Australasian Dentist Issue 93

CATEGORY 58 AUSTRALASIAN DENTIST O ne of the biggest challenges with completing clear aligner tooth movement predictably is accomplishing enough interproximal reduction (IPR) on schedule to allow for ideal tooth movement. Many clear aligner cases call for IPR to be accomplished to best level and align teeth. I tend to prefer buccal expansion wherever possible to not only allow for better alignment of teeth but to also allow for improved tongue positioning, reduced buccal corridors, and more ideal occlusal forces on posterior teeth. While buccal expansion has many advantages for patients and continues to bemy preference, many cases still require some IPR for best completion. Since IPR is an unavoidable part of orthodontic therapy, it is important to find a more predictable protocol to achieve these results. When IPR is done well and accurately, tooth movement is more likely to move on schedule and the case is likely to complete on time with fewer numbers of refinements (additional series of trays) required. Profitable clear aligner tooth movement begins with implementing systems that work for reducing the number of visits required or additional aligners needed to complete the case. For my clear aligner patients, I have found a very predictable process using both Garrison IPR hand files and Strauss Diamond rotary IPR discs. Our patient featured in this article presentedwith a chief concern of improving the esthetics of her smile and reducing her overbite and overjet for more ideal anterior tooth placement. She has a posterior implant which constricts the amount of buccal expansion we can accomplish so in this particular case, we elected to add some IPR to accomplish her toothmovements. As shown in Fig 1, she had some existing space (green boxes) on the left pre-operative image and required IPR (gray diamonds) in right ClinCheck image to improve midline and position of anterior teeth. Upon delivery of clear aligners to the patient, we will try to complete all necessary IPR at the initial appointment. Of course, there are times when it is more ideal to wait for some movement first before attempting IPR to accomplished in a stepwise fashion starting with the smallest FitStrip and moving towards thicker strips in order to slowly increase the spacing between teeth. In this case, we used the double sided FitStrip Extra Fine Grit Yellow .11mm (Fig 3) and Red .15mm (Fig 4) in a fine grit. Clinicians can use a TAC topical anesthetic if needed to get the accurate reduction. Hemorrhage is expected with gingival tissue, but patients rarely complain of any discomfort with the reduction when slow, methodical Interproximal Reduction just got more predictable using FitStrips by Garrison Dental By Dr. Jennifer Bell Dr. Jennifer Bell achieve better access to the interproximal walls. In addition, accomplishing most of the required IPR at the initial visit will increase the accuracy of the reduction. Once teeth are activated for movement, their mobility increases, and it becomes more difficult to determine if the correct amount of reduction has been completed. Our first step in our IPR protocol is to break all the contacts with the FitStrip Gray .05mm (Fig 2) to break open contacts. Reduction between teeth is then Figure 1 Figure 2 Figure 4 Figure 3 Figure 5 LINICAL