Written by Dr. Febin Mary George | Medically Reviewed by Dr. Zein El Hammouz, DDS, MFD/RCSI.
Interproximal reduction is a very common procedure that is performed during orthodontic treatment. Every procedure has its own significance and the same holds true for interproximal reduction or IPR. So, what is IPR (interproximal reduction) and why is it done? Is it really necessary? This article is meant to tell you everything that you need to know about IPR as a doctor or a patient.
Dental IPR, commonly referred to as tooth polishing, slenderization or stripping, is a routine procedure carried out before you start your orthodontic treatment.
Though a very common procedure, IPR orthodontics is not meant to be done for every orthodontic case.
It involves the removal of a very small amount of enamel interproximally (tooth surfaces or areas between two adjoining teeth) to create space.(1) This space is utilized by the clear aligners or braces to align the crowded teeth.
Yes, in some select cases, IPR is necessary for clear aligners. Your doctor will inform you if you require IPR after evaluating your case.
The main objective of IPR is to gain space by reducing the width of the teeth. The space so created helps in aligning the crowded teeth in the most natural way within the patient’s mouth.
1.2.1 Provision of/ creating spaces
In some cases, when a tooth is outside the correct dental alignment, the dental arch needs to be expanded minimally to accommodate the misaligned tooth and bring it back to its correct position.(2) Hence, IPR is immensely helpful in patients with slight to moderate dental crowding as one need not plan tooth removal to create space.
1.2.2. Front teeth protrusion
With the help of IPR, protruding front teeth can be fixed.(13) In front teeth protrusion, the upper front teeth flare out and sit infront of the lower front teeth when the upper and lower teeth are brought in contact with each other. In some cases, the lower front teeth can be angled more outwards than upper front teeth. IPR is performed on the front teeth of the protruded arch to make enough room for pulling the front teeth back to normal alignment.
Though interproximal reduction and tooth extraction are ways of gaining space to fix issues with tooth alignment, they are used in different situations.(3) Your dentist along with the Eon Aligner team will decide if IPR is ideal for you or not.
In cases of mild to moderate crowding, IPR may suffice whereas severe or complex crowding cases may need extraction of teeth. By just reducing an extremely thin layer of enamel, extraction of sound and healthy teeth can be avoided in mild cases of crowded or protruded teeth.
IPR is an orthodontic technique that flattens the contact surfaces of teeth through filing of the teeth.Dentists employ this technique for managing mild to moderate crowding, reducing the flaring of the front teeth and eliminating the need of tooth removal. (4) With the help of IPR, the teeth need to be moved only to shorter distances as compared to cases of tooth extraction. Moreover, there is an increase in stability of the orthodontic treatment leading to lesser chances of relapse. According to Sheridan, IPR is very effective in resolving a crowding of 2.5mm in the front teeth.(5)
Patients may not understand what is IPR and what its potential benefits are. Hence, it is necessary for dental practitioners to explain it in simple terms. The best way to describe interproximal reduction would be - “polishing the sides of the teeth to make space, which can be used to align the teeth correctly.”
Generally, the IPR dental kit contains the following products-
Are you upset with those black triangular spaces in between your teeth when you smile? Interproximal stripping could be the right solution for you! Black triangles are actually open gingival embrasures and you may be having them due to-
Flared teeth is when the upper front teeth called the incisors are projecting outwards and forwards. (14)Trimming the teeth through IPR makes it possible for the orthodontists to pull the flared teeth back through clear aligners by making use of the space created by interproximal reduction.
IPR is an excellent non-invasive technique of creating space that can help in bringing about effective teeth movement through clear aligners. The ideal candidates for IPR are those with (8):-
No. The tooth is reduced by orthodontists who understand the physiology of every tooth. Hence, you can rest assured that your teeth will not be damaged as the reduction is done in accurately, in harmony with the natural oral structure, based on the correct measurements.
Your nerves that pick up the pain signals are located within the pulp, the deepest layer of the tooth. As enamel is the most superficial layer and only an extremely thin layer is shaved off during the process of slenderization, you will not feel any pain.
No. Once the enamel is lost, it will not grow back. But the good news is that the enamel removed through IPR is well within the safe limits and will not pose any harm to you as it’s very minimal.
IPR, specifically, will not lead to gum disease, whatsoever.(9) Gum diseases totally depend on the way you maintain your oral hygiene. Hence, brush and floss routinely so that your gums remain healthy and strong
Studies show that 50% of the enamel on the proximal surface of a tooth can be safely trimmed without any periodontal or dental risks.(10) Most commonly, only a very fine layer of enamel is removed. And the recommended amount is most of the time divided between two teeth. For instance, if 0.5mm IPR is recommended for one contact point, then 0.25mm from each tooth of that contact point is removed.
The entire procedure may take only a couple of minutes and a bit longer when done manually. The time depends on the number of teeth that need to undergo IPR.
The cost of IPR dental may vary according to the patient needs. Minor IPR procedures may cost you anywhere between $50 to $300. Contact your orthodontist to get a clearer picture about the cost of every step involved in your clear aligners treatment.
While opting for clear aligners, you should consider consulting a qualified dentist who has the necessary skillset to meet your dental needs effectively. Every step of clear aligners need accuracy and genuine experience so as to achieve the desired outcome.
IPR may have a couple of side effects. Most of these are due to excessive trimming or inaccuracy of the dentist. Common side effects of interproximal reduction are (11)-
Before IPR, the orthodontic specialist should evaluate the condition of every tooth in the arch and then decide on the amount of IPR needed. This is because every tooth has a different morphology and hence, a different thickness of enamel interproximally.
After IPR, the specialist polishes the trimmed interproximal surface to avoid creating ledges . In some cases, you may be advised to avoid cold beverages in the first few days after IPR to reduce discomfort. Your doctor will note down all the changes in width of the teeth due to interproximal reduction before and after.
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