clear thinking about interproximal stripping › d39f › a9abe61062f... · removal of...

Reducing the mesio-distal size ofteeth by removing enamel in the pro-cess known as interproximal strip-ping is a way orthodontists can gaina modest amount of space in theirtreatment of crowding.

They have used this therapeuticprocedure since the Eighties in themandibular incisor region to correctrelapse or to prevent it. But with themore recent near universal use ofbonding to place brackets on teethand thus eliminate full mouth band-ing, it has become possible to obtainspace in a similar way in posteriorsectors of the arch with the Air RotorStripping (A.R.S.) technique thatSheridan2 described in1985.

Today interproximal stripping hasbecome a viable alternative to theextraction of permanent teeth orarch expansion in cases of moderate4 to 8 mm crowding, which makes itan attractive choice in the treatmentof adults.

But, because it is an irreversibleact, orthodontists should undertake acareful analysis before deciding touse it. This article will not only outlinethe special materials required for theremoval of interproximal enamel butreview the parameters that governinterproximal stripping according tothe different protocols proposed by avariety of authors.

Clear thinking aboutinterproximal stripping

Clément FRINDEL

Address for correspondence:

CFRINDEL, 17, rue des Docteurs Charcot, 42100 Saint Étienne,[email protected] 187

P R A C T I C A L O R T H O D O N T I C S R U B R I C

1 - CONDITIONS REQUIRED FOR USING INTERPROXIMAL STRIPPING

1 - 1 - Dental anatomy

Not all teeth are suitable for interproximal stripping. Orthodontistscan use the Le Huche index14 to helpthem determine the varying degrees ofdivergence in teeth with regard to theirmesio-distal widths at the level of theircontact points and the mesio-distalwidth of their roots at the level of the

cemento-enamel junction.Thehigherthe index the more that tooth can beconsidered to have a tri angular shapeand, according to Langlade13, the moresuitable it is for reduction of interproxi-mal enamel on its mesial and distal sur-faces (fig. 1 and 2). Before dentistsundertake this procedure they musthave a periapical X-ray film of the toothin question. For teeth whose shape is

DOI: 10.1051/odfen/2010208 J Dentofacial Anom Orthod 2010;13:187-199© RODF / EDP Sciences

Article available at http://www.jdao-journal.org or http://dx.doi.org/10.1051/odfen/2010208

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Frindel C. Clear thinking about interproximal stripping188

CLÉMENT FRINDEL

not triangular (fig. 3 and 4), the enam-el’s proximity to the root could be, if itwere stripped, a cause of periodontaldisease.

In addition, the tooth’s enamel cov-ering must be sufficiently thick toallow for safe removal of some of it.Studies by Hudson, Gillings, andBuonocore and Shillingburg andGrace in Fillion8 have shown that:

– The enamel layer covering thecrowns of maxillary and mandibularteeth is not quite 1 mm thick, but starting with the distal surface ofthe canine teeth the thickness isgreater;

– Mesial enamel is slightly lessthick than distal enamel;

– There is no correlation betweenthe thickness of enamel and the sizeof the tooth.

1 - 2 - Oral Hygiene

Because stripping roughens thesurface of the remaining enamel cov-ering plaque accumulates more onaffected teeth, according to Radlanskiet al.19. Patients whose teeth werestripped need to keep their teethscrupulously clean and have frequentprophylaxes. Accordingly, patients

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Figure 1The pronounced triangular shape of the lower leftlateral incisor makes it an excellent candidate forremoval of some of its mesial and distal enamel.

Figure 3Intraoral view of Valentin’s teeth showingthe macrognathia of the upper left central. Figure 4

Valentin’s panoramic film. The Le Hucheindex figure for the upper left central isalmost 0, which means it is not possibleto reduce the mesio-distal diameter ofthis oversized tooth.

Figure 2Periapical film of this tooth.

J Dentofacial Anom Orthod 2010;13:187-199 189

CLEAR THINKING ABOUT INTERPROXIMAL STRIPPING

with poor oral hygiene are poor candi-dates for interproximal stripping as

2 - 1 - Crowding/relapse of crowding

Arch length discrepancy is nega-tive difference between the size ofthe dental arches (the available space)and the size of the teeth (the requiredspace).

Orthodontists can utilize the inter-proximal stripping of selected tempo-rary teeth to facilitate the eruption of

they are, indeed, for orthodontic treat-ment itself.

partially blocked out teeth becausethe available space (diastema) isinsufficient, according to Bassigny1.

Van Der Linden27 suggests thatdentists can prevent crowding, orimprove conditions for the alignmentof anterior teeth by taking advantageof the leeway space in selective strip-ping of some temporary teeth (fig. 5).

But, primarily, orthodontists usestripping on permanent teeth.

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Figures 5 a to dCorrecting crowding in the mixed dentition, as suggested by Van Der Linden:

a: the crown of the temporary canine is stripped mesially in order to create space for alignment of the anterior teeth;

b: the crown of the first temporary molar is stripped mesially to create conditions that willfacilitate eruption of permanent canine into its correct position;

c: the mesial surface of the crown of the second temporary molar is stripped to ease eruption of the first bicuspid;

d: the width of the second temporary molar is more or less equal to the width of the second bicuspid.

2 - WHEN SHOULD STRIPPING BE DONE?


CLÉMENT FRINDEL

Because, as Sheridan22,23,24 pointsout, orthodontists can use stripping tocorrect crowding of 4 to 8 mm, itbecomes an attractive modality to treatadults with moderate Class I malocclu-sions, moderate bimaxillary crowding,and at risk profiles. These situationsmay even include full arch crowdingextending to posterior sectors.

2 - 2 - Disharmony in size of upper and lower teeth

A disharmony between the size ofthe maxillary and the mandibular teethcan make it difficult for orthodontists toachieve satisfactory occlusal relation-ships in finishing treatment, causingresidual overjets, canines not quite inClass I relationship, and midline devia-tions. In assessing this disharmonywith the Bolton index4 orthodontistscan calculate the excess of tooth

width of one arch over the other interms of:

– The general, over-all ratio of thesum of the mesio-distal diameters ofthe twelve mandibular teeth (the thirdmolars are not considered) with thesum of the mesio-distal diameters ofthe twelve maxillary teeth times 100.The normal figure is 91.3%.

– The anterior ratio of the sum of themesio-distal diameters of the six anteri-or teeth with the sum of the diametersof the six maxillary anterior teeth times100. The normal figure is 77.2%.

By comparing the measured per-centage with the normal percentagethe examiner can determine if thetooth disharmony results from anexcess of tooth material in themandible or in the maxilla. By selec-tive stripping in the excess zone, theorthodontist will then be able toimprove the occlusal relationships of

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Figures 6 a and bA case treated to the finishing stage: note the residual overjet resulting from an excess ofmaxillary tooth material as recorded by the Bolton index.

Figures 7 a and bThe same case after the orthodontist had adjusted the axial inclinations of the anteriorteeth by appropriate torqueing, and, after band removal, had stripped the maxillary anteri-



the two arches. For example, at theclose of treatment for a patient,whose Bolton index confirmed an excess of anterior maxillary toothmaterial, the buccal segments were in good occlusion but a residualoverjet persisted. The orthodontistwas prepared to perform distal strip-ping of the upper laterals and caninesso the anteriors could be retracted(fig. 6 and 7). But he had to considerthe possibility that excessive strippingcould cause in imbalance in tooth sub-stance so he undertook the proce-dure after careful analysis and withextreme prudence.

Another situation possibly callingfor interproximal stripping is agenesisof premolars where the treatmentplan calls for retaining a temporarywith no successor. But that tempo-rary tooth would have a wider mesio-distal diameter than the missingbicuspid and prevent the orthodontistfrom achieving a good Class I occlusion. The solution is to use inter-proximal stripping to reduce the tem-porary molar to the size of a bicuspid(fig. 8) if its anatomy is suitable forsuch a procedure.

2 - 3 - Esthetics for adults

By using interproximal strippingorthodontists can sometimes avoidhaving to extract teeth as an adjunctto their mechano-therapy. This isimportant because an important per-centage of adult patients have at-riskprofiles, that is a prominent nose withbi retrocheilia and progenia, a back-ward inclined upper lip but a bimaxil-lary protrusion. When such patientshave a healthy periodontium and amoderate crowding of about 8 mmstripping becomes the method ofchoice for obtaining needed space fortooth alignment rather than extractionof premolars. Germeç and Taner10

studied 26 puberty aged patients withClass I malocclusions characterized bya moderate arch length discrepancy of5 mm and acceptable facial profiles.Orthodontists treated the13 patientsof the first group with the extractionof four premolars and used no poste-rior anchorage. The other group of 13patients was treated with strippingand no extractions. The authors foundno skeletal differences between thetwo groups. But the upper and lower

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Figure 8Interproximal stripping is about to be per-formed on this temporary tooth toimprove occlusion.

Figure 9An unaesthetic black triangle can be seenbetween the central incisors of thispatient before treatment began. It is relat-ed to the anatomy of the teeth that causes the contact point to lie too farocclusally and the roots to diverge.


CLÉMENT FRINDEL

lips of the extraction group weremore retruded than the lips of thenon-extraction group. Moreover, thetreatment time for the stripping groupwas 8 months faster than it was forthe extraction group.

Interproximal stripping is also indi-cated for the removal of interincisalblack triangles (Zachrisson inPhilippe17). They can be caused by aloss of bone or a contact point dis-placed occlusally and be accompaniedby overly divergent roots (fig. 9),

To correct them, the orthodontistshould move the contact point gingi-vally by reshaping the teeth with inter-

proximal stripping. These trianglesusually appear, in adult patientswhose periodontal status is notstrong enough to sustain prolongedorthodontic treatment or extendedtooth movement.

So it is more important with thistype of patient for orthodontists tobear in mind that included in thechanges facial structures undergowith ageing are opening, according toCrétot6, of the interincisal angle alongwith a senescent recession of thefree borders of the lips reflecting theircontinual thinning.

3 - 1 - Protocols

• How much enamel should be removed?

Beginning with the work of Hudson,Gillings and Buonocore, Shillingburgand Grace, and Demange and Francois7

a number of authors have publishedtables giving the maximum amount ofenamel that can safely removed so thatiatrogenic damage is kept at as low alevel as possible (tab. 1).

The table gives the quantity ofenamel that should be removed fromboth surfaces of each tooth, except ofthe first molar, times four (mesial anddistal of the right and left quadrants).Enamel is taken only from the mesialsurface of the first molar. This table isapplied to the mandibular arch. Forthe maxillary teeth the orthodontistuses it without change except for theincisors, where the figures for thecentrals and laterals are reversed.

Fillion9 published a table (tab. II) inthis journal that presented the upperlimits of enamel substance that canbe removed. Using this guide,orthodontists can gain at most 8.6mm of space in the mandible and

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1 mm2 mm2 mm2 mm3 mm3 mm4 mm5 mm5 mm6 mm7 mm8 mm

1*.15.20.25.15.20.15.15.20.15.20.20.20

2*.15.30.25.15.25.15.15.25.20.20.30.30

3*

.20

.30

.20

.20

.35

.25

.30

.35

.35

4*

.25

.25

.45

.30

.40

.45

.45

5*

.35

.40

.45

.45

6**

.50

*4 surfaces: mesial, distal, right and left

**2 surfaces: mesial, right and left

Table 1Reduction of enamel as a function of thenumber of teeth, after Demange and Francois.

3 - HOW SHOULD A STRIPPING PROCEDURE BE CARRIED OUT?



10.2 mm in the interproximal stripping of all the teeth from themesial surface of one first molar tothe mesial surface of the other.According to him, “Orthodontistsshould assign priority in stripping tothe posterior teeth, because any malfunction in stripping of theincisors might disfigure them.”

These two tables, which are com-plementary, present only theoreticalfigures. The practitioner should not follow them blindly but, with the aid ofperiapical radiographs, carefully adaptthe stripping to take the specificanatomic conformation and periodontalstatus of each tooth into consideration.Practitioners should measure the widthof the teeth in every case before anyinterproximal stripping in order to knowin advance how much enamel shouldbe removed and then use calipers asthey work to see how much they areactually removing.

• The fundamental principles of stripping

Sheridan23 and Fillion8,9 have pro-posed these guidelines:

– Do not strip any teeth beforebonding attachments to them.

– Fully align rotated teeth beforestripping them.

– Do not strip all the teeth in a sin-gle appointment.

– Separate the teeth, by puttingseparators in place on a previousappointment, before stripping them soas to improve access, as Sheridan23

advises. – Always strip from the posterior

to the anterior to prevent any loss ofthe space being gained from slippageresulting from the .anterior compo-nent of force.

– Always protect adjacent soft tissuewith cotton rolls and wooden wedges.

– Always reshape the strippedteeth to their proper form and restorethe remaining enamel surface to itsoriginal smoothness, polishing beingessential.

– Finally, according to Sheridan24,prescribe a fluoride solution thatpatients can use to increase thepotential for remineralization of theabraded enamel surfaces.

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Table IIUpper limits of amount of enamel to be removed. After Fillion.

UPPERARCH

REDUCTIONOF TOOTH SURFACE

0,3

0,6

0,3

0,6 0,6 1,2 1,2 1,2

0,3 0,3 0,3 0,6 0,6 0,6 0,6 0,6 0,6 10,2

LOWER ARCH0,2 0,2 0,2 0,2 0,2 0,2 0,6 0,6 0,6 0,6 0,6 8,6

REDUCTIONOF TOOTH SURFACE

0,4 0,4 0,4 0,9 1,2 1,2

M D M D M D M D M D M D

CENTRAL LATERAL CANINEFIRST

PREMOLARSECOND

PREMOLARFIRST

MOLARTOTAL

PER ARCH


CLÉMENT FRINDEL

3 - 2 - Materials needed (fig.10)

• ManualThe tool for stripping by hand is a

thin metal strip covered on one orboth sides with an abrasive materialthat is usually used alone but may bemounted with a handle. Its thicknessvaries from .15 to .4 mm. Sheridan24

points out that hand stripping of thebuccal teeth is laborious, impracti-cal, relatively unproductive, timeconsuming, and likely to leave bits ofthe strip lodged between teeth.

• Rotary instruments– Diamond discs

These discs are covered with stan-dard or extra-fine diamond grains onone or both surfaces. Their thicknessand their diameters may vary.Zachrisson28,29 primarily employs thesediscs for stripping in accordance withthe method proposed by Tuverson26.

This is a four-handed technique thatuses air cooling as a .1 mm thick diamond disc mounted on a blue ringcontra angle removes enamel withseparators aiding the process (fig.11).Next, the orthodontist uses round ortriangular diamond burs (#8833,Komet) to round off any angularitiesleft on the enamel surface. ButSheridan24 asserts that it is dangerousto use a diamond disc on a high speedrotating instrument in close proximityto a patient’s tongue, cheeks, and lips. But attaching a disc guard to thehand piece to guard against the possi-bility of cutting into soft tissuesreduces visibility.

– Burs

To avoid these impedimentsSheridan22,23,24 recommends usingspecial burs with “deactivated”points (IDEAL burs@) that won’t createridges in the proximal enamel (fig. 12).He prefers tungsten carbide burs forposterior and lateral sectors and dia-mond burs for anterior regions.Tungsten and diamond burs are, inaddition, used for taking proximal bulkfrom amalgam and compositerestorations.

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Figure 11Zachrisson’s protocol: a fourhandedmethod utilizing a disc and a separator(from JCO).

Figure 10 A view of all of the materials and tools employed in stripping.



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tra-angle firmly or, perhaps, preparefor its use by first improving accesswith a manual stripper.– The Orthofile system (SDC)

(fig. 14)This system uses mini-stripping

bands mounted on special contra-angles that oscillate from buccal to lin-gual. Their thickness varies from 15um to 150 um. The maximal amountof enamel that can be removed pertooth is .3 to .5 mm. With this systemthere is no risk of cutting into soft tis-sue but patients still feel “vibration.”

These special kits make it possiblefor orthodontists to remove interprox-imal enamel precisely without makingpatients uncomfortable and in a rela-tively short time.

• PolishingThis important step in enamel

stripping restores correct anatomicalform to the tooth and removes rough-ness from the interproximal sur-faces... Polishing itself can removesome substance from the enamelsurface that should not be allowed go

• Special kits– KaVo O-drive oscillating contra-

angle combined with Komet O-Stripper discs

This is a segmented 60o oscillatingdiamond disc. Its pivot angle is 30o. Itcan be fixed in the contra-angle at thedesired angulation, which facilitatesaccess to the site and improves visi-bility and can safely be manipulatedwithout a risk of its cutting into softtissue. It therefore gives the practi-tioner the capability of working withall the precision afforded by a rotatingdisc but without any its undesirablefeatures. Orthodontists can assurepatients of its safe design by passingit over one of their fingers beforeintroducing it into the mouth. Thediscs have variable thicknesses of .15mm, .30 mm, and .45 mm. They oper-ate from the occlusal to the cervicalarea of the tooth under a coolingwater jet. The operator can sense itspassage through the contact point.

But if the contact point is tight thepatient will feel “vibrations” and thepractitioner will have to hold the con-

Figures 12 a to ca: difference between a conventional bur and one with a “deactivated” point;b: removing enamel with a standard bur may a ridge that will interfere with space closure;c: enamel reduction with a “deactivated” bur (IDEAL burs@) (from JCO).


CLÉMENT FRINDEL

beyond the established limits. To pre-vent this from happening some differ-ent possibilities are available to thepractitioner.

Sheridan23,24 uses medium dia-mond burs to redesign the contour ofthe teeth. Zachrisson28,29 andSheridan23,24 use a disc to improve thecondition of the interproximal sur-faces. And a study by Rossouw andTortorella20 has shown that adding anapplication of phosphoric acid to themechanical polishing improves theresult. So Sheridan24 advises practi-tioners that after stripping with discsthey finish by polishing interproximal-ly with a flexible strip dipped in a 37%solution of phosphoric acid (fig. 15).Then the area should be rinsed thor-oughly.

Filion8 says that orthodontists canpolish the interproximal areas ofincisors canines either with strips orwith polishing discs. But for premo-lars and molars he prefers tungstencarbide burs.

4 - 1 - Advantages

• Need for extractions is is elimi-nated and the possible undesirableconsequences of extractions areavoided.

• Less tooth movement isrequired.

• Treatment time is shortened.• Increases probability of stable

results.

4 - 2 - Disadvantages

• It is irreversible.

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Figure 15Polishing interproximally with a stripsoaked in phosphoric acid (from JCO).

4. ADVANTAGES/DISADVANTAGES OF STRIPPING

Figures 13 a and ba: O-drive contra-angle (Kavol) and

O-Stripper (Komet);b: teeth that have been reduced with

this system.Figure 14

The SDC Orthofile system.



5 - 1 - Stability

Some authors3,26 believe thatinterproximal stripping increases thestability of results because it broad-ens contact areas between teeth.

Up until the 1980s orthodontistsused stripping primarily to correctrelapse of incisal crowding afterorthodontic treatment. The indicesdevised by Peck and Peck16. Indicatethe ideal form of lower incisors thatwould not be likely to lead to or pro-voke crowding. One might think,accordingly, that incisors that did notconform to this high morphologicalstandard could be reshaped in sucha way they would assume a certainnormality that would precluderelapse. However, the work ofPuneky et al.18 shows that there isno correlation between the shape oflower incisors and Little’s irregularityindex15. Interproximal strippingshould not be employed for the pur-pose of creating an ideally shapedtooth in view of the not infrequentfinding of perfectly aligned teethdespite their unfavorable Peck andPeck index rating.

It wasn’t until 1985 thatSheridan21 demonstrated that strip-ping could be performed not just onanterior teeth but that it could alsobe utilized in the posterior sectors ofthe arch. This made stripping a feasi-ble alternative to extraction of per-manent teeth in borderline cases. Ithas become a reliable tool fororthodontists to employ in helpingthem to avoid increasing the interca-nine distance or tilting lower incisorstoo far labially. So it seems to offer apromise of more stable results,

although no one has as yet con-firmed this assertion with statisticalevidence.

5 - 2 - The periodontium

One might think that reducing inter-proximal enamel and thereby diminish-ing the space between teeth wouldincrease the incidence of periodontaldisease. However, several studies11,25

have shown that the narrower theinterproximal bone is the better itresists periodontal disease. Otherstudies2,3,5 have demonstrated thegood periodontal heath of patientswho have received interproximal strip-ping during the course of orthodontictreatment. Fillion8,9 concluded that“the removal of interproximal enamelhas no negative effect on the peri-odontium and it might, in fact, have thebeneficial effect, under certain condi-tions, of improving the resistance ofbone to disease.” This is even moretrue because stripping tends toremove plaque, which is usually a primary factor in causing periodontaldisease.

5 - 3 - Dental caries

Interproximal stripping leavesgrooves and creases in the enamelsurface. According to Filion8 the abra-sive strip is the most harmful toolbecause it creates the deepestgrooves. It roughens the enamel, thusleaving it, according to Radianskky et al.,19 more susceptible to the accu-mulation of plaque. So polishing, thatsmoothes out these rough edges asmuch as possible becomes a crucial

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5 - CONSEQUENCES OF STRIPPING


CLÉMENT FRINDEL

Localized or extended through-out the arch, removal of toothstructure through interproximalstripping has become a standardpart of the orthodontic therapeuticarsenal. Using it, orthodontists canavoid extractions, correct archlength discrepancies, and improveocclusal relationships. However,orthodontists should conduct this

procedure with extreme care andwith respect for dental physiology.It is essential for them to follow arigorous protocol and to equipthemselves with instruments withwhich they can quantify theamount of enamel removed. To putit another way, they must be pru-dent because the procedure is irre-versible.

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6 - CONCLUSION

BIBLIOGRAPHY

Zachrisson et al.28 studied the den-tal health of 61 patients 10 years afterthey had their mandibular incisorsstripped according to the protocol wepreviously described.

They used clinical and radiologicalexaminations to look for the pres-ence of caries, bleeding after prob-ing, pocket depth, and gingivalrecession. They measured extent ofrelapse, and width/thickness ratio onmodels, comparing the figures takenfrom end of treatment casts andthose taken 10 years later. Problemsof caries and periodontal diseasehad not increased, nor had the dis-tance between roots decreased.Thus, according to their protocol,interproximal stripping of enamel didnot cause any iatrogenic damage.

step. But because this, too, removessome enamel, should orthodontiststake away a little less enamel in strip-ping so that exquisite polishing cantake away a little more?

To answer the question of the pos-sible noxious effects of stripping,Jarjoura et al 12. examined 40 patients,all under the age of six, clinically andradiologically after a practitioner hadperformed interproximal stripping ontheir teeth. They found no increase incaries or any other harmful effects ofstripping in this group. Naturally theauthors concluded that stripping didnot increase the risk of developmentof caries. They also found that theapplication of topical fluoride onstripped surfaces for patients alreadyusing fluoride toothpaste conferredno supplementary benefits.

1. Bassigny F. Manuel d’orthopedie dento-faciale. Paris: Masson éd, 1991.2. Betteridge MA. The effects of interdental stripping on labial segments evaluated one

year out of retention. Br J Orthod 1981;8:193-7.3. Boese LR. Fibrotomy and reproximation without lower retention, nine years in ret-

rospect: part 1. Angle Orthod 1980;50:88-97.4. Bolton WA. Disharmony in tooth size and its relation to the analysis and treatment of

malocclusion. Angle Orthod 1958;28:113-30.



5. Crain G, Sheridan JJ. Susceptibility to caries and periodontal disease after posteriorair-rotor stripping. J Clin Orthod 1990;24:84-5.

6. Crétot M. Vieillissement du profil cutané chez l’adulte resté denté et équilibré.Orthod Fr 1991;62:633-51.

7. Demange C, François B. Mesuring and charting interproximal enamel removal. JClinic Orthod 1990;24:408-12.

8. Fillion D. Apport de la sculpture amélaire interproximale à l’orthodontie de l’adulte(2e partie). Revue Orthop Dento Faciale 1993;27:189-214.

9. Fillion D. Apport de la sculpture amélaire interproximale à l’orthodontie de l’adulte(3e partie). Revue Orthop Dento Faciale 1993;27:353-67.

10. Germeç D, Taner TU. Effects of extraction and non extraction therapy with air-rotorstripping on facial esthetics in post adolescent borderline patients. Am J Orthod2008;133: 539-49.

11. Heins PJ, Thomas RG, Newton JW. The relationship of interradicular width and alve-olar bone loss. J Periodontol 1988;59:73-9.

12. Jarjoura K, Gagnon G, Nieberg L. Caries risk after interproximal reduction. Am JOrthod 2006;130:26-30.

13. Langlade M. Thérapeutique orthodontique. Paris: Maloine éd, 1986.14. Le Huche R. Obturations inlays-onlays couronnes en fonction de la forme de la

dent. Paris: J. Prélat. éd, 1970.15. Little RM. The irregularity index: a quantitative score of mandibular anterior align-

ment. Am J Orthod 1975;68:554-63.16. Peck H, Peck S. An index for assessing tooth shape deviations as applied to the

mandibular incisors. Am J Orthod 1972;61:384-401.17. Philippe J. L’orthodontie de l’adulte. Paris: SID éd, 1989.18. Puneky PJ, Sadowsk C, Begole EA. Tooth morphology and lower incisor alignment

many years after orthodontic therapy. Am J Orthod 1984;86:299-305.19. Radlanski RJ, Jager A, Shwestka R, Bertzbach F. Plaque accumulation caused by

interdental stripping. Am J Orthod 1988;94:416-20.20. Rossouw PE, Tortorella A. Enamel reduction procedures in orthodntic treatment. J

Can Dent Assoc 2003;69:378-83.21. Sheridan JJ. Air rotor stripping. J Clin Orthod 1985;19:43-59.22. Sheridan JJ. The updated air rotor stripping (A.R.S.) manual. LA Raintree: Essix LLC,

2005.23. Sheridan JJ, Chudasama D. Guidelines for contemporary Air-Rotor Stripping. J Clin

Orthod 2007;41:315-20.24. Sheridan JJ, Chudasama D. Interviews John J. Sheridan on Air-Rotor Stripping.

J Clin Orthod 2008;42:381-8.25. Tal H. Relationship between the interproximal distance of roots and the prevalence

of intrabony pockets. J Periodontol 1984;55:604-7.26. Tuverson DL. Anterior interocclusal relations Part 1. Am J Orthod 1980;78:361-370.27. Van Der Linden FP. Aspects théoriques et pratiques de l’encombrement de la den-

ture humaine. Revue Orthop Dento Faciale 1975;9:329-52.28. Zachrisson BU, Nyöygaard L, Mobarak K. Dental health assessed more than 10

years after interproximal enamel reduction of mandibular anterior teeth. Am JOrthod 2007; 131:162-9.

29. Zachrisson BU. Actual damage to teeth and periodontal tissues with mesiodistalenamel reduction (« stripping »). World J Orthod 2004;5:178-83.

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