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Orthodontics with Aligners: Decisions between Stripping, Expansion, and Extractions

Foto del escritor: Gilberto SalasGilberto Salas


In orthodontics with aligners, the decision between performing extractions, stripping or applying expansion depends on multiple factors, including the available space, aesthetics, and the long-term stability needs of the treatment. Here are the pros and cons of each option:


Expansion


-Expansion is often preferred when avoiding enamel reduction and creating space in the arch without resorting to extractions. Aligners allow for controlled expansion movements, adjustable through specialized tools like Curve Arch in ArchForm, which centralizes expansion in key areas such as the premolars. Additionally, 3D biomechanics help facilitate controlled movements, avoiding adverse effects on the periodontal ligament and cortical bone. Expansion also promotes safe, controlled bone remodeling, enhancing treatment predictability. However, in cases requiring significant expansion or patients with periodontal compromise, it is essential to adjust forces to protect supporting tissues.


Stripping (Interproximal Enamel Reduction or IPR)


Stripping is a conservative technique used to gain minor space without significantly altering the arch structure. This process involves slight enamel reduction in interproximal areas and is suitable when only minimal space is required, or in cases where expansion may not be aesthetically favorable or stable. While stripping preserves the bone structure, enamel reduction raises concerns for long-term dental health, making it primarily recommended when space adjustments are minimal, offering a more conservative alternative to expansion or extractions.


Extractions in Orthodontics


Extractions are necessary in cases of severe crowding or when the space required for alignment and occlusion cannot be achieved through safe expansion alone. The three main uses of extractions in orthodontics are as follows:

  • Space for Alignment and Occlusal Control: Extractions can create the necessary space for proper alignment in cases where the arch is narrow, and expansion is not viable without compromising periodontal or aesthetic structure.

  • Facial Profile Control: Extracting strategic teeth, such as premolars, may improve the facial profile in patients with dental or lip protrusion, avoiding a “bulging” lip appearance that could result from excessive expansion.

  • Long-Term Stability: In some cases of Class II or Class III malocclusions, extraction facilitates a better relationship between the arches, promoting greater occlusal stability over time.


Summary


Expansion is a preferable option to create space without reducing enamel, aided by 3D tools and biomechanics that improve treatment predictability and safety. Stripping is a conservative approach for minor space adjustments, preserving bone structure though potentially impacting enamel health long-term. Extractions are essential in complex cases where expansion alone is insufficient or aesthetically unviable, providing benefits in facial profile control, occlusal alignment, and long-term stability.

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