Has your orthodontist suggested interproximal reduction (IPR) if you want to have braces? If yes, that means he or she is concerned about correct adjustment during orthodontic treatments.
between adjacent teeth to make space for better alignment
Dental braces are used to treat crooked teeth. In order to provide some extra space between teeth so that they can adjust correctly, a procedure called interproximal reduction, or IPR, might be needed. IPR is the removal of tooth enamel in between adjacent teeth.
The purpose of the procedure is to create more space for better alignment and correct issues like crowded teeth. This procedure is usually done to improve your bite and make your smile attractive.
IPR is also referred to as slenderizing, selective reduction, or stripping and has been recommended by orthodontists worldwide. Studies have shown that after IPR, the chances of tooth decay decrease.
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Do you really need IPR?
The answer to that question is primarily dependent on the orthodontist's examination. Factors such as size, shape, alignment, and position of your teeth will determine whether reshaping them will be beneficial or not. The ultimate goal here is to improve the health of your teeth through the appropriate orthodontic procedure.
The front teeth framework and their position can change your facial appearance completely. The evaluation for this is done through photographs or x-rays, and after that, the IPR ortho determines the extent to which you need enamel reduction.
Usually, IPR is relatively painless because the outer layer of the tooth doesn’t have any nerve endings, though you may feel some discomfort or sensitivity during the procedure. Also, after your teeth are smoothed and polished, you’ll see a visible difference in your facial characteristics.
To get a better understanding of the concept and procedure involved, watch this video from Dr. Greg Asatrian.
Enamel reduction techniques in IPR orthodontics
There are both mechanical and manual systems for the IPR procedure, and your orthodontist will use the most efficient one for your case. The extent of enamel reduction, abrasive property decay, and reduction efficiency are some of the factors the orthodontist will consider.
The manual method of teeth reduction mainly involves the use of metallic strips coated with metal oxides, abrasive discs, air rotor stripping, and some holding devices. These metal strips can be handheld or motor-driven and are used for anterior and minor tooth reduction. Your IPR orthodontist will use them for re-contouring the anterior and minor teeth. This technique is less aggressive than the mechanical system, and patients report some discomfort during the procedure. With any method of IPR, you may experience some sensitivity after the procedure.
There are different manual methods, but let's look at the most common clinical ones.
Air rotor stripping with fine tungsten-carbide or diamond burns
This method ensures precision in the reduction of interproximal enamel. It allows the orthodontist to create space between teeth quickly, and there’s no need to extract teeth with this procedure.
Abrasive diamond discs
These discs are used if orthodontists need to remove more enamel than abrasive strips can handle, both for separating and contouring. Available in different sizes, they can be double- or single-sided.
Apart from manual methods, there are some mechanical methods too. The tools used for mechanical reduction consist of discs for hand pieces or counter-angles and mechanical files for contra-angle heads with shuttle movement. These are used for added precision in the removing tooth tissue with little pressure. Only heat and vibration is used to cut the tooth very smoothly.
Here’s a comparative chart of manual and mechanical enamel reduction techniques:
| Manual | Mechanical | |
|---|---|---|
| Pros | No risk of cutting into the soft tissue; enamel surface is smoother | Disc guard is used to protect the patient; reduces working time |
| Cons | Chance of debris being left behind; time-consuming when used for buccal teeth | Risk of excessive enamel reduction; not flexible |
What is the interproximal reduction process?
IPR isn’t a particularly tedious process. It typically involves a few steps, and the procedure’s accuracy depends on the experience of the orthodontist performing it.
Step 1: Planning
In this step, the orthodontist determines the extent of enamel reduction needed. For this, the exact morphology for your teeth needs to be examined. Calibrated radiographic images are the most feasible clinical application used to identify exactly which teeth are to be slenderized.
Step 2: Interproximal area access
This is a very important step to protect the proximal areas. At this stage your IPR ortho will place appliances or guards to protect the proximal teeth prior to stripping.
Step 3: Protecting soft tissues
The ARS (air-rotor stripping) guidelines clearly suggest using brass or steel indicator wire to protect the soft tissue. This type of hardware will protect your oral tissues from interproximal gingival lesions that can be caused by the revolving diamond disc.
Step 4: Interproximal enamel removal by manual or mechanical methods
mechanical methods.
Manual methods for performing this procedure are often criticized because they’re time-consuming. Also, it’s believed that they aren’t applicable to posterior teeth and produce some errors that are irreversible. Considering the advantages over manual methods, mechanical methods (such as the use of diamond discs or segment discs) are becoming the first choice for orthodontists.
Because they can rotate 360 degrees, discs improve visual access for the orthodontist, which is very important in minimizing the risk of errors. Disc guards are also mounted over the hand piece to protect the adjacent teeth.
Step 5: Finishing and polishing the enamel surface
The last and final step of the procedure includes polishing the corners of the IPR teeth with a cone-shaped triangular diamond bur. This process is also called re-contouring. After tooth reduction, it’s very important to carefully shape the teeth to the original contours.
Step 6: Topical fluoride treatments
After the above-mentioned steps have been completed, it’s recommended that orthodontists treat tooth surfaces with fluoride gel to prevent enamel demineralization.
Conclusion
Interproximal reduction might sound like a complicated procedure, but for orthodontists, it’s a routine process that’s meant to enhance the results of other teeth straightening treatments, like braces. With the increasing demand for aesthetics and customized approaches to treatment, this method has evolved and emerged as an alternative to arch wires and brackets.
FAQs
What does IPR mean in orthodontics?
IPR stands for interproximal reduction, a technique used by orthodontists to create a temporary space between the teeth using a disc or strip. The procedure involves slenderizing teeth to create more space for teeth to move during orthodontic treatment.
Will interproximal reduction damage my teeth or gums?
Studies have shown that a patient who has gone through interproximal reduction is less susceptible to tooth decay and gum diseases. However, tooth reduction may cause some sensitivity, which is common with many types of dental treatments.
