History
- Murray L. Ballard advocated for stripping lower anterior teeth in 1944.
- John J. Sheridan introduced the Air Rotor Stripping technique in the 1980s.
- IPR can be used as an alternative to tooth extraction or expansion.
- Zachrisson stated that IPR can improve the esthetics of anterior teeth.
- Modern diets of soft and processed foods have led to increased dental crowding.
Application
- IPR is an irreversible procedure.
- Indications for IPR include mild to moderate crowding, black triangles, retention enhancement, and correction of the Curve of Spee.
- IPR is contraindicated for patients with high caries risk, poor oral hygiene, periodontal diseases, multiple restorations, excessive crowding, hypersensitivity to cold, and large pulp chambers.
Amount
- Up to 50% of proximal enamel can be stripped without causing problems.
- Sheridan recommended 2.5mm of space from IPR of five anterior contacts and 6.4mm from IPR of eight posterior contacts.
- It is recommended to remove no more than 0.5mm - 0.75mm from each proximal side of anterior teeth.
Techniques
- IPR can be carried out using abrasive metal strips, diamond coated disks, or air-rotor stripping burs.
- Metal strips are suitable for rotated teeth.
- Diamond disks should be used carefully to avoid enamel undercuts or contact with soft tissue.
- Squared-off tips should be used with air-rotor burs to prevent furrows.
- Burs may produce a rough finish on enamel.
Side-Effects
- Excessive heat during IPR can damage the dental pulp.
- IPR has been associated with caries and periodontal disease, but the association is debated.
- Topical fluoride application or wearing a fluoride varnish-infused retainer can help limit side-effects.
- A study showed that fluoride application after IPR reduced the risk of caries.
- Observational studies found no signs of gingival recession or thinning of the labial gingiva in most patients who underwent IPR.
Interproximal reduction (IPR, also called interproximal enamel reduction (IER), slendering, air rotor stripping (ARS) or reproximation) is the practice of mechanically removing enamel from between the teeth to achieve orthodontic ends, such as to correct crowding, or reshape the contact area between neighboring teeth. After reducing the enamel, the procedure should also involve anatomic re-contouring and the protection of interproximal enamel surfaces.