Interproximal Reduction: Are you a master or a beginner?
If IPR is a focus area for you, you’re in good company. With the continued rise in demand for aligners and fixed braces, IPR is a hot topic. Dr Arti Hindocha is working in partnership with DB Orthodontics to spread awareness on how clinicians can improve their IPR techniques, working practices, and review the performance of their current products.
Recently, in July's Clinical Dentistry, Arti Hindocha Shared her top ten tips for performing successful Interproximal Reduction. Here's what she said...
Tip 1. Consent.
This is an irreversible procedure with risks. Your consent form must outline why you need to carry out interproximal reduction (IPR) and how much enamel you are aiming to remove. You must consent the patient fully according to the Montgomery law and explain all associated risks and benefits.
Tip 2. Case assessment/indications.
IPR is not just used to relieve mild/moderate crowding (quantified as 1-8mm of crowding), it can also be used to eliminate black triangles, correct centrelines, reduce overjets, and contour teeth. Plan your cases carefully, and make sure the patient understands why you are utilising IPR as part of their treatment objectives.
Tip 3. Tooth form and size.
Triangular and barrel shaped teeth allow for more enamel reduction than
parallel sided teeth. Remember that lower incisors have the least amount of enamel (0.77mm on average per side). Avoid removing more than 0.75mm enamel from the lower incisors. A maximum total of 0.5mm (incisors)
and 0.8-1mm (premolars/molars) enamel removal is advocated. If you
have already carried out the maximum IPR and need to incorporate more, take
a periapical/bitewing to assess whether further reduction is appropriate.
Tip 4. Risks.
Iatrogenic damage such as enamel ledges can occur, leading to pain, sensitivity or even caries. Excessive removal of enamel can lead to residual spaces
and soft tissue injury is likely if retractors are not used. Always retract the soft
tissues if the system you use does not have protective frames around the strip/
file. Be mindful of the gingival tissues. Avoid IPR in under 18s. If necessary, take a radiograph to assess enamel thickness and root parallelism.
There are two types of system used for enamel reduction: mechanical and manual. Manual systems include strips and files while mechanical systems include burs, discs and files (calibrated and non-calibrated). I advise using a calibrated mechanical system with an oscillating handpiece (eg, Orthofile G5 Prolign). This prevents soft tissue injury, saves time and prevents hand cramp! Manual files with a frame around the strip (eg, Airo strips) may also eliminate the need to protect the labial and buccal soft tissues.
Airo Strips are popular for manual interproximal reduction.The Swiss Dentacare Prolign Kit offers a minimally invasive protocol with calibrated files, a design feature currently exclusive to Swiss Dentacare in the UK market.
Tip 6. Access to interproximal areas.
Create space prior to carrying out IPR. If you have not created space, place wedges anteriorly or separators posteriorly to gain access to the contact points. Stage your IPR. Incrementally build-up to the maximum of 0.5mm, if required. Book enough time to carry it out safely. Always use a measuring gauge to check how much enamel you have removed.
Tip 7. Polishing the teeth.
This step is crucial. If adequate polishing is not performed, scratches and furrows are likely to remain in the enamel surface. This promotes adherence of plaque, increasing susceptibility to dental caries. It is assumed that the finer the grain size used for removing enamel, the easier and less time-consuming the subsequent polishing.
Tip 8. Fluoride varnish/mouthwash.
Apply topical fluoride or ask your patient to rinse with a
fluoride mouthwash at home. As patients may not follow recommended
instructions, I place fluoride varnish as part of my protocol. Application occurs
once I have polished the teeth.
Tip 9. Document everything.
For instance: ‘IPR carried out LR3-LL3 using manual strips to relieve crowding. 0.25mm per mesial and distal surface, measuring gauge used. Total of 1.5mm enamel removed. Soft tissues retracted. All contact points polished. Fluoride varnish placed. Patient warned of temporary sensitivity’.
Tip 10. Resources.
Use the British Orthodontic Society (BOS) website (www.bos.org.uk) for patient information leaflets on IPR to aid the consent process and statements to help patients understand that they should see a dental professional to undertake their orthodontic treatment.
In partnership with Dr Arti Hindocha
DB Orthodontics is delighted to be supported by Dr Arti Hindocha. Arti uses the Swiss Dentacare Prolign kit to carry out efficient IPR on her own fixed brace and aligner patients. Click the link below to view the latest Aesthetic Catalogue featuring a selection of DB Orthodontics products - including IPR ranges - that will enhance your orthodontic treatments and clinical practice.
About Arti Hindocha
Arti Hindocha qualified with Honours from King's College London (2009). She specialised in orthodontics at Eastman Dental Institute and Kettering General Hospital obtaining her MClinDent and M.Orth from the Royal College of Surgeons England (2015, 2016). She completed a further two years of higher orthodontic training at the Royal London Hospital and William Harvey Hospital. Qualifying as a consultant in 2018, with her Fellowship in Orthodontics from the Royal College of Surgeons. She is currently a consultant orthodontist at Kettering General Hospital and works in 2 private practices in Wimpole Street and Northampton.
She is a member of the British Orthodontic Society, British Lingual Orthodontic Society, European Orthodontic Society. She has been President of the European Postgraduate Student Orthodontic Society (EPSOS), postgraduate representative on the Royal College of Surgeons Board and is currently Secretary of the European Federation of Orthodontic Specialists Association (EFOSA).
The views stated in this article are the views of Dr Arti Hindocha, Arti is working in partnership with DB Orthodontics to raise awareness of good IPR practices for GDPs and Orthodontists carrying out both fixed and aligner treatments, as part of a thorough care plan. Her recent presentation “Interproximal Reduction: Best Practice in Easy Slices” offers a comprehensive guide to IPR, including the benefits of a minimally invasive approach.
Click here to view DB Orthodontics’ latest Aesthetic Catalogue featuring mechanical calibrated IPR kits and manual IPR products.
About DB Orthodontics
It is our company mission to become a global leader in orthodontic and laboratory supplies. With over 45 years of experience in orthodontics, we recognise the importance of quality, service and innovation. Working to ISO13485 standards we strive for perfection in all that we do, from unique product design to the excellent service provided by our dedicated customer service and sales teams. We are continually developing our product range, designing innovative products through consultation with leading orthodontists from the world, to ensure that our products meet the high standards expected by today’s practitioners.