Teeth alignment is one of the most requested procedures in orthodontic practice. However, to give your patient an ideal smile, you must ensure they have enough space between their teeth for the Guber metallic self-ligating braces to move their teeth into the right spot.
So, what happens when your digital X-ray machine shows your patient has insufficient space between their teeth? You take advantage of Interproximal Reduction (IPR).
IPR helps create space between your patient's teeth, allowing enough room for the perfect alignment that corrects issues like crowded teeth. Interproximal reduction is exceptionally effective for treating open bites and improving the aesthetic appeal of the patient's smile.
However, how do you use interproximal reduction in your orthodontic practice? Stick around—this detailed guide will show you how!
Does Your Patient Need Interproximal Reduction?
To answer this question, you must first conduct an orthodontic exam. Factors like teeth position, alignment, shape, and size will play a role in deciding whether to take advantage of IPR.
As noted earlier, you will need the patient's dental x-ray to see their teeth' arrangement clearly. Digital x-rays should give you a 3D view of the patient's teeth, allowing you to zoom in and out of the x-ray image and get a closer view—this should inform your decision.
If you discover your patient needs an IPR before you can install the braces and the NiTi heat-activated archwires, this should not be a surprising diagnosis to them. The procedure is painless—you can always let them know that all you will be doing is working on their teeth' outer layer, which has zero nerve endings.
What Are the Different IPR Orthodontic Procedures You Can Implement?
Depending on your patient's situation, you can opt for manual or mechanical interproximal reduction. You can either handhold the metal strips or opt for the motor-drive version. The manual metal strips will work well for your patient if they need minor anterior tooth reduction.
Many IPR (enamel reduction) methods exist in orthodontic practice today. However, the two most commonly used are:
1. Air Rotor Stripping
This method uses fine diamond or tungsten-carbide burns. The technique guarantees precision when reducing your patient's interproximal enamel in preparation for their 3D or 4D teeth alignment installation.
This procedure makes the enamel reduction faster—you quickly create the space your patient needs for midline correction or to fix any other malocclusion they may have. It also eliminates the need for teeth extraction.
2. Abrasive Diamond Discs
You will need this method if your digital x-ray shows you have to remove more enamel than your abrasive strips can handle—this method works for contouring and separating. Abrasive diamond discs are available in varying sizes, and you can get both single-sided and double-sided versions for your clinic.
Abrasive diamond discs add precision when removing the enamel to create enough room for the Forestadent self-ligating bracket to do its work. This type of equipment adds some pressure and cuts the tooth smoothly.
What Steps Do You Need to Follow When Using IPR on Your Patient?
Don't worry—interproximal reduction is not cumbersome. You will need to follow a few simple steps, including planning, prepping, reshaping, polishing, and then using fluoride for treatment. We will explain these steps below:
Step #1: Plan the Procedure
In this step, you will figure out the enamel reduction extent your patient needs. To plan an ideal IPR procedure, you must determine the patient's exact morphology—calibrated radiographic images will be of much help. The photos will help you choose the teeth you'll need to slenderize.
Step #2: Prepare the Interproximal Access Area
This step aims to ensure your patient's proximal areas are 100% safe from the interproximal reduction procedure. You will need to install guards and appliances that improve safety at this stage. You will have to do this before initiating the stripping.
Step #3: Protect the Soft Tissues
You do not want to inflict pain on your patient. Therefore, you must ensure that the enamel reduction procedure does not affect their soft tissues.
Using an air-rotor stripping procedure, leverage a steel or brass steel indicator wire to protect the soft tissue. This should be effective enough to cover the patient's tissues, reducing the risk of suffering from interproximal gingival lesions that often result from the revolving disc.
Step #4: Reduce the Enamel
It would be best to choose between manual and mechanical procedures when reducing the enamel. However, most orthodontists tend to criticize the manual methods as they consume a lot of time and do not always work for the patient's posterior teeth. For this reason, you may want to go with the mechanical options.
Segment and diamond discs offer a 360-degree rotation, giving you more visual access and minimizing the chances of making errors. You can mount disc guards to protect the patient's adjacent teeth.
Step #5: Finishing & Polishing
The last step in interproximal reduction involves polishing the corners of your patient's IPR teeth. For this, you can use a cone-shaped triangular diamond burr.
The polishing procedure is also known as re-contouring. After the enamel reduction, it's vital that you carefully shape your patient's teeth to their original contours.
Step #6: Topical Fluoride Treatment
Finally, you will want to protect your patient from enamel demineralization. You can use a fluoride gel to treat the teeth' surface.
Overview
Interproximal reduction is a routine process that guarantees better results with teeth straightening and alignment. You can use this procedure on your patients if you determine their teeth are too close together that the teeth straightening may not deliver the desired results.
Interproximal reduction is a painless procedure. You will be working on the patient's enamel, which has zero nerves; therefore, the only thing they will have to deal with is discomfort but no pain. To further reduce the risk of pain—which can result from unexpected injuries—install the proper guards before initiating the procedure.
We hope this detailed guide has answered all your questions about using IPR. If we missed some questions, let us know in the comments—we will respond immediately.
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