Dr. Jerry Gildner

	Dental crowding is just one of countless conditions for which a patient seeks orthodontic care. Solutions for creating more space in these cases range from extractions or comprehensive treatments like arch development using fixed or removable orthopedic appliances, to more conservative options like interproximal reduction (IPR). While IPR is not the solution for every patient, it is particularly suitable for those whose malocclusion can be corrected by creating a small amount of space. In addition, IPR is effective for correcting Bolton tooth-size discrepancies, for keystoning an arch, and for simply creating the necessary space for clear aligner therapy.Traditional IPR procedures rely on diamond-impregnated strips or handpiece-powered discs to make the all-important initial cut and to follow through with the complete amount of reduction required. These methods, however, can be frustrating because of their inherent levels of unpredictability and the danger of injury to the patient. In addition, diamond-strip methods are time-consuming, uncomfortable for the patient, and often awkward for the dentist-particularly when making the initial opening reduction. Likewise, standard-shaped discs are unsatisfactory because of their 360° rotation and the required guards that encircle the discs. These guards obstruct the doctor’s vision, easily leading to tissue lacerations, inaccuracies or ledging of the adjacent teeth.

	A simple solutionThe IPR Starter Kit (LD0528) addresses the limitations of traditional IPR techniques, eliminating user frustration and patient discomfort and adding precision, safety and reliability to the procedure.

	Its contact breakers provide a simple and effective method for making an initial reduction of 0.18 mm, effectively eliminating the need for diamond strips or discs in this phase. Once that initial cut is made, the appropriate 0.20 mm instrument easily slides into the space created and is used to continue the reduction, followed as needed by the remaining discs to gradually and safely achieve the desired amount of interproximal reduction. Obstructed vision is no longer a difficulty thanks to the pairing of an oscillating handpiece with the OS instrument’s wedge shape and perforated design. The practitioner finally has unimpeded access to the interproximal areas, creating unparalleled safety and predictability in a procedure that, until now, has been inherently inconsistent.

	This case involves a 32-year-old female patient who sought an orthodontic evaluation of her crowded, misaligned teeth (Fig. 1). Her primary concerns were tooth crowding and esthetics, and she was unwilling to pursue conventional orthodontic treatment. A treatment plan was created to address these points as well as the additional clinical concerns of protruding lower incisors and gingival recession. Following three months of arch development consisting of removable mandibular and maxillary functional appliances, the patient was ready to begin Invisalign® treatment.

A wooden wedge was inserted into the interproximal area to protect the gingival tissue (Fig. 2). 

Note: This step is optional, but it is particularly useful to operators just becoming familiar with the system. 

The appropriate single-sided contact breaker was selected to initiate the first reduction at a position that provided straight-line access to the contact (Fig. 3). Note: If both interproximal surfaces are equally accessible, the tooth with the greatest height of contour should be selected for the initial reduction.

The instrument was positioned so that a finger rest was achieved, providing the user with a stable fulcrum to prevent impingement of the handpiece body on the teeth or oral structures. At rest prior to starting the KOMET OS30 handpiece, the instrument was centered at the contact point. 

Important: For every step in the reduction procedure, the instrument position remained perpendicular to the contact point and parallel to the long axis of the contact. 

The OS30 oscillating contra-angle handpiece was accelerated to full speed prior to engaging the contact. Note: The handpiece features four water ports that flood the instrument with water throughout the procedure.

Gentle, intermittent, apical pressure was applied until the contact was fully reduced (Fig. 4). The width of the cut was then verified (Fig. 5).

The single-sided OS20-FH honeycomb instrument was used to continue the reduction to the prescribed amount (Fig. 6). The flexible honeycomb construction facilitated anatomical recontouring, making it easy to maintain natural embrasure spaces. The width was verified at every step, and the steps were repeated for the seven contacts that required reduction.

The 4564 KOMET Composite Polishing System’s 3-in-1 strips were used to complete the procedure, starting with the medium-grit section of strip CS40 (Fig. 7).

The fine-grit section of the same strip was used (Fig. 8), followed by the ultra-fine grit section to finalize polishing (Fig. 9).

In-office topical fluoride was applied to all reduced interproximal areas per manufacturer instructions (Fig. 10). Fluoride gel was given to the patient for daily use at home.

	This case involved seven separate areas that required IPR, yet it took mere minutes to complete. The patient indicated there was no pain during the procedure and there was no frustration for the dentist. Following treatment, the patient’s teeth exhibited normal tooth contours and natural anatomy far beyond that possible with standard discs or strips (Fig. 11). Clearly, patients and doctors alike will benefit from a technique that is safe, effective, simple and remarkably precise. 

Articles

 Dental crowding is just one of countless conditions for which a patient seeks orthodontic care. Solutions for creating more space in these cases range from extractions or comprehensive treatments like arch development using fixed or removable orthopedic appliances, to more conservative options like interproximal reduction (IPR).