A dentist can intentionally reduce or “grind” down a tooth’s structure to achieve a better bite. This controlled tooth reduction is known professionally as odontoplasty, enameloplasty, or occlusal adjustment. These procedures involve the precise removal of very small amounts of the outermost layer of the tooth, the enamel, to reshape the surface. The goal is to smooth or re-contour the tooth to correct minor alignment issues or functional problems. Adjustments are always performed conservatively, focusing on minimal alteration for functional or aesthetic improvement.
Specific Reasons for Tooth Reduction
Intentional tooth reduction serves both functional and cosmetic improvements. The primary functional goal relates to how the upper and lower teeth meet. Occlusal adjustment eliminates “high points” in the bite that prevent the jaw from closing correctly. These interferences cause uneven pressure, contributing to excessive wear or temporomandibular joint (TMJ) discomfort, but reducing these contact points harmonizes the bite, ensuring all teeth contact simultaneously and evenly.
Tooth reduction is also used to create space, particularly with orthodontic treatment. Interproximal Reduction (IPR) reduces the width of teeth on their sides to resolve minor crowding or alignment discrepancies, often eliminating the need for extraction. This modifies the mesiodistal dimension, allowing teeth to shift into better positions as guided by braces or clear aligners. Generally, no more than 50% of the proximal enamel is removed to maintain structural integrity.
Dentists perform enameloplasty to address minor cosmetic and comfort issues. This involves smoothing sharp or jagged edges resulting from a small chip or natural wear. Sharp points can irritate the tongue, cheek, or gums, and smoothing them improves oral comfort. Aesthetic reshaping also includes leveling uneven incisal edges of the front teeth for a more balanced smile line.
The Technique of Reshaping Teeth
Reshaping a tooth involves highly controlled mechanical removal of the enamel surface, typically performed with specialized instruments. Dentists use fine diamond burs or abrasive discs mounted on a slow-speed handpiece. These tools allow for gradual, incremental reduction, which maintains control and prevents the removal of too much tooth structure.
For work between the teeth, such as IPR, the dentist may use thin abrasive strips to gently file the contact points. This manual method provides exceptional tactile control for minimal reduction. Throughout the process, the dentist employs a water spray to dissipate frictional heat generated by the rotary instruments, preventing thermal damage to the dental pulp.
After reduction, the treated surface is meticulously smoothed and polished. Grinding can initially create a rougher enamel surface, making it susceptible to plaque accumulation. The final step involves using progressively finer polishing tools to restore the surface to a high luster. Because the procedure involves only the outermost layer of the tooth, it is typically performed without local anesthesia and is generally painless.
Limits and Irreversibility of Enamel Removal
The most significant constraint on tooth reduction is the finite nature of dental enamel, which cannot regenerate once removed. Any intentional reduction of tooth structure is an irreversible modification, necessitating a cautious, conservative approach that limits the procedure to only minor adjustments.
The maximum safe depth of reduction is dictated by the thickness of the enamel layer, which is thickest on the chewing surfaces. If reduction extends too far, it exposes the underlying dentin, which is less dense and contains microscopic tubules. Dentin exposure can lead to increased tooth sensitivity, especially to hot and cold temperatures.
Tooth reduction is not appropriate for large structural corrections or for teeth that already have significant enamel loss or deep decay. In cases requiring substantial reshaping or bite correction, the dentist will recommend alternative treatments that cover and protect the tooth, such as a dental crown or a veneer. The procedure is reserved for minor adjustments where the structural integrity of the tooth can be maintained.