Preparation

Doctor Preparation:

• Determine whether to perform the recommended IPR at this appointment
• Determine if pre-IPR separation is needed due to any excessive crowding or rotation 
• Determine which surfaces of the teeth will be reduced 
• Determine which instruments and methods you want to use 
• Don't do IPR where there is already space

Staff Preparation:

• When a patient has arrived for delivery of new aligners, review the treatment setup or the treatment plan sent with the case to see if IPR is recommended at this appointment
• If yes, confirm that the patient or parent understands the procedure and has signed an informed consent form
• Prepare instrumentation as required by the doctor 
• Identify locations and measurements of the IPR to be performed 
• Always check compliance before doing IPR:

1. Check for the contact between teeth with dental floss
2. Contact means the patient is compliant (has been wearing their aligners). Continue treatment as planned 
3. No contact means the patient is likely not complying. Don't continue with the next step yet. Have the patient wear their current step for another 1-2 weeks and recheck for compliance at the next appointment

Patient Preparation:

• Fully explain the IPR procedure to the patient and the patient's guardian, if appropriate) before beginning
• Discuss improbable, but possible, negatives:

1. Sensitivity/discomfort
2. Bleeding gums, lips, or cheeks
3. Feeling a slight "vibration" on the tooth 
4. May feel some pressure on the gums
5. Misshaped anatomy

• Emphasize that this does not increase the possibility of cavities 
• Always get signed consent before performing IPR 
• Perform any pre-IPR separation of the teeth, if necessary 
• Apply a small amount of topical anesthetic, if preferred by the patient

• Secure safe and adequate access to the IPR site(s):

1. Consider using a disc guard if access is tenuous
2. Begin with the most posterior sites, working anteriorly
3. Begin with low RPM until desired angulation is achieved, then increase the RPM to make the reduction