Fantastic video Jaz, thank you so much for this! I am just about to start my first invisalign cases and this gives me so much more knowledge and confidence!
Great video Jaz! Thank you to you and your brother in-law for putting this together. It was great to see all 3 methods of IPR creation performed in one video.
Wow what an incredible resource! This is the video I wish I had two years ago when I started my Invisalign journey! I have tried all of these techniques, but was going in pretty much blind and finding out how things worked in my hands as I went along based on whatever info I could find online or from colleagues.. On my Invisalign course strips were briefly touched upon, and nothing about other techniques. Even though I have successfully used all of the techniques explained I still gained loads of useful tips from watching this. 10/10 from Jaz as always. And if anyone watching this wants to learn more from Jaz, I highly recommend his splint course and RBB course.
Great video Dr. Gulati. I'm honored that you used my image that I use in my lectures (4:89). If you need anymore images, I'd be happy to accommodate. Thanks for these fabulous videos...Dr. Jaimee Morgan
Hi Dr Jaz! Thanks so much for this video it was very clear and informative ... please make more like these :) ... I have a question: can you achieve 0.5 mm IPR with strips alone? Thank you :)
Thanks doc! YES it's possible, but to do it in one session will be very sore for your wrists! You can do it sequentially eg 0.2 at visit 1, 0.2 next time, and 0.1 a few months later. That is much kinder to your wrists and to the poor patient.
@@protrusive Dr Jaz thanks so much! Starting my first cases soon. Would you think discs and strips are a good combo to achieve IPR and polishing? Thank you again 😊
@@ambicabhambra8680 yes it's a good start but with experience you will desire to be mor efficient so will move to the other techniques highlighted in this video - all the best in your journey!
Are your teeth more subseptible to cavities after ipr on all the teeth between my canine on the lower jaw thats my only concern about getting cavities between the teeth do i need to be concerned ?
Thank you so much, Dr. Gulati, for creating such a marvelous and informative video! Would you please comment on the severity of crowding (for example, degree of rotation or mm of overlapping) that is 1) not feasible to do any IPR, 2) okay to do with only stripping, and 3) okay to do with swingle? Thank you for being so awesome!
appreciate your kind comment, friend! Whilst I'm no Orthodontist, I have done a fair amount of IPR so I have an opinion on this I can share. If I want to use burs or swingle, I am going to be very strict about having 99% + well aligned contacts. You can be clever in your aligner planning to group IPR together and only plan it once contacts are aligned (this must be balanced with risks of roundtripping) - eg. if 4 contacts need 0.2mm then let's instead (IF FEASIBLE) do 0.4mm on 2 contacts. I will accept more rotation and crowding with strips but if I am passing my strip and it's not really cutting the correct (proximal) part of the tooth, then I know it's not an ideal time for IPR, even with strips. In those instances use of a disc of sof flex can help
@@protrusive Thank you for the detailed explanation, Dr. Gulati! It goes without saying your lecture covers such a great breadth and depth that we surely learn more by revisiting the concepts. I will keep in mind that moderately/severely crowded teeth can benefit from direct disc use early in treatment. IPR should be weighted based on individual anatomies, hence the value of single-sided reduction. Meanwhile, swingle provides an effective solution for teeth that are aligned from the beginning or planned for roundtrip. Thank you so much again for enlightening us!
Burs hurt bad. I had it done like 4 times on the same teeth and those teeth are thin as heck as if im preparing for veneers. Gonna decline that treatment next time. Ive had enough!
Great video doc 😃👌👌👌 i just want to know if spaces created between premolars after they are closed can it be retained by just giving a fixed lingual retainer from canine to canine?
Thanks @zonejvm - I'm not a specialist Ortho but from my understanding, it depends on the neutral zone and if expansion was carried out (maxilla) - expansion can relapse so in my hands essix retainers are key - the fixed retainers are a bonus
I am not aware of this being a recognised technique but as a restorative dentist it does not sound appealing! Zirconia can be tough to drill through/grind away, especially in awkward places if you are trying to finish and shape and polish it. I avoid IPR where there are definitive crowns that do not need replacing
Help Doc, I had this done prior to my Invisalign with NO warning ! I didn’t even know that I needed it ! The orthodontist just started drilling with the disc while I was lying down. Now I feel like the gaps she created in between my teeth are too big because it’s so visible ! What are the chances that the teeth moving will fill in the gaps ? I’m scared that after my treatment I’ll still have those gaps ! Can that be fixed ? HELP !😢😢😢😢
Is it possible or likely to accidentally remove from the root cementum below the enamel if you accidentally cut 2 mm into the gingiva with the Swingle or the strip? (between premolars and premolar and canine) Thank you.
I guess it's theoretically possible if you get over the CEJ bulbosity and on to the cementum with enough contact - definitely if the swingle would wrap right on to the root somehow but the gingiva acts as a guide so not easy to remove cementum IMHO
@@protrusive Assuming cutting straight, aligned with the tooth axis and guided by the gingiva, how many millimeters are acceptable to cut into the gingiva in your opinion? (I believe it is necessary to cut a bit into it to avoid subgingival ledge creation.) Thank you.
Have you ever used IPR in the towards the end of the case? Ex: pt wearing class-3 elastics just to correct .5-1mm underbite…slow progress on young teen….mentor does not like IPR & says only will give 1mm retraction but I need more than that to help jump the bite & then sink in the overbite. Tips/tricks??
Indeed many of my ortho colleagues are careful about IPR - can cause bolton discrepancy. Have I done it? yes in class 3 protocols IPR on lower teeth - but always case dependent, no recipe book IMO
Assuming cutting straight, aligned with the tooth axis and guided by the gingiva, how many millimeters are acceptable to cut into the gingiva in your opinion? (I believe it is necessary to cut a bit into it to avoid subgingival ledge creation.) Thank you.
will be case dependent IMHO based on anatomy, position of gingival margin, papilla height etc - do you know if there are any clinical guidelines on this? I am not aware
@@protrusive because i already underwent orthodontic treatment and after that my wisdom teeth started growing and that pushed my upper frontal teeth slightly outward..therefore i want to just slightly push upper teeth inside not too much..And i don't want expansion as my jaw is already broad.
Help Doc, I had this done prior to my Invisalign with NO warning ! I didn’t even know that I needed it ! The orthodontist just started drilling while I was lying down. Now I feel like the gaps she created in between my teeth are too big because it’s so visible ! What are the chances that the teeth moving will fill in the gaps ? I’m scared that after my treatment I’ll still have those gaps ! Can that be fixed ? HELP !😢😢😢😢
my ortho just did IPR for me on my bottom teeth bc of small black triangles but now the gap is so much more noticeable than the black triangles itself.. i keep regretting bc the black triangles weren't even that bad to begin with... do you think my ortho messed up? :/
@@protrusive is it normal to see black triangles/holes now that i have braces? i didn't see this many before braces and my teeth were pretty straight to begin with.. only got them because of my open bite
What is the accuracy of IPR that you can achieve in mm? For example, can you achieve +/-0.02 mm accuracy? Can you do just 0.02 mm IPR between teeth? Thank you.
@@protrusive If you had to do for example 0.02 mm IPR between premolars to adjust bite, how would you do it? Especially without an accurate measuring tool. Thank you.
it's a bit like trying to floss without touching your gums.. IPR instruments will likely and lightly scratch the gum. it is expected and not worth worrying about.
This was all mambo jambo of Orthodontrics. I have several overlapping teeth and rough edges with crowded teeth. Visit to orthodontist will cost me arm and leg. I was looking for some self help. Which you have not provided. You are talking about the size of strips. How do I know what to use. I can purchase the strips online. Please advise in plain English language.
@@protrusive when you started talking about Orthodontrics. I thought you would display the technics of using IPR. but you talked as if I am an orthodontist.
@noormotani9719 you need to see some patient facing orthodontric videos- mine are for dental professionals. all the best with your IPR journey (disclaimer: please don't do DIY Dentistry)
personally, i feel for the patient...sometimes he's talking and there's pool of saliva in his mouth..poor lad. could use a typho model to do all that experimenting...
Fantastic video Jaz, thank you so much for this! I am just about to start my first invisalign cases and this gives me so much more knowledge and confidence!
thanks - hope you ace your first case!
Literally the best resource on the web for IPR. Such a legend Jaz!!!
thank you Brendan!!!
Great video Jaz! Thank you to you and your brother in-law for putting this together. It was great to see all 3 methods of IPR creation performed in one video.
Thanks so much for this Jaz. Am starting my first Invisalign case soon and this video helped curve my nerves on IPR! :)
Good luck!!
Wow what an incredible resource! This is the video I wish I had two years ago when I started my Invisalign journey! I have tried all of these techniques, but was going in pretty much blind and finding out how things worked in my hands as I went along based on whatever info I could find online or from colleagues.. On my Invisalign course strips were briefly touched upon, and nothing about other techniques. Even though I have successfully used all of the techniques explained I still gained loads of useful tips from watching this. 10/10 from Jaz as always. And if anyone watching this wants to learn more from Jaz, I highly recommend his splint course and RBB course.
Such a great video! Thanks Jaz
Thank you!
Awesome video Jaz, definitely the best resource for all things IPR.
Jaz .. this was brilliant.. needed it so much as was starting my first case in the summer . Keep them coming
all the best - you got this!
Great video Dr. Gulati. I'm honored that you used my image that I use in my lectures (4:89). If you need anymore images, I'd be happy to accommodate. Thanks for these fabulous videos...Dr. Jaimee Morgan
thank you so much Dr Morgan - I will surely add this to the video description too!
You sir are a legend!
appreciate you brother!
Beautifully explained brother...very hands on ... thanks for it...😊
Wow amazing video Jaz! How have I just used strips all this time 😅.
This is explained so well.
Thanks Jaz. This is very helpful.
thanks for taking the time to comment and appreciate!
Awesome video! New GP over here in Colorado. Definitely helped with my first Align case
really appreciate you commenting doc, all the best!
Lovely video mate. Exactly what I needed
Hi Dr Jaz! Thanks so much for this video it was very clear and informative ... please make more like these :) ... I have a question: can you achieve 0.5 mm IPR with strips alone? Thank you :)
Thanks doc! YES it's possible, but to do it in one session will be very sore for your wrists! You can do it sequentially eg 0.2 at visit 1, 0.2 next time, and 0.1 a few months later. That is much kinder to your wrists and to the poor patient.
@@protrusive Dr Jaz thanks so much! Starting my first cases soon. Would you think discs and strips are a good combo to achieve IPR and polishing? Thank you again 😊
@@ambicabhambra8680 yes it's a good start but with experience you will desire to be mor efficient so will move to the other techniques highlighted in this video - all the best in your journey!
Top vídeo. Great work. Thx
thank YOU!
Are your teeth more subseptible to cavities after ipr on all the teeth between my canine on the lower jaw thats my only concern about getting cavities between the teeth do i need to be concerned ?
the wealth of evidence suggests that it does not increase your risk of tooth decay.
Very helpful. Thanks a ton. What speeds are recommended with the swingle ? Since you said it’s 2:1, you use it at 40000 rpm ?
thank you and yes 40,000 rpm is right
This is brilliant.
Thank you!
Enjoyed the informative video. Thanks
thank you for leaving this kind comment!
Great doctr!👍🏻
thank you!
amazing video and great content! thank you very much
thank you so much!
Thank you so much, Dr. Gulati, for creating such a marvelous and informative video! Would you please comment on the severity of crowding (for example, degree of rotation or mm of overlapping) that is 1) not feasible to do any IPR, 2) okay to do with only stripping, and 3) okay to do with swingle? Thank you for being so awesome!
appreciate your kind comment, friend! Whilst I'm no Orthodontist, I have done a fair amount of IPR so I have an opinion on this I can share. If I want to use burs or swingle, I am going to be very strict about having 99% + well aligned contacts. You can be clever in your aligner planning to group IPR together and only plan it once contacts are aligned (this must be balanced with risks of roundtripping) - eg. if 4 contacts need 0.2mm then let's instead (IF FEASIBLE) do 0.4mm on 2 contacts. I will accept more rotation and crowding with strips but if I am passing my strip and it's not really cutting the correct (proximal) part of the tooth, then I know it's not an ideal time for IPR, even with strips. In those instances use of a disc of sof flex can help
@@protrusive Thank you for the detailed explanation, Dr. Gulati! It goes without saying your lecture covers such a great breadth and depth that we surely learn more by revisiting the concepts. I will keep in mind that moderately/severely crowded teeth can benefit from direct disc use early in treatment. IPR should be weighted based on individual anatomies, hence the value of single-sided reduction. Meanwhile, swingle provides an effective solution for teeth that are aligned from the beginning or planned for roundtrip. Thank you so much again for enlightening us!
Great video sir , can u tell me the brand of dental loupes u use and magnification .
thanks! I used Xenosys 7.5x
Burs hurt bad. I had it done like 4 times on the same teeth and those teeth are thin as heck as if im preparing for veneers. Gonna decline that treatment next time. Ive had enough!
having IPR done by my dentist soon ,do they use local anaesthetic for this procedure.
not normally
Great video doc 😃👌👌👌 i just want to know if spaces created between premolars after they are closed can it be retained by just giving a fixed lingual retainer from canine to canine?
Thanks @zonejvm - I'm not a specialist Ortho but from my understanding, it depends on the neutral zone and if expansion was carried out (maxilla) - expansion can relapse so in my hands essix retainers are key - the fixed retainers are a bonus
funny on the onions! I was wondering on that
Thank you so much 🌹
Great video! What is the name of the electronic gauge that you used to measure the tooth width?
thanks! digital calipers. finding good dental ones with sharp/thin points is hard!
Awesome video!
thanks Doc!
Could IPR be used if a case involved making space next to or between zirconia crowns? Are there tools specifically made for IPR on crown materials?
I am not aware of this being a recognised technique but as a restorative dentist it does not sound appealing! Zirconia can be tough to drill through/grind away, especially in awkward places if you are trying to finish and shape and polish it. I avoid IPR where there are definitive crowns that do not need replacing
Help Doc,
I had this done prior to my Invisalign with NO warning ! I didn’t even know that I needed it ! The orthodontist just started drilling with the disc while I was lying down. Now I feel like the gaps she created in between my teeth are too big because it’s so visible ! What are the chances that the teeth moving will fill in the gaps ? I’m scared that after my treatment I’ll still have those gaps ! Can that be fixed ? HELP !😢😢😢😢
Hi doctr, could you share the link or details of the ipr kit that is being used.. Would like to know the price details too
sure doc www.tocdental.com/swingle-ortho-professional-kit/p757
Amazing video. Excellent explanation doc, very helpful.
Regards
appreciate your comment!
Hi Dr. What's up?
What is meant by the low angle and high angle cases?
www.researchgate.net/publication/232742692/figure/fig2/AS:202521097314309@1425296200646/The-3-finite-element-models-A-Model-A-low-angle-B-model-B-average-angle-C-model.png
Is it possible or likely to accidentally remove from the root cementum below the enamel if you accidentally cut 2 mm into the gingiva with the Swingle or the strip? (between premolars and premolar and canine) Thank you.
I guess it's theoretically possible if you get over the CEJ bulbosity and on to the cementum with enough contact - definitely if the swingle would wrap right on to the root somehow but the gingiva acts as a guide so not easy to remove cementum IMHO
@@protrusive Assuming cutting straight, aligned with the tooth axis and guided by the gingiva, how many millimeters are acceptable to cut into the gingiva in your opinion? (I believe it is necessary to cut a bit into it to avoid subgingival ledge creation.) Thank you.
Have you ever used IPR in the towards the end of the case? Ex: pt wearing class-3 elastics just to correct .5-1mm underbite…slow progress on young teen….mentor does not like IPR & says only will give 1mm retraction but I need more than that to help jump the bite & then sink in the overbite. Tips/tricks??
Indeed many of my ortho colleagues are careful about IPR - can cause bolton discrepancy. Have I done it? yes in class 3 protocols IPR on lower teeth - but always case dependent, no recipe book IMO
Assuming cutting straight, aligned with the tooth axis and guided by the gingiva, how many millimeters are acceptable to cut into the gingiva in your opinion? (I believe it is necessary to cut a bit into it to avoid subgingival ledge creation.) Thank you.
will be case dependent IMHO based on anatomy, position of gingival margin, papilla height etc - do you know if there are any clinical guidelines on this? I am not aware
Can I ask what type of disc you're using? How many mm is it? Thank you!
They come in various thicknesses - I believe mine was 0.15mm
Can this technique be done on premolars or molars to create space to push the front teeth a bit inside?
There might be better ways but CAN you do IPR posteriorly: yes - but I try to avoid if I can achieve space by other means eg expansion
@@protrusive because i already underwent orthodontic treatment and after that my wisdom teeth started growing and that pushed my upper frontal teeth slightly outward..therefore i want to just slightly push upper teeth inside not too much..And i don't want expansion as my jaw is already broad.
@Urooj pathan Wisdom teeth causing crowding is a Myth and has been disproven by clinical trials.
Where do you buy the IPR discs from? 😢
I think most ortho suppliers should have discs? www.tocdental.com/diamond-discs/p300
Help Doc,
I had this done prior to my Invisalign with NO warning ! I didn’t even know that I needed it ! The orthodontist just started drilling while I was lying down. Now I feel like the gaps she created in between my teeth are too big because it’s so visible ! What are the chances that the teeth moving will fill in the gaps ? I’m scared that after my treatment I’ll still have those gaps ! Can that be fixed ? HELP !😢😢😢😢
don't fret! gaps can close very predictably
@@protrusive thank you 🙏🏾
Do u have any sensitivity issues due to this treatment?
my ortho just did IPR for me on my bottom teeth bc of small black triangles but now the gap is so much more noticeable than the black triangles itself.. i keep regretting bc the black triangles weren't even that bad to begin with... do you think my ortho messed up? :/
it's totally normal for the gap to look noticeable after IPR - does not sound worrisome to me. Trust in the process, you'll be fine.
@@protrusive what happens if you leave the black triangles alone? does it get bigger or affect anything in the long run?
@@hanahlee9520 food keeps getting trapped - could lead to issues if not well maintained
@@protrusive is it normal to see black triangles/holes now that i have braces? i didn't see this many before braces and my teeth were pretty straight to begin with.. only got them because of my open bite
What is the accuracy of IPR that you can achieve in mm? For example, can you achieve +/-0.02 mm accuracy? Can you do just 0.02 mm IPR between teeth? Thank you.
You can do 0.02 but there isn't a way in the practice to measure that. The smallest gauge I have is 0.1mm
@@protrusive If you had to do for example 0.02 mm IPR between premolars to adjust bite, how would you do it? Especially without an accurate measuring tool. Thank you.
@@sonnyboy2026 No aligner program I am aware of prescribes 0.02mm - are you sure you don't mean 0.2mm?
@@protrusive yes, 0.02 mm, 0.04 mm or 0.05 mm. Was the smallest amount of IPR you did 0.1 mm between molars? Thank you.
@@sonnyboy2026 smallest is 0.1mm because I can measure that
Coming from a soon to be braces patient... how likely is it that an orthodontist will cut my gums while doing ipr?
it's a bit like trying to floss without touching your gums.. IPR instruments will likely and lightly scratch the gum. it is expected and not worth worrying about.
@@protrusive awesome, thank you!
How much cost
tocdental.com/protrusive-ipr-package/p950 disclaimer: I have zero financial interest
This was all mambo jambo of Orthodontrics. I have several overlapping teeth and rough edges with crowded teeth. Visit to orthodontist will cost me arm and leg. I was looking for some self help. Which you have not provided. You are talking about the size of strips. How do I know what to use. I can purchase the strips online.
Please advise in plain English language.
lol at what point did you figure out you weren't the intended audience for this? 😂
@@protrusive when you started talking about Orthodontrics. I thought you would display the technics of using IPR. but you talked as if I am an orthodontist.
@noormotani9719 you need to see some patient facing orthodontric videos- mine are for dental professionals. all the best with your IPR journey (disclaimer: please don't do DIY Dentistry)
I can do this
YOU GOT THIS!
personally, i feel for the patient...sometimes he's talking and there's pool of saliva in his mouth..poor lad. could use a typho model to do all that experimenting...
lucky it was my brother in law! he's a good egg
@@protrusive haha, alright! kudos to him for all that patience...definitely a good egg