Strategies to make IPR easier and more

predictable.

Let’s start by discussing the 6 obstacles to predictable IPR. Then

we can discuss their solutions.

Let’s start by discussing the 6 obstacles to predictable IPR. Then

we can discuss their solutions.

1. The Case has too much IPR

2. I don’t have access to do IPR

3. Can’t keep track of how much I’ve done.

4. Hard to know when & how much

5. What’s the best tool and technique?

6. I might end up with open contacts.

Before we discuss strategies, let’s review where IPR falls into

our options.

Before we discuss strategies, let’s review where IPR falls into

our options.

ExpansionProclinationDistalization

Interproximal ReductionExtraction

ExpansionProclinationDistalization

Interproximal ReductionExtraction

Only 5 ways to resolve Crowding

A Tug of War between Expansion and IPR

A Tug of War between Expansion and IPR

.”“You should never do IPR except extreme cases, and for a few

specific reasons”

“Do as much IPR as possible to reduce tooth movement, and increase

stability “

Why do IPR at all??Why do IPR at all??Simplifies the CaseOften speeds up the CaseReduces the need for AP Shift Increases the stability of the caseControls & improves the overjetCan improve the esthetic result

Simplifies the CaseOften speeds up the CaseReduces the need for AP Shift Increases the stability of the caseControls & improves the overjetCan improve the esthetic result

However….However….It’s the most rigorous and exacting

of the Invisalign disciplines It’s the most rigorous and exacting

of the Invisalign disciplines

Frankly, IPR is the highest risk. Frankly, IPR is the highest risk.

Warning:Warning:The images you are about to see are

very graphic and may be inappropriate for some dentists

above the age of 13.

View discretion advised.

The images you are about to see are very graphic and may be

inappropriate for some dentists above the age of 13.

View discretion advised.

I tend to think there’s a great need to become experts in IPR, both in

judgement and in execution.

I tend to think there’s a great need to become experts in IPR, both in

judgement and in execution.

Let’s examine 6 strategies to make IPR more predictable

Let’s examine 6 strategies to make IPR more predictable

What makes IPR so unpredictable???What makes IPR so unpredictable???The Case has too much IPR

When to solve?

During Clincheck

Strategy 1Reduce IPR by increasing expansion, and proclination. Favor .2, and .3, not .4 and .5

Spread out the IPR among as many teeth as possible. (Reduce IPR per tooth.)

Treatment Preferences:Treatment Preferences:

Please in most cases avoid .4s and .5s in treatment set-ups. Favor less IPR between more teeth, than more IPR between less teeth.

Please in most cases avoid .4s and .5s in treatment set-ups. Favor less IPR between more teeth, than more IPR between less teeth.

What makes IPR so unpredictable???What makes IPR so unpredictable???

Strategy 1Reduce IPR by increasing expansion, and proclination. Favor .2, and .3, not .4 and .5Spread out the IPR among as many teeth as possible. (Reduce IPR per tooth.)

Strategy 1Reduce IPR by increasing expansion, and proclination. Favor .2, and .3, not .4 and .5Spread out the IPR among as many teeth as possible. (Reduce IPR per tooth.)

The Case has too much IPR

When to solve?

During Clincheck

What makes IPR so unpredictable???What makes IPR so unpredictable???I don’t have access!!

When to solve?

During Clincheck

UNPREDICTABLE PREDICTABLE

DO NOT TRY IPR

HERE

WAIT UNTIL YOU HAVE

ACCESS

How can I get Access?How can I get Access?

Solution – Expand First, Procline next, THEN IPR

Solution – Expand First, Procline next, THEN IPR

IPR MUST BE LATE IN

STAGING

TIMING DOESN’T MATTER

Treatment PreferencesTreatment Preferences

Please procline teeth out until there is .1mm of space between _____ and ____. Procline, then rotate, the return to original arch position with IPR. Stage IPR as late as possible. Round Trip the teeth so IPR is last.

Please procline teeth out until there is .1mm of space between _____ and ____. Procline, then rotate, the return to original arch position with IPR. Stage IPR as late as possible. Round Trip the teeth so IPR is last.

What makes IPR so unpredictable???What makes IPR so unpredictable???

Strategy 2

1.Delay IPR until after expansion and proclination. As late as possible.

2.Do Not IPR crowded teeth.

Strategy 2

1.Delay IPR until after expansion and proclination. As late as possible.

2.Do Not IPR crowded teeth.

I don’t have access to IPR

When to solve?

During Clincheck

Here’s another aspect of the ACCESS problem.

Here’s another aspect of the ACCESS problem.

Trying to IPR during

Rotation

This is very common to see in set-ups.

This is very common to see in set-ups.

Why does this make IPR so unpredictable???

Why does this make IPR so unpredictable???

It’s actually trying to IPR teeth that are rotating

It’s a moving Target!

Non-anatomic ContactNon-anatomic Contact

Let’s put these two strategies together. Let’s put these two strategies together.

Do not IPR crowded teeth.Expansion 1st, Proclination2nd, IPR 3rd.Round Trip to avoid IPR on rotating teeth.

Do not IPR crowded teeth.Expansion 1st, Proclination2nd, IPR 3rd.Round Trip to avoid IPR on rotating teeth.

Solution – Expand before you RotateSolution – Expand before you Rotate

What makes IPR so upredictable???What makes IPR so upredictable???

Strategy 21. Round Trip. Ask for .1mm

between teeth before rotating.

2. Delay IPR until after expansion and proclination. As late as possible.

3. DO not IPR crowded teeth.

Strategy 21. Round Trip. Ask for .1mm

between teeth before rotating.

2. Delay IPR until after expansion and proclination. As late as possible.

3. DO not IPR crowded teeth.

When to solve?

During Clincheck

I don’t have access to IPR

What makes IPR so unpredictable???What makes IPR so unpredictable???

Strategy 3Use an IPR

Tracker

Strategy 3Use an IPR

Tracker

I can’t keep track of how much IPR I’ve done.

When to solve?

During each IPR Visit.

Some General Rules for Tracking IPR

Some General Rules for Tracking IPR

Begin IPR 2 Aligners sooner than requested.

You would start this IPR when delivering Aligner 12.

Begin IPR 2 Aligners sooner than requested.

You would start this IPR when delivering Aligner 12.

.03 mm before aligner 14 between

Tooth 26 and 27

Some General Rules for Tracking IPR

Some General Rules for Tracking IPR

1. Begin IPR 2 Aligners sooner than requested. 2. Never do all the IPR at the same

appointment. 3. Limit your IPR to .1, or .2mms per visit.4. Check 1 box for every 1mm of IPR done

today.

1. Begin IPR 2 Aligners sooner than requested. 2. Never do all the IPR at the same

appointment.3. Limit your IPR to .1, or .2mms per visit.4. Check 1 box for every 1mm of IPR done

today.

IPR is NOT an exact Science.IPR is NOT an exact Science.

Sometimes you need a little bit moreSometimes you need a little bit less.Do not do it all at once. Do it a little at a time.If you are happy with the contact, and teeth have finished moving, ‘X’ out the box.

Sometimes you need a little bit moreSometimes you need a little bit less.Do not do it all at once. Do it a little at a time.If you are happy with the contact, and teeth have finished moving, ‘X’ out the box.

IPR is NOT an exact Science.IPR is NOT an exact Science.

Sometimes you need a little bit moreSometimes you need a little bit less.Do not do it all at once. Do it a little at a time.If you are happy with the contact, and teeth have finished moving, ‘X’ out the box.If you do a little extra, to get the teeth into place, mark it with a pink entry.

Sometimes you need a little bit moreSometimes you need a little bit less.Do not do it all at once. Do it a little at a time.If you are happy with the contact, and teeth have finished moving, ‘X’ out the box.If you do a little extra, to get the teeth into place, mark it with a pink entry.

How do you judge if you need a little more than the Tracker says?

How do you judge if you need a little more than the Tracker says?

The position of the teeth will lag behind the actually position of the next aligner, or will be behind the Clincheck.This is the number one reason that teeth don’t move where you want them: They need a little more room to move. A little more IPR.

The position of the teeth will lag behind the actually position of the next aligner, or will be behind the Clincheck.This is the number one reason that teeth don’t move where you want them: They need a little more room to move. A little more IPR.

Strategy 3Use an IPR TrackerDon’t do it all at once. Do .1 or .2mms at a time. Remember its not an exact science.

Strategy 3Use an IPR TrackerDon’t do it all at once. Do .1 or .2mms at a time. Remember its not an exact science.

I can’t keep track of how much IPR I’ve done.

When to solve?

During each IPR Visit.

What makes IPR so unpredictable?What makes IPR so unpredictable?

“To IPR or Not to IPR.

That is the question.”

“To IPR or Not to IPR.

That is the question.”

It’s hard to know when and how much to do in the mouth.

When to solve?

During the Invisalign

Appointment

Let’s make a pile of reasons to do IPR today, and a pile or reasons not to.

Let’s make a pile of reasons to do IPR today, and a pile or reasons not to.

Reasons to do IPRThe Clincheck and Tracker tell you to.

Reasons to do IPRThe Clincheck and Tracker tell you to.

Reasons not to do IPR

The space is wide open

Reasons not to do IPR

The space is wide open

5 things you must know to make a good decision about IPR today. 5 things you must know to make a good decision about IPR today.

1. What does the Tracker tell you about where to IPR and when. (Use the tracker to find out.)

2. How does the next aligner compare to the position of the teeth. (Use the aligner to find out.)

3. Are the contacts open or closed (Use floss to find out)

4. Are the contacts actually tight/tighter when the aligner is in place. (Use a condenser to find out)

5. What movements will occur during the next three aligners. (Use Clincheck to find out.)

1. What does the Tracker tell you about where to IPR and when. (Use the tracker to find out.)

2. How does the next aligner compare to the position of the teeth. (Use the aligner to find out.)

3. Are the contacts open or closed (Use floss to find out)

4. Are the contacts actually tight/tighter when the aligner is in place. (Use a condenser to find out)

5. What movements will occur during the next three aligners. (Use Clincheck to find out.)

Evaluation and Decision Making during an Invisalign Appointment

Evaluation and Decision Making during an Invisalign Appointment

Once patient is seated, Assistant Notes all IPR due today. (What does my tracker say about today?)Assistant flosses to check any open contacts. Now you compare the teeth with the aligner and teeth with Clincheck. Now you floss while using a condenser. This might change everything. If contacts are tight, do IPRIf you can see space, Don’t IPRPlay the clincheck to see what happens during the next 3 aligners. Does the space close? Does it Overclose? This might change everything.

Once patient is seated, Assistant Notes all IPR due today. (What does my tracker say about today?)Assistant flosses to check any open contacts. Now you compare the teeth with the aligner and teeth with Clincheck. Now you floss while using a condenser. This might change everything. If contacts are tight, do IPRIf you can see space, Don’t IPRPlay the clincheck to see what happens during the next 3 aligners. Does the space close? Does it Overclose? This might change everything.

No IPR in areas that are open or will not close in 3 Aligners

No IPR in areas that are open or will not close in 3 Aligners

Remember teeth can move .25 mm per aligner

Remember teeth can move .25 mm per aligner

Let’s make a pile of reasons to do IPR today, and a pile or reasons not to.

Let’s make a pile of reasons to do IPR today, and a pile or reasons not to.

Reasons to do IPR

1. The Clincheck and Tracker tell you to.

2. The condensor closes the contact

3. The contact closes in the next 3 aligners.

Reasons to do IPR

1. The Clincheck and Tracker tell you to.

2. The condensor closes the contact

3. The contact closes in the next 3 aligners.

Reasons not to do IPR1. The space is wide

open and won’t close in 3 aligners

Reasons not to do IPR1. The space is wide

open and won’t close in 3 aligners

What makes IPR so unpredictable?What makes IPR so unpredictable?

“To IPR or Not to IPR.

That is the question.”

“To IPR or Not to IPR.

That is the question.”

It’s hard to know when and how much to do in the mouth.

When to solve?

During the Invisalign

Appointment

What makes IPR so unpredictable?What makes IPR so unpredictable?It’s hard to know when and how much to do in the mouth.

When to solve?

During the Invisalign

Appointment

Strategy 4Follow the TrackerCompare the Aligner to the TeethCheck the contacts with floss and condensorEvaluate the next 3

stages

Strategy 4Follow the TrackerCompare the Aligner to the TeethCheck the contacts with floss and condensorEvaluate the next 3

stages

What makes IPR so unpredictable??What makes IPR so unpredictable??

Using the

wrong tools

Strategy 5Use the best

tools

Strategy 5Use the best

tools

IPR Instruments “The Scalpels”IPR Instruments “The Scalpels”

Hand InstrumentsFinishing Strips

Handpiece Driven Instruments

Hand InstrumentsFinishing Strips

Handpiece Driven Instruments

Finishing StripsFinishing Strips

Double Sided metal Strip Single Sided Paper Strip

IPR ToolsIPR ToolsHand Instruments

Finishing StripsAxis Qwik Strips

Handpiece Driven Instruments

Hand InstrumentsFinishing StripsAxis Qwik Strips

Handpiece Driven Instruments

IPR ToolsIPR Tools

Hand InstrumentsFinishing StripsAxis Qwik StripsSpee Mounted StripsManual Disk Hand Tool

Handpiece Driven Instruments

Hand InstrumentsFinishing StripsAxis Qwik StripsSpee Mounted StripsManual Disk Hand Tool

Handpiece Driven Instruments

Hand ToolsHand Tools

IPR ToolsIPR Tools

Hand InstrumentsFinishing StripsQwik StripsSpee Mounted Strips

Handpiece Driven InstrumentsMandrel Mounted Disks

Hand InstrumentsFinishing StripsQwik StripsSpee Mounted Strips

Handpiece Driven InstrumentsMandrel Mounted Disks

Slow Speed, High Torque Motor

Slow Speed, High Torque Motor

Spee

Dental

If you don’t have access, you still get

If you don’t have access, you still get

IPR InstrumentsIPR InstrumentsHand Instruments

Finishing StripsQwik StripsSpee Mounted Strips

Handpiece Driven InstrumentsMandrel Mounted DisksVision FlexDisks by Brasseler

Hand InstrumentsFinishing StripsQwik StripsSpee Mounted Strips

Handpiece Driven InstrumentsMandrel Mounted DisksVision FlexDisks by Brasseler

Vision Flex Disks – BrasselerVision Flex Disks – Brasseler

952-180 952-140

Vision Flex DisksVision Flex Disks

IPR Instruments IPR Instruments

Hand InstrumentsFinishing StripsQwik StripsSpee Mounted Strips

Handpiece Driven InstrumentsDisksDiamonds

Hand InstrumentsFinishing StripsQwik StripsSpee Mounted Strips

Handpiece Driven InstrumentsDisksDiamonds

IPR InstrumentsIPR Instruments

Hand InstrumentsFinishing StripsQwik StripsSpee Mounted Strips

Handpiece Driven InstrumentsDisksDiamondsReciprocating Strips

Hand InstrumentsFinishing StripsQwik StripsSpee Mounted Strips

Handpiece Driven InstrumentsDisksDiamondsReciprocating Strips

This is the best of both worlds!

This is the best of both worlds!

Safe, Anatomic, Easy, and Very Fast

We can do IPR Better…Stronger…Faster…..

We can do IPR Better…Stronger…Faster…..

Kavo makes the handpiece that operates the OrthoStrips

Kavo makes the handpiece that operates the OrthoStrips

2320 LN

The head is a LRG 61The head is a LRG 61

Holds like a regular handpieceAs safe, and predictable as a finishing stripFast or faster than disksA dial turns it to the exact angle of entryHas water spray to keep tooth and strip clean.Has fibre optics

Holds like a regular handpieceAs safe, and predictable as a finishing stripFast or faster than disksA dial turns it to the exact angle of entryHas water spray to keep tooth and strip clean.Has fibre optics

Ortho Strips in ActionOrtho Strips in Action

The Profin

system and Ortho-Strips achieved the significantly smoothest surfaces (p<.05) with polishing.

OS Set – SS6 REF No. 064

Axis Dental, Coppell, Texas,1-800-355-5063

Axis Dental, Coppell, Texas,1-800-355-5063

Hand InstrumentsFinishing StripsQwik StripsSpee Mounted Strips

Handpiece Driven InstrumentsDisks

Mandrel MountedVision Flex

DiamondsOrtho Strips Reciprocating Strips

Hand InstrumentsFinishing StripsQwik StripsSpee Mounted Strips

Handpiece Driven InstrumentsDisks

Mandrel MountedVision Flex

DiamondsOrtho Strips Reciprocating Strips

Hand InstrumentsFinishing StripsQwik StripsSpee Mounted Strips

Handpiece Driven InstrumentsDisks

Mandrel MountedVision Flex

DiamondsOrtho Strips Reciprocating Strips

Hand InstrumentsFinishing StripsQwik StripsSpee Mounted Strips

Handpiece Driven InstrumentsDisks

Mandrel MountedVision Flex

DiamondsOrtho Strips Reciprocating Strips

Suggestions for Vision Flex DiskSuggestions for Vision Flex DiskVery useful for opening the contact on relatively straight teeth, and bicuspidsDisks are more efficient than strips.Only comes in 2 sidedThe greater the crowding, the lessuseful the diskHarder than strips to preserve

natural antatomyAlways rotate the disk toward the inside of the mouth.

Very useful for opening the contact on relatively straight teeth, and bicuspidsDisks are more efficient than strips.Only comes in 2 sidedThe greater the crowding, the lessuseful the diskHarder than strips to preserve

natural antatomyAlways rotate the disk toward the inside of the mouth.

the risk of caries is not affected by ARS. Furthermore, our data show that the application of topical fluoride on the

enamel surfaces immediately after ARS in patients exposed to fluoridated water and fluoride-containing toothpaste

may not provide any additional benefit.

Jarjoura

et.al

What makes IPR so unpredicable??What makes IPR so unpredicable??

Strategy 6Always use

Overcorrection Aligners

Strategy 6Always use

Overcorrection Aligners

Open contacts at the end

When to solve?

During Clincheck

What are overcorrection Aligners?

What are overcorrection Aligners?

Aligners whose sole function is to squeeze the teeth tightly at the end of treatment.

The case must be completely straight to use them.

Use them if you have any open or slightly open contacts

Aligners whose sole function is to squeeze the teeth tightly at the end of treatment.

The case must be completely straight to use them.

Use them if you have any open or slightly open contacts

Ask for it this way:Ask for it this way:

Please add 3 c-chain aligners at the end of every case.

Move the anterior teeth lingually, and

Move the posterior teeth mesially.

(If you’ve done IPR around the bicuspids)

Please add 3 c-chain aligners at the end of every case.

Move the anterior teeth lingually, and

Move the posterior teeth mesially.

(If you’ve done IPR around the bicuspids)

Rules of Overcorrection AlignersRules of Overcorrection Aligners

Plan them into your Clincheck.Teeth must be completely straight. If not, DO NOT USE THESE 3 ALIGNERS.Do NOT use them for final movements.If refinement is needed, discard the original Overcorrection aligners, and order three more at the end of refinement.

Plan them into your Clincheck.Teeth must be completely straight. If not, DO NOT USE THESE 3 ALIGNERS.Do NOT use them for final movements.If refinement is needed, discard the original Overcorrection aligners, and order three more at the end of refinement.

What makes IPR so unpredicable??What makes IPR so unpredicable??

Strategy 6Always use

Overcorrection Aligners

Strategy 6Always use

Overcorrection Aligners

Open contacts and the end

When to solve?

During Clincheck

6 Strategies to make IPR easier

and more predictable.

For further info please contact: For further info please contact:

David Gates DDSLas Vegas, Nevada

atlantisdds@lvcm.com

David Gates DDSLas Vegas, Nevada

atlantisdds@lvcm.com

Questions???Questions???