Interproximal enamel reduction

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Interproximal enamel reduction, also called slenderizing, is the removal of interproximal enamel. Although slenderizing is most often practiced in the mandibular anterior dental segment, it is not confined strictly to this area. It is possible to slenderize in any segment of either arch.

It is perfectly safe3 to remove up to 0.25 mm from each interproximal surface, which translates to 0,50 mm per tooth. Therefore, the tooth mass of the six anterior teeth can be reduced up to 3.00 mm. If mandibular premolars and first molars are also slenderized, tooth mass can be reduced by a total of 6.00 mm.

In choosing specific teeth to be slenderized, the orthodontist may have to perform a Bolton analysis. A visual inspection of the mandibular arch to examine the anatomic design of each tooth can also help the orthodontist to clearly define which teeth can afford more reduction in the interproximal areas.

The mesiodistal width of the maxillary incisors has a major effect on the amount of possible mandibular anterior slenderizing. If the maxillary central and lateral incisors are oversized and the mandibular incisors are not especially large, mandibular anterior slenderizing should not be performed alone as this would increase the tooth size discrepancy. It is possible in such cases to slenderize in both the maxillary and mandibular arches.

More commonly, the maxillary lateral incisors are usually found to be narrower, mesiodistally, than the ideal. This condition allows more enamel reduction in the mandibular Incisors.

The initiation of mandibular interproximal enamel reduction can occur at the beginning of treatment or during treatment (Fig 17-1 a). Furthermore, slenderizing remodels the mandibular anterior interproximal contact points into broader contact surfaces. The larger interproximal contact areas help to maintain the mandibular anterior alignment.

Slenderizing is performed with steel carborundum strips (Fig 17-1 c), a diamond disk, or an air rotor handpiece. The diamond disk is used primarily on maxillary and mandibular anterior teeth that are large and bell shaped. The diamond disk removes enamel faster than carborundum strips, so it must be used with care. The abrasive strips can be used on all anterior teeth. I find them easier to use on crowded teeth during the early stages of treatment.

Fluoridated prophylaxis paste is used while slenderizing is performed (Fig 17-1 b). The paste increases the life of the abrasive instrument because the paste becomes a part of the abrasive surface. When the diamond disk is used, the paste creates a smoother enamel surface. A rough surface could collect bacteria, which might cause interproximal caries.

Treating the newly exposed enamel with fluoride gel is important because the fluoride-rich enamel has been removed. Having performed this procedure on several thousand patients as well as myself, I have never seen interproximal caries develop.

In addition, the mandibular anterior teeth may be slenderized at the end of retention, immediately following removal of the fixed canine-to-canine retainer (Fig 17-2). This procedure allows for future anterior and lingual migration of the canines without concurrent mandibular anterior relapse.

Fig 17-2a After removal of 3 X 3, generous enamel reduction Is performed with the Dome stripper.

Fig 17-1 Slenderizing procedure, (a) Crowded mandibular arch requiring slenderizing. Archwire is removed anteriorly for better access. (b) Prophylaxis paste with fluoride is placed before the procedure begins, (c) Interproximal enamel reduction with a steel carborundum strip (Dome).

Fig 17-2a After removal of 3 X 3, generous enamel reduction Is performed with the Dome stripper.

Fig 17-2b Immediately after slenderizing, note the flat contact surfaces from canine to canine.

Fig 17-2b Immediately after slenderizing, note the flat contact surfaces from canine to canine.

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