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ªÂÛÔ‰fi
fiÓÓÙÈ· Ì›ˆÛË Ù˘ ·‰·Ì·ÓÙ›Ó˘ (stripping): ÂӉ›ÍÂȘ
Î·È ÂȉڿÛÂȘ ÛÙËÓ ÂÈÊ¿ÓÂÈ· Ù˘ ·‰·Ì·ÓÙ›Ó˘
X. °∫π√∫∞*, £. ∏§π∞¢∏™**
* ºÔÈÙ‹ÙÚÈ· √‰ÔÓÙÈ·ÙÚÈ΋˜, ∆Ì‹Ì· √‰ÔÓÙÈ·ÙÚÈ΋˜, ¶·ÓÂÈÛÙ‹ÌÈÔ ∞ıËÓÒÓ.
** √ÚıÔ‰ÔÓÙÈÎfi˜, ™˘ÓÂÚÁ¿Ù˘ ∂Ú¢ÓËÙ‹˜ ∂ÈÛÙ‹Ì˘ µÈÔ¸ÏÈÎÒÓ, √‰ÔÓÙÈ·ÙÚÈ΋ ™¯ÔÏ‹ Turner, ¶·ÓÂÈÛÙ‹ÌÈÔ Manchester, ∏ӈ̤ÓÔ µ·Û›ÏÂÈÔ Î·È ™˘ÓÂÚÁ¿Ù˘ ∂Ú¢ÓËÙ‹˜, ∂ÚÁ·ÛÙ‹ÚÈÔ µÈÔ¸ÏÈÎÒÓ,
∆Ì‹Ì· √‰ÔÓÙÈ·ÙÚÈ΋˜, ¶·ÓÂÈÛÙ‹ÌÈÔ ∞ıËÓÒÓ.
Interproximal enamel reduction (stripping): indications and enamel
surface effects
C. GIOKA*, T. ELIADES**
* Dental student, School of Dentistry, University of Athens.
** Orthodontist, Research Associate Biomaterials Science, Turner Dental School, University of Manchester, UK; and Research Associate, Biomaterials Laboratory, School of Dentistry, University
of Athens.
¶EPI§HæH
ABSTRACT
∏ ÌÂÛÔ‰fiÓÙÈ· Ì›ˆÛË Ù˘ ·‰·Ì·ÓÙ›Ó˘ (stripping) ÂÊ·ÚÌfi˙ÂÙ·È
·fi ·ÏÈ¿ ÁÈ· Ó· ‰È¢ÎÔχÓÂÈ ıÂÚ·¢ÙÈΤ˜ Û¯‹Ì·Ù· ¯ˆÚ›˜ ÂÍ·ÁˆÁ¤˜ Û ÂÚÈÙÒÛÂȘ Ì ‹ÈÔ ¤ˆ˜ ̤ÙÚÈÔ Û˘ÓˆÛÙÈÛÌfi ÙˆÓ ÚÔÛı›ˆÓ ‰ÔÓÙÈÒÓ. ¶ÔÏϤ˜ ̤ıÔ‰ÔÈ (‰È¿ ¯ÂÈÚfi˜, Ì˯·ÓÈΤ˜ Î·È ÌÂ
¯ËÌÈο ̤۷) ¤¯Ô˘Ó ¯ÚËÛÈÌÔÔÈËı› ÁÈ· ·Ê·›ÚÂÛË Ù˘ ·‰·Ì·ÓÙ›Ó˘ ÒÛÙ ӷ Â›Ó·È ÂÏÂÁ¯fiÌÂÓË Î·È Ó· ÚÔηÏ› ÂÏ¿¯ÈÛÙ˜
·ÏÏÔÈÒÛÂȘ ÛÙÔ ·‰·Ì·ÓÙÈÓÈÎfi ˘fiÛÙڈ̷. ™Ùfi¯Ô˜ Â›Ó·È Ó· ÂÏ·¯ÈÛÙÔÔÈËı› Ë ·‰ÚfiÙËÙ· ÙˆÓ ÔÌfiÚˆÓ ÂÈÊ·ÓÂÈÒÓ ¤ÙÛÈ ÒÛÙ ӷ
ÌÂȈı› Ô Î›Ó‰˘ÓÔ˜ ·ÓÂÈı‡ÌËÙˆÓ ÂȉڿÛÂˆÓ ÛÙÔ˘˜ ÛÎÏËÚÔ‡˜
Î·È Ì·Ï·ÎÔ‡˜ ÈÛÙÔ‡˜. ¶·ÚfiÏÔ Ô˘ ‰ÂÓ ¤¯ÂÈ ÙÂÎÌËÚȈı› ÛÔ‚·Úfi˜ ΛӉ˘ÓÔ˜ ÌÂÁ¿ÏÔ˘ ‚·ıÌÔ‡ ··Û‚ÂÛÙ›ˆÛ˘ Î·È ·˘ÍË̤ÓË
Èı·ÓfiÙËÙ· ÙÂÚˉÔÓÈÎÒÓ ‚Ï·‚ÒÓ, ÂÁ›ÚÔÓÙ·È ·ÚÎÂÙ¤˜ ·ÓËÛ˘¯›Â˜ Û¯ÂÙÈο Ì ÙȘ Èı·Ó¤˜ È·ÙÚÔÁÂÓ›˜ Û˘Ó¤ÂȘ Ù˘ Ù¯ÓÈ΋˜
·˘Ù‹˜. ∏ ·Ó·ÛÎfiËÛË ·˘Ù‹ Û˘ÓÔ„›˙ÂÈ ÙË ‰È·ı¤ÛÈÌË ‚È‚ÏÈÔÁÚ·ÊÈ΋ ÙÂÎÌËÚ›ˆÛË fiÛÔÓ ·ÊÔÚ¿ ÛÙȘ ÂӉ›ÍÂȘ, ÌÂıfi‰Ô˘˜ ηÈ
··Ú·›ÙËÙ˜ ÚÔÊ˘Ï¿ÍÂȘ. ∞ÎfiÌË, Á›ÓÂÙ·È ·Ó·ÛÎfiËÛË Ù˘
ÌÂıÔ‰ÔÏÔÁ›·˜ Ô˘ ·ÎÔÏÔ˘ıÂ›Ù·È Û ÌÂϤÙ˜ ÔÈ Ôԛ˜ ‰ÈÂÚ¢ÓÔ‡Ó ÙËÓ ÂÌÊ¿ÓÈÛË Ù˘ ·‰·Ì·ÓÙÈÓÈ΋˜ ÂÈÊ¿ÓÂÈ·˜ ÌÂÙ¿ ÙËÓ ·Ê·›ÚÂÛË Ù˘ ·‰·Ì·ÓÙ›Ó˘. ¶ÂÚÈÔÚÈṲ̂ÓÔ˜ ·ÚÈıÌfi˜ ÂÚ¢ÓËÙÈÎÒÓ
ÂÚÁ·ÛÈÒÓ Û˘ÌʈÓÔ‡Ó ÛÙÔ fiÙÈ ‰ÂÓ ˘Ê›ÛÙ·Ù·È Î›Ó‰˘ÓÔ˜ ÙÂÚˉÔÓÈÛÌÔ‡ Ô˘ Ó· Û˘Û¯ÂÙ›˙ÂÙ·È ·ÔÎÏÂÈÛÙÈο Ì ÙË ÌÂÛÔ‰fiÓÙÈ·
·Ê·›ÚÂÛË ·‰·Ì·ÓÙ›Ó˘, ·ÚfiÏÔ Ô˘ ‰ÂÓ ˘¿Ú¯Ô˘Ó Â› ÙÔ˘
·ÚfiÓÙÔ˜ Ì·ÎÚÔ¯ÚfiÓÈ· ‰Â‰Ô̤ӷ ÛÙÔ ı¤Ì· ·˘Ùfi.
§∂•∂π™ ∫§∂π¢π∞: ªÂÛÔ‰fiÓÙÈ· Ì›ˆÛË Ù˘ ·‰·Ì·ÓÙ›Ó˘, ÔÚıÔ‰ÔÓÙÈ΋ ıÂÚ·›·, È·ÙÚÔÁÂÓ›˜ ÂÈÙÒÛÂȘ.
∂ÏÏ. √ÚıÔ‰. ∂Èı. 2002; 5: 21-32
¶·ÚÂÏ‹ÊıË: 15.02.2002 – ŒÁÈÓ ‰ÂÎÙ‹: 26.03.2002
Interproxinal enamel reduction (stripping) has long been used
to facilitate non-extraction treatment approaches in cases with
mild to moderate anterior crowding. A wide array of methods
(manual, mechanically-driven and chemical means), have
been employed to remove the enamel in a controlled manner
with minimum substrate alterations. The goal is to minimize
roughness in the proximal surfaces to decrease the potential
for undesirable hard and soft tissue effects. Although a
definitive risk for severe decalcification and high probability
for carious lesions has not been established, a number of
concerns have been raised over the potential iatrogenic
sequalae linked with the technique. This review summarizes
the currently available evidence in the literature on the
indications, methods and necessary safety precautions. Also,
reviewed, is the methodology utilized in studies investigating
the surface enamel appearance following enamel removal.
The consensus of a limited number of research studies is that
no specific risk for caries is associated with stripping, although
long-term evidence on this issue is not currently available.
KEY WORDS: Interproxinal enamel reduction, stripping,
orthodontic treatment, iatrogenic sequalae.
Hel. Orthod. Rev. 2002; 5: 21-32
Received: 15.02.2002 – Accepted: 26.03.2002
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H 2002 ñ TOMO™ 5
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¢ONTIKH
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X. °KIOKA Î·È £. H§IA¢H™ MÂÛÔ‰fiÓÙÈ· Ì›ˆÛË Ù˘ ·‰·Ì·ÓÙ›Ó˘ (stripping): ÂӉ›ÍÂȘ Î·È ÂȉڿÛÂȘ
C. GIOKA and T. ELIADES Interproximal enamel reduction (stripping): indications and enamel surface effects
EI™A°ø°H
INTRODUCTION
∏ ÌÂÛÔ‰fiÓÙÈ· ·Ê·›ÚÂÛË ·‰·Ì·ÓÙ›Ó˘ Â›Ó·È Ì›· ÎÏÈÓÈ΋
‰È·‰Èηۛ· ÁÓˆÛÙ‹ ÛÙÔ˘˜ ÔÚıÔ‰ÔÓÙÈÎÔ‡˜ Â‰Ò Î·È
ÂÚÈÛÛfiÙÂÚ˜ ·fi ¤ÓÙ ‰ÂηÂٛ˜ (Hudson, 1956).
¶·ÚfiÏÔ Ô˘ Ë Ù¯ÓÈ΋ ·˘Ù‹ ·Ú¯Èο ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ
·ÔÎÏÂÈÛÙÈο ÁÈ· ÙË ‰ÈfiÚıˆÛË fi„ÈÌÔ˘ ‰Â˘ÙÂÚÔÁÂÓÔ‡˜
Û˘ÓˆÛÙÈÛÌÔ‡ Û ÂÓ‹ÏÈΘ (Phillippe, 1991; de Harfin,
2000), ÚfiÛÊ·Ù· ¿Ú¯ÈÛ ӷ ÂÊ·ÚÌfi˙ÂÙ·È ÛÙË ıÂÚ·›· ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ (Stroud Î·È Û˘Ó., 1998).
™‹ÌÂÚ·, Ë ÌÂÛÔ‰fiÓÙÈ· ·Ê·›ÚÂÛË ·‰·Ì·ÓÙ›Ó˘ ¯ÚËÛÈÌÔÔÈÂ›Ù·È Û˘¯Ó¿ ÛÙËÓ Î·ıËÌÂÚÈÓ‹ Ú¿ÍË Û ÂÚÈÙÒÛÂȘ ̤ÙÚÈÔ˘ Û˘ÓˆÛÙÈÛÌÔ‡ fiÔ˘ ··ÈÙÂ›Ù·È ¯ÒÚÔ˜ ÁÈ· ÙË
‰È¢ı¤ÙËÛË ÙˆÓ ‰ÔÓÙÈÒÓ Î·ıÒ˜ Î·È ÁÈ· ÙË ‰ÈfiÚıˆÛË
‰˘Û·ÚÌÔÓÈÒÓ ÌÂÁ¤ıÔ˘˜ ‰ÔÓÙÈÒÓ. ∂ÈϤÔÓ, Ë ÂÈÛ·ÁˆÁ‹
ÌÈ·˜ ηÈÓÔ‡ÚÈ·˜ ıÂÚ·¢ÙÈ΋˜ Ù¯ÓÈ΋˜ (Invisalign®),
fiÔ˘ ‰ÂÓ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÔÈ Û˘Ì‚·ÙÈΤ˜ ÔÚıÔ‰ÔÓÙÈΤ˜ Û˘Û΢¤˜ ÁÈ· ÙËÓ Ô‰ÔÓÙÈ΋ ÌÂٷΛÓËÛË Î·È Ë ÔÔ›·
‚·Û›˙ÂÙ·È ÛÙË ‰ËÌÈÔ˘ÚÁ›· ¯ÒÚÔ˘ ̤ۈ Ù˘ Ì›ˆÛ˘ Ù˘
·‰·Ì·ÓÙ›Ó˘, Â›Ó·È Èı·Ófi Ó· ·˘Í‹ÛÂÈ ÙË Û˘¯ÓfiÙËÙ·
ÂÊ·ÚÌÔÁ‹˜ Ù˘ Ù¯ÓÈ΋˜ Ù˘ ÌÂÛÔ‰fiÓÙÈ·˜ ·‰·Ì·ÓÙÈÓÈ΋˜ Ì›ˆÛ˘ ÛÙËÓ Î·ıËÌÂÚÈÓ‹ ÎÏÈÓÈ΋ Ú¿ÍË.
¢È¿ÊÔÚ˜ ̤ıÔ‰ÔÈ, Ì˯·ÓÈΤ˜, ¯ËÌÈΤ˜ ‹ Û˘Ó‰˘·ÛÌfi˜
ÙˆÓ ‰‡Ô ·ÚÔ˘ÛÈ¿ÛÙËÎ·Ó Î·Ù¿ ηÈÚÔ‡˜ ˆ˜ ̤ıÔ‰ÔÈ ÂÈÏÔÁ‹˜ ÁÈ· ·ÛÊ·Ï‹ Î·È ·ÔÙÂÏÂÛÌ·ÙÈ΋ ·Ê·›ÚÂÛË ·‰·Ì·ÓÙ›Ó˘ (Valinoti, 1974; Paskow, 1970). ¶·ÚfiÏÔ
Ô˘ ‰È¿ÊÔÚ˜ ÌÂϤÙ˜ ¤¯Ô˘Ó ÂÛÙÈ¿ÛÂÈ ÙÔ ÂӉȷʤÚÔÓ
ÛÙȘ ÂȉڿÛÂȘ Â› Ù˘ ÌÔÚÊÔÏÔÁ›·˜ Î·È Ù˘ ÂÈÊ·ÓÂȷ΋˜ ·‰ÚfiÙËÙ·˜ Ù˘ ·‰·Ì·ÓÙ›Ó˘ Î·È ÙÔÓ Û¯ÂÙÈÎfi ÌÂ
·˘Ù¤˜ ΛӉ˘ÓÔ ÙÔÈ΋˜ Û˘ÛÛÒÚ¢Û˘ Ͽη˜, ‰ÂÓ
˘¿Ú¯ÂÈ ÔÌÔʈӛ· Û¯ÂÙÈο Ì ÙËÓ Èı·ÓfiÙËÙ· ·˘ÍË̤ÓÔ˘ ÎÈÓ‰‡ÓÔ˘ ÙÂÚˉÔÓÈÛÌÔ‡.
™ÎÔfi˜ Ù˘ ÂÚÁ·Û›·˜ Â›Ó·È Ó· ·ÚÔ˘ÛÈ¿ÛÂÈ ÙȘ ‰È¿ÊÔÚ˜ ÌÂıfi‰Ô˘˜ ÌÂÛÔ‰fiÓÙÈ·˜ Ì›ˆÛ˘ Ù˘ ·‰·Ì·ÓÙ›Ó˘
Ô˘ Â›Ó·È ‰È·ı¤ÛÈ̘ Û‹ÌÂÚ·, Ó· ·Ó·Ê¤ÚÂÈ ÙȘ ÂӉ›ÍÂȘ Î·È Ó· Û˘˙ËÙ‹ÛÂÈ ÙȘ Èı·Ó¤˜ ÂȉڿÛÂȘ Ù˘ Ù¯ÓÈ΋˜ ÛÙËÓ ·ÎÂÚ·ÈfiÙËÙ· Ù˘ ·‰·Ì·ÓÙ›Ó˘ ÂȯÂÈÚÒÓÙ·˜ ÌÈ·
ÎÚÈÙÈ΋ ·Ó·ÛÎfiËÛË Ù˘ Û¯ÂÙÈ΋˜ ‚È‚ÏÈÔÁÚ·Ê›·˜.
∞ÎfiÌË, Ë ÂÚÁ·Û›· ·ÚÔ˘ÛÈ¿˙ÂÈ Ì›· ÚfiÙ·ÛË ÁÈ· ÙËÓ
ÂÍ¿ÏÂÈ„Ë Ù˘ ˘ÔÎÂÈÌÂÓÈÎfiÙËÙ·˜ Î·È ÙË ‚ÂÏÙ›ˆÛË Ù˘
Û˘Ó¤ÂÈ·˜ Î·È Ù˘ ÈηÓfiÙËÙ·˜ ÎÏÈÓÈ΋˜ ÂÊ·ÚÌÔÁ‹˜ ÙˆÓ
ÂÚ¢ÓËÙÈÎÒÓ ÚˆÙÔÎfiÏψÓ.
Interproximal enamel reduction is a clinical procedure
known to orthodontists for more than five decades
(Hudson, 1956). Even though stripping was initially
used exclusively for the correction of the late
secondary crowding problems in adults (Phillipe,
1991; de Harfin, 2000), recently, this procedure has
been implemented in the treatment of children and
adolescents (Stroud et al., 1998). Today, stripping is
commonly used in everyday practice in cases where
space is needed to align the teeth in moderate
crowding and correct tooth size discrepancies. In
addition, the introduction of a new treatment
technique (Invisalign®), which does not employ the
conventional orthodontic appliances for the movement
of teeth, thus relying on the generation of space
through enamel reduction, may increase the frequency
of stripping in routine practice.
A number of methods utilizing mechanical, chemical
or a combination has been presented as methods of
choice for safe and efficient enamel reduction
(Valinoti, 1974; Paskow, 1970). While several
reports have focused on the effects induced in the
morphology and surface roughness of enamel, and
associated potential for plaque accumulation locally,
a consensus is lacking concerning the potential for
increased caries risk.
The purpose of this paper is to present the various
stripping methods currently available, list the
indications, and discuss the potential effects of
stripping on enamel integrity through a critical
review of the relevant literature. A proposal for
elimination of bias and enhancement of the
coherence and clinical applicability of research
protocols is also provided
I N D I C AT I O N S F O R
STRIPPING
Major indications for stripping involve the late
crowding developed after orthodontic treatment and
the mild or moderate primary crowding (JostBrinkmann et al., 1991). In general, crowing that
does not exceed 5-6 mm could be an ideal candidate
for interproximal stripping (Betteridge, 1981).
Furthermore stripping can be useful in cases where the
leeway space cannot be utilized to generate space,
and the maintenance of the primary molar is critical,
as in arches with congenitally missing premolars
EN¢EI•EI™ ME™O¢ONTIA™
A¢AMANTINIKH™ MEIø™H™
√È Î‡ÚȘ ÂӉ›ÍÂȘ Ù˘ Ù¯ÓÈ΋˜ ·ÊÔÚÔ‡Ó ÛÙÔÓ fi„ÈÌÔ
Û˘ÓˆÛÙÈÛÌfi Ô˘ ÂÌÊ·Ó›˙ÂÙ·È ÌÂÙ¿ ÙËÓ ÔÚıÔ‰ÔÓÙÈ΋
ıÂÚ·›· Î·È ÛÙÔÓ ‹ÈÔ ‹ ̤ÙÚÈÔ ÚˆÙÔÁÂÓ‹ Û˘ÓˆÛÙÈÛÌfi
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H 2002 ñ TOMO™ 5
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HELLENIC ORTHODONTIC REVIEW 2002 ñ VOLUME 5
¢ONTIKH
£O
ET
OP
E§
™ 1963
¢O
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A
PEI
AI
X. °KIOKA Î·È £. H§IA¢H™ MÂÛÔ‰fiÓÙÈ· Ì›ˆÛË Ù˘ ·‰·Ì·ÓÙ›Ó˘ (stripping): ÂӉ›ÍÂȘ Î·È ÂȉڿÛÂȘ
(Jost-Brinkmann Î·È Û˘Ó., 1991). °ÂÓÈο, Û˘ÓˆÛÙÈÛÌfi˜
ÌÈÎÚfiÙÂÚÔ˜ ÙˆÓ 5-6 ¯ÈÏ. ·ÔÙÂÏ› ȉ·ÓÈ΋ ÂÚ›ÙˆÛË ÁÈ·
ÌÂÛÔ‰fiÓÙÈ· ·Ê·›ÚÂÛË ·‰·Ì·ÓÙ›Ó˘ (Betteridge,
1981).
∞ÎfiÌË, Ë Ù¯ÓÈ΋ ÌÔÚ› Ó· ÂÊ·ÚÌÔÛÙ› Û ÂÚÈÙÒÛÂȘ
fiÔ˘ ‰ÂÓ ÌÔÚ› Ó· ¯ÚËÛÈÌÔÔÈËı› ÁÈ· ÂÍÔÈÎÔÓfiÌËÛË
¯ÒÚÔ˘ ÙÔ ‰È¿ÛÙËÌ· leeway Î·È Ë ‰È·Ù‹ÚËÛË ÙÔ˘ ÓÂÔÁÈÏÔ‡ ÁÔÌÊ›Ô˘ Â›Ó·È ·ÔÊ·ÛÈÛÙÈ΋˜ ÛËÌ·Û›·˜, fiˆ˜ ÛÂ
ÂÚÈÙÒÛÂȘ ÌÂ Û˘ÁÁÂÓÒ˜ ÂÏÏ›ÔÓÙ˜ ÚÔÁÔÌÊ›Ô˘˜
(Proffit Î·È Fields, 2000).
∆¤ÏÔ˜, Ë Ù¯ÓÈ΋ ·ÔÙÂÏ› ÙËÓ Û˘Ó‹ıË ÛÙÚ·ÙËÁÈ΋ Ô˘
·ÎÔÏÔ˘ıÂ›Ù·È Û ÂÚÈÙÒÛÂȘ ÚÔ‚ÏËÌ¿ÙˆÓ Ô˘ ÔÊ›ÏÔÓÙ·È Û ‰˘Û·ÚÌÔӛ˜ ÌÂÁ¤ıÔ˘˜ ‰ÔÓÙÈÒÓ, ‰ËÏ·‰‹
ÂÚÈÙÒÛÂȘ ‰˘Û·ÚÌÔÓ›·˜ Bolton. ¢˘Û·ÚÌÔÓ›· ÌÂÁ¤ıÔ˘˜ ‰ÔÓÙÈÒÓ ÌÈÎÚfiÙÂÚË ·fi 1.5 ¯ÈÏ. Û¿ÓÈ· ›ӷÈ
ÛËÌ·ÓÙÈ΋. √È ÌÂÁ·Ï‡ÙÂÚ˜, fï˜, ‰˘Û·ÚÌÔӛ˜ ‰ËÌÈÔ˘ÚÁÔ‡Ó ÚÔ‚Ï‹Ì·Ù· ÛÙË ıÂÚ·›· Î·È Ú¤ÂÈ Ó·
Û˘ÌÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÛÙË Ï›ÛÙ· ÙˆÓ ÔÚıÔ‰ÔÓÙÈÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ (Proffit Î·È Fields, 2000).
™Â ·ÚÎÂÙ¤˜ ÂÚÈÙÒÛÂȘ ·Ô‰ÂÈÎÓ‡ÂÙ·È ¯Ú‹ÛÈÌË Ë ÂÊ·ÚÌÔÁ‹ Ù˘ Ù¯ÓÈ΋˜ ÛÙ· Ô›ÛıÈ· ‰fiÓÙÈ·. ∞˘Ùfi ·Ó·Ê¤ÚÂÙ·È ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· ˆ˜ ARS (Air-Rotor Stripping,
ÌÂÛÔ‰fiÓÙÈ· ·‰·Ì·ÓÙÈÓÈ΋ Ì›ˆÛË Ì ¯ÂÈÚÔÏ·‚‹ ˘„ËÏÒÓ
Ù·¯˘Ù‹ÙˆÓ) Î·È ·ÔÙÂÏ› ηϋ ÂÓ·ÏÏ·ÎÙÈ΋ χÛË ¤Ó·ÓÙÈ
ÙˆÓ ÂÍ·ÁˆÁÒÓ ‹ Ù˘ ‰È‡ڢÓÛ˘ Û ÂÚÈÙÒÛÂȘ ‹ÈÔ˘
ˆ˜ ̤ÙÚÈÔ˘ Û˘ÓˆÛÙÈÛÌÔ‡ (Sheridan, 1987). ∏ Ù¯ÓÈ΋
ARS ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÁÈ· Â›Ï˘ÛË ÙÔ˘ Û˘ÓˆÛÙÈÛÌÔ‡
·Ê·ÈÚÒÓÙ·˜ ·‰·Ì·ÓÙÈÓÈ΋ Ô˘Û›· ¿ˆ ÙˆÓ Î˘ÓÔ‰fiÓÙˆÓ,
fiÔ˘ Î·È ‚Ú›ÛÎÂÙ·È Ë ÌÂÁ·Ï‡ÙÂÚË ÔÛfiÙËÙ· ·‰·Ì·ÓÙ›Ó˘ (El-Mangoury Î·È Û˘Ó., 1991). ∏ ̤ıÔ‰Ô˜ ·˘Ù‹
‰›ÓÂÈ, ÂÈϤÔÓ, χÛË Û ÂÚÈÙÒÛÂȘ ̤ÙÚÈÔ˘ Û˘ÓˆÛÙÈÛÌÔ‡ 4-6 ¯ÈÏ., fiÔ˘ ·‰·Ì·ÓÙÈÓÈ΋ Ì›ˆÛË ÌÂÁ·Ï‡ÙÂÚË
·fi 2-3 ¯ÈÏ. ÛÙËÓ ÚfiÛıÈ· ÂÚÈÔ¯‹ ı· ‹Ù·Ó ·ÓÂ·Ú΋˜ ÏfiÁˆ ÙÔ˘ ÂÍ·ÈÚÂÙÈο ÌÂȈ̤ÓÔ˘ ¿¯Ô˘˜ ·‰·Ì·ÓÙ›Ó˘ Ô˘ ·Ô̤ÓÂÈ ÛÙÔ˘˜ οو ÙÔÌ›˜ (Sheridan, 1987).
¶ÚÔÊ·ÓÒ˜, Ë Ì›ˆÛË Ù˘ ·‰·Ì·ÓÙ›Ó˘ ÛÙ· Ô›ÛıÈ·
‰fiÓÙÈ· ·ÔÙÂÏ› ÔχÙÈÌË ıÂÚ·¢ÙÈ΋ ÂÓ·ÏÏ·ÎÙÈ΋ χÛË
Û ÔÚȷΤ˜ ÂÚÈÙÒÛÂȘ ÂÍ·ÁˆÁÒÓ. ∂Ó ÙÔ‡ÙÔȘ, ÙÔ Û¯‹Ì·
ÙˆÓ Ô›ÛıÈˆÓ ÌÂÛÔ‰fiÓÙÈˆÓ ÛËÌ›ˆÓ Â·Ê‹˜ ÌÔÚ› Ó·
‰ËÌÈÔ˘ÚÁ‹ÛÂÈ ÚÔ‚Ï‹Ì·Ù·. √È Â·Ê¤˜ ÛÙÔ ÚfiÛıÈÔ
ÙÌ‹Ì· ÙÔ˘ ÙfiÍÔ˘ ÌÔÚ› Ó· ηٷÛÙÔ‡Ó ÈηÓÔÔÈËÙÈο Â›‰˜, ·ÊÔ‡ Ë ÌÂÛÔ‰fiÓÙÈ· ÌÔÚÊÔÏÔÁ›· ÙˆÓ Î¿Ùˆ ηÈ
¿Óˆ ÙÔ̤ˆÓ ÌÔÈ¿˙ÂÈ Ì ·˘Ù‹ Ù˘ Â›‰˘ ÂÈÊ¿ÓÂÈ·˜.
¶·ÚfiÏ· ·˘Ù¿, ÌÂÙ·‚ÔÏ‹ ÙˆÓ Î·Ì‡ÏˆÓ Ô›ÛıÈˆÓ fiÌÔÚˆÓ Â·ÊÒÓ ÌÔÚ› Ó· ¤¯ÂÈ ÂÈ‚Ï·‚›˜ ÂÈÙÒÛÂȘ ÛÙË
ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ· Ù˘ Â·Ê‹˜, fiˆ˜ Û˘ÛÛÒÚ¢ÛË Ͽη˜ Î·È ÌË ·ÔÙÂÏÂÛÌ·ÙÈÎfi ·˘ÙÔηı·ÚÈÛÌfi. °È· ·ÏÔ‡ÛÙ¢ÛË Ù˘ fiÏ˘ ‰È·‰Èηۛ·˜, Ô Sheridan (1987) ÚÔÙ›ÓÂÈ ÙË ¯Ú‹ÛË ·ÓÔÈÎÙÔ‡ ÂÏ·ÙËÚ›Ô˘ ÚÈÓ ÙËÓ ÂÊ·ÚÌÔÁ‹
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H 2002 ñ TOMO™ 5
C. GIOKA and T. ELIADES Interproximal enamel reduction (stripping): indications and enamel surface effects
(Proffit and Fields, 2000).
Finally, reduction of interproximal enamel is the usual
strategy to compensate for discrepancies caused by
tooth size discrepancies i.e., Bolton’s discrepancy. A
tooth size discrepancy of less than 1.5 mm is rarely
significant, but larger discrepancies create treatment
problems and must be included in the orthodontic
problem list (Proffit and Fields, 2000).
Stripping of posterior teeth may also be proven
useful in several cases. The technique for
interproximal enamel reduction in the posterior area
is referred in the literature as air-rotor stripping (ARS)
and appears to be a good alternative to extraction
or expansion procedures in cases of mild-tomoderate crowding (Sheridan, 1987). ARS is used
to resolve crowding by reducing enamel mass distal
to the canines, where the greatest amount of enamel
is present (El-Mangoury et al., 1991). This method
offers further solution in cases of moderate crowing
of 4-6 mm, where anterior interproximal reduction of
more than 2-3 mm would be inadequate because of
the alarmingly reduced enamel thickness remaining
on the lower incisors (Sheridan, 1987). Obviously,
stripping of posterior teeth is a valuable treatment
option in borderline extraction cases. However, a
concern may arise from the shape of posterior
proximal contact points. Contacts in the anterior
arch segment may be efficiently flattened since the
proximal morphology of lower and upper incisors
approximates that of a flat surface. ∏owever,
alteration of the curved posterior proximal contacts
may inflict detrimental changes on the functionality
of the contact including accumulation of plaque and
reduced self-cleaning efficiency. To decrease the
complexity of the procedure, Sheridan (1987)
proposes the use of open coil spring prior to
stripping to efficiently control the removal of enamel
with a bur.
In spite of the generation of arch space in crowded
cases, some authors have proposed that stripping
may contribute to lower incisor stability based on the
fact that this procedure results in flattened contact
surfaces and the reduced procumbation of the
crowns, an effect which may decrease the tendency
for relapse (Proffit and Fields, 2000). However, others
support that an opposite effect may be seen in
stripped lower incisors, based on the decrease of the
intercanine width and the associated greater
tendency for relapse (Betteridge, 1981). Therefore,
further evidence is required before a definitive
consensus is formed on this issue.
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X. °KIOKA Î·È £. H§IA¢H™ MÂÛÔ‰fiÓÙÈ· Ì›ˆÛË Ù˘ ·‰·Ì·ÓÙ›Ó˘ (stripping): ÂӉ›ÍÂȘ Î·È ÂȉڿÛÂȘ
Ù˘ Ù¯ÓÈ΋˜ ÒÛÙ ӷ ·ÛÎÂ›Ù·È ÈηÓÔÔÈËÙÈÎfi˜ ¤ÏÂÁ¯Ô˜
ηٿ ÙËÓ ·Ê·›ÚÂÛË Ù˘ ·‰·Ì·ÓÙ›Ó˘ Ì ÂÁÁÏ˘Ê›‰·.
∂ÎÙfi˜ ·fi ÙË ‰ËÌÈÔ˘ÚÁ›· ¯ÒÚÔ˘ Û ÂÚÈÙÒÛÂȘ Û˘ÓˆÛÙÈÛÌÔ‡, ÔÚÈṲ̂ÓÔÈ Û˘ÁÁÚ·Ê›˜ ÚÔÙ›ÓÔ˘Ó fiÙÈ Ë Ù¯ÓÈ΋ ·˘Ù‹ Û˘Ì‚¿ÏÏÂÈ ÛÙË ÛÙ·ıÂÚfiÙËÙ· ÙˆÓ Î¿Ùˆ ÙÔ̤ˆÓ,
‰ÈfiÙÈ ‰ËÌÈÔ˘ÚÁ› Â›‰˜ ÂÈÊ¿ÓÂȘ Â·Ê‹˜ Î·È ÂÏ·ÙÙÒÓÂÈ ÙË ¯ÂÈÏÈ΋ ·fiÎÏÈÛË Ù˘ ̇Ï˘ ÙˆÓ ÙÔ̤ˆÓ, Ú¿ÁÌ· Ô˘ ÌÔÚ› Ó· ÌÂÈÒÛÂÈ ÙËÓ Ù¿ÛË ˘ÔÙÚÔ‹˜ (Proffit
Î·È Fields, 2000). ∂Ó ÙÔ‡ÙÔȘ, ¿ÏÏÔÈ Û˘ÁÁÚ·Ê›˜ ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ ÌÔÚ› ηÓ›˜ Ó· ‰ÂÈ ÙÔ ·ÓÙ›ıÂÙÔ ·ÎÚÈ‚Ò˜
·ÔÙ¤ÏÂÛÌ· Û οو ÙÔÌ›˜ fiÔ˘ ¤¯ÂÈ Á›ÓÂÈ ÌÂÛÔ‰fiÓÙÈ·
·Ê·›ÚÂÛË ·‰·Ì·ÓÙ›Ó˘, ÏfiÁˆ Ù˘ Ì›ˆÛ˘ ÙÔ˘ ‰È·Î˘ÓÔ‰ÔÓÙÈÎÔ‡ ‡ÚÔ˘˜ Î·È ÙË Û¯ÂÙÈ˙fiÌÂÓË Ì ·˘Ù‹Ó ÌÂÁ·Ï‡ÙÂÚË Ù¿ÛË ˘ÔÙÚÔ‹˜ (Betteridge, 1981). °È· ÙÔ˘˜
·Ú·¿Óˆ ÏfiÁÔ˘˜, ··ÈÙÂ›Ù·È ÂÚ·ÈÙ¤Úˆ ÙÂÎÌËÚ›ˆÛË
ÒÛÙ ӷ ˘¿ÚÍÂÈ ÔÚÈÛÙÈ΋ ÔÌÔʈӛ· Â› ÙÔ˘ ı¤Ì·ÙÔ˜.
DESCRIPTION OF THE
TECHNIQUE
(i) Standard interproximal reduction
The clinical procedure of stripping may be divided
into two stages: the initial enamel reduction and the
final enamel polishing, which is necessary to
decrease the roughness of the reduced surface.
Enamel reduction is basically performed by
mechanical or chemical means:
(a) The mechanical means of obtaining enamel
reduction is typically achieved by grinding the
interproximal tooth surfaces. For this purpose various
types of diamond burs or perforated diamond-coated
discs can be utilized in conjunction with handpieces
(air-rotor or micromotor). The use of diamond-coated
strips adapted to handpieces has also been
suggested for the same purpose, whilst diamond
coated strips may also be used manually. Stripping of
teeth which have rounded proximal surfaces may be
achieved with the use of specially fabricated burs
which remove enamel tissue in the direction of
curvature, thus preserving the anatomic shape of the
surface (Zachrisson, 2001).
(b) The chemical method of mesiodistal enamel
reduction is based on the microabrasive effect of
acids on enamel. Acid etching of enamel with the use
of 37% orthophosphoric acid may be employed in
combination with mechanical stripping, to facilitate a
faster stripping procedure and supposedly a smoother
surface. This mode of enamel reduction eliminates the
disadvantages of the single mechanical procedure by
creating a relative smooth surface that has the
potential to remineralize (Joseph et al., 1992).
πn general, enamel reduction leaves a relatively rough
enamel surface, and thus polishing should follow in
every stage to decrease the roughness. For this
purpose a wide array of So-flex discs and polishing
strips may be used in handpiece or manually,
whereas fine and ultrafine diamond burs may assist
the operator in achieving a smooth contact area,
which will presumably prevent excessive plaque
accumulation.
¶ E P I ° PA º H T H ™ T E X N I K H ™
È) ¶Úfi
fiÙÙ˘Ë ÌÂÛÔ‰fi
fiÓÓÙÈ· Ì›ˆÛË ·‰·Ì·ÓÙ›Ó˘
∏ ÎÏÈÓÈ΋ ‰È·‰Èηۛ· Ù˘ Ù¯ÓÈ΋˜ ÌÔÚ› Ó· ¯ˆÚÈÛÙ›
Û ‰‡Ô ÛÙ¿‰È·: ÛÙËÓ ·Ú¯È΋ ·‰·Ì·ÓÙÈÓÈ΋ Ì›ˆÛË Î·È
ÛÙËÓ ÙÂÏÈ΋ Ï›·ÓÛË Î·È ÛٛςˆÛË Ù˘ ·‰·Ì·ÓÙ›Ó˘, Ô˘
Â›Ó·È ··Ú·›ÙËÙË ÁÈ· Ó· ÌÂȈı› Ë ·‰ÚfiÙËÙ· Ù˘ ÂÈÊ¿ÓÂÈ·˜.
∏ ·‰·Ì·ÓÙÈÓÈ΋ Ì›ˆÛË Á›ÓÂÙ·È ‚·ÛÈο Ì Ì˯·ÓÈÎfi ‹
¯ËÌÈÎfi ÙÚfiÔ:
(·) √ Ì˯·ÓÈÎfi˜ ÙÚfiÔ˜ Û˘Ó›ÛÙ·Ù·È Î·Ù¿ ηÓfiÓ· ÛÂ
ÙÚÔ¯ÈÛÌfi ÙˆÓ ÔÌfiÚˆÓ Ô‰ÔÓÙÈÎÒÓ ÂÈÊ·ÓÂÈÒÓ. °È· ÙÔ
ÛÎÔfi ·˘Ùfi ÌÔÚ› Ó· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó ‰È¿ÊÔÚÔÈ
Ù‡ÔÈ ÂÁÁÏ˘Ê›‰ˆÓ ‰È·Ì·ÓÙÈÔ‡ ‹ ‰È¿ÙÚËÙÔÈ ‰›ÛÎÔÈ Ì ÂÈÎ¿Ï˘„Ë ‰È·Ì·ÓÙÈÔ‡ Û ¯ÂÈÚÔÏ·‚¤˜ (˘„ËÏÒÓ ‹ ¯·ÌËÏÒÓ
Ù·¯˘Ù‹ÙˆÓ). °È· ÙÔÓ ›‰ÈÔ ÛÎÔfi ¤¯ÂÈ Â›Û˘ ÚÔÙ·ı› Ë
¯Ú‹ÛË Ù·ÈÓÈÒÓ Ì ÂÈÎ¿Ï˘„Ë ‰È·Ì·ÓÙÈÔ‡ Ô˘ ÚÔÛ·ÚÌfi˙ÔÓÙ·È ÛÙȘ ¯ÂÈÚÔÏ·‚¤˜, ÂÓÒ, ·ÎfiÌË, Â›Ó·È ‰˘Ó·ÙfiÓ
Ó· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó Ù¤ÙÔȘ Ù·Èӛ˜ Ì ÙÔ ¯¤ÚÈ. ∞Ê·›ÚÂÛË Ù˘ ·‰·Ì·ÓÙ›Ó˘ Û ‰fiÓÙÈ· Ì ·ÔÛÙÚÔÁÁ˘ÏÂ̤Ó˜
fiÌÔÚ˜ ÂÈÊ¿ÓÂȘ ÌÔÚ› Ó· Á›ÓÂÈ Ì ÙË ¯Ú‹ÛË ÂȉÈο
ηٷÛ΢·ÛÌ¤ÓˆÓ ÂÁÁÏ˘Ê›‰ˆÓ Ô˘ ·Ê·ÈÚÔ‡Ó ÙÔÓ ·‰·Ì·ÓÙÈÓÈÎfi ÈÛÙfi ÚÔ˜ ÙËÓ Î·Ù‡ı˘ÓÛË Ù˘ ηÌ˘ÏfiÙËÙ·˜,
‰È·ÙËÚÒÓÙ·˜ ¤ÙÛÈ ÙÔ ·Ó·ÙÔÌÈÎfi Û¯‹Ì· Ù˘ ÂÈÊ¿ÓÂÈ·˜
(Zachrisson, 2001).
(‚) ∏ ¯ËÌÈ΋ ̤ıÔ‰Ô˜ Ù˘ ÂÁÁ‡˜-¿ˆ ·Ê·›ÚÂÛ˘ ·‰·Ì·ÓÙ›Ó˘ ‚·Û›˙ÂÙ·È ÛÙË ÌÈÎÚÔ-ÂÎÙÚÈÙÈ΋ Â›‰Ú·ÛË ÙˆÓ
ÔͤˆÓ ÛÙËÓ ·‰·Ì·ÓÙ›ÓË. ∏ ·‰ÚÔÔ›ËÛË Ù˘ ·‰·Ì·ÓÙ›Ó˘ Ì ÔÚıÔʈÛÊÔÚÈÎfi Ô͇ 37% ÌÔÚ› Ó· Û˘Ó‰˘·ÛÙ› Ì Ì˯·ÓÈ΋ ·Ê·›ÚÂÛË, ¤ÙÛÈ ÒÛÙ ӷ ‰È¢ÎÔÏ˘Óı›
Ë Ù·¯‡ÙÂÚË ÂÊ·ÚÌÔÁ‹ Ù˘ Ù¯ÓÈ΋˜ ηÈ, Èı·ÓfiÓ, Ë ‰ËÌÈE§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H 2002 ñ TOMO™ 5
C. GIOKA and T. ELIADES Interproximal enamel reduction (stripping): indications and enamel surface effects
(ii) Modified technique
The typical form of interproximal enamel reduction is
basically an invasive procedure, for both the enamel
and the soft periodontal tissues. Over-stripped teeth
may show signs of sensitivity to stimuli because of the
enamel reduction and possible exposure of dentine to
the intraoral environment. Furthermore, following
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X. °KIOKA Î·È £. H§IA¢H™ MÂÛÔ‰fiÓÙÈ· Ì›ˆÛË Ù˘ ·‰·Ì·ÓÙ›Ó˘ (stripping): ÂӉ›ÍÂȘ Î·È ÂȉڿÛÂȘ
Ô˘ÚÁ›· ÔÌ·ÏfiÙÂÚ˘ ÂÈÊ¿ÓÂÈ·˜. ∞˘Ùfi˜ Ô ÙÚfiÔ˜ ·‰·Ì·ÓÙÈÓÈ΋˜ Ì›ˆÛ˘ ÂÍ·Ï›ÊÂÈ Ù· ÌÂÈÔÓÂÎÙ‹Ì·Ù· Ù˘ ÌÂÌÔӈ̤Ó˘ Ì˯·ÓÈ΋˜ ‰È·‰Èηۛ·˜, ‰ËÌÈÔ˘ÚÁÒÓÙ·˜ Û¯ÂÙÈο Ï›· ÂÈÊ¿ÓÂÈ· Ô˘ ¤¯ÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· Â·Ó·Û‚ÂÛÙ›ˆÛ˘ (Joseph Î·È Û˘Ó., 1992).
°ÂÓÈο, Ë ÂÊ·ÚÌÔÁ‹ Ù˘ Ù¯ÓÈ΋˜ ηٷϋÁÂÈ Û ۯÂÙÈο
·‰Ú‹ ·‰·Ì·ÓÙÈÓÈ΋ ÂÈÊ¿ÓÂÈ· Î·È ÁÈ’ ·˘Ùfi Ú¤ÂÈ ÛÂ
οı ÛÙ¿‰ÈÔ Ó· ·ÎÔÏÔ˘ı› Ï›·ÓÛË Î·È ÛٛςˆÛË. °È·
ÙÔ ÛÎÔfi ·˘Ùfi ÌÔÚ› Ó· ¯ÚËÛÈÌÔÔÈËı› ÌÂÁ¿ÏË ÔÈÎÈÏ›· ‰›ÛÎˆÓ Sof-Lex Î·È Ù·ÈÓÈÒÓ ÛٛςˆÛ˘ Û ¯ÂÈÚÔÏ·‚‹ ‹ Ì ÙÔ ¯¤ÚÈ, ÂÓÒ ÏÂÙfiÎÔÎΘ Î·È ˘ÂÚÏÂÙfiÎÔÎΘ
ÂÁÁÏ˘Ê›‰Â˜ ‰È·Ì·ÓÙÈÔ‡ ÌÔÚ› Ó· ˘Ô‚ÔËı‹ÛÔ˘Ó ÛÙË
‰ËÌÈÔ˘ÚÁ›· Ï›·˜ ÂÚÈÔ¯‹˜ Â·Ê‹˜ Ô˘ ˘ÔÙ›ıÂÙ·È ˆ˜
ı· ·ÔÙÚ¤„ÂÈ ÙËÓ ˘ÂÚ‚ÔÏÈ΋ Û˘ÛÛÒÚ¢ÛË Ͽη˜.
stripping, the surface properties of enamel are altered
with major effects on roughness, a fact, which may
predispose for plaque accumulation. Several studies
have focused on the investigation of comparative
enamel roughness following stripping with the
fundamental objective of proposing a method of
choice, which will efficiently eliminate the furrows
formed on the enamel following removal (Lundgren et
al., 1993).
A wide array of oscillating perforated diamondcoated discs for enamel reduction and a series of sofLex discs, cattle disks, or fine pumice media used for
polishing have been found to induce the least amount
of enamel roughness. A study focusing on this issue
has shown that more than 90% of the reproximated
surfaces of the enamel samples were very well
polished resulting in enamel surfaces smoother than
untreated enamel. In addition, this method was found
to be less time-consuming, as it required an average
of 2.2 min per session, whilst being safe and
comfortable for the patient because it eliminated the
use of lip and/or cheek protectors to prevent injuries
(Zhong et al., 2000).
Similarly, an efficient alternative to standard form of
stripping is the use of tungsten carbide burs to reduce
enamel, in conjunction with polishing, typically
achieved with the use of fine and ultrafine diamond
burs, sof-Lex discs or strips. A recent investigation
showed that the use of an 8-fluted tungsten carbide
bur followed by Sof-Lex discs for polishing enamel,
results in the formation of a relatively polished
surfaces, which often appeared smoother than the
intact or untreated enamel (Piacentini and Sfondrini,
1996). The same investigators demonstrated that the
formation of furrows left on the enamel by diamond
burs, diamond discs and 16- blade tungsten carbide,
is an irreversible alteration, which cannot be
eliminated using normal polishing and cleaning
methods.
A study focusing on stripping of the posterior dentition,
demonstrated that the use of tungsten carbide burs to
reduce enamel is preferable not only because it
leaves a smooth surface but because it contributes to
the formation of an anatomic shape, which
approximates that of the original tooth surface (Jarvis,
1989).
Finally, a method of effectively improving the enamel
surface appearance following stripping may pertain
to the polishing with aluminum oxide-coated strips or
discs with the use of a handpiece. Hein et al. (1990),
have shown that, after 60 sec of polishing, the treated
ÈÈ) ∆ÚÔÔÔÈË̤ÓË Ù¯ÓÈ΋
∏ Ù˘È΋ ÌÔÚÊ‹ Ù˘ Ù¯ÓÈ΋˜ ·ÔÙÂÏ› Ô˘ÛÈ·ÛÙÈο Ì›·
ÂÂÌ‚·ÙÈ΋ ‰È·‰Èηۛ·, ÙfiÛÔ ÁÈ· ÙËÓ ·‰·Ì·ÓÙ›ÓË fiÛÔ
Î·È ÁÈ· ÙÔ˘˜ Ì·Ï·ÎÔ‡˜ ÂÚÈÔ‰ÔÓÙÈÎÔ‡˜ ÈÛÙÔ‡˜. ¢fiÓÙÈ·
ÛÙ· ÔÔ›· ¤¯ÂÈ Á›ÓÂÈ ˘ÂÚ‚ÔÏÈ΋ ÌÂÛÔ‰fiÓÙÈ· ·Ê·›ÚÂÛË
·‰·Ì·ÓÙ›Ó˘ ÌÔÚ› Ó· ÂÌÊ·Ó›ÛÔ˘Ó ÛËÌ›· ¢·ÈÛıËÛ›·˜ Û ‰È¿ÊÔÚ· ÂÚÂı›ÛÌ·Ù· ÏfiÁˆ Ù˘ ·‰·Ì·ÓÙÈÓÈ΋˜
Ì›ˆÛ˘ Î·È Èı·Ó‹˜ ¤ÎıÂÛ˘ Ô‰ÔÓÙ›Ó˘ ÛÙÔ ÂÓ‰ÔÛÙÔÌ·ÙÈÎfi ÂÚÈ‚¿ÏÏÔÓ. ∂ÈϤÔÓ, ÌÂÙ¿ ÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘
Ù¯ÓÈ΋˜, ÌÂÙ·‚¿ÏÏÔÓÙ·È ÔÈ ÂÈÊ·ÓÂȷΤ˜ ȉÈfiÙËÙ˜ Ù˘
·‰·Ì·ÓÙ›Ó˘ Ì ·ÚÈ· Â›‰Ú·ÛË Â› Ù˘ ·‰ÚfiÙËÙ¿˜ Ù˘,
ÁÂÁÔÓfi˜ Ô˘ ÌÔÚ› Ó· Úԉȷı¤ÛÂÈ ÛÂ Û˘ÛÛÒÚ¢ÛË
ÌÈÎÚԂȷ΋˜ Ͽη˜. ∞ÚÎÂÙ¤˜ ÌÂϤÙ˜ ·Û¯ÔÏ‹ıËÎ·Ó ÌÂ
ÙË ‰ÈÂÚ‡ÓËÛË Ù˘ Û˘ÁÎÚÈÙÈ΋˜ ·‰·Ì·ÓÙÈÓÈ΋˜ ·‰ÚfiÙËÙ·˜ ÌÂÙ¿ ÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘ Ù¯ÓÈ΋˜ Ì ·ÚÈÔ ÛÙfi¯Ô Ó·
ÚÔÙ·ı› Ì›· ̤ıÔ‰Ô˜ ÂÎÏÔÁ‹˜, Ë ÔÔ›· ı· ÂÍ·Ï›„ÂÈ
·ÔÙÂÏÂÛÌ·ÙÈο ÙȘ ÁÚ·ÌÌÒÛÂȘ Ô˘ ‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È
ÛÙËÓ ·‰·Ì·ÓÙ›ÓË ÌÂÙ¿ ÙËÓ ·Ê·›ÚÂÛ‹ Ù˘ (Lundgren ηÈ
Û˘Ó., 1993).
µÚ¤ıËΠfiÙÈ Ì›· ÌÂÁ¿ÏË ÔÈÎÈÏ›· ‰ÔÓÔ‡ÌÂÓˆÓ ‰È¿ÙÚËÙˆÓ
·‰·Ì¿ÓÙÈÓˆÓ ‰›ÛÎˆÓ ÁÈ· ·Ê·›ÚÂÛË ·‰·Ì·ÓÙ›Ó˘ ηÈ
ÛÂÈÚ¿ ‰›ÛÎˆÓ Sof-Lex, ‰›ÛÎˆÓ ‹ Ì¤ÛˆÓ ÏÂÙfiÎÔÎ΢
ÂÏ·ÊÚfiÂÙÚ·˜ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÁÈ· ÛٛςˆÛË ÂÈÙ˘Á¯¿ÓÔ˘Ó ÂÏ¿¯ÈÛÙË ·‰·Ì·ÓÙÈÓÈ΋ ·‰ÚfiÙËÙ·. ™¯ÂÙÈ΋
ÌÂϤÙË ¤‰ÂÈÍ fiÙÈ ÂÚÈÛÛfiÙÂÚÔ ·fi 90% ÙˆÓ ÂÈÊ·ÓÂÈÒÓ
ÙˆÓ ‰ÂÈÁÌ¿ÙˆÓ ·‰·Ì·ÓÙ›Ó˘ fiÔ˘ ÂÊ·ÚÌfiÛÙËÎÂ Ë Ù¯ÓÈ΋ ›¯·Ó ÛÙÈÏ‚ˆı› Ôχ ηϿ, ÁÂÁÔÓfi˜ Ô˘ ›¯Â ˆ˜
·ÔÙ¤ÏÂÛÌ· ÂÈÊ¿ÓÂȘ ÈÔ Ï›˜ ·fi ·˘Ù¤˜ Ô˘ ‰ÂÓ
›¯·Ó ÙÚÔ¯ÈÛÙ› ηıfiÏÔ˘. ∂ÈϤÔÓ, ‚Ú¤ıËΠfiÙÈ Ë Ì¤ıÔ‰Ô˜ ·˘Ù‹ ‹Ù·Ó ÏÈÁfiÙÂÚÔ ¯ÚÔÓÔ‚fiÚ· ηıÒ˜ ··ÈÙÔ‡ÛÂ
ÂÚ›Ô˘ 2.2 ÏÂÙ¿ ·Ó¿ Û˘Ó‰ڛ·, ÂÓÒ, Ù·˘Ùfi¯ÚÔÓ·,
‹Ù·Ó ·ÛÊ·Ï‹˜ Î·È ¿ÓÂÙË ÁÈ· ÙÔÓ ·ÛıÂÓ‹ ÂÂȉ‹ ‰ÂÓ
··ÈÙÔ‡ÓÙ·Ó Ë ¯Ú‹ÛË ÚÔÊ˘Ï·ÎÙÈÎÒÓ Ì¤ÛˆÓ ÁÈ· Ù·
¯Â›ÏË Î·È / ‹ ÙȘ ·ÚÂȤ˜ ÚÔ˜ ·ÔÊ˘Á‹Ó ÙÚ·˘Ì·ÙÈÛÌÒÓ
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H 2002 ñ TOMO™ 5
C. GIOKA and T. ELIADES Interproximal enamel reduction (stripping): indications and enamel surface effects
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HELLENIC ORTHODONTIC REVIEW 2002 ñ VOLUME 5
¢ONTIKH
£O
ET
OP
E§
™ 1963
¢O
§A
A
PEI
AI
X. °KIOKA Î·È £. H§IA¢H™ MÂÛÔ‰fiÓÙÈ· Ì›ˆÛË Ù˘ ·‰·Ì·ÓÙ›Ó˘ (stripping): ÂӉ›ÍÂȘ Î·È ÂȉڿÛÂȘ
(Zhong Î·È Û˘Ó., 2000).
√ÌÔ›ˆ˜, ·ÔÙÂÏÂÛÌ·ÙÈ΋ ÂÓ·ÏÏ·ÎÙÈ΋ χÛË ¤Ó·ÓÙÈ Ù˘
Ù˘È΋˜ ÌÔÚÊ‹˜ Ù˘ Ù¯ÓÈ΋˜ ·ÔÙÂÏ› Ë ¯ÚËÛÈÌÔÔ›ËÛË
ÂÁÁÏ˘Ê›‰ˆÓ ηڂȉ›Ô˘ ÙÔ˘ ÙÔ˘ÓÁÎÛÙÂÓ›Ô˘ ÁÈ· ÙË Ì›ˆÛË
Ù˘ ·‰·Ì·ÓÙ›Ó˘, ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÛٛςˆÛË Ô˘ Û˘Ó‹ıˆ˜ Á›ÓÂÙ·È Ì ÏÂÙfiÎÔÎΘ ‹ ˘ÂÚÏÂÙfiÎÔÎΘ ÂÁÁÏ˘Ê›‰Â˜ ‰È·Ì·ÓÙÈÔ‡, ‰›ÛÎÔ˘˜ Sof-Lex ‹ Ù·Èӛ˜. ¶ÚfiÛÊ·ÙË ¤Ú¢ӷ ¤‰ÂÈÍ fiÙÈ Ë ¯Ú‹ÛË ÂÁÁÏ˘Ê›‰·˜ ηڂȉ›Ô˘ ÙÔ˘
ÙÔ˘ÓÁÎÛÙÂÓ›Ô˘ Ì 8 ·‡Ï·Î˜ ·ÎÔÏÔ˘ıÔ‡ÌÂÓË ·fi Ï›·ÓÛË Ù˘ ·‰·Ì·ÓÙ›Ó˘ Ì ‰›ÛÎÔ˘˜ Sof-Lex ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙË ‰ËÌÈÔ˘ÚÁ›· Û¯ÂÙÈο Ï›ˆÓ ÂÈÊ·ÓÂÈÒÓ, ÔÈ
Ôԛ˜ Û˘¯Ó¿ ‹Ù·Ó ÈÔ Ï›˜ ·fi ¿ıÈÎÙË ‹ ·‰·Ì·ÓÙ›ÓË
Ô˘ ‰ÂÓ Â›¯Â ˘ÔÛÙ› ηÌÈ¿ ÂÂÍÂÚÁ·Û›· (Piacentini ηÈ
Sfondrini, 1996). √È ›‰ÈÔÈ ÂÚ¢ÓËÙ¤˜ ¤‰ÂÈÍ·Ó fiÙÈ ÔÈ
ÁÚ·ÌÌÒÛÂȘ Ô˘ ‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È ÛÙËÓ ·‰·Ì·ÓÙ›ÓË ·fi
ÂÁÁÏ˘Ê›‰Â˜ ‰È·Ì·ÓÙÈÔ‡, ‰›ÛÎÔ˘˜ ‰È·Ì·ÓÙÈÔ‡ Î·È Î·Ú‚›‰ÈÔ ÙÔ˘ ÙÔ˘ÓÁÎÛÙÂÓ›Ô˘ ·ÔÙÂÏÔ‡Ó ÌË ·Ó·ÛÙÚ¤„ÈÌË
·ÏÏÔ›ˆÛË Ô˘ ‰ÂÓ ÌÔÚ› Ó· ÂÍ·ÏÂÈÊı› Ì ÙȘ Û˘Ó‹ıÂȘ ÌÂıfi‰Ô˘˜ ÛٛςˆÛ˘ Î·È Î·ı·ÚÈÛÌÔ‡.
ªÂϤÙË Û¯ÂÙÈο Ì ÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘ Ù¯ÓÈ΋˜ ÛÙ· Ô›ÛıÈ· ‰fiÓÙÈ· ¤‰ÂÈÍ fiÙÈ Ë ¯Ú‹ÛË ÂÁÁÏ˘Ê›‰ˆÓ ηڂȉ›Ô˘
ÙÔ˘ ÙÔ˘ÓÁÎÛÙÂÓ›Ô˘ ÁÈ· ÙË Ì›ˆÛË Ù˘ ·‰·Ì·ÓÙ›Ó˘ ›ӷÈ
ÚÔÙÈÌfiÙÂÚË, fi¯È ÌfiÓÔ ‰ÈfiÙÈ ·Ê‹ÓÂÈ Ï›· ÂÈÊ¿ÓÂÈ·,
·ÏÏ¿ ÂÂȉ‹ Û˘Ì‚¿ÏÏÂÈ ÛÙË ‰ËÌÈÔ˘ÚÁ›· ·Ó·ÙÔÌÈÎÔ‡
Û¯‹Ì·ÙÔ˜ Ô˘ ÏËÛÈ¿˙ÂÈ ·˘Ùfi Ù˘ ·Ú¯È΋˜ Ô‰ÔÓÙÈ΋˜
ÂÈÊ¿ÓÂÈ·˜ (Jarvis, 1989).
∆¤ÏÔ˜, Ì›· ̤ıÔ‰Ô˜ Ô˘ ‚ÂÏÙÈÒÓÂÈ ÈηÓÔÔÈËÙÈο ÙËÓ
ÂÌÊ¿ÓÈÛË Ù˘ ·‰·Ì·ÓÙÈÓÈ΋˜ ÂÈÊ¿ÓÂÈ·˜ ÌÂÙ¿ ÙËÓ ·Ê·›ÚÂÛË ÙÔ˘ ÈÛÙÔ‡ ÌÔÚ› Ó· ¤¯ÂÈ Û¯¤ÛË Ì ÙË ÛٛςˆÛË ÌÂ
Ù·Èӛ˜ ÂÈÎ·Ï˘Ì̤Ó˜ Ì ÔÍ›‰ÈÔ ÙÔ˘ ·ÏÔ˘ÌÈÓ›Ô˘ ‹
‰›ÛÎÔ˘˜ Ô˘ ÚÔÛ·ÚÌfi˙ÔÓÙ·È Û ¯ÂÈÚÔÏ·‚‹. √È Hein
Î·È Û˘Ó. (1990) ¤‰ÂÈÍ·Ó fiÙÈ, ÌÂÙ¿ ·fi 60 ‰Â˘ÙÂÚfiÏÂÙ·
ÛٛςˆÛ˘, ÔÈ ·‰·Ì·ÓÙÈÓÈΤ˜ ÂÈÊ¿ÓÂȘ ·ÚÔ˘Û›·˙·Ó
ۯ‰fiÓ È‰·ÓÈ΋ Ï›·ÓÛË Ì ϛÁ˜ ÌfiÓÔ ÌÂÌÔӈ̤Ó˜
ÁÚ·ÌÌÒÛÂȘ Ô˘ Î˘Ì·›ÓÔÓÙ·Ó Û ̤ÁÂıÔ˜ ·fi 1 ˆ˜ 3
Ìm.
enamel surfaces approached ideal smoothness, with
only a few isolated furrows present ranging from 1 to
3 Ìm.
EFFECTS ON THE ENAMEL
S U R FA C E A N D P U L P T I S S U E
Generally, proximal reduction generates the formation
of grooves and valleys located mainly in the cervical
region of the teeth. Scanning electron images of
treated enamel surfaces 12 weeks after stripping
revealed furrows having edges of decreased
roughness relative to the roughness obtained
immediately after stripping, whereas evidence of
plaque accumulation was also identified. One year
following stripping, further levelling of the edges was
observed in some specimens on the proximal contact
areas, but not in the cervical regions (Radlanski et al.,
1990). The furrows left after stripping and finishing
remain obviously an unsolved problem, which may
predispose for periodontal pathology and carries,
since a rough enamel surface in the oral environment
may provide more retentive sites for bacterial
attachment. However, there appears to be a dispute
over the potential predisposition of stripped enamel to
caries. The main body of the literature in the filed
indicates that there are no detrimental effects on
enamel or the periodontal status of treated teeth
(Radlanski et al., 1988; 1989; Crain and Sheridan,
1990; Jost-Brinkmann et al., 1991; Joseph et al.,
1992; El-Mangoury et al., 1991). Although some
authors have shown that in vivo-aged teeth exhibit
decalcification 6 months after stripping, followed by
reminerilization 9 months following the procedure (ElMangoury et al., 1991), long-term evidence
concerning the potential for caries risk is lacking. This
effect may be further exaggerated by the recent
application of stripping to mixed dentition treatment,
where the level of oral hygiene may not be optimum.
Stripping removes the surface layer of enamel, which
are harder and tend to have higher mineral and lower
water content than subsurface enamel (Ogaard,
2001), whilst they contains more fluoride than deeper
zones (Jenkins, 1978). The loss of the surface enamel
and associated exposure of the enamel prism endings
to oral environment, induces a decrease in the
resistance of the tooth surface to organic acids
produced in plaque and more prone to
decalcification (Ogaard, 2001). Therefore, stripping
of lower incisors may be performed to the extent that
E¶I¢PA™EI™ ™THN
A¢AMANTINIKH E¶IºANEIA
KAI ™TON ¶O§ºIKO I™TO
°ÂÓÈο, Ë fiÌÔÚË ·Ê·›ÚÂÛË ·‰·Ì·ÓÙ›Ó˘ ÚÔηÏ›
·‡Ï·Î˜ Î·È ÎÔÈÏ¿ÓÛÂȘ ΢ڛˆ˜ ÛÙËÓ ·˘¯ÂÓÈ΋ ÂÚÈÔ¯‹
ÙˆÓ ‰ÔÓÙÈÒÓ. ∂ÈÎfiÓ˜ ËÏÂÎÙÚÔÓÈÎÔ‡ ÌÈÎÚÔÛÎÔ›Ô˘ ·fi
ÂÂÍÂÚÁ·Ṳ̂Ó˜ ÂÈÊ¿ÓÂȘ ·‰·Ì·ÓÙ›Ó˘ 12 ‚‰ÔÌ¿‰Â˜ ÌÂÙ¿ ÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘ Ù¯ÓÈ΋˜ ·ÔÎ¿Ï˘„·Ó ÙËÓ
·ÚÔ˘Û›· ÁÚ·ÌÌÒÛÂˆÓ Ì ¿ÎÚ· ÌÂȈ̤Ó˘ ·‰ÚfiÙËÙ·˜
Û˘ÁÎÚÈÙÈο Ì ÙËÓ ·‰ÚfiÙËÙ· Ô˘ ˘¿Ú¯ÂÈ ·Ì¤Ûˆ˜ ÌÂÙ¿
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H 2002 ñ TOMO™ 5
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£O
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¢O
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PEI
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X. °KIOKA Î·È £. H§IA¢H™ MÂÛÔ‰fiÓÙÈ· Ì›ˆÛË Ù˘ ·‰·Ì·ÓÙ›Ó˘ (stripping): ÂӉ›ÍÂȘ Î·È ÂȉڿÛÂȘ
ÙË ‰È·‰Èηۛ· ·˘Ù‹, ÂÓÒ Ù·˘Ùfi¯ÚÔÓ· ·Ó·ÁÓˆÚ›ÛÙËΠË
‡·ÚÍË Û˘ÛÛÒÚ¢Û˘ Ͽη˜. ŒÓ· ¯ÚfiÓÔ ÌÂÙ¿ ÙËÓ
·Ê·›ÚÂÛË Ù˘ ·‰·Ì·ÓÙ›Ó˘ ·Ú·ÙËÚ‹ıËΠÂÚ·ÈÙ¤Úˆ
Ï›·ÓÛË ÙˆÓ ¿ÎÚˆÓ Û ÔÚÈṲ̂ӷ ‰Â›ÁÌ·Ù· ÛÙȘ fiÌÔÚ˜
ÂÚÈÔ¯¤˜ Â·Ê‹˜, fi¯È fï˜ ÛÙȘ ·˘¯ÂÓÈΤ˜ ÂÚÈÔ¯¤˜
(Radlanski Î·È Û˘Ó., 1990). √È ÁÚ·ÌÌÒÛÂȘ Ô˘ ·Ú·Ì¤ÓÔ˘Ó ÌÂÙ¿ ÙËÓ ·Ê·›ÚÂÛË Ù˘ ·‰·Ì·ÓÙ›Ó˘ Î·È ÙË Ï›·ÓÛË Î·È ÛٛςˆÛË ·ÔÙÂÏÔ‡Ó ·ÛÊ·ÏÒ˜ ¿Ï˘ÙÔ Úfi‚ÏËÌ· Ô˘ Úԉȷı¤ÙÂÈ ÁÈ· ÂÚÈÔ‰ÔÓÙÈ΋ ·ıÔÏÔÁ›·
Î·È ÙÂÚˉfiÓ·, ÂÊfiÛÔÓ Ì›· ·‰Ú‹ ·‰·Ì·ÓÙÈÓÈ΋ ÂÈÊ¿ÓÂÈ· ÛÙÔ ÛÙÔÌ·ÙÈÎfi ÂÚÈ‚¿ÏÏÔÓ ÚÔÛʤÚÂÈ ÂÚÈÛÛfiÙÂÚ· ÛËÌ›· Û˘ÁÎÚ¿ÙËÛ˘ ÌÈÎÚÔ‚›ˆÓ.
∂Ó ÙÔ‡ÙÔȘ, Ê·›ÓÂÙ·È fiÙÈ ˘¿Ú¯Ô˘Ó ‰È·ÊˆÓ›Â˜ Û¯ÂÙÈο ÌÂ
ÙËÓ Èı·Ó‹ ÚԉȿıÂÛË Ù˘ ÂÂÍÂÚÁ·Ṳ̂Ó˘ ·‰·Ì·ÓÙ›Ó˘ ÁÈ· ÙÂÚˉfiÓ·. √ ·ÚÈÔ˜ fiÁÎÔ˜ Ù˘ Û¯ÂÙÈ΋˜
‚È‚ÏÈÔÁÚ·Ê›·˜ ˘Ô‰ÂÈÎÓ‡ÂÈ fiÙÈ ‰ÂÓ ˘¿Ú¯Ô˘Ó ‚Ï·‚ÂÚ¤˜ ÂȉڿÛÂȘ ÛÙËÓ ·‰·Ì·ÓÙ›ÓË ‹ ÛÙËÓ ÂÚÈÔ‰ÔÓÙÈ΋
ηٿÛÙ·ÛË ÙˆÓ ‰ÔÓÙÈÒÓ ·˘ÙÒÓ (Radlanski Î·È Û˘Ó.,
1988; 1989; Crain Î·È Sheridan, 1990; JostBrinkmann Î·È Û˘Ó., 1991; Joseph Î·È Û˘Ó., 1992; ElMangoury Î·È Û˘Ó., 1991). ¶·ÚfiÏÔ Ô˘ ÔÚÈṲ̂ÓÔÈ
Û˘ÁÁÚ·Ê›˜ ¤‰ÂÈÍ·Ó fiÙÈ ‰fiÓÙÈ· ÁËÚ·Ṳ̂ӷ in vivo
·ÚÔ˘ÛÈ¿˙Ô˘Ó ··Û‚ÂÛÙ›ˆÛË 6 Ì‹Ó˜ ÌÂÙ¿ ÙËÓ ÌÂÛÔ‰fiÓÙÈ· ·‰·Ì·ÓÙÈÓÈ΋ Ì›ˆÛË ·ÎÔÏÔ˘ıÔ‡ÌÂÓË ·fi Â·Ó·Û‚ÂÛÙ›ˆÛË 9 Ì‹Ó˜ ÌÂÙ¿ ÙË ‰È·‰Èηۛ· (El-Mangoury
Î·È Û˘Ó., 1991), ‰ÂÓ ˘¿Ú¯ÂÈ Ì·ÎÚÔ¯ÚfiÓÈ· ÙÂÎÌËÚ›ˆÛË Û¯ÂÙÈο Ì ÙÔÓ Èı·Ófi ΛӉ˘ÓÔ ÙÂÚˉÔÓÈÛÌÔ‡. ∏ Â›‰Ú·ÛË ·˘Ù‹ ÌÔÚ› Ó· ÂÈÙ·ı› ÂÚ·ÈÙ¤Úˆ ·fi ÙËÓ ÚfiÛÊ·ÙË ÂÊ·ÚÌÔÁ‹ Ù˘ Ù¯ÓÈ΋˜ Û ıÂÚ·›· ÌÈÎÙ‹˜ Ô‰ÔÓÙÔÊ˘›·˜, fiÔ˘ ÙÔ Â›Â‰Ô ÛÙÔÌ·ÙÈ΋˜ ˘ÁÈÂÈÓ‹˜ ‰ÂÓ
Â›Ó·È ÙÔ Î·Ï‡ÙÂÚÔ ‰˘Ó·Ùfi.
ªÂ ÙËÓ Ù¯ÓÈ΋ ·˘Ù‹ ·Ê·ÈÚÔ‡ÓÙ·È ÔÈ ÂÈÊ·ÓÂȷΤ˜ ÛÙÈ‚¿‰Â˜ Ù˘ ·‰·Ì·ÓÙ›Ó˘ Ô˘ Â›Ó·È ÛÎÏËÚfiÙÂÚ˜ Î·È Ù›ÓÔ˘Ó Ó· ÂÚȤ¯Ô˘Ó ÂÚÈÛÛfiÙÂÚ· ·ÓfiÚÁ·Ó· ÛÙÔȯ›· ηÈ
ÏÈÁfiÙÂÚÔ ÓÂÚfi ·fi ÙËÓ ˘ÔÂÈÊ·ÓÂȷ΋ ·‰·Ì·ÓÙ›ÓË
(Ogaard, 2001), ÂÓÒ ÂÚȤ¯Ô˘Ó ÂÚÈÛÛfiÙÂÚÔ ÊıfiÚÈÔ
·fi ÙȘ ‚·ı‡ÙÂÚ˜ ÛÙÈ‚¿‰Â˜ (Jenkins, 1978). ∏ ·ÒÏÂÈ· Ù˘ ÂÈÊ·ÓÂȷ΋˜ ·‰·Ì·ÓÙ›Ó˘ Î·È Ë ¤ÎıÂÛË ÙˆÓ
¿ÎÚˆÓ ÙˆÓ ·‰·Ì·ÓÙÈÓÈÎÒÓ ÚÈÛÌ¿ÙˆÓ ÛÙÔ ÛÙÔÌ·ÙÈÎfi
ÂÚÈ‚¿ÏÏÔÓ ÚÔηÏÔ‡Ó Ì›ˆÛË Ù˘ ·ÓÙ›ÛÙ·Û˘ Ù˘ Ô‰ÔÓÙÈ΋˜ ÂÈÊ¿ÓÂÈ·˜ ÛÙ· ÔÚÁ·ÓÈο Ôͤ· Ù˘ ÌÈÎÚԂȷ΋˜
Ͽη˜ Î·È ÙËÓ Î·ıÈÛÙÔ‡Ó ÈÔ ÂÈÚÚÂ‹ Û ··Û‚ÂÛÙ›ˆÛË (Ogaard, 2001). ŒÙÛÈ, Ë Ù¯ÓÈ΋ ·˘Ù‹ ÌÔÚ›
Ó· ÂÊ·ÚÌfi˙ÂÙ·È ÛÙÔ˘˜ οو ÙÔÌ›˜ ̤¯ÚÈ ÙÔ Ôχ 0.5
¯ÈÏ. Û οı ÏÂ˘Ú¿ ¯ˆÚ›˜ Ó· ‰È·ÂÚÓ¿ÂÈ ÙË ÌÂÛÔ‰fiÓÙÈ· ·‰·Ì·ÓÙ›ÓË. ™Â Ì›· Ù˘È΋ ÂÚ›ÙˆÛË ÌÂ Û˘ÓˆÛÙÈÛÌfi ÙˆÓ Î¿Ùˆ ÙÔ̤ˆÓ fi¯È ÌÂÁ·Ï‡ÙÂÚÔ ·fi 4 ¯ÈÏ., ÌÔÚ› Ó· ‰ËÌÈÔ˘ÚÁËı› ¯ÒÚÔ˜ Ì Ì›ˆÛË Î¿ı ÙÔ̤· ηٿ
0.25 ¯ÈÏ. ·fi οı ÏÂ˘Ú¿ (Proffit Î·È Fields, 2000).
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H 2002 ñ TOMO™ 5
C. GIOKA and T. ELIADES Interproximal enamel reduction (stripping): indications and enamel surface effects
a maximum of 0.5 mm on each side, without going
through the interproximal enamel. For a typical
crowded case where mandibular crowding usually
does not exceed 4 mm, space can be gained by
reducing each incisor 0.25 mm per side (Proffit and
Fields, 2000). Based on a minimum enamel thickness
of 0.36 mm for the mandibular anterior teeth, Hudson
(1956), in one of the earliest reports available,
suggested a maximum removal of 0.25 mm per
surface from the incisors, and 0.3 mm from the
canines; others modified these limits for the
mandibular incisors to 0.5 mm per surface. However,
some authors have warned against removing more
than 0.2 mm of enamel (Zhong et al., 1999)
emphasizing the higher caries risk.
A recent study showed that there is a remarkable
variation in the thickness of incisors among
individuals, whilst it seems that enamel is thicker on
the distal than the mesial margins of both the lateral
and central incisors, with a mean difference of 0.1
mm (Harris and Hicks, 1998). The same authors
found that the widths of the dentine of the crowns
were significantly greater in males, by an average of
6.5% (Harris and Hicks, 1998); this evidence should
be taken into account in planning stripping.
Enamel removal in posterior teeth using the ARS
technique should be limited to 1 mm in each contact
area (0.5 mm per surface) (Sheridan and Hastings,
1992). The accumulating space should be measured
and charted by means of an interdental spacemeasuring gauge.
In general, the dispute over the safe limits of enamel
removal derives from the lack of long-term studies
investigating the prevalence of caries or
decalcification on stripped teeth. As a result, the
figures found in the literature represent subjective
estimates of authors and thus, should not serve as a
guideline for clinicians.
RELIABILITY AND CLINICAL
R E L E VA N C E O F R E S E A R C H
PROTOCOLS ASSESSING
ENAMEL APPEARANCE
FOLLOWING STRIPPING
The foregoing studies have focused on the surface
roughness associated with stripping, employing
optical or scanning electron microscopy (SEM), to
reveal the topography and morphology of the
stripped enamel surface. However, both microscopic
27
HELLENIC ORTHODONTIC REVIEW 2002 ñ VOLUME 5
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X. °KIOKA Î·È £. H§IA¢H™ MÂÛÔ‰fiÓÙÈ· Ì›ˆÛË Ù˘ ·‰·Ì·ÓÙ›Ó˘ (stripping): ÂӉ›ÍÂȘ Î·È ÂȉڿÛÂȘ
µ¿ÛÂÈ ÙÔ˘ ÂÏ¿¯ÈÛÙÔ˘ ·‰·Ì·ÓÙÈÓÈÎÔ‡ ¿¯Ô˘˜ ÙˆÓ 0.36
¯ÈÏ. ÁÈ· Ù· ÚfiÛıÈ· οو ‰fiÓÙÈ·, Ô Hudson, Û ̛·
·fi ÙȘ ·ÏÈfiÙÂÚ˜ ‰È·ı¤ÛÈ̘ ÌÂϤÙ˜, ÚfiÙÂÈÓ ̤ÁÈÛÙË ·Ê·›ÚÂÛË 0.25 ¯ÈÏ. ·Ó¿ ÂÈÊ¿ÓÂÈ· ·fi ÙÔ˘˜
ÙÔÌ›˜ Î·È 0.3 ¯ÈÏ. ·fi ÙÔ˘˜ ΢Ófi‰ÔÓÙ˜ (Hudson,
1956). ÕÏÏÔÈ ÂÚ¢ÓËÙ¤˜ ÙÚÔÔÔ›ËÛ·Ó ·˘Ù¿ Ù· fiÚÈ·
ÁÈ· ÙÔ˘˜ οو ÙÔÌ›˜ ÛÙ· 0.5 ¯ÈÏ. ·Ó¿ ÂÈÊ¿ÓÂÈ·. ∂Ó
ÙÔ‡ÙÔȘ, ÔÚÈṲ̂ÓÔÈ Û˘ÁÁÚ·Ê›˜ ÂÊÈÛÙÔ‡Ó ÙËÓ ÚÔÛÔ¯‹
ÂÓ¿ÓÙÈ· ÛÙËÓ ·Ê·›ÚÂÛË ÂÚÈÛÛfiÙÂÚˆÓ ·fi 0.2 ¯ÈÏ.
·‰·Ì·ÓÙ›Ó˘ (Zhong Î·È Û˘Ó., 1999) ÙÔÓ›˙ÔÓÙ·˜ ÙÔÓ
·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÙÂÚˉfiÓ·˜.
¶ÚfiÛÊ·ÙË ÌÂϤÙË ¤‰ÂÈÍ ·ÍÈÔÛËÌ›ˆÙË ‰È·Î‡Ì·ÓÛË ÛÙÔ
¿¯Ô˜ ÙˆÓ ÙÔ̤ˆÓ ÌÂٷ͇ ÙˆÓ ‰È·ÊfiÚˆÓ ·ÙfïÓ, ÂÓÒ
Ê·›ÓÂÙ·È fiÙÈ Ë ·‰·Ì·ÓÙ›ÓË Â›Ó·È ·¯‡ÙÂÚË ÛÙ· ¿ˆ ·Ú¿
ÛÙ· ÂÁÁ‡˜ fiÚÈ·, ÙfiÛÔ ÛÙÔ˘˜ Ï¿ÁÈÔ˘˜ fiÛÔ Î·È ÛÙÔ˘˜
ÎÂÓÙÚÈÎÔ‡˜ ÙÔÌ›˜ Ì ̤ÛË ‰È·ÊÔÚ¿ 0.1 ¯ÈÏ. (Harris ηÈ
Hicks, 1998). √È ›‰ÈÔÈ Û˘ÁÁÚ·Ê›˜ ‚Ú‹Î·Ó fiÙÈ ÙÔ
‡ÚÔ˜ Ù˘ Ô‰ÔÓÙ›Ó˘ Ù˘ ̇Ï˘ ÙˆÓ ‰ÔÓÙÈÒÓ ‹Ù·Ó ÛËÌ·ÓÙÈο ·˘ÍË̤ÓÔ ÛÙÔ˘˜ ¿Ó‰Ú˜ Û ÔÛÔÛÙfi 6.5% ηٿ
̤ÛÔ fiÚÔ (Harris Î·È Hicks, 1998). ∆· ‰Â‰Ô̤ӷ ·˘Ù¿
ı· Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÔÓÙ·È ˘’ fi„ÈÓ Î·Ù¿ ÙË Û¯Â‰›·ÛË
ÂÊ·ÚÌÔÁ‹˜ Ù˘ Ù¯ÓÈ΋˜.
∏ ·Ê·›ÚÂÛË ·‰·Ì·ÓÙ›Ó˘ ·fi Ù· Ô›ÛıÈ· ‰fiÓÙÈ· Ì ÙËÓ
Ù¯ÓÈ΋ ARS (Air-Rotor Stripping) Ú¤ÂÈ Ó· ÂÚÈÔÚ›˙ÂÙ·È
ÛÙÔ 1 ¯ÈÏ. Û οı ÂÚÈÔ¯‹ Â·Ê‹˜ (0.5 ¯ÈÏ. ·Ó¿ ÂÈÊ¿ÓÂÈ·) (Sheridan Î·È Hastings, 1992). √ ¯ÒÚÔ˜ Ô˘
‰ËÌÈÔ˘ÚÁÂ›Ù·È Ú¤ÂÈ Ó· ÌÂÙÚ¿Ù·È Î·È Ó· ηٷÁÚ¿ÊÂÙ·È
Ì ‚·ıÌÔÓÔÌË̤ÓÔ ÌÂÙÚËÙ‹ ÌÂÛÔ‰ÔÓÙ›ˆÓ ‰È·ÛÙËÌ¿ÙˆÓ.
°ÂÓÈο, Ë Û˘˙‹ÙËÛË Û¯ÂÙÈο Ì ٷ ·ÛÊ·Ï‹ fiÚÈ· ·‰·Ì·ÓÙÈÓÈ΋˜ ·Ê·›ÚÂÛ˘ ÔÊ›ÏÂÙ·È ÛÙËÓ ¤ÏÏÂÈ„Ë Ì·ÎÚÔ¯ÚfiÓÈˆÓ ÌÂÏÂÙÒÓ Ô˘ ‰ÈÂÚ¢ÓÔ‡Ó ÙÔÓ ÂÈÔÏ·ÛÌfi Ù˘ ÙÂÚˉfiÓ·˜ ‹ Ù˘ ··Û‚ÂÛÙ›ˆÛ˘ ÙˆÓ ‰ÔÓÙÈÒÓ fiÔ˘ ¤¯ÂÈ
ÂÊ·ÚÌÔÛÙ› Ë Ù¯ÓÈ΋. ∞ÔÙ¤ÏÂÛÌ· ·˘ÙÔ‡ Â›Ó·È ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÔÈ ÙÈ̤˜ Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙË ‚È‚ÏÈÔÁÚ·Ê›·
·ÔÙÂÏÔ‡Ó ˘ÔÎÂÈÌÂÓÈΤ˜ ÂÎÙÈÌ‹ÛÂȘ ÙˆÓ ÂοÛÙÔÙÂ Û˘ÁÁڷʤˆÓ ηÈ, ˆ˜ ÂÎ ÙÔ‡ÙÔ˘, ‰ÂÓ Ú¤ÂÈ Ó· ıˆÚÔ‡ÓÙ·È
ηÙ¢ı˘ÓÙ‹ÚȘ ÁÚ·Ì̤˜ ·fi ÙÔ˘˜ ÎÏÈÓÈÎÔ‡˜.
techniques lack a quantitative scale and as such
cannot be used for the comparative assessment of
surface roughness of the treated surfaces. As a result
the information provided is subjective and may vary
among different observers. Because the reports
presented in the relevant literature have a pivotal role
in formulating guidelines for clinicians, caution should
be exercised in extrapolating results from in vitro
studies to the clinical conditions.
Further, the vast majority of studies utilized extracted
teeth to investigate the effects of various enamel
reduction techniques on enamel. A variety of teeth
have been used to investigate the effects induced on
enamel by stripping, including upper central incisors,
premolars, and lower incisors, and therefore, there is
a lack of comparable results among trials performed
in different laboratories. Whilst premolar extraction
may be an integral part of orthodontic therapy
facilitating the easy collection of those teeth, premolar
crown contour variations (Taylor, 1978) may
complicate the effort to have substrate surface
consistency.
In addition, a wide variability has been noted with
respect storage media and time periods for
extracted teeth; these parameters may have an
undetermined effect on the enamel surface
morphology (Eliades and Brantley, 1999). When
these varying storage times are combined with the
use of miscellaneous storage media that have
employed different concentrations of thymol, saline
or formalin, it becomes very difficult to draw
conclusions from such studies. Also, the influence of
post-extraction time and storage conditions on
enamel surface structure has not been investigated.
Evidence available from enamel bonding studies,
has indicated that that strength values provided by
teeth stored in formalin were reported to be twice as
much as those of their saline-stored counterparts
(Kimura et al., 1985). These considerations gain
special importance since the composition and
topography of surface properties of enamel are of
paramount importance for a reliable assessment of
the effect of stripping on the hard tooth tissue
integrity. In one of the few articles published on the
effect of storage medium on enamel, it was showed
that enamel specimens stored in physiologic saline
were softer than corresponding specimens stored in
water (Muhlemann, 1964). As a rule, formaldehyde
should be avoided, because its strong acidity
following oxidation to formic acid may affect the pH
of storage media (Eliades and Brantley, 1999). The
A•IO¶I™TIA KAI K§INIKH
™HMA™IA TøN EPEYNHTIKøN
¶PøTOKO§§øN ¶OY
A•IO§O°OYN THN
EMºANI™H TH™
A¢AMANTINH™ META THN
ME™O¢ONTIA AºAIPE™H
√È ÌÂϤÙ˜ ÂÛÙÈ¿˙ÔÓÙ·È Î˘Ú›ˆ˜ ÛÙËÓ ÂÈÊ·ÓÂȷ΋ ·‰ÚfiÙËÙ· Ô˘ ‰ËÌÈÔ˘ÚÁÂ›Ù·È ·fi ÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘ Ù¯ÓÈ΋˜,
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H 2002 ñ TOMO™ 5
C. GIOKA and T. ELIADES Interproximal enamel reduction (stripping): indications and enamel surface effects
28
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X. °KIOKA Î·È £. H§IA¢H™ MÂÛÔ‰fiÓÙÈ· Ì›ˆÛË Ù˘ ·‰·Ì·ÓÙ›Ó˘ (stripping): ÂӉ›ÍÂȘ Î·È ÂȉڿÛÂȘ
¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ΢ڛˆ˜ ÔÙÈÎfi ‹ ËÏÂÎÙÚÔÓÈÎfi ÌÈÎÚÔÛÎfiÈÔ Û¿ÚˆÛ˘ (SEM) ÁÈ· ÙËÓ ·ÔÎ¿Ï˘„Ë Ù˘ ÙÔÔÁÚ·Ê›·˜ Î·È ÌÔÚÊÔÏÔÁ›·˜ Ù˘ ÂÂÍÂÚÁ·Ṳ̂Ó˘ ·‰·Ì·ÓÙÈÓÈ΋˜ ÂÈÊ¿ÓÂÈ·˜. ∂Ó ÙÔ‡ÙÔȘ, Î·È ÔÈ ‰‡Ô ·˘Ù¤˜
ÌÈÎÚÔÛÎÔÈΤ˜ Ù¯ÓÈΤ˜ ‰ÂÓ ‰È·ı¤ÙÔ˘Ó ÔÛÔÙÈ΋ Îϛ̷η Î·È ¤ÙÛÈ ‰ÂÓ ÌÔÚÔ‡Ó Ó· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó ÁÈ·
Û˘ÁÎÚÈÙÈ΋ ·ÍÈÔÏfiÁËÛË Ù˘ ÂÈÊ·ÓÂȷ΋˜ ·‰ÚfiÙËÙ·˜.
∞ÔÙ¤ÏÂÛÌ· ·˘ÙÔ‡ Â›Ó·È ÔÈ ·Ú¯fiÌÂÓ˜ ÏËÚÔÊÔڛ˜
Ó· Â›Ó·È ˘ÔÎÂÈÌÂÓÈΤ˜ Î·È Ó· ÔÈΛÏÏÔ˘Ó ÌÂٷ͇ ÙˆÓ
‰È·ÊfiÚˆÓ ÂÚ¢ÓËÙÒÓ. ∂Âȉ‹ ÔÈ ·Ó·ÊÔÚ¤˜ ÛÙË Û¯ÂÙÈ΋
‚È‚ÏÈÔÁÚ·Ê›· ·›˙Ô˘Ó Ô˘ÛÈ·ÛÙÈÎfi ÚfiÏÔ ÛÙË ‰È·ÌfiÚʈÛË ·Ú¯ÒÓ ÁÈ· ÙÔ˘˜ ÎÏÈÓÈÎÔ‡˜, Ë ÂÍ·ÁˆÁ‹ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ·fi in vitro ÌÂϤÙ˜ Î·È Ë ÂÊ·ÚÌÔÁ‹ ÙÔ˘˜ ÛÂ
ÎÏÈÓÈΤ˜ Û˘Óı‹Î˜ Ú¤ÂÈ Ó· Á›ÓÂÙ·È Ì ÂÈʇϷÍË.
∂ÈϤÔÓ, Ë ÌÂÁ¿ÏË ÏÂÈÔ„ËÊ›· ÙˆÓ ÌÂÏÂÙÒÓ ¯ÚËÛÈÌÔÔ›ËÛ ‰fiÓÙÈ· Ô˘ ›¯·Ó ÂÍ·¯ı› ÁÈ· Ó· ‰ÈÂÚ¢ÓËıÔ‡Ó
ÔÈ ÂȉڿÛÂȘ ÙˆÓ ‰È·ÊfiÚˆÓ Ù¯ÓÈÎÒÓ ·‰·Ì·ÓÙÈÓÈ΋˜
Ì›ˆÛ˘ Â› Ù˘ ·‰·Ì·ÓÙ›Ó˘. ÃÚËÛÈÌÔÔÈ‹ıËÎ·Ó ‰È¿ÊÔÚ˜ ÔÌ¿‰Â˜ ‰ÔÓÙÈÒÓ ÁÈ· ÙË ÌÂϤÙË ÙˆÓ ÂȉڿÛˆÓ
Ù˘ Ù¯ÓÈ΋˜ ÛÙËÓ ·‰·Ì·ÓÙ›ÓË, fiˆ˜ ÎÂÓÙÚÈÎÔ› ¿Óˆ
ÙÔÌ›˜, ÚÔÁfiÌÊÈÔÈ Î·È Î¿Ùˆ ÙÔÌ›˜. ŒÙÛÈ, ‰ÂÓ ˘¿Ú¯Ô˘Ó Û˘ÁÎÚ›ÛÈÌ· ·ÔÙÂϤÛÌ·Ù· ÌÂٷ͇ ‰ÔÎÈÌ·ÛÈÒÓ Ô˘
Ï·Ì‚¿ÓÔ˘Ó ¯ÒÚ· Û ‰È·ÊÔÚÂÙÈο ÂÚÁ·ÛÙ‹ÚÈ·. ¶·ÚfiÏÔ
‰Â Ô˘ ÔÈ ÂÍ·ÁˆÁ¤˜ ÚÔÁÔÌÊ›ˆÓ ÌÔÚ› Ó· ·ÔÙÂÏÔ‡Ó
·Ó·fiÛ·ÛÙÔ ÙÌ‹Ì· Ù˘ ÔÚıÔ‰ÔÓÙÈ΋˜ ıÂÚ·›·˜ ‰È¢ÎÔχÓÔÓÙ·˜ ¤ÙÛÈ ÙËÓ Â‡ÎÔÏË Û˘ÏÏÔÁ‹ ·˘ÙÒÓ ÙˆÓ ‰ÔÓÙÈÒÓ,
Ë ÔÈÎÈÏÔÌÔÚÊ›· ÙÔ˘ Ì˘ÏÈÎÔ‡ ÂÚÈÁÚ¿ÌÌ·ÙÔ˜ ÙˆÓ ÚÔÁÔÌÊ›ˆÓ (Taylor, 1978) ÌÔÚ› Ó· ÂÈÛ·Á¿ÁÂÈ ÙÔÓ ·Ú¿ÁÔÓÙ· Ù˘ ·ÓÔÌÔÈÔÁ¤ÓÂÈ·˜ ÙˆÓ ÂÈÊ·ÓÂÈÒÓ ÙÔ˘ ·‰·Ì·ÓÙÈÓÈÎÔ‡ ˘ÔÛÙÚÒÌ·ÙÔ˜.
∂ÈÚfiÛıÂÙ·, ¤¯Ô˘Ó ·Ú·ÙËÚËı› ÌÂÁ¿Ï˜ ‰È·Î˘Ì¿ÓÛÂȘ fiÛÔÓ ·ÊÔÚ¿ ÛÙ· ̤۷ Î·È ÛÙÔ˘˜ ¯ÚfiÓÔ˘˜ ‰È·Ù‹ÚËÛ˘ ÙˆÓ ÂÍ·¯ı¤ÓÙˆÓ ‰ÔÓÙÈÒÓ. √È ·Ú¿ÌÂÙÚÔÈ ·˘Ù¤˜
ÌÔÚ› Ó· ÌËÓ ¤¯Ô˘Ó ηıÔÚÈṲ̂ÓË Â›‰Ú·ÛË ÛÙË ÌÔÚÊÔÏÔÁ›· Ù˘ ·‰·Ì·ÓÙÈÓÈ΋˜ ÂÈÊ¿ÓÂÈ·˜ (Eliades ηÈ
Brantley, 1999). √È ‰È·ÊÔÚÂÙÈÎÔ› ¯ÚfiÓÔÈ ‰È·Ù‹ÚËÛ˘
ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙË ¯Ú‹ÛË ‰È·ÊfiÚˆÓ Ì¤ÛˆÓ ‰È·Ù‹ÚËÛ˘ Ô˘ ÂÚȤ¯Ô˘Ó ‰È·ÊÔÚÂÙÈΤ˜ Û˘ÁÎÂÓÙÚÒÛÂȘ ı˘ÌfiÏ˘, Ê˘ÛÈÔÏÔÁÈÎÔ‡ ÔÚÔ‡ ‹ ÊÔÚÌ·Ï›Ó˘ ηıÈÛÙÔ‡Ó ÂÍ·ÈÚÂÙÈο ‰‡ÛÎÔÏË ÙËÓ ÂÍ·ÁˆÁ‹ Û˘ÌÂÚ·ÛÌ¿ÙˆÓ ·fi Ù¤ÙÔȘ ÌÂϤÙ˜. ∂Í¿ÏÏÔ˘, ‰ÂÓ ¤¯ÂÈ ‰ÈÂÚ¢ÓËı› Ë Â›‰Ú·ÛË
Â› Ù˘ ‰ÔÌ‹˜ Ù˘ ·‰·Ì·ÓÙÈÓÈ΋˜ ÂÈÊ¿ÓÂÈ·˜ Ô‡Ù ÙÔ˘
¯ÚfiÓÔ˘ Ô˘ ÌÂÛÔÏ·‚› ÌÂÙ¿ ÙËÓ ÂÍ·ÁˆÁ‹ Ô‡ÙÂ ÙˆÓ Û˘ÓıËÎÒÓ ‰È·Ù‹ÚËÛ˘. ¢Â‰Ô̤ӷ Ô˘ ÚԤ΢„·Ó ·fi
ÌÂϤÙ˜ Û˘ÁÎfiÏÏËÛ˘ ÛÙËÓ ·‰·Ì·ÓÙ›ÓË Î·Ù¤‰ÂÈÍ·Ó fiÙÈ ÔÈ
ÙÈ̤˜ ·ÓÙÔ¯‹˜ Ô˘ ÚÔ¤Ú¯ÔÓÙ·È ·fi ‰fiÓÙÈ· ‰È·ÙËÚË̤ӷ Û ÊÔÚÌ·Ï›ÓË ‹Ù·Ó ‰ÈÏ¿ÛȘ ·fi ·˘Ù¤˜ Ô˘ ·ÊÔÚÔ‡Û·Ó ‰fiÓÙÈ· ‰È·ÙËÚË̤ӷ ÛÂ Ê˘ÛÈÔÏÔÁÈÎfi ÔÚfi
(Kimura Î·È Û˘Ó., 1985). √È ·fi„ÂȘ ·˘Ù¤˜ ¤¯Ô˘Ó ȉÈE§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H 2002 ñ TOMO™ 5
C. GIOKA and T. ELIADES Interproximal enamel reduction (stripping): indications and enamel surface effects
implication of the aforementioned factors in
modifying the results of stripping on enamel acting as
confounding variables has not been investigated in
the associated literature.
Most interestingly, the investigation of surface
roughness following various stripping methods as
performed in relevant studies, presents some
fundamental flaws. Generally, three major roughness
variables have been utilized in the greater biomedical
literature to study the roughness of surfaces. These
include:
a) the roughness parameter (Ra), which describes the
overall surface roughness and can be defined as the
arithmetical average value of all absolute distances of
the roughness profile from the center line within the
measuring length;
b) the root mean square (Rq) parameter representing
the height distribution relative to the a mean line; and
c) the maximum roughness depth (Rmax), which
registers isolated profile features on the surface.
The multiplicity and variability of the parameters used
in the relevant literature may be indicative of the
complexity of the surface roughness, especially when
this is applied in various biomaterials including the
biological materials surfaces. In the case of enamel
surface morphology following stripping, it could be
that an overall decreased Ra, which implies a
generally smooth surface, may be accompanied by
an increased Rmax, which would indicate that the
isolated presence of deep grooves. Thus, the use of
roughness factors indiscriminately and without
reference to the nature of the measured surface and
associated physical and biological phenomena,
cannot provide an insight into the issue of enamel
surface roughness.
In as much, the lack of any roughness parameter as
an indicator of the extent of enamel surface alterations
imposed by grinding and polishing, cannot withstand
any scrutiny as to the soundness and clinical
relevance of the method of study.
A proposed technique to bypass the lack of data on
this topic, pertain to the application of Atomic Force
Microscopy (AFM) which is capable of furnishing
crucial information on the surface alteration of enamel
including all three roughness parameters. AFM may
be applied to studies of phenomena such as
abrasion, adhesion, cleaning, corrosion, etching,
friction, and polishing because of its capacity to
provide images of the surface in atomic resolution
along with the special features such as surface
roughness (Habelitz et al., 2001).
29
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X. °KIOKA Î·È £. H§IA¢H™ MÂÛÔ‰fiÓÙÈ· Ì›ˆÛË Ù˘ ·‰·Ì·ÓÙ›Ó˘ (stripping): ÂӉ›ÍÂȘ Î·È ÂȉڿÛÂȘ
·›ÙÂÚË ‚·Ú‡ÙËÙ·, ÂÊfiÛÔÓ Ë Û‡ÓıÂÛË Î·È ÙÔÔÁÚ·Ê›·
ÙˆÓ ÂÈÊ·ÓÂÈ·ÎÒÓ È‰ÈÔÙ‹ÙˆÓ Ù˘ ·‰·Ì·ÓÙ›Ó˘ Â›Ó·È ıÂÌÂÏÈÒ‰Ô˘˜ ÛËÌ·Û›·˜ ÁÈ· ÙËÓ ·ÍÈfiÈÛÙË ÂÎÙ›ÌËÛË Ù˘ Â›‰Ú·Û˘ Ù˘ Ù¯ÓÈ΋˜ Â› Ù˘ ·ÎÂÚ·ÈfiÙËÙ·˜ ÙÔ˘ ÛÎÏËÚÔ‡
Ô‰ÔÓÙÈÎÔ‡ ÈÛÙÔ‡. ŒÓ· ·fi Ù· Ï›Á· ‰ËÌÔÛÈÂ˘Ì¤Ó·
¿ÚıÚ· Û¯ÂÙÈο Ì ÙËÓ Â›‰Ú·ÛË ÙÔ˘ ̤ÛÔ˘ ‰È·Ù‹ÚËÛ˘
Â› Ù˘ ·‰·Ì·ÓÙ›Ó˘ ¤‰ÂÈÍ fiÙÈ Ù· ‰Â›ÁÌ·Ù· ·‰·Ì·ÓÙ›Ó˘
Ô˘ ‰È·ÙËÚ‹ıËÎ·Ó ÛÂ Ê˘ÛÈÔÏÔÁÈÎfi ÔÚfi ‹Ù·Ó ÈÔ Ì·Ï·Î¿ ·fi ·ÓÙ›ÛÙÔȯ· ‰Â›ÁÌ·Ù· ‰È·ÙËÚË̤ӷ Û ÓÂÚfi
(Muhlemann, 1964). ∫·Ù¿ ηÓfiÓ·, Ú¤ÂÈ Ó· ·ÔʇÁÂÙ·È Ë ÊÔÚÌ·Ï‰Â˛‰Ë, ÂÂȉ‹ Ë ÈÛ¯˘Ú‹ Ù˘ Ô͇ÙËÙ·
ÌÂÙ¿ ÙËÓ ÔÍ›‰ˆÛ‹ Ù˘ Û ÊÔÚÌÈÎfi Ô͇ ÌÔÚ› Ó· ÂËÚ¿ÛÂÈ ÙÔ pH ÙÔ˘ ̤ÛÔ˘ ‰È·Ù‹ÚËÛ˘ (Eliades ηÈ
Brantley, 1999). √È ÂÈÙÒÛÂȘ ÙˆÓ ÚÔ·Ó·ÊÂÚı¤ÓÙˆÓ
·Ú·ÁfiÓÙˆÓ, ÔÈ ÔÔ›ÔÈ ·Ú·ÌÔÚÊÒÓÔ˘Ó ÙËÓ Ú·ÁÌ·ÙÈ΋ ÂÈÎfiÓ· Î·È ÙÚÔÔÔÈÔ‡Ó Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ Ù¯ÓÈ΋˜ Â› Ù˘ ·‰·Ì·ÓÙ›Ó˘, ‰ÂÓ ¤¯Ô˘Ó ‰ÈÂÚ¢ÓËı› ÛÙË
Û¯ÂÙÈ΋ ‚È‚ÏÈÔÁÚ·Ê›·.
∞ÎfiÌË ÌÂÁ·Ï‡ÙÂÚÔ ÂӉȷʤÚÔÓ ¤¯ÂÈ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ù·
ÚˆÙfiÎÔÏÏ· ‰ÈÂÚ‡ÓËÛ˘ Ù˘ ÂÈÊ·ÓÂȷ΋˜ ·‰ÚfiÙËÙ·˜
ÌÂÙ¿ ÙËÓ ÂÊ·ÚÌÔÁ‹ ‰È·ÊfiÚˆÓ ÌÂıfi‰ˆÓ ÌÂÛÔ‰fiÓÙÈ·˜
·‰·Ì·ÓÙÈÓÈ΋˜ Ì›ˆÛ˘ ÛÙȘ Û¯ÂÙÈΤ˜ ÌÂϤÙ˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÔÚÈṲ̂ӷ ıÂÌÂÏÈÒ‰Ë ÛÊ¿ÏÌ·Ù·. °ÂÓÈο, ÙÚÂȘ
Â›Ó·È ÔÈ Î‡ÚȘ ·Ú¿ÌÂÙÚÔÈ ·‰ÚfiÙËÙ·˜ Ô˘ ¤¯Ô˘Ó ¯ÚËÛÈÌÔÔÈËı› ÛÙËÓ Â˘Ú‡ÙÂÚË ‚ÈÔ˚·ÙÚÈ΋ ‚È‚ÏÈÔÁÚ·Ê›·
ÁÈ· ÙË ÌÂϤÙË Ù˘ ·‰ÚfiÙËÙ·˜ ÙˆÓ ÂÈÊ·ÓÂÈÒÓ. ∞˘Ù¤˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó:
·) ÙËÓ ·Ú¿ÌÂÙÚÔ ·‰ÚfiÙËÙ·˜ (Ra), Ô˘ ÂÚÈÁÚ¿ÊÂÈ ÙË
Û˘ÓÔÏÈ΋ ÂÈÊ·ÓÂȷ΋ ·‰ÚfiÙËÙ· Î·È ÔÚ›˙ÂÙ·È ˆ˜ Ë
·ÚÈıÌËÙÈ΋ ̤ÛË ÙÈÌ‹ fiÏˆÓ ÙˆÓ ·fiÏ˘ÙˆÓ ·ÔÛÙ¿ÛˆÓ
Ù˘ Ï¿ÁÈ·˜ fi„˘ ·‰ÚfiÙËÙ·˜ (ÚÔÊ›Ï ·‰ÚfiÙËÙ·˜) ·fi
ÙË ÁÚ·ÌÌ‹ ÙÔ˘ ΤÓÙÚÔ˘ ÂÓÙfi˜ ÙÔ˘ ÌÂÙÚÔ‡ÌÂÓÔ˘ Ì‹ÎÔ˘˜,
‚) ÙËÓ ·Ú¿ÌÂÙÚÔ ÙÔ˘ ̤ÛÔ˘ ÙÂÙÚ·ÁÒÓÔ˘ Ù˘ Ú›˙·˜ (Rq)
Ô˘ ·ÓÙÈÚÔÛˆ‡ÂÈ ÙËÓ Î·Ù·ÓÔÌ‹ ÙÔ˘ ‡„Ô˘˜ Û ۯ¤ÛË
Ì ÙË Ì¤ÛË ÁÚ·ÌÌ‹ a, ηÈ
Á) ÙÔ Ì¤ÁÈÛÙÔ ‚¿ıÔ˜ ·‰ÚfiÙËÙ·˜ (Rmax), Ô˘ ηٷÁÚ¿ÊÂÈ ÌÂÌÔӈ̤ӷ ¯·Ú·ÎÙËÚÈÛÙÈο Ù˘ Ï¿ÁÈ·˜ fi„˘
(ÚÔÊ›Ï) Â› Ù˘ ÂÈÊ·Ó›·˜.
√È ÔÏÏ·Ϥ˜ Î·È ÔÈΛϘ ·Ú¿ÌÂÙÚÔÈ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÛÙË Û¯ÂÙÈ΋ ‚È‚ÏÈÔÁÚ·Ê›· Â›Ó·È Èı·ÓfiÓ
ÂÓ‰ÂÈÎÙÈΤ˜ Ù˘ ÔÏ˘ÏÔÎfiÙËÙ·˜ Ù˘ ÂÈÊ·ÓÂȷ΋˜
·‰ÚfiÙËÙ·˜, ȉȷ›ÙÂÚ· fiÙ·Ó ·˘Ùfi ÂÊ·ÚÌfi˙ÂÙ·È Û ‰È¿ÊÔÚ· ‚ÈÔ¸ÏÈο Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ ÙˆÓ ÂÈÊ·ÓÂÈÒÓ ÙˆÓ
‚ÈÔÏÔÁÈÎÒÓ ˘ÏÈÎÒÓ. ™ÙËÓ ÂÚ›ÙˆÛË Ù˘ ÌÔÚÊÔÏÔÁ›·˜
Ù˘ ·‰·Ì·ÓÙÈÓÈ΋˜ ÂÈÊ¿ÓÂÈ·˜ ÌÂÙ¿ ÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘
Ù¯ÓÈ΋˜, ÌÔÚ› Ó· ÈÛ¯‡ÂÈ fiÙÈ Ì›· Û˘ÓÔÏÈο ÌÂȈ̤ÓË
ÙÈÌ‹ Ra, Ô˘ ˘ÔÓÔ› Ì›· ÁÂÓÈο Ï›· ÂÈÊ¿ÓÂÈ·, ›Ûˆ˜
Ó· Û˘Óԉ‡ÂÙ·È ·fi ·˘ÍË̤ÓË ÙÈÌ‹ Rmax, ÁÂÁÔÓfi˜ Ô˘
˘Ô‰ÂÈÎÓ‡ÂÈ ÙË ÌÂÌÔӈ̤ÓË ·ÚÔ˘Û›· ‚·ı¤ˆÓ ·˘Ï¿E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H 2002 ñ TOMO™ 5
C. GIOKA and T. ELIADES Interproximal enamel reduction (stripping): indications and enamel surface effects
PROTECTION OF THE
P R O X I M ∞ L LY- R E D U C E D
TEETH
The rough enamel surface, that stripping unavoidably
creates, raises serious concerns about the potential
risk of carries and periodontal inflammation; the latter
may derive from the location of the majority of furrows
confined in the cervical region of the crown.
Fluoridation of the stripped enamel protects the
surface from demineralization and the possible
consequent lesions and is recommended by most
authors (El-Mangoury et al., 1991; Joseph et al.,
1992).
The application of sealants on stripped enamel
surfaces has been suggested by some investigators to
eliminate the danger of caries lesions (Sheridan and
Ledoux, 1989). However, the use of sealants in the
proximal areas is not a straightforward task, since the
quality of sealing may be poor because it is difficult
to achieve dry conditions in the subgingival area.
Furthermore, the control of removal of excessive resin
and the biocompatibility of the sealer are
questionable (Jost-Brinkmann et al., 1991). Finally,
sealing would probably delay remineralization of the
grinded enamel surface that is otherwise expected to
occur within a period of nine months, with proper oral
hygiene (El-Mangoury et al., 1991).
REFERENCES
Betteridge MA. The effects of interdental stripping on
the labial segments evaluated one year out of
retention. Br J Orthod 1981;8:193-7.
Crain G, Sheridan JJ. Susceptibility to caries and
periodontal disease after posterior air-rotor
stripping. J Clin Orthod 1990;24:84-5.
De Harfin JF. Interproximal stripping for the treatment
of adult crowding. J Clin Orthod 2000;34:42433.
Eliades T, Brantley WA. The inappropriateness of
conventional orthodontic bond strength assessment
protocols. Eur J Orthod 1999;21:13-25.
El-Mangoury NH, Moussa MM, Mostafa YA, Girgis
As. In vivo remineralization after air-rotor stripping.
J Clin Orthod 1991;25:75-8.
Habelitz S, Marshall SJ, Marshall GW Jr, Balooch M.
The functional width of the dentino-enamel junction
determined by AFM-based nanoscratching. J Struct
Biol. 2001;135:294-301.
30
HELLENIC ORTHODONTIC REVIEW 2002 ñ VOLUME 5
¢ONTIKH
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X. °KIOKA Î·È £. H§IA¢H™ MÂÛÔ‰fiÓÙÈ· Ì›ˆÛË Ù˘ ·‰·Ì·ÓÙ›Ó˘ (stripping): ÂӉ›ÍÂȘ Î·È ÂȉڿÛÂȘ
ΈÓ. ŒÙÛÈ, Ë ¯ÚËÛÈÌÔÔ›ËÛË ·Ú·ÁfiÓÙˆÓ ·‰ÚfiÙËÙ·˜
·‰È·ÎÚ›Ùˆ˜ Î·È ¯ˆÚ›˜ ·Ó·ÊÔÚ¿ ÛÙË Ê‡ÛË Ù˘ ÌÂÙÚËı›۷˜ ÂÈÊ¿ÓÂÈ·˜ Î·È ÙˆÓ Û¯ÂÙÈÎÒÓ Ì ·˘Ù‹ Ê˘ÛÈÎÒÓ Î·È
‚ÈÔÏÔÁÈÎÒÓ Ê·ÈÓÔ̤ӈÓ, ‰ÂÓ ‰È·Û·ÊËÓ›˙ÂÈ ÙÔ ı¤Ì· Ù˘
ÂÈÊ·ÓÂȷ΋˜ ·‰ÚfiÙËÙ·˜ Ù˘ ·‰·Ì·ÓÙ›Ó˘.
ªÂ Ï›Á· ÏfiÁÈ·, Ë ¤ÏÏÂÈ„Ë ÔÔÈ·Û‰‹ÔÙ ·Ú·Ì¤ÙÚÔ˘
·‰ÚfiÙËÙ·˜ ˆ˜ ‰Â›ÎÙË ÙÔ˘ ‚·ıÌÔ‡ ÙˆÓ ·ÏÏÔÈÒÛÂˆÓ Ù˘
·‰·Ì·ÓÙÈÓÈ΋˜ ÂÈÊ¿ÓÂÈ·˜ Ô˘ ÚÔηÏÔ‡ÓÙ·È ·fi ÙÔÓ
ÙÚÔ¯ÈÛÌfi Î·È ÙË ÛٛςˆÛË ÛËÌ·›ÓÂÈ fiÙÈ ‰ÂÓ Â›Ó·È ‰˘Ó·Ù‹
Ë ÙÂÎÌËÚ›ˆÛË Ù˘ ·ÍÈÔÈÛÙ›·˜ Î·È ÎÏÈÓÈ΋˜ ÛËÌ·Û›·˜ Ù˘
ÂοÛÙÔÙ ÌÂıfi‰Ô˘ ÌÂϤÙ˘ Ù˘ Ù¯ÓÈ΋˜.
ª›· Ù¯ÓÈ΋ Ô˘ ÚÔÙ›ÓÂÙ·È ÁÈ· Ó· ·Ú·Î·ÌÊı› ÙÔ
Úfi‚ÏËÌ· Ù˘ ¤ÏÏÂȄ˘ ‰Â‰ÔÌ¤ÓˆÓ ÛÙÔ ı¤Ì· ·˘Ùfi
·ÊÔÚ¿ ÛÙËÓ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ªÈÎÚÔÛÎÔ›Ô˘ ∞ÙÔÌÈ΋˜
πÛ¯‡Ô˜ (AFM – Atomic Force Microscopy), Ô˘ ¤¯ÂÈ ÙË
‰˘Ó·ÙfiÙËÙ· Ó· ·Ú¤¯ÂÈ ÛËÌ·ÓÙÈΤ˜ ÏËÚÔÊÔڛ˜ Û¯ÂÙÈο Ì ÙȘ ÂÈÊ·ÓÂȷΤ˜ ·ÏÏÔÈÒÛÂȘ Ù˘ ·‰·Ì·ÓÙ›Ó˘
Û˘ÌÂÚÈÏ·Ì‚¿ÓÔÓÙ·˜ Î·È ÙȘ ÙÚÂȘ ·Ú·Ì¤ÙÚÔ˘˜ ·‰ÚfiÙËÙ·˜. ∆Ô AFM ÌÔÚ› Ó· ÂÊ·ÚÌÔÛÙ› Û ÌÂϤÙ˜ Ê·ÈÓÔÌ¤ÓˆÓ fiˆ˜ Ë ·ÔÙÚÈ‚‹, Ë ÚfiÛÊ˘ÛË, Ô Î·ı·ÚÈÛÌfi˜, Ë ‰È¿‚ÚˆÛË, Ë ·‰ÚÔÔ›ËÛË, Ë ÙÚÈ‚‹ Î·È Ë ÛٛςˆÛË ÏfiÁˆ Ù˘ ‰˘Ó·ÙfiÙËÙ·˜ Ó· ·Ú¤¯ÂÈ ·ÙÔÌÈ΋˜ ¢ÎÚ›ÓÂÈ·˜ ÂÈÎfiÓ˜ Ù˘ ÂÈÊ¿ÓÂÈ·˜ ηıÒ˜ Î·È È‰È·›ÙÂÚ·
¯·Ú·ÎÙËÚÈÛÙÈο, fiˆ˜ Ë ÂÈÊ·ÓÂȷ΋ ·‰ÚfiÙËÙ·
(Habelitz Î·È Û˘Ó., 2001).
Harris EF, Hicks JD.A radiographic assessment of
enamel thickness in human maxillary incisors. Arch
Oral Biol 1998;43:825-31.
Hein C, Jost-Brinkmann PG, Schillai G. The enamel
surface quality after interproximal stripping - a
scanning electron microscopic assessment of
different
polishing
procedures.
Fortschr
Kieferorthop 1990;51:327- 37.
Hudson AL. A study of the effects of mesiodistal
reduction of mandibular anterior teeth. Am J
Orthod 1956;42:615-24.
Jarvis RG. Interproximal reduction: a restorative
adjunct to orthodontic procedures: Part I. Aust
Prosthodont J 1989;3:51-6.
Jost-Brinkmann PG, Otani H, Nakata M. Surface
condition of primary teeth after approximal
grinding and polishing. J Clin Pediatr Dent
1991;16:41-5.
Jenkins GN. The Physiology of the Mouth. Oxford:
Blackwell Scientific Publications, 1978.
Joseph VP, Rossouw PE, Basson NJ. Orthodontic
micriabrasive reproximation. Am J Ortod
Dentofacial Orthop 1992;102:351-9.
Kimura S, Shimizu T, Fujii B. Influence of dentin on
bonding of composite resin, Part 1 -Effect of fresh
dentin and storage conditions. Dent Mater J
1985;4:68-80.
Lundgren T, Milleding O, Mohlin B, Nannmark U.
Restitution of enamel after interdental stripping.
Swed Dent J 1993;17:217-24.
Muhlemann HR. Storage medium and enamel
hardness. Helv Odontol Acta 1964;8:112-7.
Phillippe JA. A method of enamel reduction for
correction of adult arch-length discrepancy. J Clin
Orthod 1991;25:484-9.
Piacentini C, Sfondrini G. A scanning electron
microscopy comparison of enamel polishing
methods after air-rotor stripping. Am J Orthod
Dentofac Orthop 1996;109:57-63.
Proffit W, Fields HW . Contemporary Orthodontics.
St. Louis: Mosby, 2000.
Ogaard B. Oral microbiological changes, long-term
enamel alterations due to decalcification and
caries prophylactic aspects. In: Brantley WA,
Eliades T (eds). Orthodontic Materials: Scientific
and Clinical Aspects. Stuttgart: Thieme, 2001.
Paskow H. Self-alignment following interproximal
stripping. Am J Orthod 1970;58:240-9.
Radlanski RJ, Jager A, Zimmer B. Morphology of
interdentally stripped enamel one year after
treatment. Am J Orthod 1989;23:748-50.
¶PO™TA™IA TøN ¢ONTIøN
META THN TEXNIKH
∏ ·‰Ú‹ ·‰·Ì·ÓÙÈÓÈ΋ ÂÈÊ¿ÓÂÈ· Ô˘ ·Ó·fiÊ¢ÎÙ·
‰ËÌÈÔ˘ÚÁÂ›Ù·È ·fi ÙËÓ Ù¯ÓÈ΋ ·˘Ù‹ ÂÁ›ÚÂÈ ÛÔ‚·Ú¿
ÂÚˆÙ‹Ì·Ù· Û¯ÂÙÈο Ì ÙÔÓ Èı·Ófi ΛӉ˘ÓÔ ÙÂÚˉfiÓ·˜
Î·È ÂÚÈÔ‰ÔÓÙÈ΋˜ ÊÏÂÁÌÔÓ‹˜. ∆Ô ÙÂÏÂ˘Ù·›Ô ÌÔÚ› Ó·
ÔÊ›ÏÂÙ·È ÛÙËÓ ÂÓÙfiÈÛË Ù˘ ÏÂÈÔ„ËÊ›·˜ ÙˆÓ ÁÚ·ÌÌÒÛÂˆÓ ÛÙËÓ ·˘¯ÂÓÈ΋ ÂÚÈÔ¯‹ Ù˘ ̇Ï˘. ∏ ÊıÔÚ›ˆÛË
Ù˘ ÂÂÍÂÚÁ·Ṳ̂Ó˘ ·‰·Ì·ÓÙ›Ó˘ ÚÔÛٷهÂÈ ÙËÓ ÂÈÊ¿ÓÂÈ· ·fi ··Û‚ÂÛÙ›ˆÛË Î·È Èı·Ó¤˜ Â·ÎfiÏÔ˘ı˜
·ÏÏÔÈÒÛÂȘ Î·È Û˘ÓÈÛÙ¿Ù·È ·fi ÙÔ˘˜ ÂÚÈÛÛfiÙÂÚÔ˘˜
Û˘ÁÁÚ·Ê›˜ (El-Mangoury Î·È Û˘Ó., 1991, Joseph ηÈ
Û˘Ó., 1992).
√ÚÈṲ̂ÓÔÈ ÂÚ¢ÓËÙ¤˜ ¤¯Ô˘Ó ·ÎfiÌË ÚÔÙ›ÓÂÈ ÙËÓ ÂÊ·ÚÌÔÁ‹ ˘ÏÈÎÒÓ ·ÔÊÚ·ÎÙÈÎÒÓ ÙˆÓ ÔÒÓ Î·È Û¯ÈÛÌÒÓ ÛÙȘ
ÂÂÍÂÚÁ·Ṳ̂Ó˜ ·‰·Ì·ÓÙÈÓÈΤ˜ ÂÈÊ¿ÓÂȘ ÁÈ· ÂÍ¿ÏÂÈ„Ë
ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÙÂÚˉÔÓÈÎÒÓ ·ÏÏÔÈÒÛÂˆÓ (Sheridan ηÈ
Ledoux, 1989). ∂Ó ÙÔ‡ÙÔȘ, Ë ¯Ú‹ÛË ·˘ÙÒÓ ÙˆÓ ˘ÏÈÎÒÓ
ÛÙȘ fiÌÔÚ˜ ÂÚÈÔ¯¤˜ ‰ÂÓ Â›Ó·È Â‡ÎÔÏË ˘fiıÂÛË, ÂÂȉ‹ Â›Ó·È ‰‡ÛÎÔÏÔ Ó· ÂÈÙ¢¯ı› ÛÙÂÁÓfi ÂÚÈ‚¿ÏÏÔÓ
ÛÙËÓ ˘ÔÔ˘ÏÈ΋ ÂÚÈÔ¯‹ Î·È ¤ÙÛÈ Ë ÔÈfiÙËÙ· Ù˘ ·ÔηE§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H 2002 ñ TOMO™ 5
C. GIOKA and T. ELIADES Interproximal enamel reduction (stripping): indications and enamel surface effects
31
HELLENIC ORTHODONTIC REVIEW 2002 ñ VOLUME 5
¢ONTIKH
£O
ET
OP
E§
™ 1963
¢O
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X. °KIOKA Î·È £. H§IA¢H™ MÂÛÔ‰fiÓÙÈ· Ì›ˆÛË Ù˘ ·‰·Ì·ÓÙ›Ó˘ (stripping): ÂӉ›ÍÂȘ Î·È ÂȉڿÛÂȘ
Ù¿ÛÙ·Û˘ ‰ÂÓ Â›Ó·È Î·Ï‹. ∂ÈϤÔÓ, ·ÌÊÈÛ‚ËÙÔ‡ÓÙ·È
ÙfiÛÔ Ô ¤ÏÂÁ¯Ô˜ Ù˘ ·Ê·›ÚÂÛ˘ Ù˘ ÂÚ›ÛÛÂÈ·˜ Ù˘ ÚËÙ›Ó˘ fiÛÔ Î·È Ë ‚ÈÔÛ˘Ì‚·ÙfiÙËÙ· ÙÔ˘ ˘ÏÈÎÔ‡ (JostBrinkmann Î·È Û˘Ó., 1991). ∆¤ÏÔ˜, Ë ÂÊ·ÚÌÔÁ‹ ·˘ÙÒÓ
ÙˆÓ ˘ÏÈÎÒÓ Èı·Ófiٷٷ ηı˘ÛÙÂÚ› ÙËÓ Â·Ó·Û‚ÂÛÙ›ˆÛË
Ù˘ ÙÚÔ¯ÈṲ̂Ó˘ ·‰·Ì·ÓÙ›Ó˘ Ë ÔÔ›·, Ô‡Ùˆ˜ ‹ ¿Ïψ˜,
·Ó·Ì¤ÓÂÙ·È Ó· ÂÈÛ˘Ì‚Â› ÂÓÙfi˜ ÂÓÓ¤· ÌËÓÒÓ Ì ۈÛÙ‹
ÛÙÔÌ·ÙÈ΋ ˘ÁÈÂÈÓ‹ (El-Mangoury Î·È Û˘Ó., 1991).
C. GIOKA and T. ELIADES Interproximal enamel reduction (stripping): indications and enamel surface effects
Radlanski RJ, Jager A, Zimmer B, Bertzbach F.
Scanning electron microscopic research on the
clinical use of interdental stripping. Fortschr
Kieferorthop 1990;51:117-22.
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