IPR - Best Practices

Know before you go

IPR (interproximal reduction) is a procedure where, by reducing the proximal surfaces of the teeth, a very small amount of space between the teeth is created to allow the teeth to move during treatment. IPR is often recommended when treating patients with clear aligners.

There are a number of important things to keep in mind when you perform IPR.

Know before you go

• The amount and location of IPR will be recommended by ClearCorrect, but those recommendations are not absolute.
• You can let us know how you want to perform IPR (which teeth, when and how, no IPR, expansion, limited IPR, limited expansion, etc.).
• IPR is always at the discretion of the clinician and it’s up to you to make any necessary changes.
• Let us know what you want in the IPR and additional instructions sections of the form when you submit your case.

Pre-IPR review by doctor

• Determine whether to perform the recommended IPR at this appointment. (You may choose to delay some of the IPR until the next appointment.)
• Determine if pre-IPR separation is needed due to any excessive crowding or rotation. (Pre-IPR separation is when an orthodontic separator, rubber or wire is placed between overlapping teeth to move them apart sufficiently to make room for the IPR disc to fit interproximally. Depending on the amount of crowding, the separator can be left for a few minutes to up to a day or two.)
• Determine which surfaces of the teeth will be reduced.
• Determine which intruments and methods you want to use (abrasive strips, single- or double-sided discs, etc.).

Pre-IPR preparation by staff

• When patient is seated for delivery of new aligners, review the treatment setup or the treatment plan sent with the case to see if IPR is recommended at this appointment.
• If yes, confirm that the patient or parent understands the procedure and has signed an informed consent form.
• Prepare instrumentation as required by doctor.
• Identify locations and measurements of the IPR to be performed.

Pre-IPR preparation of the patient

• Fully explain the IPR procedure to the patient (and the patient's guardian, if appropriate) before beginning.
• Discuss improbable, but possible, negatives:
• Sensitivity/discomfort
• Bleeding gums, lips, or cheeks
• Feeling of a slight “vibration” on the tooth
• May feel some pressure on the gums
• Mis-shaped anatomy
• Does not increase possibility of cavities
• Always get signed consent before performing IPR.
• Perform any pre-IPR separation of the teeth, if necessary.
• Apply a small amount of topical anesthetic, if preferred by the patient.

Performing IPR

• Don’t do IPR where there’s already space.
  
• Always check compliance before doing IPR:
  • Check for contact between teeth with dental floss.
  • Contact means patient is compliant (has been wearing their aligners). Continue treatment as planned.
  • No contact means patient is likely not complying. Don't continue with the next step yet. Have the patient wear their current step for another 1-2 weeks and re-check for compliance at the next appointment.
• Secure safe and adequate access to the IPR site(s):
  • Consider using a disc guard if access is tenuous.
  • Begin with the most posterior sites, working anteriorly.
  • Begin with low RPM until desired angulation is achieved, then increase the RPM to make the reduction.
• Have your assistant direct an air stream across the IPR site away from your and the patient’s face.
• Be sure to constantly observe both the labial and lingual aspects to ensure that the teeth are not being cut inappropriately.
• Use light pressure on the instrument – let the abrasives do the cutting.
• To perform the amount of IPR indicated on the treatment plan:
  • 0.1 mm IPR can be achieved with abrasive strips that are 0.08mm (extra fine), 0.10mm (fine) and 0.13mm (medium).
  • 0.2 mm IPR can be achieved with a one-sided disc that is 0.1 mm thick.
  • 0.3 mm IPR can be achieved with a two-sided disc that is 0.15 to 0.2mm thick, by gently moving the disc back and forth, mesially and distally in the interproximal space until the desired space is made.
• To confirm that the contact has been fully broken, stop the instrument and gently push it against the gum tissue.
• When reducing a contact, be sure to break the contact all the way through. The resistance will diminish and the gum tissue will blanch.
• Confirm interpoximal space created by using an IPR thickness gauge.
• Idealize the tooth anatomy post-IPR:
  • Angulate the cuts so that they do not disturb the appearance of the tooth.
  • Check the reduced surfaces with an explorer or floss to see if there are any nicks or ledges on the tooth.
  • Use diamond burs or abrasive strips to round off any sharp corners.
  • Document IPR performed including the amount and location. You can use the IPR Tracking Chart on our Help Center or place notes directly on the treatment plan or other paperwork.

  Following these best practices can help make an otherwise possibly uncomfortable experience for the patient a simple and quick visit before handing out their next set of aligners.