Recommendation for enamel stripping in the orthodontic treatment

Abstract

Introduction: Enamel stripping is a common procedure part of the orthodontic treatment,where the interproximal enamel is stripped to create space in the arch in case of a mild to moderate crowding. Objective: The main objective was to determine which is the safest way to perform enamel stripping. To answer this,we compared manual and mechanical techniques,evaluated the usefulness of polishing,determined the need for remineralization and defined the safest margins on how much enamel can be removed. Material and methods: A literature review was performed through Medline Complete,ScienceDirect and Pubmed. Results: 51 articles were read from which 26 were selected. Between manual and mechanical techniques,the mechanical polishing discs left the smoothest enamel surface. Polishing proved to be essential to reduce the enamel roughness and Sof lex discs followed by 37% orthophosphoric acid showed the best results. The necessity of remineralization techniques are still under discussion but using a casein phosphopeptide-amorphous calcium phosphate varnish in the interproximal area is the most helpful tool to promote the enamel health after stripping. The width of the enamel is specific to each tooth and each individual but all authors agreed that 50% of the existing enamel is available for reduction. The use of X-rays is highly recommended to increase the success rate of the procedure. Conclusion: The safest way to perform enamel stripping is through the use of mechanical diamond discs followed by polishing with Sof-lex discs and the application of 37% orthophosphoric acid. The practitioner can remove up to 50% of the enamel. It is suggested to use a casein phosphopeptide-amorphous calcium phosphate varnish at the end of the procedure