Interproximal reduction (IPR) can be a very useful approach to gaining space to align teeth. In many cases it can be employed instead of or in combination with expansion or proclination to avoid the need for orthodontic extractions. While IPR is a relatively simple and safe procedure; patients typically always have questions surrounding it and to some patients the notion of "filing the teeth" can conjure images of skinny little pegs akin to teeth that have been prepped for crowns.
When patients have a good understanding of interproximal reduction (IPR) it not only puts them at ease but also allows you as the clinician to be more efficient in performing it, confident in the knowledge that your patient is fully on board and comfortable!
Often patients will not have heard of IPR, and may not understand why the teeth cannot simply be moved into position without the need for extra procedures. It is here that your occlusal photographs can be of huge help! Showing these to the patient and pointing out areas of overlap will allow them to quickly realise that there is simply not enough space present to accommodate all of their teeth. Once they see a need for some answer to this puzzle, they tend to be more engaged in your explanation of the concept of IPR.
Pro Tip: Many times here- we say something along the lines of: “in order to make your teeth straight, we need space. There are a few ways to make space (1) expansion, which means pushing your teeth into a wider circle (2) IPR and (3) in severe cases, extraction or taking teeth out! In your case, good news! We do not need to take any teeth out; however, if I widen things too much then your bite will be compromised. Utilizing IPR will allow you to have nice straight teeth that won’t flare out!”
Additionally, if you notice that your patient has black triangles or has made a comment in regards to the shape of their teeth-there may even be additional benefits to IPR.
Likening the process to shaping fingernails, just removing a third of a millimetre from the white part of the nail, is a fair reflection of the process. If you emphasise just how minimal the dimensions are this can be reassuring as it is important to steer the patient away from thoughts of "drilling teeth".
Pro Tip: Sometimes patients are wondering the long term effect of IPR on their teeth but are unsure how to ask. It could always be good to reassure the patient that research has not shown that IPR under a certain amount, does not have any detrimental effects on their teeth (ie. no increased risk for cavities!) so the amount you will be doing is safe!
Lastly, you also want to prepare the patient for the process of IPR itself. If you don't cover this topic then they can assume the worst and dread the appointment. You can inform them that it's such a surface level adjustment that there is no need for any injections or numbing. In instances in which the patient has anxiety around the process, sometimes showing him/her the hand strip (if you use them) and pointing out how “thin” it is can relieve some of their fears!
Remember you can always stage the IPR in a timeline that suits you, the patient and/or the case. If your patient is perhaps a little anxious, it can be beneficial in some cases to delay the IPR so that it is not performed at the first visit. This allows them to get accustomed to the aligners and perhaps the attachments before commencing IPR at a later stage.
We know IPR can be one of the more daunting procedures in orthodontics. We want you to be set up for success armed with effective and proper communication to patients!
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