Stripping: contribution to the control of iatrogenic periodontal effects

Abstract

The gum and the gingival festoon in particular are essential elements of the good periodontal health and the harmony of the smile. How does this engage orthodontics? Orthodontists are directly concerned by the vertical position of the collars which they must consider. More indirectly, they can have an influence on the gum festoon and in particular on the papillae. The analysis of the literature of the undesirable effects of orthodontics on the periodontium is provided but with limited conclusions which do not constitute scientific evidence. It remains very important to analyze them in order to draw a guide of clinical conduct. The vestibular version and the alveolar expansion present risks of gingival recession that must be taken into account. The presence of the papillae responds to precise anatomical conditions that have to be controlled to avoid disastrous black triangles when aligning the teeth. The shape of the teeth is directly involved in these phenomena. Stripping may be an appropriate therapeutic response to prevent or limit these iatrogenic effects. The approach is first of all diagnostic (identification of the shape of the teeth, analysis of the dento-dental disharmony (DDD), evaluation of the amount of stripping and its consequences on the DDD) and then prognostic in order to establish the treatment plan... The author will illustrate this approach by the teachings of the literature and by clinical illustrations of treated cases. The balance of a smile is based on the respect of shapes, anatomical proportions and the conditions necessary for healthy tissue. It is our role to respect them in the project of establishing harmony. The beauty of the smile reflects the patient's own personality: «Orthodontists are the technicians of the semaphore of the soul», Axel Kahn, Journées de l'Orthodontie, 2007.