April 25th, 2013
By John S. Casko, DDS, MS, PhD Based on: Zachrisson BU, Nyogaard L, Mobarak K. Dental Health Assesed More Than 10 Years After Interproximal Enamel Reduction of Mandibular Anterior Teeth. Am J Orthodontics Dentofacial Orhtop 2007; 131 (Feburary): 162-169
When you have patients with crowded mandibular anterior teeth, do you sometimes use interproximal reduction or enamel stripping to resolve the crowding and avoid extractions? I suspect many orthodontists do. If you do use interproximal stripping or enamel reduction, what are the long term dental and periodontal effects of using this procedure? A recent study addresses this question.
Authors evaluated 61 patients who had undergone interproximal enamel reduction of the mandibular anterior teeth an average of 12.5 years after treatment. The procedure for enamel reduction used at the time these patients were treated consisted of reducing the interproximal enamel with fine- or medium- grit, safe sided diamond disk at mdium speed with the contra- angle handpiece. Air-cooling was usd during the procedure. Polishing after stripping with a diamond disk was done with fine sand disks. Topical fluoride agents were not applied to the ground tooth surfaces, but all patients were routinely instructed to use diluted sodium fluoride mouth rinses once daily. Sixteen dental students were used as a control group to compare the long-term dental and periodontal results of stripping.
The results of this study were very encouraging. No new carious lesions were detected. Premature adults had some minor labial gingival recession. There was no evidence of root pathology, and 59 of 61 patients reported no increased sensitivity due to temperature variations. Additionally, the overall irregularity index at the long-term follow-up period was only 0.67.
I believe the results of this study provide great news particularly for the treatment of adult patients with full class II malocclusions and a large anteroposterior skeletal discrepancy. For these patients with the maxillary premolars extracted, it is necessary to attract the maxillary canines the entire width of the maxillary first premolar space. If the mandibular canines are retracted to any degree for instance after the extraction of mandibular first premolars, it then becomes necessary to retract the maxillary canines a greater distance than the full maxillary first premolar space, which creates an extremely difficult if not impossible treatment problem. Therefore, avoiding the retraction of the mandibular canines becomes an important goal of treatment. If the patient has small maxillary lateral incisors, this can often be accomplished by the extraction of one mandibular incisor.
However, if the patient does not have small maxillary lateral incisors and protrusion of the mandibular anterior teeth is not appropriate, interproximal reduction of the mandibular anterior teeth becomes the only alternative to avoid extracting mandibular premolars. It is, therefore, nice to know this procedure can be safely applied with no long-term negative dental or periodontal effects.