Farooq Ahmed explores the topic of interproximal reduction (IPR), whether we should be delivering it to orthodontic patients and when is the best time to assess.
Please introduce yourself
I’m Farooq Ahmed. I’m a consultant and specialist orthodontist working in central and north London at Guy’s Hospital and in private practice.
I’ve been qualified as a specialist since 2015 and I’m really passionate about everything orthodontics – it’s something I enjoy both personally and professionally.
I have my own podcast and share my passion for orthodontics through lectures as well as social media.
I love sharing with my community, whether that’s my patients, orthodontists or general dentists who are interested in learning more about this field to benefit their own patients.
I’m very privileged to have the job that I do.
What is IPR and when should dentists offer it to patients?
IPR means interproximal reduction. It’s simply the slenderisation of teeth to create space for orthodontic purposes.
Its function has become more popular due to the use of aligners. But also a part of fixed appliances in contemporary practice to create space.
In terms of when you should carry out IPR, it’s a question that’s not simple to answer. It’s about planning and staging, the same as when it comes to preparing a full-mouth rehabilitation case.
The planning of IPR has been missed out, I feel, within orthodontics. Both for aligners and fixed appliances. The premise of having a protocol, which is what I educate on, allows dentists to have that first point of knowing how much quantity of IPR is appropriate. They can then work towards the tools that they have in their own clinical practice to deliver reliable and safe IPR.
I think the challenge that we have is that IPR is just overlooked. Many deliver the IPR as a side note, and focus on moving the teeth. You can’t do one without the other and that’s really why I like teaching this topic.
My IPR course is available at www.iprcourse.com.
Dentistry Show London
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Is every patient suitable for IPR?
No, inherently not. It really depends upon a number of factors such as the anatomy of the patient’s teeth and the quantity of movement that’s required.
One of the saddest things for me is when a patient has IPR and we have spaces left over at the end – it’s an irreversible process. There’s no enamel coming back and we haven’t followed a protocol. We’ve just done what we’ve been requested to do without due consideration. For me that’s the worst case scenario in IPR.
Who is requesting IPR?
Usually it is aligner companies. They develop an AI driven or algorithm driven plan. This works out how much the teeth overlap and advise on the amount of IPR needed.
The challenge with that is that there’s errors throughout the process. Whether it comes to taking a scan that isn’t 100% accurate or when digitally manipulating the teeth they’re systematically undersizing the teeth.
As a result, not understanding the limitations of planning, we can unfortunately over-deliver on what is clinically needed.
When is the best time to deliver IPR?
Doing IPR in one stage or one visit may not be ideal. You can spread it by planning it at the beginning, reassessing it in the middle, and delivering anything residual at the end that you need.
That is the way to maximise IPR in a safe, reliable, and anatomical way.
It’s not a one stage process or one size fits all. There’s no one item to deliver IPR that’s perfect. You’ve got to go between tools depending on what you need, and that fluidity is really key. It’s a reassessment through the process.
Just like reassessing a patient’s periodontal health, you don’t fix it at the beginning. You monitor it and assess it and re-treat the patient as needed.
‘One of the saddest things for me is when a patient has IPR and we have spaces left over at the end – it’s an irreversible process. There’s no enamel coming back and we haven’t followed a protocol.’
Are there any long-term risks associated with IPR?
The concept of IPR, reducing the enamel, points us towards thinking there must be less protection for the patient’s dentine – there could be sensitivity that takes place and increased carious processes because it has less enamel.
Fundamentally, we have to understand that mechanical removal of enamel is different to demineralisation. This is not the same as a caries-driven process resulting in loss of enamel.
From the research, what we understand is that when you remove the enamel mechanically, the surface that’s left is likely to remineralise and is resistant to carious processes. Long-term follow-up studies show no increase in caries taking place over 10 years. Periodontal health is also not compromised and no increase in sensitivity.
The point though is that patients have to have a low caries risk plus the IPR has to follow a protocol because that’s what the research is based on. Without having stages and processes of planning, delivering anatomical IPR and polishing, that research doesn’t apply. I think that’s where we miss out on IPR. Without a protocol, we can create these problems.
What will you be discussing at this year’s Dentistry Show London?
At this year’s Dentistry Show London, I’ll be discussing IPR. We will focus on both the clinical side, which has different methods that are available and discuss this in detail, as well as the second stage, which gets missed out – the planning of IPR.
Specifically, we’ll be looking at staging of IPR and when to defer IPR.
IPR is one mechanism to deliver space. We’ll talk to you about how to deliver it safely, how to follow my protocols so you can be reliable in delivering it.
I’ll go through how to use the space once it’s created. This is something we forget about after we create our space.
So please join me this year at the Dentistry Show London, which will be on the 4 and 5 of October at the ExCeL London. I’ll go through my lecture on interproximal reduction and share my pearls of wisdom over the years of teaching, education and clinical practice within orthodontics.
To find out more about interproximal reduction, you can follow my course that I teach twice a year. Visit www.iprcourse.com or follow @farooqorthodontist on Facebook or Instagram. You can also send me messages – I’m happy to advise and share content.
Don’t forget to join me at the Dentistry Show London, where you can find out more about this topic so you can plan things safely and also follow the evidence-based protocols, which I’ll be sharing with you.
This article is sponsored by CloserStill.
