Stripping (enamel reduction) in Aligner treatment

Dental crowding occurs when there is a sizeable discrepancy between the teeth and jaw proportions, which ultimately might lead to malposition and/or rotation of the teeth. Today, the prevalence of dental crowding can be estimated anywhere from 30 to 60% worldwide. Unsurprisingly, it is also one of the most frequent reasons why people consult an orthodontist in the first place.

Owing to the heightened aesthetic demands of today’s orthodontic space, solutions for dental crowding are widely sought after. The main ways of resolving tooth crowding are by increasing the length of the dental arches and by reducing the tooth mass. This can be achieved by means of either tooth extractions or another much lesser-known procedure known as interproximal enamel reduction (IPR).

Enamel reduction, also known as dental stripping or shaving, is a procedure by which a small thickness of the tooth enamel is trimmed off to make space for other teeth. The dentist typically recommends this procedure to patients with proclined incisors, tooth crowding, or for overjet correction.

It is crucial to remember, however, that IPR can only be used in patients with mild to moderate crowding where the dentist can readily correct discrepancies in tooth shape or size and create adequate space. It is a painless technique used to reduce enamel thickness at the contact points of the teeth and is often used adjunct to orthodontic treatment.

Stripping in aligner treatment

Often used as a popular and attractive alternative to tooth extraction, enamel reduction has become a vital step in orthodontic treatment progression. IPR is commonly paired with aligner therapy to sufficiently maintain the transverse arch dimensions and anterior tooth inclinations throughout the process.

In the past, IPR was done first at the beginning of the aligner treatment process. Today, however, with the advancements in clear aligner technology, digital set-up software is able to precisely show the staging of the movement and the exact point where IPR needs to be applied, as well as the amount of IPR needed.

Aligner software can now suggest the location of the IPR based on the final labial position of the tooth. The clinician can adjust the software to automatically detect collisions and specify the exact envelope of movement required, thereby avoiding any unwanted expansion or proclination of the teeth. Using this technology, your dentists can see real-time changes and note occlusal contacts continuously while also making necessary modifications to fit the desired final outcomes.

Therefore, with clear aligners today, the dentist can perform IPR at later stages of the treatment when they have better access to the surfaces that need to be adjusted. Meanwhile, for traditional fixed appliances like braces, tooth stripping can be done at any point during the treatment process.

Indications of tooth stripping

Tooth stripping can reduce the width of the teeth between 0.2 and 0.5 millimetres. This reduced area is taken from the sides to aesthetically find the necessary space between the teeth. If dental crowding is severe, the best option to make space would be the extraction of a tooth.

However, dental stripping can also be used to reduce the black spaces that usually arise as a result of orthodontic treatment. These black triangles between the teeth can be eliminated by reducing the width and allowing the gums enough space to recover and grow.

In some cases when the upper incisors protrude in front of the lower incisors, it is recommended to reduce the size of the upper lateral incisors, especially when disproportions in the mesiodistal size of the lower later incisors are observed. This condition is known as the problem in the Bolton Analysis and a great way to resolve it is by using the stripping technique.

With the increasing popularity of aligners in recent years, more adult patients are seeking a more aesthetic and non-extraction method to treat space discrepancies and with it, the popularity of procedures like stripping has gained momentum.