Tooth reshaping as an integral part of orthodontic treatment

Teeth may be reshaped for various reasons as a part of orthodontic treatment. Common examples of tooth reduction include removal of mamelons where lack of tooth contact has prevented significant abrasion and recontouring fractured, uneven incisal edges. Following trauma, central incisors may end up with an unfavourable width-to-length ratio, and this was discussed in a case involving ankylosed central incisors following avulsion and re-implantation.¹ Other examples where teeth need reshaping include patients with congenitally missing lateral incisors where treatment results in canine substitution for the laterals.² Tooth reshaping may also be required as mesial and distal enamel reduction (interdental stripping) as an alternative to the extraction of permanent units. It is a popular method for gaining space which allows alignment of irregularly positioned teeth.^3,4

Excluding third molars, maxillary lateral incisors are the most commonly congenitally missing teeth with a reported incidence of 2%.⁵ When patients present with missing lateral incisors, historically the space was often opened up for placement of adhesive bridges or single-toothed implants. Recently, with the improvement of bleaching techniques, canine substitution increasingly forms part of the treatment plan. Contouring the canine appropriately and ensuring that the canine cusps are sympathetically reduced can give the illusion that they are lateral incisors.²