How to Perform IPR

IPR, or Interproximal Reduction, involves making slight spaces between neighboring teeth to facilitate necessary movements during orthodontic treatments. This method trims the sides of the teeth that are close together, to create space, that will be closed with further orthodontic movement. IPR is also used as an aesthetic means to reduce `black triangles` - the natural gap that occurs from receded gingiva. Always refer to the treatment guide that comes with your aligners which will indicate the specific IPR amounts and locations. It's important to document each IPR session, noting the specific teeth and the extent of reduction. Treatment planning specifies the likely aligner stage to perform IPR determined by projected contacts between those teeth. 

Instrument Options:

• Diamond Strips: Medium (blue 0.125mm) , Fine (red 0.1mm) , Extra-fine (yellow 0.08mm)
• Low Speed Diamond Discs: Coated on the bottom, both sides, or top
• High Speed Burs: Mosquito, Needle
• IPR Gauges: 0.3mm, 0.2mm, 0.1mm

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Additional Guidelines:

• Keep clear of the patient’s tongue, lips, and cheeks using a mirror and cheek retractor for safety.
• Secure your hand using a finger or thumb rest for better control over the handpiece and to properly align the disc or bur with the area of contact.
• Regularly check the spacing achieved using unwaxed dental floss and IPR gauges. Always maintain a log of all IPR procedures conducted.

Performing IPR

For 0.1mm Reduction using Hand Strips:

This is the most conservative and recommended method to perform IPR

• Instruments:
  • Fine and Extra-fine diamond strips
  • IPR gauges
• Procedure:
  
  • Break contact with a 0.08mm (yellow) diamond strip
  • Use the 0.1mm (red) diamond strip in a sawing motion to move back and forth between the teeth in the contact area, typically taking 8-12 strokes depending on the patient.
  • Turn the strip over and repeat the sawing motion for another 8-12 times. Afterward, rinse the area thoroughly.
  • Use the 0.1mm gauge to measure the space between the teeth to ensure adequate spacing.
  • If the gauge doesn't fit, more IPR may be necessary until the required space is achieved.

For 0.2mm Reduction using Hand Strips:

•  Instruments:
  • Fine and Extra-fine diamond strips
  • IPR gauges
• Procedure:
  
  • Break contact with a 0.08mm (yellow) diamond strip
  • Use the 0.1mm (red) diamond strip in a sawing motion to move back and forth between the teeth in the contact area, typically taking 8-12 strokes depending on the patient.
  • Fold the strip in half (so that its twice as thick) and repeat the sawing motion for another 8-12 times. Afterward, rinse the area thoroughly.
  • Use the 0.2mm gauge to measure the space between the teeth to ensure adequate spacing.
  • If the gauge doesn't fit, more IPR may be necessary until the required space is achieved.

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For 0.3mm Reduction using Hand Strips:

•  Instruments:
  • Medium, Fine and Extra-fine diamond strips
  • IPR gauges
• Procedure:
  
  • Break contact with a 0.08mm (yellow) diamond strip
  • Use the 0.1mm (red) diamond strip in a sawing motion to move back and forth between the teeth in the contact area, typically taking 8-12 strokes depending on the patient.
  • Use the 0.125mm (blue) diamond strip in a sawing motion to move back and forth between the teeth in the contact area, typically taking 8-12 strokes depending on the patient.
  • Fold the blue strip in half (so that its twice as thick) and repeat the sawing motion for another 8-12 times. Afterward, rinse the area thoroughly.
  • Now place the red strip between the folded blue strip so that its three times as thick - this will equal about 0.3mm thickness of space
  • Use the 0.3mm gauge to measure the space between the teeth to ensure adequate spacing.
  • If the gauge doesn't fit, more IPR may be necessary until the required space is achieved.

 

For 0.2mm Reduction using a slow speed disc:

• Required Tools:
  • Diamond disc (single or double sided)
  • IPR gauges
  • Optional: Fine or extra-fine diamond strip
• Procedure:
  • Select the appropriate single-sided diamond disc based on the tooth's position and direction as indicated in your treatment plan.
  • Have a dental assistant retract the patient's lips and cheeks and hold the tongue using a mirror or retractor to prevent injuries.
  • Position the disc parallel to the contact area and start the handpiece. Move the disc from the facial side to the lingual side, stopping when you reach the interdental papilla or feel the contact break.
  • Use dental floss to confirm the contact break and a diamond strip to smooth any sharp edges or roughness left by the disc.
  • Insert the 0.2mm gauge between the teeth to check for the appropriate spacing.

For 0.3mm Reduction using a slow speed disc:

• Required Equipment:
  • Double-sided diamond disc
  • IPR gauges
• Procedure:
  • Ensure a dental assistant is available to safely hold back the patient’s lips and cheeks and to keep the tongue out of the way using a mirror or retractor. Adjust the handpiece neck if necessary to avoid any interference with the front teeth.
  • Position the diamond disc parallel to the area between the teeth. Start the handpiece and carefully move the disc from the facial side to the lingual side. Continue until you reach the top of the interdental papilla or notice that the contact has been broken.
  • After completing the disc movement, thoroughly rinse the area. Then, place the 0.3mm gauge between the teeth to confirm that the correct space has been created.