Before you Start
Interproximal reduction (IPR) may be critical to your treatment plan. While Orthosnap can create space through full-body movement arch expansions, there are still circumstances where IPR is prescribed and must be adhered to in order to achieve certain tooth movements and results. With IPR, a small space is created by reducing the proximal surface of a tooth. But it can also be used to contour teeth and help eliminate black triangles.
Before performing IPR, keep the following important information in mind to help increase patient comfort and reduce anxiety.
Remember that...
Orthosnap will make recommendations for the location and amount of IPR needed to achieve ideal results.
As the treating doctor, the final decision and any necessary changes are up to you.
If you do not intend to perform the IPR, please inform Orthosnap so we can make adjustments to the treatment plan.
You can always reach out to our support at support@orthosnap.com for additional guidance or training for a specific case.
Orthosnap will provide an IPR guide specific to your patient, that will look like this:
Informing the Patient
Explain the procedure to the patient or guardian, making sure they fully understand the procedure will slightly change the appearance of the tooth and doesn’t increase the risk of dental decay.
Discuss possible risks, including:
Discomfort or sensitivity
Pressure sensation
Feeling vibrations on the tooth
Possible bleeding lips, gums, or cheeks
Once you have answered all the patient’s questions, and they fully understand and agree, be sure to get informed consent signed.
Pre-IPR Preparation
Follow the prescribed instructions on when to perform the IPR. Orthosnap will recommend where and when to perform the IPR.
If the patient has excessive rotation or crowding, pre-IPR separation may be needed.
Before performing each IPR, locate and confirm which teeth and surfaces need reduction.
Choose your preferred method and instruments. For instance, depending on the amount and surface of the tooth where IPR is needed, you may choose either
Single or double-sided discs
Abrasive strips
Oscillating handpieces like the Intensiv Swingle
A flame-shaped bur
[TIP: You can find some of these products at shop.orthosnap.com]
We've found the best results when using a combination of the Swingle and abrasive strips.
After each cut, measure with an IPR thickness gauge. Caution as forcing a gauge into an interproximal space should be somewhat passive. Otherwise, you're just compressing PDL space.
Guidelines for selecting the right tool:
Abrasive Strips. Depending on the amount of IPR you are trying to achieve, you can use one or some combination of the following abrasive strips:
0.13 mm (medium)
0.10 mm (fine)
0.08 mm (extra fine)
Abrasive strips are best used for creating small spaces: 0.1mm. You can fold the strip to double the thickness. While not totally accurate, it can help achieve the desired thickness for reduction. Keep in mind that abrasive strips get worn out quickly but they're safe and are less prone to ledging.
Discs are very efficient but can quickly create a problem if you are not careful. They are best used for creating 0.2mm and 0.3mm of space. Use a wooden wedge to create a little space between teeth first. To achieve a 0.2 mm IPR, you can use a 0.2 mm one-sided or double-sided disc, depending on the treatment plan instructions. To achieve a 0.3 mm IPR, you can choose either a 0.3 mm one-sided or double-sided.
It should also be noted that discs can wobble and create more space than you originally planned. Start small, see what happens, then adjust.
Oscillating Handpiece. Our clinical team's preferred tool. You can start off by using a space opener and increase the thickness as you are able to access the appropriate surface. The attachments can also be bent to contour to the tooth's surface, which is extremely helpful.
Please check with your tool manufacturer for specific information on your tool. Also, check if your tool is single or double-sided as that also impacts the performed action. Start by performing a cut with the thinnest attachment you have, measure the cut with a thickness gauge, and then use that to assess what you performed matches up to what was expected/written in the guide.
Here is a guide from Intensiv to help you determine the thickness of your attachments...
Tips for Performing IPR
For patient comfort, consider the use of a topical anesthetic.
Consider the use of a disc guard if access is questionable.
Start with posterior teeth and then progress anteriorly.
Remember to allow the instrument to do the cutting—only use light pressure.
Aim the IPR tool so that you are cutting perpendicular to the tooth, not diagonally. The reduction needs to happen at the future interproximal contact point
Keep the RPM low until you have achieved the desired angulation. Then, increase RPM to perform the reduction.
Gently move the disc back and forth in the interproximal space to achieve the desired reduction. Don't add pressure.
While performing the reduction, have an assistant direct a stream of air across the site, away from you and your patient’s face.
Diligently observe the lingual and labial aspects, making sure you cut the teeth appropriately and aren't overly reducing the facial or lingual surfaces of the teeth.
Be careful not to damage adjacent teeth. Proceed slowly and cautiously. If access is still an issue, contact Orthosnap for guidance or to adjust the treatment plan.
Final Steps
Stop the instrument and carefully push it against the gum to ensure the contact is fully broken.
Using an IPR thickness gauge, confirm the interproximal space.
Angulate the cuts to improve the appearance of the tooth. Using a hand strip is ideal here to shape the tooth.
Using floss or an explorer, check for ledges or nicks on the tooth.
Round off sharp corners with abrasive strips or diamond bur.
Document the IPR, including the location and amount.
Generally, practices tend to underperform IPR, so it's good to use the IPR thickness gauge to confirm that you have the right thickness.
Need a visual demonstration of IPR techniques? Check out this youtube video by Jaz Gulati Skip to approximately min 38 to see how he performs the procedure with the oscillating handheld.
If you have questions or need to speak with someone at Orthosnap, please reach out to us at support@orthosnap.com.