Pre-IPR Evaluation by the Doctor
Pre-IPR Evaluation by the Doctor
- Decide if the recommended IPR should be performed at this appointment or postponed to a future visit.
- Identify which tooth surfaces need to be contoured.
- Choose the appropriate tools and techniques for the procedure, such as abrasive strips or single/double-sided discs.
- Remember that doctor has control over timing, location and amount of IPR performed
Pre-IPR Staff Preparation
- Upon seating the patient for new aligners, review the treatment setup or plan to determine if IPR is advised during this session.
- Ensure that the patient or their guardian comprehends what the IPR entails.
- Arrange all instruments as specified by the doctor.
- Confirm and note the exact locations and dimensions for the IPR
Conducting IPR
- Avoid performing IPR in areas where there is already spacing.
- Always verify tooth contacts before proceeding:
- Use dental floss to check for tight contacts; presence indicates good aligner compliance and the treatment can proceed.
- Absence of contact suggests possible non-compliance; in this case, instruct the patient to continue wearing the current aligners for an additional 1-2 weeks and reassess at the next visit.
- For use with a slow speed disc, ensure safe and clear access to the IPR sites:
- Consider using a disc guard for difficult-to-reach areas.
- Start with the back teeth and move forward.
- Use a low RPM initially to achieve the correct angle, then increase RPM for effective reduction.
- Have an assistant direct a stream of air/water at IPR location to clear debris.
- Regularly monitor both the front and back sides of the teeth to prevent excessive reduction.
- Apply gentle pressure; allow the abrasive instruments to do the work.
- To achieve the specified amount of IPR:
- Use abrasive strips for 1 mm of reduction: 0.08mm (extra fine), 0.10mm (fine), or 0.13mm (medium).
- Use a one-sided disc for 2 mm, and a double-sided disc (0.15-0.2mm thick) for 3 mm, by moving it back and forth until the desired spacing is achieved.
- After reduction, pause to check if the contact is completely eliminated.
- Ensure complete separation during the reduction; you will notice less resistance and slight blanching of the gum.
- Verify the new space with an IPR gauge.
- Refine the tooth shape post-IPR:
- Angle the reduction properly to maintain the tooth's aesthetic.
- Inspect the contoured surfaces for any irregularities using an explorer or floss.
- Smooth any sharp edges with diamond burs or abrasive strips.
- Record the details of the IPR performed, including the extent and specific locations. Following these guidelines will help ensure a smooth and efficient treatment session as you prepare to provide the patient with their next set of aligners.
Procedure for Contouring
Contouring involves using a diamond strip to adjust the contact points between teeth, specifically after interproximal reduction (IPR). The goal is to shape these areas into a convex (curved) rather than flat surface to enhance the tooth's natural appearance.
Initial Condition After IPR: Typically, using a diamond disc for IPR results in flat surfaces between teeth with potential sharp edges, which might not be aesthetically pleasing or physiologically functional.
Objective: Proper contouring modifies these flat areas and sharp corners to mimic the natural curvature of teeth, concealing any signs of IPR. This not only improves the appearance but also facilitates better alignment by allowing teeth to rotate smoothly without sharp corners causing space issues. Rounded edges can also enhance oral hygiene as they create ideal contact points rather than flat contacts which can trap food particles and plaque.
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Instruments Needed for Contouring:
Diamond Strips (available in medium, fine, and extra-fine grits)
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Steps to Contour Teeth:
Smooth the Edges: After completing IPR, use a diamond strip to smooth any sharp corners on the teeth.
Technique: Shape the strip into a "U" form and maintain this shape while moving it back and forth across the tooth's surface. Focus on the edges you wish to round off, avoiding extensive contact with the central part of the interproximal area to prevent over-reduction.
By following these detailed steps, you can ensure that the teeth not only look better but are also positioned to meet functional standards of dental health and aesthetics.