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.

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.

Only 5 ways to resolve Crowding Expansion Proclination Distalization Interproximal Reduction Extraction

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 Case Often speeds up the Case Reduces the need for AP Shift Increases the stability of the case Controls & improves the overjet Can improve the esthetic result

However. It s the most rigorous and exacting of the Invisalign disciplines

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

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.

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

What The makes Case IPR has so too unpredictable??? much IPR When to solve? During Clincheck Strategy 1 Reduce 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.

The Case has too much IPR What makes IPR so unpredictable??? When to solve? During Clincheck Strategy 1 Reduce 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.)

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

IPR MUST BE LATE IN STAGING TIMING DOESN T MATTER

Treatment Preferences Treatment 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.

I don t have access to IPR What makes IPR so unpredictable??? When to solve? During Clincheck Strategy 2 1.Delay IPR until after expansion and proclination. As late as possible. 2.Do Not IPR crowded teeth.

Here s another aspect of the ACCESS problem. Trying to IPR during Rotation This is very common to see in set-ups.

Why does this make IPR so unpredictable??? It s actually trying to IPR teeth that are rotating It s a moving Target!

Non-anatomic Contact Non-anatomic Contact

Let s put these two strategies together. Do not IPR crowded teeth. Expansion 1st, Proclination 2 nd, IPR 3 rd. Round Trip to avoid IPR on rotating teeth.

Solution Expand before you Rotate Solution Expand before you Rotate

I don t have access to IPR What makes IPR so upredictable??? When to solve? During Clincheck Strategy 2 1. 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.

I What can t makes keep IPR track so of unpredictable??? how much IPR I ve done. When to solve? During each IPR Visit. Strategy 3 Use an IPR Tracker

Some General Rules for Tracking IPR Begin IPR 2 Aligners sooner than requested..03 mm before aligner 14 between Tooth 26 and 27 You would start this IPR when delivering Aligner 12.

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.

IPR is NOT an exact Science. IPR is NOT an exact Science. Sometimes you need a little bit more Sometimes 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.

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.

I can t keep track of how much IPR I ve done. When to solve? During each IPR Visit. Strategy 3 Use an IPR Tracker Don t do it all at once. Do.1 or.2mms at a time. Remember its not an exact science.

It s hard to know when and how much to do in the mouth. What makes IPR so unpredictable? When to solve? During the Invisalign Appointment To IPR or Not to IPR. That is the question.

Let s make a pile of reasons to do IPR today, and a pile or reasons not to. Reasons to do IPR The Clincheck and Tracker tell you to. Reasons not to do IPR The space is wide open

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.)

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 IPR If you can see space, Don t IPR Play 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 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. 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 IPR 1. The space is wide open and won t close in 3 aligners

It s hard to know when and how much to do in the mouth. What makes IPR so unpredictable? When to solve? During the Invisalign Appointment To IPR or Not to IPR. That is the question.

It s hard to know when and how much to do in the mouth. What makes IPR so unpredictable? When to solve? During the Invisalign Appointment Strategy 4 Follow the Tracker Compare the Aligner to the Teeth Check the contacts with floss and condensor Evaluate the next 3 stages

What makes IPR so unpredictable?? What makes IPR so unpredictable?? Using the wrong Strategy 5 Use the best tools tools

IPR Instruments The Scalpels IPR Instruments The Scalpels Hand Instruments Finishing Strips Handpiece Driven Instruments

Finishing Strips Finishing Strips Double Sided metal Strip Single Sided Paper Strip

Hand Instruments Finishing Strips Axis Qwik Strips IPR Tools Handpiece Driven Instruments

IPR Tools IPR Tools Hand Instruments Finishing Strips Axis Qwik Strips Spee Mounted Strips Manual Disk Hand Tool Handpiece Driven Instruments

Hand Tools Hand Tools

IPR Tools IPR Tools Hand Instruments Finishing Strips Qwik Strips Spee Mounted Strips Handpiece Driven Instruments Mandrel Mounted Disks

Slow Speed, High Torque Motor Spee Dental

If you don t have access, you still get

IPR Instruments IPR Instruments Hand Instruments Finishing Strips Qwik Strips Spee Mounted Strips Handpiece Driven Instruments Mandrel Mounted Disks Vision FlexDisks by Brasseler

Vision Flex Disks Brasseler Vision Flex Disks Brasseler 952-180 952-140

Vision Flex Disks Vision Flex Disks

IPR Instruments IPR Instruments Hand Instruments Finishing Strips Qwik Strips Spee Mounted Strips Handpiece Driven Instruments Disks Diamonds

IPR Instruments IPR Instruments Hand Instruments Finishing Strips Qwik Strips Spee Mounted Strips Handpiece Driven Instruments Disks Diamonds Reciprocating Strips

This is the best of both worlds! Safe, Anatomic, Easy, and Very Fast

We can do IPR Better Stronger Faster..

Kavo makes the handpiece that operates the OrthoStrips 2320 LN

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

Holds like a regular handpiece As safe, and predictable as a finishing strip Fast or faster than disks A dial turns it to the exact angle of entry Has water spray to keep tooth and strip clean. Has fibre optics

Ortho Strips in Action Ortho 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

Hand Instruments Finishing Strips Qwik Strips Spee Mounted Strips Handpiece Driven Instruments Disks Mandrel Mounted Vision Flex Diamonds Ortho Strips Reciprocating Strips

Suggestions for Vision Flex Disk Suggestions for Vision Flex Disk Very useful for opening the contact on relatively straight teeth, and bicuspids Disks are more efficient than strips. Only comes in 2 sided The greater the crowding, the less useful the disk Harder than strips to preserve natural antatomy Always rotate the disk toward the inside of the mouth.

Jarjoura et.al 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.

Open contacts at the end What makes IPR so unpredicable?? When to solve? During Clincheck Strategy 6 Always use 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

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)

Rules of Overcorrection Aligners Rules 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.

Open contacts and the end What makes IPR so unpredicable?? When to solve? During Clincheck Strategy 6 Always use Overcorrection Aligners

6 Strategies to make IPR easier and more predictable.

For further info please contact: For further info please contact: David Gates DDS Las Vegas, Nevada atlantisdds@lvcm.com

Questions???