(27)(28)(29)(30). ...
Objectives:
Interproximal enamel reduction (IPR) is routinely used in orthodontics to generate small to moderate amounts of space within the dental arch. Aim of this ex vivo study was to evaluate the effect of two different IPR systems on the enamel surface's waviness, roughness, and elemental composition after 6 months of intraoral exposure.
Materials and methods:
Fifteen orthodontic extraction patients were included in the present study. The 39 healthy premolars, which were scheduled to be extracted, were subjected to IPR at least 6 months before their extraction. IPR was performed on their mesial side with two different methods: (1) instrumented method with the Ortho-Strips system (on handpiece) and (2) manually with the Intensiv ProxoStrip (strips)-each with four different grits for contouring, finishing, and polishing. The distal side of each premolar served as its own internal control. Treated and untreated tooth surfaces were evaluated by optical profilometry, Raman, and scanning electron microscope/X-ray energy-dispersive (EDX) analyses. Data were analysed with descriptive statistics and generalized linear models at alpha = 5%.
Results:
Both IPR methods significantly reduced the waviness of the enamel surface (P < 0.001), with manual IPR leading to smaller waviness reductions than the instrumented IPR (P ≤ 0.001). On the other side, both IPR methods led to a significant increase in enamel surface roughness (P < 0.001), with no significant differences between IPR methods. EDX and Raman analyses did not demonstrate any alterations on elemental composition of enamel after at least 6 months of intraoral exposure.
Conclusions:
Both stripping systems led to a flatter but rougher enamel surface. Further polishing is needed to restore the initial enamel smoothness. The elemental composition of the stripped enamel returns to the baseline level after 6 months of intraoral exposure.
... The need for extraction in case of crowding might be eliminated by interdental stripping [4,5]. Reshaping the proximal contacts, solving Bolton discrepancy problems, treating mild or moderate crowding, and stabilizing the dental arch are the main clinical indications to interproximal enamel reduction [6,7], especially when lingual appliances are used and labial inclination of incisor could be not easily obtainable [8]. ...
Objective:
To perform a morphological evaluation concerning the extent of interproximal enamel reduction (IPR) with different manual instruments in different types of teeth and a qualitative analysis of enamel surface characteristics at the contact point before and after IPR. Material and Methods: 40 freshly extracted, caries-free, and intact human teeth were used for the study (20 bicuspids and 20 incisors) and performed IPR just on the mesial surface. The morphological variation of contact point was evaluated by superimposed the stl file, obtained thanks to an extraoral scanner, at T0 and T1 for each tooth. Two types of strip were used, Intensiv Manual Ortho Strips Coarse/Medium and Steelcarbo Horico Strips. Teeth were then cut lengthwise, removed the most apical root portion and the mesial and distal halves were gilded and observed at different magnifications.
Results:
The morphological variation following stripping mainly depends on the extent of the stripping, while the diameter, the type of strip and the shape of the tooth itself do not appear to be relevant. The 500X and 1500X magnifications allowed to appreciate better the characteristics of the surface of the stripped enamel and the differences with the intact enamel. All teeth treated, independently from the kind of strip used, shows deep marks and grooves in the direction of stripping. In both cases, the enamel appears significantly damaged at great magnifications
.
Conclusion:
Stripping always and inevitably leads to a change in the shape of the
contact point and is directly correlated to the amount of stripping performed. The use of polishing after the removal of enamel interproximal is necessary in all cases.
... IER is also recommended to improve the unaesthetic appearance caused by the loss of the interdental papilla, which is a consequence of bone loss or occlusal interproximal tooth contact [7]. In addition, IER is also used in temporary dentition to facilitate the eruption of partially erupted teeth blocked by insufficient space [8]. However, IER procedures are not recommended in small teeth, hypoplasia, severe tooth rotations, high risk of caries, poor oral hygiene, and young patients with large pulp chambers [9]. ...
The aim of this study was to show a novel and accurate digital measurement protocol by analyzing the area and volume for interproximal tooth enamel surface reduction. In total, 14 lower teeth from all dental sectors were embedded into an epoxy resin and distributed as the lower dental arch, keeping the contact points. The experimental model was submitted to an intraoral digital impression before and after interproximal tooth enamel surface reduction using air-rotor strips and then re-contouring and polishing the interproximal enamel surfaces. These steps helped obtain standard tessellation language (STL) digital files. Furthermore, each tooth in the preoperative and postoperative full-arch STL digital files was segmented individually and aligned to analyze the area and volume of the interproximal tooth enamel surface reduction using engineering morphometry software. Descriptive analysis of the area and volume of the interproximal tooth enamel surface reduction was performed using a Student t-test. Higher enamel reduction area (3.53 ± 3.08 mm2) and volume (0.32 ± 0.22 mm3) values were shown on the distal surface compared with the area (2.97 ± 3.05 mm2) and volume (0.22 ± 0.16 mm3) of the enamel reduction on the mesial surface measured using the morphometric measurement digital protocol. The morphometric measurement protocol is an accurate digital measurement protocol for analyzing the area and volume of interproximal enamel surface reduction.
... Sheridan, (2008) özellikle ağrıyı azaltmak ve üretilen sıcaklığı dağıtmak için Air Rotor Stripping tekniği ile birlikte su spreyi kullanımını önermektedir. Zachrisson (2011), daha iyi görüş açısı ve optimum sonuçlar için, dişhekimi asistanı tarafından hava soğutma sistemi kullanırken, elmas disklerle interdental mine aşındırma işlemi yapılmasını gerektiğini ifade etmiştir. Birçok yazar (Pinheiro, 2002;Sheridan, 2008), hastaların termal değişikliklerden etkilenmemeleri için her stripping vakasında bu güncel araçların kullanılmasını önermiştir. ...
... Twesme et al 21 found more lesion depth in a stripped enamel surface than in an intact surface. Zachrisson et al 22 and Lapenaite et al 9 also found a higher caries risk in stripped enamel surfaces. In the current study, the negative control showed a smoother surface, which is in accordance with Bayram et al, 8 Bhambri et al, 4 and Meredith et al 18 who showed smoother surfaces when interproximal stripping was done with a disc followed by polishing with a disc. ...
Aim
The aim of the present study was to compare the effects of remineralizing agents (nano-hydroxyapatite [n-HAP], NovaMin, calcium sucrose phosphate [CaSP], and Pro-Argin) on surface characteristics of slenderized enamel using Vickers microhardness and scanning electron microscope–energy dispersive X-ray (SEM-EDX) analysis.
Materials and Method
Sixty extracted premolar teeth were divided into 6 groups: group 1—natural teeth; group 2—slenderization and polishing; group 3—n-HAP; group 4—NovaMin; group 5—CaSP; and group 6—Pro-Argin. Remineralizing agents were applied for 21 days. Specimens were evaluated using Vickers microhardness and SEM-EDX analysis. A 1-way analysis of variance (ANOVA) and post-hoc Tukey honestly significant difference (HSD) test were used for intragroup comparisons.
Results
Among all remineralizing agents, CaSP showed significantly maximum surface microhardness, followed by NovaMin, n-HAP, and Pro-Argin. SEM also showed increased surface roughness for all remineralizing agents. EDX showed maximum increase in mineral content obtained with CaSP.
Conclusion
All remineralizing agents significantly remineralized the stripped enamel surface. CaSP demonstrated promising results by effectively and significantly remineralizing the enamel lesions as compared to other test agents.
... 7,8 Long-term studies on IPR have demonstrated that careful IPR in the anterior region (the most common area of IPR), using an appropriate technique and with excellent hygiene control, can be performed safely with no negative consequences on the teeth. [9][10][11] Interproximal reduction is considered a safe procedure on the dental pulp for teeth with average dentin thickness. 12 A variety of techniques and products can be used for IPR, including handheld abrasive strips, burs, and contra angle mounted discs. ...
Objectives
To investigate the correspondence between programmed interproximal reduction (p-IPR) and implemented interproximal reduction (i-IPR) in an everyday-practice scenario. The secondary objective was to estimate factors that might influence i-IPR to make the process more efficient.
Materials and Methods
Fifty patients treated with aligner therapy by six orthodontists were included in this prospective observational study. Impressions were taken at the beginning of treatment and after the first set of aligners. Data on p-IPR, i-IPR and technical aspects of IPR were gathered for 464 teeth. Statistical analyses included the Wilcoxon signed-rank test, Kruskal-Wallis, and multilevel mixed regression.
Results
Mean difference between p-IPR and i-IPR was 0.15 mm (SD: 0.14 mm; P = .0001), with lower canines showing the highest discrepancy. Use of burs and measuring gauges resulted in a smaller difference (respectively: coeff.: 0.09, P = .029; coeff.: −0.06, P = .013). IPR was performed more accurately on the mesial surface of teeth than on the distal surface. Round tripping before IPR resulted in a slightly more precise i-IPR compared to the previous alignment (coeff.: −0.021, P = .041).
Conclusions
Implemented IPR tends to be less than p-IPR, especially for lower canines and distal surfaces of teeth. Burs tend to provide more precise i-IPR, especially compared to manual strips; however, there is variation between the techniques. Using a measuring gauge tends to increase the precision of i-iPR. As several factors influence the implementation of IPR, particular attention must be paid during the procedure to maximize its precision.
... Also, some studies reported that widened proximal tooth contacts obtained after this procedure can stabilize treatment results [11]. Moreover, correction of anterior crowding with IPR can avoid imperfections known as "black triangles," due to the presence of ideal gingiva apposition areas that reduce or prevent retrusion of papillae thereby improving esthetic results [12]. Long-term analysis of IPR showed the absence of iatrogenic damage like dental caries, gingival problems, or increased alveolar bone loss [13,14]. ...
Aim:
The aim of the present study was to compare the accuracy of the actual space obtained through interproximal enamel reduction (IPR) compared to the amount of IPR planned through the digital setup during clear aligner treatment (CAT).
Materials and methods:
A total of 10 clinicians were randomly recruited using the Doctor Locator by Align Technology (California). For each clinician, four consecutive patients treated with CAT and manual stripping were selected for a total of 40 subjects and 80 dental arches. For each patient, the amount of planned IPR and the amount of actual IPR performed were recorded. Each arch was considered individually. For each arch, the mesio-distal tooth measurements were obtained from second to second premolars.
Results:
No systematic measurement errors were identified. In 25 cases, stripping was planned and performed in both arches; in 4 cases only in the upper arch and in the remaining 7 cases only in the lower arch. The difference between planned IPR and performed IPR was on average 0.55 mm (SD, 0.67; P = 0.022) in the upper arch and 0.82 mm (SD, 0.84; P = 0.026) in the lower arch. The accuracy of IPR in the upper arch was estimated to be 44.95% for the upper arch and 37.02% for the lower arch.
Conclusion:
Overall, this study showed that the amount of enamel removed in vivo did not correspond with the amount of IPR planned. In most cases, the performed IPR amount was lower than planned. When considering the actual amount in millimeter, these differences may not be considered clinically relevant.
... 7 Since various techniques and materials were available, studies were conducted to evaluate the most efficient IPR procedure. 8,9 Scanning Electron Microscopic studies were undertaken to compare the surface roughness produced by different reduction techniques and polishing procedures. 10-14 They concluded that mechanical reduction followed by polishing provided smoother enamel surface compared to other techniques. ...
Objective: A vivo study was conducted to evaluate the surface roughness produced by two different methods: hand-held mechanical and air-rotor stripping and also by HORICO and Ortho-Organizer strips (Bengaluru, India), before and after polishing with 3M Sof-Lex Finishing Strips under Atomic Force Microscope.
Methodology: Study included 44 proximal surfaces of extracted premolars divided into a control group and 3 experimental groups with 12 surfaces in each. Hand-held mechanical stripping was done by 40 passages of 6 cm long abrasive strips and air-rotor stripping using high-speed air-rotor turbine hand piece. Polishing was done using 3M Sof-Lex finishing strips. Reduced teeth samples were viewed under Atomic Force Microscope and the proximal strips under Confocal microscope for surface roughness.
Results: Air-rotor stripping produced statistically significant more surface roughness compared to the mechanical reduction technique ( P = .01). There was no significant difference between the roughnesses produced by 2 different proximal strips. Tooth surface after IPR with polishing had less roughness compared to unpolished surface. There was no mean difference between the wear of proximal strips.
Conclusion: The mechanical reduction technique of interproximal surface produces less surface roughness compared to air-rotor stripping. Polishing with 3M Sof-Lex strips after reduction irrespective of the technique and material used gives smoother surface than even normal enamel.
... In the study by Pereira et al, 14 the highest temperature was produced by perforated stripping discs in molars (3.2˚C) followed by 3.1˚C in premolars and incisors. Some authors 4,5 have suggested that cooling techniques, such as an air-water spray, were effective in limiting the temperature increase in the pulp chamber. However, according to some of these authors 4 the use of water for cooling hampers visibility during the procedure. ...
Introduction:
Proximal stripping of enamel is a routine clinical procedure employed in orthodontics to create space or for balancing tooth size discrepancies. This procedure may result in heat transfer to the pulp, predisposing it to histopathological changes and necrosis of the pulp tissue.
Objective:
To measure the temperature changes in the pulp chamber during different stripping procedures.
Methods:
80 proximal surfaces of 40 extracted human premolar teeth were stripped using four techniques: diamond burs in air-rotor handpiece with air-water spray; diamond burs in micromotor handpiece, with and without a coolant spray; and hand-held diamond strips. A J-type thermocouple connected to a digital thermometer was inserted into the pulp chamber for evaluation of temperature during the stripping procedure.
Results:
An increase in the pulpal temperature was observed for all stripping method. Diamond burs in micromotor handpiece without coolant resulted in the higher increase in temperature (3.5oC), followed by hand-held diamond strips (2.8oC), diamond burs in air-rotor with air-water spray (1.9oC); and the smallest increase was seen with diamond burs in micromotor handpiece with coolant (1.65oC). None of the techniques resulted in temperature increase above the critical level of 5.5oC.
Conclusion:
Frictional heat produced with different stripping techniques results in increase in the pulpal temperature, therefore, caution is advised during this procedure. A coolant spray can limit the increase in temperature of the pulp.
... We have developed a new innovative technique which assists in instant tooth separation before interproximal reduction of enamel. Elliot's tooth separator [4] is a wellaccepted method for quick separation of adjacent teeth for polishing proximal restorations in restorative dentistry. The same can be applied in orthodontics to create space within the confines of periodontal ligament space, and this is not injurious to tooth [ Figure 1]. ...
... Several studies have investigated the harmful effects of proximal stripping due to loss of the protective superficial enamel layer. [Sheridan et al,1989;Zachrisson et al , 2007Zachrisson et al , , 2011Arman et al, 2006] Few studies claim that any injury to sound proximal enamel surface by stripping can lead to caries and periodontal problem. [Arman et al,2006;Radlanski et al,1988;Mikulewicz et al,2007] .However to prevent the undesirable side effects of interproximal stripping, it is advised to use polishing discs and some agents (fluoride products and sealants to produce a smoother enamel surface and enhancing remineralization. ...
... Another method of creating space is IER. Potential periodontal changes in the anterior tooth area during orthodontic treatment with IER for adult crowding have been a topic of discussion in the literature [4][5][6]. In addition to the treatment of patients with periodontally healthy dentition, the question arises for the orthodontist of the way in which periodontally high-risk dentition is likely to behave during treatment. ...
Background:
The aim of this study was to use three-dimensional datasets to identify associations between treatment for adult crowding, using Invisalign aligner and interproximal enamel reduction (IER), and changes in the volume of interradicular bone.
Methods:
A total of 60 cone-beam computed tomography (CBCT) scans from 30 adult patients (28 women, two men; 30 CBCTs pre-treatment, 30 post-treatment) were examined retrospectively in order to measure bone volume three-dimensionally. The patients' average age was 36.03 ± 9.7 years. The interradicular bone volume was measured with OsiriX at four levels in the anterior tooth areas of the maxilla and mandible. Differences in bone between T0 and T1 were analyzed with IBM SPSS 21.0 using the Wilcoxon test for paired samples.
Results:
Overall, a slight increase in the quantity of bone was found (0.12 ± 0.73 mm). There was a highly significant increase in bone in the mandible (0.40 ± 0.62 mm; P < 0.001), while in the maxilla there was a slight loss of bone, which was highly significant in the apical third (- 0.16 ± 0.77 mm; P = 0.001).
Conclusions:
Overall, treatment for adult crowding using an aligner and IER appears to have a positive effect on interradicular bone volume, particularly in patients with severe grades of the condition (periodontally high-risk dentition). This effect is apparently independent of IER. This is extremely important with regard to the treatment outcome, since IER and root proximity have been matters of debate in the literature and teeth should remain firmly embedded in their alveolar sockets.
... Frequently, discomfort occurs during tooth brushing as the bristles move across the side of the tooth. 15,16 More seriously, the dentin itself can be literally cut away by the toothbrush if a forceful brushing technique is continuously used. Once a receded gumline has exposed enough dentin, the toothbrush can easily start to cut a hole into the tooth. ...
Objectives:
Evaluation of the impact of a soft toothbrush with tapered-tip (Test Toothbrush) bristles and an ADA reference toothbrush (ADA Toothbrush) on gingival abrasion over a 12-week period.
Methods:
This was a randomized, single-center, examiner-blind, two-cell, parallel clinical research study and used the Danser Gingival Abrasion Index to assess the level of gingival abrasion after a single brushing, as well as after six weeks and 12 weeks of twice-daily brushing. Adult male and female subjects from the Central New Jersey, USA area refrained from all oral hygiene procedures for 24 hours. They reported to the study site after refraining from eating, drinking, and smoking for four hours. Following a qualifying examination using plaque and gingivitis scores along with a baseline gingival abrasion examination, subjects were randomized into two balanced groups, each group using one of the two study toothbrushes. Subjects were instructed to brush their teeth for one minute, under supervision, with their assigned toothbrush and a commercially available fluoride toothpaste (Colgate© Cavity Protection Toothpaste), after which they were again evaluated for gingival abrasion. Subjects were dismissed from the study site with their assigned toothbrush and toothpaste, and instructed to brush twice daily at home for the next 12 weeks. The subjects were instructed to brush for one minute during each tooth brushing. The subjects reported to the study site after six weeks and 12 weeks of product use, at which time they were evaluated for gingival abrasion.
Results:
Seventy-one (71) subjects complied with the protocol and completed the clinical study. The results of this study showed that the Test Toothbrush provided statistically significantly (p < 0.05) greater reductions in gingival abrasion scores as compared to the gingival abrasion scores of the ADA Toothbrush after a single tooth brushing, after six weeks, and after 12 weeks of product use (75.0%, 85.5%, 73.9%, respectively).
Conclusions:
The soft toothbrush with tapered-tip bristles produced significantly less gingival abrasion after 12 weeks of product use as compared to the ADA reference toothbrush.
... Estima-se que utilizando a técnica de redução interproximal de esmalte se possa ganhar 1,0mm entre os dentes posteriores (0,5mm por superfície), enquanto o desgaste nos dentes anteriores não deve exceder a 0,75mm em cada ponto de contato 1 . No entanto, o ortodontista não deve subestimar as variações na espessura do esmalte proximal em cada grupo dentário e em diferentes grupos étnicos, avaliando individualmente cada caso, para evitar desgastes iatrogênicos 3 . ...
... No studies published so far could find a higher caries risk after IER [4,26,43,44]. The present study could also demonstrate that a surface corresponding to that of an untreated tooth could be attained with appropriate polishing of the treated area. ...
Objective:
This aims to evaluate the efficiency of three different powered interproximal enamel reduction (IER) systems and to assess enamel roughness before and after polishing using different polishing times.
Material and methods:
Four metal strips of the G5 ProLign Set (swissdentacare, SDC, Grancia, Switzerland), four segmental discs of the ASR-Set 4594 and two sonic tips of the SonicLine Set (both Gebr. Basseler GmbH & Co. KG, Komet, Lemgo, Germany) were evaluated. Human extracted incisors served as the medium. Enamel reduction was determined in five intervals of 15 s each. Polishing was performed for 15 and 30 s using the manufacturers' recommended polishing systems. Enamel roughness (Ra) was quantitatively assessed by confocal laser scanning microscopy (CLSM).
Results:
Significant differences in terms of enamel reduction were found among the working ends of all tested systems. The time needed to remove 0.1, 0.2 and 0.3 mm of enamel was determined. Surface analysis showed significantly higher mean Ra values for nine out of ten working ends before polishing. This was still the case for five working ends after 15 s and for two after 30 s of polishing.
Conclusion:
The graining and the system used have a significant influence on enamel reduction. The time needed for polishing depends on the last working end used; a polishing time of 30 s is not always appropriate.
Clinical relevance:
Knowledge about the cutting efficiency of powered IER working ends might help the clinician to estimate better the amount of enamel reduction during the stripping process.
... Zachrisson et al 6 demonstrated that 10 years after interproximal reduction in mandibular anterior teeth, no sensitivity was found in 59 of 61 patients, and there was no increase in caries susceptibility. 32 However, temporary sensitivity might appear immediately after interproximal reduction and should be treated with fluoride varnish, fluoride mouth rinse, and fluoride gel. 33,34 Morphologic changes after interproximal reduction are related to changes in tooth size and shape of the proximal contact area. ...
Proximal enamel thickness (PET) at the mesial and distal contact areas of the complete permanent dentition has not been previously reported. Anatomic investigation of PET is essential for interproximal reduction treatment. Our objectives were to measure the PETs of the complete maxillary and mandibular dentitions at the contact areas, to compare the PETs of adjacent teeth, and to evaluate the vertical position of each contact area.
We evaluated 720 extracted teeth; of these, 109 intact teeth were selected. The mesial and distal contact areas were demarcated, and each tooth was embedded in transparent epoxy resin. Blocks were prepared so that the 2 demarcated contact areas were exposed, and 6 measurements were taken and statistically analyzed.
Both jaws showed the same PET pattern characterized by 5 features: PET increased progressively from incisor (0.63 mm) to first molar (1.48 mm). Per tooth, mesial and distal PET did not differ. Total maxillary (26.86 mm) and mandibular (24.52 mm) PETs were similar. Paired PETs at the interproximal interface were similar, with the exception of the lateral incisor-canine interfaces. From incisor to first molar, the contact area becomes located farther gingivally.
The existing guideline of maximal 0.5-mm interproximal reduction per 2 adjacent teeth should be kept in the anterior region and could be increased to 1 mm in the posterior region, when an equal amount is removed.
Copyright © 2015 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.
... Various studies have been published on this subject indicating that stripping was not accompanied by caries or periodontal disease 4,[9][10][11][12] if no more than 50% of enamel is removed. It is recommended that the orthodontist perform an ''anatomical'' stripping followed by a meticulous polishing. ...
... Several treatment options for mild to moderate tooth crowding are available in Orthodontics and, after diagnosis and clinical planning, one suitable alternative is the indication of interproximal stripping in permanent teeth [1][2][3][4][5][6][7][8][9] . Stripping has long been indicated in cases of tooth-size discrepancy to avoid extractions, reshape tooth morphology and create contact surfaces, which would improve posttreatment stability 4,6-7, 10 . ...
AIM: Knowledge of enamel thickness is relevant to perform stripping during orthodontic treatment. Thus, proximal enamel measurements of human permanent teeth were compared in this study. METHODS: The measurements were previously obtained on cut sections of mandibular central (n = 30) and lateral (n = 30) incisors, canines (n = 20), first (n = 40) and second (n = 40) premolars; maxillary central (n = 20) and lateral (n = 20) incisors, canines (n = 20), first (n = 40) and second (n = 42) premolars. Comparisons between thicknesses by arch side and proximal surface were carried out using Student's t-tests (α = 0.05). Teeth were compared according to the mesial and distal thicknesses by ANOVA and Tukey's test. RESULTS: No significant differences were found between right and left teeth. For the mesial surface, the mandibular second premolar presented the highest mean value (1.376 mm ± 0.198; p<0.001). The mandibular central incisor had the smallest thickness in relation to the other teeth (0.675 mm ± 0.144), although not significant compared with the mandibular lateral incisor and canine (0.734-0.781 mm). The mandibular second premolar also presented the higher distal thickness in relation to the others (1.450 mm ± 0.172), although not significant compared with the maxillary first premolar (1.322 mm ± 0.195). Mandibular incisors had the lowest means for distal thickness (0.872-0.879 mm), although not statistically different compared with maxillary incisors and mandibular canine (1.002-1.015 mm). Distal thickness was greater than mesial (p<0.001). CONCLUSIONS: Interproximal stripping should be less marked in incisors and mesial surfaces.
Aggressive promotion by stakeholders and increased public awareness for alternative esthetic orthodontic treatment options have popularized the demand for clear aligner therapy (CAT). Patient demand is driven by appearance, comfort, convenience, and less complicated oral hygiene control. CAT is an important treatment alternative to conventional fixed appliances and a viable alternative for mild-to-moderate malocclusions in nonextraction, nongrowing patients. CAT is less effective and predictable than conventional fixed appliances for complex orthodontic tooth movements and malocclusions. However, the introduction of improved software, aligner materials, and auxiliary devices has enhanced the scope of malocclusions that may be treated. Managing complex tooth movements during CAT requires auxiliaries, overcorrections, and refinements to improve the predictability, effectiveness, and stability of treatment outcomes. The main predictors of treatment outcome are proper patient selection, patient complexity, treatment planning, compliance, clinician experience, and regular monitoring. Currently, there are no evidence-based clinical guidelines for CAT. Aligner technology and therapy are continuously evolving and improving. This literature review aimed to assess and summarize current scientific knowledge and evidence relating to CAT.
Introduction:
Contemporary literature agrees that orthodontic results can no longer be limited to occluso-functional success. The integration of the teeth into a healthy periodontium is essential to good treatment finish and durability.
Materials and methods:
This article proposes to describe the orthodontic physiopathological and iatrogenic lesions leading to the opening of black triangles in place of the inter-dental papillae. It goes on to discuss different periodontal, prosthetic as well as orthodontic reconstruction protocols.
Results:
This last point, supported by a biological rationale well-known to periodontologists, is described using clinical cases.
Objectives
The aim of this in vitro study was to investigate the demineralization rate in human enamel after interproximal polishing (IPP) and to detect possible correlations with the IPP method used, with special emphasis on the surface characteristics of the enamel being treated.
Materials and methods
This in vitro study tested five IPP systems (Profin Directional System®, Intensiv ProxoStrip®, OS discs®, ARS Safe-Tipped Bur Kit® and Ortho-Strips Set®) that are currently available on the market. Each of the five examination groups comprised 12 randomly selected teeth, while the control group consisted of six teeth. The teeth were placed in an artificial model for each group. The proximal contacts were then resolved by IPP. To allow detection of any surface characteristics, one surface was not further processed after IPP, while the other side was additionally polished. After IPP, the teeth were exposed to a pH-cycling model with alternating phases of demineralization and remineralization. Substance loss was analyzed using optical emission spectrometry. Data were subjected to simple analysis of variance (ANOVA) performed with Tukey’s test. Comparison between the groups with and without polishing was conducted using the t test for independent samples. The significance level was set at p
Objective:
Interproximal enamel reduction is a part of orthodontic treatment for gaining a modest amount of space in the treatment of crowding. Today interproximal enamel reduction has become a viable alternative to the extraction of permanent teeth, and helps to adjust the Bolton Index discrepancy. The aim of the study is to evaluate various interproximal enamel reduction techniques, its indications, contraindications and complications presented in recent scientific studies.
Material and methods:
Papers published in English language between 2003 and 2012 were searched in PubMed, ScienceDirect and The Cochrane Library databases, as well as the Web search Google Scholar. Initial searches were made to find peer-reviewed systematic reviews, meta-analyses, literature reviews, clinical trials, which analysed at least one interproximal enamel reduction method. 31 published data fulfilled the inclusion criteria.
Results:
According to the study, abrasive metal strips, diamond-coated stripping disks, and air-rotor stripping are the main interproximal enamel reduction techniques. Indications for use are mild or moderate crowding in dental arches, Bolton Index discrepancy, changes in tooth shape and dental esthetics within the enamel, enhancement of retention and stability after orthodontic treatment, normalization of gingival contour, elimination of black gingival triangles, and correction of the Curve of Spee. Complications of interproximal enamel reduction are hypersensitivity, irreversible damage of dental pulp, increased formation of plaque, the risk of caries in the stripped enamel areas and periodontal diseases.
Conclusion:
Interproximal enamel reduction is an important part of orthodontic treatment for gaining space in the dental arch, and for the correction of the Bolton index discrepancy.
To test and describe the use of various combinations of mechanical and chemical techniques for enamel reduction to obtain a smooth surface.
Bovine teeth (2 surfaces on each of 32 teeth) were used. The teeth were mounted in blocks of dental plaster, which were then mounted in a vise. The mesiodistal enamel contact areas were reduced by various combinations of mechanical and chemical aids. The mesiodistal width of each tooth was measured with a digital caliper after initial reduction of the enamel surface and again after polishing. The teeth were subsequently prepared and mounted for scanning electron microscopy.
All combinations yielded statistically significant enamel reduction (p < 0.05). The use of acid stripping in conjunction with mechanical procedures produced especially smooth enamel surfaces.
Steps must be taken to ensure that a smooth enamel surface remains after enamel reduction and polishing. It is recommended that conventional enamel etchants be added to the polishing procedure. Enamel reduction can increase available space, but the quantity of enamel that can be removed without adverse consequences should be carefully evaluated.
To assess the surface roughness resulting after application of currently available interproximal polishing.
The analysis was carried out by means of digital subtraction radiography, profilometry, and scanning electron microscopy. The roughness of natural untreated enamel served as the reference. Five enamel reduction methods were tested (Profin, New Metal Strips, O-Drive D30, Air Rotor, and the Ortho-Strips) and were applied in accordance with their manufacturers' recommendations. Fifty-five teeth were treated by randomly chosen methods, all of which were applied by one person. One proximal surface was only ground and left unpolished while the other received the finishing and polish recommended by the manufacturer.
Loss of tooth substance, as measured by subtraction radiography, was significantly lower (P < .05) for the group treated with Ortho-Strips. Profilometric analysis of enamel roughness showed that the use of Ortho-Strips, O-Drive D30, and New Metal Strips in the grinding mode produced equally rough surfaces (P > .05). The Air Rotor and Profin system in the grinding mode produced the significantly (P < .05) roughest surfaces. A significant (P < .05) reduction of the mean roughness values was registered in all groups when treatment was followed by polishing. The Profin system and Ortho-Strips achieved the significantly smoothest surfaces (P < .05) with polishing.
In general, interproximal enamel reduction should be followed by thorough polishing. Furthermore, oscillating systems seem to be advantageous.
This work describes a method for treating mild to moderate crowding. It is an innovative technique based on a non extraction therapy to reduce interproximal enamel of the teeth without increasing the risk of caries or periodontal disease. Stripping of interproximal enamel surfaces with O-drive method is an acceptable alternative to extractive or expansion treatment in many cases. The space created by enamel reduction is used to align the teeth. The amount of enamel removed is generally proportional to the extent of crowding. O-drive method offers an alternative to extraction or expansion procedures in cases of mild to moderate crowding. It does not cause periodontal distress since periodontal complications and caries are primarily due to bacterial plaque, while they are independent from the effects of interproximal enamel reduction and alterations of tooth shape.
The study aimed to investigate the morphology and composition of the interproximal reduced enamel after exposition to saliva and casein phosphopeptide amorphous calcium phosphate with sodium fluoride (CPP-ACPF). Fourteen patients undergoing an orthodontic treatment with 4 premolars extractions participated to the study. Interproximal enamel reduction (IER) was performed on mesial surfaces of 3 extractive premolars for each patient while 1 served as untreated control. Premolars were assigned to 4 groups: No-S group, sound enamel as control; S-Ex group, stripped and immediately extracted enamel; S-Sal group, stripped and exposed to saliva enamel; S-CPP group, stripped enamel treated with CPP-ACPF. Teeth were extracted at different times, depending on the group they were assigned to and sliced into mesial and distal halves. Mesial surfaces were subjected to environmental scanning electron microscopy with energy dispersive X-ray spectrometry (ESEM/EDX) and to scanning electron microscopy (SEM) analysis. ESEM/EDX investigations showed no statistically significant differences in the content of calcium and phosphate between the 4 groups. SEM observations showed no difference in the morphological appearance of stripped enamel after 30 days of exposure to saliva and CPP-ACPF. Saliva and CPP-ACPF effects on stripped enamel in vivo showed no difference after 30 days.
Decalcifications in the form of white spot lesions appear frequently in orthodontic patients as small lines along the bracket periphery and in a few patients as large decalcifications with or without cavitations. Improper oral hygiene around the appliance induces a low resting pH plaque that may reduce the cariostatic properties of fluoride therapy. Optimal oral hygiene and daily use of a fluoride toothpaste and mouth rinse are essential and have a synergistic effect. Recent advances in fluoride research have shown that fluoride agents like stannous fluoride and titanium fluoride deposit reservoirs on the tooth surface that may resist even low pH and severe caries challenges.
The influence of daily fluoride mouthrinsing on development of enamel lesions was investigated in an in vivo caries model. A local cariogenic environment was created on the buccal surface of premolars scheduled for extraction by applying orthodontic bands favouring plaque accumulation. Daily mouthrinsing with a neutral 0.2% NaF solution was carried out by 5 patients during a 4-week period. Another 5 patients served as control; no fluoride supplementation was given while the bands were in position for 4 weeks. The mineral content of the teeth was determined by contact microradiography and quantified by microdensitometry. Fluoride rinsing resulted in a substantial retardation of lesion development compared to the non-fluoride group. The reduction of mineral loss in the rinsing group was 80% and the lesion depth was reduced by a factor of 3. The results show that daily fluoride rinsing gives nearly total caries protection even in the poorly accessible areas under orthodontic bands. The fluoride level in saliva after fluoride rinses was measured in 5 children. The salivary fluoride levels ranged between 17 and 115 ppm but decreased rapidly during the 3 h after rinsing.
The quality of enamel surfaces after debonding of orthodontic brackets was assessed under clinical and experimental conditions by means of stereomicroscopy and scanning electron microscopy. Orthodontic attachments were direct-bonded with either of two diacrylate resin adhesives. After bracket removal with a ligature cutter, remnants of adhesive on the tooth surface were removed by means of various rotating instruments at low speed. A particular replica technique made it possible to make sequential assessments of step-by-step polishing procedures and directly follow the gradual reduction and possible disappearance of individual scratches in the microscope. The observable qualitative trait was assigned a score of from 0 to 4 according to a proposed enamel surface index system: 0 = perfect surface; 1 = satisfactory surface; 2 = acceptable surface; 3 = imperfect surface; 4 = unacceptable surface.The instruments tested yielded the following ESI scores (Table I): fine diamond bur, 4; sandpaper coarse and medium grit, 3, fine grit, 2; green rubber wheel, 3; spiral-fluted and plain-cut tungsten carbide (TC) bur, 1. With the first three instruments, it was not possible to obtain a satisfactory surface (score 1), regardless of subsequent polishing (Figs. 4 to 6).Thus, of the instruments tested, the most adequate results were obtained with the TC bur. This tool, operated at low speed, produced the finest scratch pattern (Fig. 3) and the least enamel loss (Fig. 7), and it was superior in accessibility to developmental grooves and other difficult-to-reach areas.The clinical significance of inducing scratches in teeth of adolescents was discussed in the light of “normal” enamel surface appearance at various ages, wear of teeth, and remineralization.
Pulp and dentin reactions to extensive grinding of human teeth were studied clinically and histologically. The facial portions of forty-eight premolars to be extracted for orthodontic reasons were reshaped to "lateral incisors" using diamond instruments and abundant water cooling. Following grinding and polishing with sandpaper discs and pumice, topical fluoride was administered. The patients were asked to report any increased sensitivity reactions. The teeth were extracted at 0, 1, or 3 weeks or 3 to 5 months and examined histologically. No significant discomfort was reported by the patients except for an initial period of a few days during which there was increased sensitivity to temperature changes. The histologic findings indicated that extensive remodeling of young permanent teeth is possible with no or only minor pulp and dentin reactions. Some initial localized effects in terms of aspiration of odontoblast nuclei, hyperemia, absence of a cell-free zone, and slight cellular infiltration were sometimes observed, but the long-term observations indicated that these reactions were transient. Secondary dentin formation was not registered. It is important that gentle grinding techniques with abundant water spray be used and that smooth and self-cleansing surfaces which allow hypermineralization of the ground enamel and dentin be prepared. In a few teeth in which proximal retention areas were unintentionally prepared, caries developed and marked pulp reactions occurred. Therefore, great care must be taken not to introduce proximal steps when mesiodistal tooth width adjustments are performed. The present study has provided histological and clinical evidence to indicate that even extensive recontouring by grinding may not be harmful to the teeth. This should encourage orthodontists to remodel teeth by grinding to improve the final occlusal and esthetic results in a number of different cases.
Reproximation (enamel stripping) is described in the literature as a clinical procedure for correction of tooth size deviations. The objective of this study was to qualitatively assess, by means of scanning electron microscopy, (1) the differences exhibited on enamel with mechanical and chemical methods of stripping, and (2) the effect of a synthetic calcifying solution on the etched enamel. Part 1. Sixty human anterior teeth (10 complete sets) that were previously stored in 70% ethanol were subdivided into groups I and II. The teeth in group I were divided into five sets of six teeth mounted in a plaster block in the anterior arch form. Each set was stripped with one of the following mechanical abrasive methods: garnet disks, tungsten carbide and fine diamonds burs, coarse and fine diamond burs, diamond wheel and 3M strips, diamond-coated metal and 3M strips. The teeth in group II were similarly treated, except each set was subjected to a further microabrasive chemical stripping with 37% phosphoric acid used in conjunction with 3M strips. The teeth were then prepared for scanning electron microscopy, viewed, and photographed under magnification. Part 2. Ten human central incisor teeth were etched and used to study the effect of remineralization solutions at various time intervals. The results showed that teeth stripped by routine mechanical abrasive methods exhibited deep furrows and roughness. The teeth that received mechanical and chemical abrasive treatments showed a flattened, etched surface free of furrows. These etched surfaces showed marked crystal growth at 5 and 10 hours after remineralization suggesting the possibility of repair of the chemically altered enamel surface.
A long-term clinical and radiographic follow-up study was performed after extensive remodeling of the permanent teeth of 26 adolescent patients. The canines were ground to the shape of lateral incisors as part of the orthodontic treatment, and the patients were recalled after 10 to 15 years for clinical examinations. Grinding had been performed either unilaterally or bilaterally on 37 teeth. Unground canines or adjacent teeth served as control or reference teeth. Standardized intraoral radiographs were taken with a paralleling technique. Enamel surface replicas produced by epoxy resin in silicone impressions of the ground teeth were studied by stereomicroscopy. The long-term results were favorable. No significant color differences were observed in 36 of the 37 ground canines. Only one tooth displayed a generalized yellowish discoloration, probably the result of extensive pulp obliteration. There were no significant differences between ground and unground teeth with regard to mobility, reaction to percussion, or temperature sensitivity. Electric pulp testing revealed no statistically significant differences between test and control teeth. Radiographic changes were evident in two of the 37 ground canines. One tooth showed marked obliteration of the crown pulp, and in another tooth the pulp obliteration was almost complete. In the remaining 35 teeth no apparent differences were noted between the ground and unground teeth. In the stereomicroscope two of the ground labial surfaces showed evidence of scratches and grooves produced by the diamond instrument after more than 10 years' observation, but in all other instances the ground surfaces were indistinguishable from normal adult enamel surfaces. In conclusion, the present study has demonstrated that extensive cuspal, labial, lingual, and interproximal recontouring by the grinding of young teeth associated with orthodontic treatment can be performed without discomfort to the patients and with only minor or no long-term clinical and radiographic reactions.
The cariostatic effects of tooth-bound fluoride reported in the recent literature are reviewed. Several treatment procedures which can increase the tooth-bound fluoride content are described. Based on this information, it is suggested that effectiveness of currently used topical fluoride treatments may be significantly increased by (1) including in the regimen a dicalcium-phosphate-dihydrate-forming treatment so that a portion of the labile fluoride is re-incorporated as tooth-bound fluoride, and (2) employing application methods which ensure the effective delivery of treatment agents to the fissures, and to approximal and cervical surfaces, where most caries occurs.
The surface features of incipient carious lesions around bonded orthodontic brackets were assessed during a 3-year period after appliance removal. At standardized intervals color slides and silicone impressions for replication were made of two maxillary incisors on each of six adolescent patients. The labial surfaces of the teeth had demineralized white areas around the bonded brackets. The color slides were projected and studied in a darkroom. The positive surface replicas were studied by scanning electron microscopy (SEM). At the time of debonding, large accumulations of dental plaque were observed in those areas with white, demineralized surfaces. During the posttreatment or experimental period, there was a reduction in the amount of plaque. The appearance of the lesions changed from chalky-white at time of debonding to a more diffuse opacity, particularly in the peripheral parts. Under SEM the surfaces of the lesions were less irregular 3 years after debonding. At higher magnification the labial surfaces showed signs of wear. The present study confirms that removal of cariogenic challenge results in arrest of further demineralization. The gradual regression of the lesion at the clinical level is believed to be primarily a result of surface abrasion.
The aim of the present study was to compare the resistance of fluoroapatite (shark enamel) and hydroxyapatite (human enamel) against a high caries challenge in a human in vivo model. Two samples of shark enamel and human enamel were each placed in removable appliances in six children and carried for 1 month and a plaque retentive device was placed over each enamel sample. The results showed that the mean total mineral loss (delta Z) was 1680 vol% micron in human enamel and 965 vol% micron in shark enamel. The corresponding mean values for lesion depth were 90 micron and 36 micron, respectively. It is concluded that even shark enamel containing 30,000 ppm F has a limited resistance against caries attacks.
A clinical trial was conducted to investigate carious lesion development associated with fixed orthodontic therapy. Specially designed orthodontic bands for plaque accumulation were attached to premolars scheduled to be extracted as part of an orthodontic treatment. Visible white spot lesions were seen within 4 weeks in the absence of any fluoride supplementation. Both microradiographic and SEM examinations showed surface softening of the enamel surface--that is, a surface layer was not seen in the lesions. The clinical significance of the present study is that enamel demineralization associated with fixed orthodontic therapy is an extremely rapid process caused by a high and continuous cariogenic challenge in the plaque developed around brackets and underneath ill-fitting bands. Careful inspection of the appliance at every visit and preventive fluoride programs are therefore required.
Human enamel surfaces were stripped with orthodontic grinding and finishing materials, and evaluated with the scanning electron microscope (SEM). Even under in vitro conditions with the finest finishing strips, it was not possible to produce an enamel surface free of the furrows that result from the initial abrasion caused by the coarse strip. Enamel surfaces stripped gradually from coarse to superfine were left in the mouths of patients for 12 weeks and evaluated with the SEM. The edges of the furrows were found to be smoother but the furrows remained wide and deep enough to facilitate more plaque accumulations than those on untreated surfaces. The use of dental floss did not result in prevention of plaque accumulations along the bottom of the furrows.
Caries was produced in sixty-seven premolars from children by means of the gold plate technique. Natural caries and lesions produced in pretreated enamel surfaces were studied by means of microradiography, macroscopic inspection, polarized light, and 32P uptake. Except for the thickness of the surface layer, the produced lesions were found to be similar to natural caries. In unabraded enamel the X-ray dense surface layer was found to have an average thickness of 20μ, which is less than that observed in natural lesions. Enamel surfaces which were either abraded or abraded and exposed to the oral milieu for periods of 7-56 days, did not show significantly different lesions. The average thickness of the X-ray dense layer in these groups was 7-8μ. Topical treatment with a hexafluorostannate solution resulted in increased thickness of the surface layer. The results support the concept of a caries resistant surface layer, but indicate that this layer may be re-established after removal. Furthermore, the thickness of the X-ray dense outer layer in carious lesions appears to be influenced by the nature of the attack.
Teeth that showed early proximal lesions were examined to determine the extent to which clinical radiography demonstrates tissue involvement in the carious process. The histopathologic condition of a lesion depicted on clinical radiographs was compared with that of the same lesion depicted on a contact microradiograph and a photomicrograph. The clinical method is least sensitive to the subtle changes that occur in dental caries.
It is not uncommon for discrepancies in anterior interocclusal arch length to exist in the orthodontic patient. A frequent cause of this problem is a decrease in upper anterior dental arch length. This discrepancy, if left uncorrected, may result in an end-to-end incisal relation whereby the anterior teeth are unable to perform their function in the mutually protected dentition. This article will discuss the following procedures which may be useful in the correction of discrepancies in anterior interocclusal arch length: (1) repositioning of upright maxillary incisors to increase upper dental arch length, (2) mesiodistal enamel reduction to reduce mandibular dental arch length, promote stability, and improve gingival conditions, and (3) treatment of three-mandibular-incisor cases to decrease mandibular dental arch length, allow correction of crowded mandibular anterior teeth, and reduce protrusion of the lower anterior teeth.
This investigation sought to evaluate the effects of air-rotor stripping on the susceptibility of human enamel to demineralization using an in vitro caries model. Crowns of extracted premolar teeth were abraded (0.5 mm) on one proximal surface by air-rotor stripping. The teeth were placed in a demineralizing gel and removed at various intervals up to 336 hours. Lesion depth and mineral content on the abraded and intact surfaces was measured with contact microradiography and computerized image analysis (double window technique). For each time interval measured, lesion depth was greater (p < 0.05) on the abraded surfaces and mineral density was significantly less (p < 0.05). In a second experiment, the effect of fluoride supplements (dentifrice or topical gel) were examined on abraded and intact enamel surfaces that were exposed to the acid gel for 192 hours. The data showed that fluoride treatments significantly reduced lesion penetration on intact and abraded surfaces compared with a no fluoride group. Lesion depth on the abraded, fluoride treated surfaces was significantly greater (p < 0.05) than on the intact untreated surfaces. No significant differences (p < 0.05) were apparent between the fluoride treatment groups with respect to lesion depth and mineral density within the lesion. These results suggest that air-rotor stripping significantly increases the susceptibility of proximal enamel surfaces to demineralization. As a result, the clinician should use caution in the application of this technique until the long-term effects on caries susceptibility have been determined.
In orthodontics, reduction of tooth-size by grinding interproximal surfaces (stripping) of teeth is a common procedure. In order to achieve perfectly smooth surfaces, clinicians have carefully tested various methods and progressively improved this therapeutic procedure. In this in-vivo study we used scanning electron microscopy (SEM) to evaluate the morphologic effect of a 3-step technique using an oscillating perforated diamond-coated disc for enamel reduction and 2 Sof-Lex XT discs for polishing. This technique was applied in 32 patients with an average age of 15.5 years. A total of 296 interproximal surfaces was treated and replicas were produced for scanning electron microscopy evaluation. The scanning electron microscopy investigations demonstrated that more than 90% of the reproximated surfaces were very well or well polished, resulting in polished enamel surfaces smoother than untreated enamel. This technique proved to be clinically expedient as it finished each interproximal surface within about 2.2 minutes. At the same time, it was demonstrated to be safe and comfortable for the patient, eliminating the need for lip or cheek protectors and making injuries unlikely.
Air-rotor stripping (ARS) is a commonly used method to alleviate crowding in the permanent dentition. Its widespread acceptance, however, has been limited by the potential increase in caries risk of the abraded enamel surface. The aim of this study was to compare the susceptibility of ARS-treated enamel surfaces with intact surfaces in patients undergoing fixed orthodontic therapy.
Forty patients treated with ARS were examined clinically and radiographically for caries 1 to 6 years after interproximal enamel reduction. All patients were seen by their dentists for prophylaxis at 6-month intervals during active orthodontic treatment and were exposed to fluoridated water and toothpaste. Topical fluoride agents or sealants were not applied on the abraded surface after any ARS session. Caries incidence was compared between ARS-treated and unaltered surfaces within subjects. The decayed, missing, filled tooth (DMFT) and surface (DMFS) scores were used to evaluate the subjects' overall caries risk.
Totals of 376 test and 376 control surfaces were examined. The number of interproximal lesions detected was found to be low with no statistically significant difference detected between the groups (test = 3; control = 6; P = .33]. The DMFT and DMFS scores increased significantly during the study period, indicating that these patients were clearly at risk of tooth decay (P <.001).
The findings indicate that the risk of caries is not affected by ARS. Furthermore, our data show that the application of topical fluoride on the enamel surfaces immediately after ARS in patients exposed to fluoridated water and fluoride-containing toothpaste may not provide any additional benefit.
In this study, we investigated ultramorphology, surface roughness, and microhardness of permanent and deciduous tooth enamel after various stripping methods.
One hundred twenty deciduous and permanent teeth (n = 60 each) were used. Qualitative (scanning electron microscopy) and quantitative (surface roughness and microhardness tests) experiments were carried out in the following experimental groups: group 1, stripping disk; group 2, diamond-coated metal strip; group 3, stripping disk and Sof-Lex discs (3M-ESPE, Seefeld, Germany); group 4, diamond-coated metal strip and Sof-Lex discs; group 5 (chemical stripping), 37% orthophosphoric acid in conjunction with diamond-coated metal strip; group 6 (control), no stripping. Surface roughness values (Ra) for permanent and deciduous enamel were evaluated with Welch analysis of variance (ANOVA) and Tamhane tests, and Kruskal-Wallis and Mann-Whitney tests, respectively. Microhardness values were evaluated statistically with Kruskal-Wallis, 1-way ANOVA, and Duncan tests.
Deciduous and permanent teeth showed similar results in terms of surface roughness and surface morphology. Groups 3 and 4 had the smoothest deciduous and permanent enamel surfaces, whereas chemical stripping (group 5) produced the roughest surfaces in both enamel types. Stripping did not lead to a significant change in the microhardness of permanent enamel.
All stripping methods significantly roughened the enamel surfaces. Polishing the stripped surface with Sof-Lex discs decreased the roughness.
We investigated whether interdental enamel reduction using fine diamond disks with air cooling, followed by polishing, leads to iatrogenic damage or reduced interradicular distances.
Our subjects were 61 consecutive patients who had received mesiodistal enamel reduction of all 6 mandibular anterior teeth more than 10 years previously. Dental caries, bleeding on probing, probing depths, and gingival recessions were assessed with standard techniques. Incisor irregularities and tooth width/thickness ratios were measured on models, and the patients were asked about any increased tooth sensitivity. The reference group comprised 16 students.
No new caries lesions were detected. Three mature adults had some minor labial gingival recessions. There was no evidence of root pathology. The