Mastering IPR Orthodontics: A Comprehensive Guide to Safe Enamel Reduction

December 27th, 2023.

Dr. Rodrigo F. Viecilli, DDS, PhD

Board Certified Orthodontist

IPR stands for interproximal reduction. IPR orthodontics (technique), IPR dental (technique), interproximal reduction technique, are all synonyms of a common procedure for creating more space between teeth, often needed for optimal alignment that can sometimes avoid the need for dental extraction as part of the orthodontic braces or Invisalign treatment plan. This concise guide will explain when an IPR dental procedure is recommended, its safety, and its pivotal role in orchestrating a successful orthodontic treatment.

Key Takeaways for IPR Orthodontic Procedure

  • Interproximal reduction (IPR) is a technique in dentistry designed to do several things:

    1. Correct asymmetry of certain teeth widths that can cause issues with the bite fit of the patient.

    2. Correct proportions between the teeth in the dental arches – lower and upper teeth (Bolton discrepancy)– For instance, an upper lateral incisor is around 75% of the width of the upper central. If it’s smaller or absent, it can lead to spaces in the upper arch or crowding in the lower arch. The lady in the picture below has lower incisors slightly smaller than average, which could cause crowding in the lower arch. Sometimes, this can be corrected with interproximal reduction (or by extracting teeth) to create space and it is one of the main reasons I see for it to be performed clinically. Another way to correct this would be to increase the width of the lateral incisors with composite (filling material) or a veneer. The choice depends on whether the patient thinks she will look better with a larger lateral incisor. If she doesn’t care, interproximal reduction is a no cost or low option that keeps all teeth natural.

      Bolton analysis of the dental arches

      Below you see an illustration of slightly better proportion:

      Good anterior teeth proportions often don't need interproximal reduction (IPR Orthodontics)
    3. Correct abnormalities of the patient’s dental shape (teeth that are too large in width or have a barrel or triangular shaped teeth) that are causing issues with the bite or crowding, or black triangle spaces near the gumline while the teeth themselves touch.

    4. Indirectly, or directly, create space for dental alignment by removing small amounts of enamel, producing both aesthetic and practical benefits such as enhanced tooth shape and less crowding. For instance, lower crowding can be caused by an incorrect bite due to a larger lower jaw or an increased overbite (deep bite). A proper diagnosis on how to create space to correct crowding is necessary before interproximal reduction is done. Make sure your dentist or orthodontist checks the Bolton values- doing IPR for crowding can be a “lazy” way to correct it if is not optimum for the bite. Interproximal reduction must be done in the correct places to not misalign the bite. It can’t just picked randomly. Sometimes the jaws are too small for the teeth and we have to choose between IPR and tooth extractions for treatment. An orthodontist will make the best choice for your facial appearance and based on the amount of enamel that can be removed.

  • A skilled professional must perform interproximal reduction to harmonize the dental arches within recommended guidelines (no more than 50% of proximal enamel removal) to minimize risks such as dental damage and sensitivity. Sometimes, if the discrepancy of dental widths is too much, we may have to suggest restorations (veneers of fillings) of opposing teeth.

  • Interproximal reduction is both a standalone procedure and a complement to Invisalign treatment and braces, aiding in the customization of orthodontic treatments for both adults and younger patients. Invisalign software usually makes the IPR recommendations very precise due to the use of the digital 3D images of teeth in the proper occlusion, but the dentist makes the final decision on the occlusion.

  • Invisalign technicians may leave a deep overbite during treatment or are forced to because a dentist elected a case for a cheaper modality of Invisalign that doesn’t support overbite correction. Always make sure that you have a second opinion from an Orthodontist before undergoing substantial IPR planned for Invisalign treatment by a general dentist. You may end up not needing it at all, and I say that based on experience in consultations.

Demystifying IPR: A Primer on Interproximal Reduction

Dental tools used in orthodontic treatment

Interproximal Reduction, otherwise known as IPR in the orthodontic field, is a procedure intended to correct size to size or arch to arch tooth proportions or compensate for black triangle spaces near the gumline.

It accomplishes this by selectively removing minor portions of tooth enamel on specific sides of teeth with precision and care. The primary aim behind it is to make use of space more efficiently so that proper dental placement can be achieved along with tighter fitting between neighboring pearly whites. In other words, it’s like giving your choppers some extra wiggle-room when adjusting them into their ideal position!

IPR has numerous perks associated with it. Such as generating necessary clearance required for successful teeth straightening outcomes which leads to improved overall shape and symmetry – Eliminating gaps around the gum line that could mar an immaculate smile even than desired.

Results are typically far more stable not forgetting aesthetically pleasing at well when accomplished properly from qualified personnel only due to its potentially hazardous effects including heightened sensibility or exaggerated elimination beneficial layers if administered through non-specialized means.

BOOK A FREE CONSULTATION WITH US HERE TO SEE IF INTEPROXIMAL REDUCTION IPR IS RIGHT FOR YOU

The Need to Correct a Tooth Size Discrepancy: Bolton Analysis

Comparison of tooth sizes in Bolton Analysis is instrumental for interproximal reduction

Orthodontic treatment is necessary to address issues such as overcrowding or spacing due to discrepancies in tooth size. This calls for Bolton Analysis, a quantitative measurement that evaluates the maxillary and mandibular teeth proportions of an individual. It furnishes information about any differences between the sizes surrounding crowded teeth – this helps attain proper alignment with overjet and bite conditions plus aesthetic enhancement of dental rehabilitation which can be done via Interproximal Enamel Reduction (IPR orthodontics) or restorations.

According to the Bolton study, the sum of all widths of lower left canine to right canine teeth divided by all widths of the same upper teeth should be approximately 77.2%. The sum of all widths of upper teeth from molar to molar divided by all widths of upper teeth should be 91.3%. The most common problems that cause a Bolton discrepancy, which is a deviation from these values are: small upper lateral incisors, large lower premolars and large upper central incisors. Obviously, missing or extra teeth will also cause major issues in dental size proportions.

Teeth enamel reduction or buildup with restorations thus play a crucial role while engaging in orthodontic practice aimed at achieving ideal results for the patient. Make sure to always ask your dentist or orthodontist if a Bolton analysis and proper bite analysis was done to prepare more space for a restoration or perform IPR.

If you plan to do your treatment with a general dentist, usually IPR is their main method or “tool” to correct dental crowding because it’s easy to do. Due to the larger number of misdiagnosis and less than ideal treatments with IPR we see in our practice consultations, we recommend you ask for a Bolton analysis result or take a second opinion from an Orthodontist to see if IPR is the best solution for you, especially if you are hesitant.

Orthodontists have a lot more training than general dentists to diagnose if you really need IPR or it’s being done as “an easy way out” of dental crowding. As some would say, if the only tool you were trained to use to fix something is a hammer, you will use the hammer almost all the time.

BOOK A FREE CONSULTATION WITH US HERE TO SEE IF IPR IS RIGHT FOR YOU

The Need for Space: How Interproximal Reduction Helps Align Crowded Teeth and Correct Black Triangles

IPR particularly works well on front teeth when it comes to alleviating overcrowding issues. As much as 6mm can be created in each of the dental arches with its help which helps those patients who have triangular shape teeth that are often victims of crowding problems and need not endure extractions involving their molars or premolars due to an available ample amount of space.

Sometimes patients present with ” dark triangles” or “black triangles”. These black triangles are a black space between the dental contact and the gums caused by bone loss, or abnormalities of dental shape and may require IPR or bone and gingival grafting for correction. In these cases, IPR can be indicated, and the main objective is to reduce the black triangles or black space between teeth.

Precision Matters: Ensuring Safe Enamel Removal

The IPR process requires gentle abrasion with very thin diamond discs or diamond-tipped strips that will surround crowded teeth at the proximal surfaces for removing small portions of dental enamel surfaces. The amount taken away by these stainless steel or round orthodontic wire gauges varies from 0.2mm widths and upwards as approved standards dictate it should be done so in order to minimize any potential risks.

Many times, we need to use unilateral abrasion surfaces on the discs or strips to make sure only target teeth and not adjacent teeth are decreased in width contact area.

Potential risks are less resistance to damage by cavities since there will be less enamel, or prolonged sensitivity post procedure when performed properly without exceeding prescribed limits on reduction size. Interproximal reduction does not expose any nerve endings, but it can make physical stimuli such as heat or cold reach more easily inside the pulp more easily if the enamel is completely removed and the dentinal tubules where the nerve endings extend into are exposed.

Protecting the tooth pulp is critical when performing ipr (interproximal reduction)

When the risks outweigh the benefits of IPR to gain space, and too much has to be done, permanent tooth extraction or extractions may be recommended to create more space. Studies have proven that there isn’t a heightened risk associated if safety measures are met during interproximal reduction.

BOOK A FREE CONSULTATION WITH US HERE TO SEE IF IPR IS RIGHT FOR YOU

The Interproximal Reduction Procedure: What Patients Can Expect

Close-up of dental instruments

Interproximal Reduction IPR involves using specific tools to delicately remove a small amount of enamel from the outer surfaces of teeth, allowing to achieve extra space and resulting in what patients may call dental polishing. It is relatively painless, with minimal aftercare required.

Tools of the Trade: Instruments Used in IPR

Interproximal reduction treatment makes use of different dental instruments like rotating diamond discs and specialized tools that are exclusively designed for reducing enamel. The dentist carefully files down the tiny amount between teeth from the top edge to the gum line, which provide quality results along with ease and efficiency.

Many use burs, but we at Limestone Hills Orthodontics don’t because slight movements of the patient’s mouth or the friction associated with a small bur makes the procedure a lot more prone to cause dental damage.

Polishing is then done with interproximal strips for tooth polishing to prevent rough surfaces. These can have different polishing grades and will also help recontour and round the edges of the teeth to the desired outcome.

Keeping Comfort in Mind: Does Interproximal Reduction IPR Hurt?

Interproximal reduction is a very common procedure, that many people have concerns about regarding the potential pain involved. Fortunately, most individuals don’t experience any significant discomfort when undergoing this routine operation, reporting only slight pressure and mild sensitivity at worst.

The sensation associated with IPR typically isn’t as intense compared to some other dental procedures either. It can be carried out safely by an experienced dentist without causing much distress for patients. Sometimes, minor bleeding near the gums can happen as we have to assure the contour is smooth all the way below the contact point with the gumline.

old, dentist sign, signage

Patients almost never feel anything, and anesthesia is not necessary. It’s important to follow the instructions of the provider and in the case of sensitivity due to heat generated during IPR, not move suddenly. We suggest just lifting a hand so we can move slower if needed. Every person has a different level of sensitivity.

BOOK A FREE CONSULTATION WITH US HERE TO SEE IF IPR IS RIGHT FOR YOU

After the Procedure: Caring for Your Teeth Post-IPR

To reduce the potential for damage and dental decay after having IPR, patients should engage in good dental hygiene habits such as daily brushing and flossing while also adhering to regular check-ups.

This consistent approach will help keep any post-procedure issues minimized since you will have less enamel available to protect your tooth. Thus, interproximal reduction IPR is contra-indicated in individuals with questionable dental hygiene habits that may be a problem in the future.

Illustration of teeth sizes and shape variations

Beyond Aesthetics: The Functional Benefits of IPR Orthodontics

Properly performed Interproximal Reduction IPR provides not only visual enhancements and enough space, but also important functional advantages. It is essential in improving bite function by narrowing the width of teeth to help with alignment and optimize occlusion while creating even tooth surfaces, that will uphold tooth positioning following treatment.

IPR likewise benefits oral hygiene as it reduces strain on periodontal support plus encourages beneficial tooth contouring leading to no increased risk for gum disease making this procedure secure when considering periodontal health maintenance. The necessary space needed for proper alignment between each individual tooth can be made possible through moderation provided by interproximal reduction.

The Safety Profile of Interproximal Reduction

Safety guidelines for enamel reduction in IPR

Performed by a qualified and knowledgeable dentist, IPR is considered a safe orthodontic procedure. Although with only the suggestion of removing no more than 50% of proximal enamel for ensuring long-term protection and healthiness in teeth.

How Much is Too Much? Guidelines on Enamel Reduction

Maintaining the guidelines while performing Interproximal Reduction is paramount for protecting and preserving good oral health. It’s essential to avoid that more than 50% of the proximal surface enamel between two teeth should ever be eradicated in order to avert any dental or periodontal risks.

Understanding precisely how much enamel gets extracted during this method is very crucial. In our practice we take CT scans of the teeth and can tell exactly how much enamel is available to assure your safety.

Long-Term Outlook: Is Interproximal Reduction Safe for Future Dental Health?

Patients often have worries about the long-term effects dental IPR might have on their oral health. But research shows that, when done correctly, it does not make one prone to cavities or periodontal disease. Nor is there a heightened risk of sensitivity in the aftermath.

Potential risks of ipr treatment exist – as previously discussed. It is paramount for patients seeking such procedure to get treated by only qualified professionals to preserve a healthy amount of enamel layer.

We never had issues with patients with increased sensitivity after IPR after thousands of patients treated. Which doesn’t mean it will never happen, but it means we make sure to follow safety protocols to avoid problems.

BOOK A FREE CONSULTATION WITH US HERE TO SEE IF IPR IS RIGHT FOR YOU

Customizing Your Smile: IPR in Conjunction with Clear Aligners and Braces

To facilitate the movement of teeth, the IPR method creates room for successful use of both clear aligners or braces.

invisalign, clear aligners, dental

This combination empowers a more exhaustive approach to orthodontics through precise extraction of enamel from teeth for ideal results in every patient’s case.

Tailored Treatments: IPR for Specific Dental Shapes and Positions

The IPR method stands out in its great adaptability. It can be altered to suit particular teeth shapes and positions, giving patients the best results possible with a beautiful smile as well.

For certain teeth that are not aligned straight or at an angle, extra care must be taken during IPR by taking off some enamel which will then make room for proper alignment of such teeth. This individualized approach ensures each patient gets their bite just right, so they have full dental function without any complication.

Achieving Harmony: Balancing IPR Across All the Teeth

Achieving a harmonious, well-aligned smile requires an even distribution of IPR across all teeth and making sure dental widths are measured properly to avoid creating asymmetry.

To ensure this is done correctly and achieve the desired result, it’s imperative that dentists focus on certain specific areas for adjustment while taking into account the overall alignment correct position and balance of the dental arches.

Any unevenness or miscalculation while performing IPR can lead to numerous issues such as crowding, excessive incisor flare, midlines, occlusion or bites off or discrepancies with size between teeth.

woman, smile, beauty

Instability due to bone loss or recession can also occur, which can also have detrimental effects on gum health and TMJ disorder development too. For these reasons, there must be emphasis placed on ensuring consistency when conducting IPR among every single one of your patients, for maximum aesthetic effect.

IPR for Adults: Not Just for Teens and Kids

For adults seeking orthodontic care, IPR is often an effective solution that offers several advantages. It reduces tooth width and provides the necessary space in cavities to ensure proper alignment of teeth. Thereby improving overall dental health.

Patients with mild to moderate crowding requiring either enough space or only a small amount of additional space can benefit greatly from this type of treatment which has been performed on numerous adult patients worldwide.

Lifelong Smiles: The Role of IPR in Adult Orthodontics

IPR is a vital part of adult orthodontic treatment. It serves to rectify tooth size discrepancies as well as promote oral health, allowing adults the chance to get the smile they desire. IPR proves immensely helpful in tackling problems such as overcrowding and can also often create room between teeth quickly without having any teeth extracted, making it an important factor for sustained dental wellness over time. This procedure helps modify dentition in order that each individual has a perfectly shaped grin tailored specifically towards them for optimal aesthetic purposes.

woman, face, freckles

Payment Options and Accessibility: Making IPR Feasible for Adult Budgets

Orthodontic treatment which includes interproximal reduction can be expensive for some adults. Fortunately, there are several methods of payment available to make it easier on the wallet and more accessible. The cost usually ranges from $50-350 per case if the dentist or orthodontist charges for it.

We don’t charge for IPR in our practice and consider it part of orthodontic treatment. Most orthodontists offer discounts or installment plans if you pay upfront or use their own financing service that allows payments over time. Dental insurance might cover a portion of your expenses too! All these options help minimize out-of-pocket costs related to IPR Orthodontics so as not to overwhelm individuals with hefty bills all at once.

Summary

Orthodontics IPR, or Interproximal Reduction, is an important orthodontic procedure performed, which can help create the space needed for successful tooth alignment and improve tooth shape. This necessary step can often but not always prevent tooth extraction and can result in a beautiful smile when done by qualified professionals.

By using IPR, you may increase the chances achieve optimum outcomes with your teeth. It is routine procedure should always be performed correctly in order to secure their health and longevity over time. With proper care given throughout each stage of this process, having that sought-after beautiful smile could soon become reality!

BOOK A FREE CONSULTATION WITH US HERE TO SEE IF IPR IS RIGHT FOR YOU

Frequently Asked Questions

What is IPR in dental terms?

IPR in dentistry, more specifically orthodontics, is a routine procedure that stands for interproximal reduction, a technique used to remove small amounts of enamel between teeth to aid in orthodontic treatments involving overcrowding or reshaping.

How much does IPR cost for teeth?

The amount of money one has to pay for teeth shaving, also referred to as IPR, depends on the complexity and individual patient’s needs. This procedure can be between $50-$1,500. Some dental plans may contribute towards covering these expenses. We don’t charge anything extra for it in our office.

What is the IPR process for teeth?

The process for teeth which utilizes flexible strips or diamond-coated discs to delicately remove a small amount of enamel from crowded sections permits clear aligners to move the teeth more efficiently.

Is IPR only for teens and kids?

IPR is not only for teenagers and young ones. It can be an advantageous option to consider by adults who require orthodontic treatment as well, with the procedure often conducted on adult patients.

Is IPR painful? Does Interproximal Reduction Hurt?

Patients typically experience no pain or discomfort during IPR treatments, only slight pressure or sensitivity at most.

BOOK A FREE CONSULTATION WITH US HERE TO SEE IF IPR IS RIGHT FOR YOU