IPR Techniques – Strips vs Burs vs Discs vs Oscillating Handpiece – PDP107

Check out the TOC IPR Kit with the Intensiv Swingle – Protruserati Discount!

IPR can be a tough gig – from the feeling of ‘making it up as you go along’, to the genuine threat of repetitive strain injury from using strips. Let me help you take guesswork out of it! By the end of this episode, you’ll know exactly what instruments to use and have a step-by-step process in place. Why? Because I didn’t learn this the easy way. I learned it the hard way, but now I’m going to share with you these different techniques to use that will definitely give you confidence and help you get high quality, efficient and SAFE IPR for your ortho cases.

Check out this full episode on YouTube

Need to Read it? Check out the Full Episode Transcript below!

Protrusive Dental Pearl: No matter how much IPR you think you have done, do some more. You probably haven’t done enough. Don’t believe me? Check out this paper below by Dr. Tony Weir.

“You can avoid the random learning experience I had, and you’ll be able to provide better IPR than I first did for my patients.” Dr. Jaz Gulati

In this audio-only episode (IPR Video on YouTube) I discussed:

  • How I learned IPR 00:50
  • IPR Strips 12:52
  • IPR Burs 20:17
  • IPR Perforated Discs 24:25
  • Intensiv Swingle Review 28:12
  • IPR Planning 35:21

Check out this paper as mentioned by Dr. Jaz Gulati:

Thank you TOC Dental for the instruments I used. Show them your warmth and support, Protruserati!

Email TOC Dental for the Discount!

If you enjoyed this orthodontic episode, you may also enjoy my episode with Dr. Devaki Patel all about IPR for Dummies.

Click below for full episode transcript:

Opening Snippet: Five years ago, I went on a one-day short-term orthodontic course. And another course they talked about IPR. But very briefly, it wasn't covered in much detail at all. In fact, I remember them talking about, call it tooth slenderizeation, don't call it IPR call it to slenderization because it's more patient-friendly. So that was the main thing I remembered. And there we are, you know, they said, go ahead, and you can start doing orthodontic cases now and IPR is totally safe, don't worry. And by the way, use these strips...

So that was my first experience about learning about IPR. I then did my first ortho case, which was my wife. Quite commonly, I think as dentist, we tend to treat a family member or our spouses first when we’re learning a technique like orthodontics. I also find by the way that splints when people start doing anterior occlusal splints or whatnot, they also find somewhere to practice with their spouse, but it’s a similar theme. Now, I actually remember being in Singapore, and my wife was in the chair, I was doing some IPR with strips and I was thinking, wow, this is really slow. What does the orthodontist in the practice use? Because we had an orthodontist at work there. And my nurse said, oh, yeah, he just use these discs. He makes it look really easy. I’m sure it’ll be fine, Jaz. And so I started using this disc. And boy, that was an interesting experience, because I was using it and I was like, I was asking the nurse, I was asking LC. LC, am I doing this right? Is this correct? She said, No, no, no, he doesn’t like this, like that, this kind of a stroke. And how about now? Am I doing it right? And say, yes, yes, you’re doing it right now. So it’s quite a laughable experience. When I think about it now. It’s quite a dangerous way to learn IPR. But this is our reality. I find that so many dentists that start orthodontics, IPR is like learning from YouTube, winging it or from mentors. So for me, it was winging it. But then also, when I came back to the UK, I did the Invisalign course, which, by the way, again, didn’t teach me much about IPR. Would it be great if these courses had a hands on IPR component? I think that’d be really cool. Because it’s not as a simple thing. And it’s important to do right. And it’s important to do safely, I think. So I’m hoping that by the end of this podcast, or the video, which I’ll tell you about in a moment, that you’ll feel much more confident in IPR. You can avoid the random learning experience I had, and you’ll be able to provide better IPR than I first did for my patients. 

Now back to my old boss Hap Gill, who taught me so much about orthodontics, Invisalign, and how to do IPR. He is a huge fan of using burs. And so he taught me how to use burs. And I kid you not like my palms were so sweaty, the first day I had to use a bur for IPR. And it was the only time that someone actually taught me how to do it. So I felt more competent than just winging it. But I still felt uneasy about putting a bur between his teeth, you know, coming from a minimally invasive background and enamel is king and now having to remove this enamel with a bur. It seems scary for me. And I know I’m not the only one I know you guys can also feel as though that is a scary thing to do. So lots of colleagues are stuck on strips, because they’re afraid to use burs. And the interesting thing about using burs for IPR is that some people and some orthodontists are really pro-burs like it doesn’t, there’s only one way to do it, you’ve got to be burs, it’s gonna be quick, it’s gonna be good, and it’ll be fine. Whereas other orthodontist I know if like, for example, Gos, who was a previous guest of the show, I know that he is quite anti-burs when used anteriorly. In fact, he said that in the Facebook group recently, and I know other dentists who say never use it posteriorly so here we are, some people are saying burs are great. Some people are saying don’t use burs anteriorly, other saying don’t use burs, posteriorly. So where do we go with that? So don’t worry, I’ve got you covered. I’ve got you covered with burs both in this audio episode and in the video, which I’ll tell you all about. 

Now this episode that you’re listening to right now, it came to fruition, because you might have seen on my Instagram story, I had found my old disc, so I bought some IPR discs in Singapore. And I completely forgot about them. And in my sort of associate box, I just found them at the bottom of it. And I was like, Yes, I found my discs. Let me use them today. And I used them with great efficiency. And I thought wow, this allow me to have a 10 minute break on my appointment today. And I got to have a coffee and I thought wow, this is such a great way to do IPR. It was much more efficient. So when I went to the next Cephtactics course, which I teach on, I teach about TMD screening before doing orthodontics, TMD diagnosis and how to stop your patients chewing up your retainers. So that was my lecture talk. And while I was there, I met Saj from TOC dental and I asked her Hey, Saj, Do you sell these discs? I’m looking to buy some more discs because I rediscovered, I remember I had these discs and I forgot how awesome they were. And Saj said yes, we sell these disc but Jaz, if you’re interested in doing efficient IPR that’s high quality, then I’ve got something better for you. So that really piqued my interest. And he was telling me about an oscillating handpiece called the Intensive Swingle. So it’s called the Swingle. So he really wanted to show me this. So I said, You know what, in two weeks time, my brother-in-law is coming in, he’s having some Invisalign. I had to do quite a fair bit of IPR in him. Why don’t you bring just everything over? Because you’re gonna bring the Swingle anyway, why don’t you bring the Swingle, some burs that you guys sell, some strips, add some discs, and let’s do a little educational experiment, okay? Let’s keep the same practitioner ie me and the same patient. And let me just choose different contacts and make some educational content from this, but also test out this Swingle that you’re raving on about. And this happened. 

So on 31st January, my brother in law came in, and Debbie and Saj from TOC dental was such great sports, they bought everything in that I need to use. And Saj was carrying around the camera as I was doing the IPR. And we made some great footage, how to footage for, how to use a bur, how to properly use strips, how I use a discs, how to be clever, and measure the teeth before you do the IPR, and measure them afterwards in certain scenarios. And this is all now on a separate YouTube video. So the main message I send you is that this audio episode is unique. And I will go through my experiences of using various IPR forms. And my aim is that by the end of this episode, you will feel more confident about what’s out there for IPR, and also to improve your IPR come Monday morning. But if you really want to gain from all the filming that I’ve done, then you should check out the YouTube video. So usually, my podcast episodes are our copies. So IE the audio version is pretty much the same as the video version. This episode is unique. The audio is completely unique. I’m recording audio only just for you guys. And the video is completely different. I share some similar themes, but in the video I focus more on the how, how to do the IPR, which contacts, why I’m doing what I’m doing. And also showing you how I found the experience of using the Swingle, how I found the burs, how I found the disc and and how to use those things appropriately. Whereas this audio episode is more about the why and how to be a bit more clever when it comes to IPR. So, you know, check out both, but I really think you’ll get the full immersion, the full experience, especially if you’re nervous about how to do the IPR that will come from the video. So do check out the YouTube video. The channel is Protrusive Dental Podcast, and it will be easy to search and find the IPR videos, I’m pretty sure something called ‘Which is the best IPR system’ So check it out. Let me know what you think. Or you can visit protrusive.co.uk/iprvideo. That’s /iprvideo and it’ll take you exactly to that video, but let’s continue with this discussion on IPR. 

Now before you listen any further you need to understand that I am no ortho specialist. I’m just a GDP, who’s palms used to get very sweaty when I had to do IPR. I’m just sharing my experiences like if a specialist tells you something opposite of what I’m telling you, then listen to a specialist, okay? Because they are probably correct. But if you’re happy to listen to someone who’s got his hands dirty, who’s experimented, who’s experienced, who’s failed, who struggled and has got a postgraduate diploma in orthodontics thrown in, then I do hope that this IPR resource will be very useful to you. My aim with this episode, and that the video is to make something that I wish I had access to when I was starting out in orthodontics, and I was struggling through IPR and I still struggled through IPR hencewhy this episode was made because I was looking for more efficient solutions. And finally, I think I found it. So listen to the end of this episode to figure out how I think I’ve nailed that scenario. Now, in the remainder of this episode, I’m gonna be talking about the different forms of IPR. And I’m going to be rating them like giving them like an out of five stars, which is best for safety, efficiency, and quality, which I think are three really important parameters when it comes to IPR. 

Now the Protrusive Dental Pearl I have for you is very much linked to the quality of IPR. The Pearl is that no matter how much IPR you think you’re doing, do some more, because you’re probably under doing the IPR. I know there’s the case because I came across a study from 2021. So just last year, Tony Weir based in Australia published this piece of evidence in the Australasian orthodontic journal, and it is just so eye opening. So what they did is they looked at 10 orthodontic practice, not general practices, specifically, orthodontists and orthodontic practices, and they looked at 10,000 cases in the Australian aligner research database within Invisalign, and using this data they calculated, how much IPR these orthodontists were supposed to do, versus how much IPR was actually carried out which is very clever. And the results were absolutely shocking. To give you the TLDR of this, if the plan the average IPR was 0.29 millimeters IE for all the IPR that they had to do where they had to do an IPR, the average they needed to do was 0.29 millimeters across these 10,000 patients. However, they only achieved 0.13. Let me say, again, they only achieved 0.13 millimeters for every 0.29 they were supposed to do. So really, they only achieved 44% of the IPR. So that is crazy. That’s a shortfall of 0.16 millimeters of IPR per contact, which was supposed to be 0.29. That’s really, really crazy. Think about it, because these are A) orthodontic practices and B) less than half of the planned IPR was actually carried out by the time they finished the aligners that’s really saying something. Now this study will be available on the Protrusive app coming soon, will also be on the Protrusive Dental community. And I’ll put it on the blog of the website as well. So you can check it out this really fascinating study. And I don’t think it’s new information. I think we’ve always known this, that dentists were a little bit shy to do IPR. And we don’t do enough, but I hope you can appreciate to do the correct amount of IPR will be important for efficiency and predictability of movements, you know, you need to create the space to get the movements. So this is a really important study to consider. And if you think that okay, you know, I think I have 0.2 millimeters here, then you probably don’t, and obviously, that’s where the use of the IPR gauge or thickness gauge comes in, which I also demonstrate in the video. 

The other interesting thing about the study was that all practices were effective. So every 1 of the 10 practices was underperforming the IPR, but it vary greatly from practice to practice. In the study orthodontist I, so they labeled this orthodontist, orthodontists I, and he was the best orthodontist in terms of IPR. He only managed still 75% of the IPR. So he missed out 25% of the IPR. But the the real shocking thing is that the you know, “the worst” orthodontist here, obviously, you know, what I mean here is that the person who underperformed the IPR, the most only manage 9.9% of the IPR. Like, let’s say you needed, you know, two millimeters of IPR across the arch, they would have only done 0.2 millimeters that is absolutely crazy. As I was reading this study, I was trying to figure out okay, is it because maybe they were using strips, is it because they use a certain type of IPR that these orthodontists were not achieving the targets or the required amount of IPR. And then I came across another study by Johner et al on references, reference number 25, within this study, and this study found that actually, the stripping technique was not a significant predictor of the actual amount of enamel reduction in vitro. So we don’t know yet whether those orthodontist who use strips only are more efficient than those orthodontist that use burs, we don’t know if that’s the case or not. 

But let’s talk about strips as the first main tool, because this is something that I think we all start off using when we enter the world of orthodontics. And it is something that’s been around since about 1944. And you get different thicknesses and different coarses. Now, I personally have a bias towards single sided and perforated diamond ones. Okay, so single sided, I like single sided, because when you’re getting the slightly crowded areas, it’s just makes sense to use a single sided because what you don’t want to do is as you’re preferentially removing tooth structure perpendicularly to the proximal surface, then you’re also scraping the tooth next door, and then you’re catching that sort of the labial part of a different tooth, at the same time as catching the palatal part of another tooth, and that just makes for Ugly IPR. So I prefer single sided. Because if I have two perfectly aligned contacts that need, let’s say, some IPR, at that point, double sided makes sense, because then you’re happy to remove from both of those teeth. So my bias is towards a single sided. The typical way I’ve been using strips for the past few years is sequential IPR IE, if someone needs 0.3 millimeters, let’s say across the lower incisors, then I will do 0.1 or 0.12 millimeters, okay. And then maybe six weeks later, I might do another 0.1. And then another six weeks later, I’ll just slightly going with strips again until I feel as though okay, I’ve done 0.3. So maybe that is one reason why we are under doing the IPR is because we’re not being so accurate. And maybe because we’re doing it a little bit by little bit, we don’t actually get a gauge of exactly how much we’ve done. 

I find this useful because the main reason I do orthodontics for patients is because of crowding. And with crowding, when you’re planning on the ClinCheck Invisalign, we try and avoid doing round tripping. So round tripping is, for example, we’ve got some lower crowded incisors. And if you align these incisors and you let them unravel and just proclaim and expand outwards, without doing any IPR then and then once they’re aligned, to then reduce the overjet again, you then start stripping and doing the IPR, and then you bring the teeth back in, that’s round tripping, because you’re tipping the teeth out, then you bring the teeth back in. So to avoid round tripping, so you say, Okay, why do you want to avoid round tripping? Cool, I was taught that you should avoid Round Tripping because you risk disturbing the gingiva IE, you might get recession, you know, by proclining and tipping the teeth forward, you might get some recession, and then that’s not good. So you want to then ideally minimize how far forward the teeth are coming. So we want to avoid round tripping. So the way to avoid Round Tripping would be to do the IPR, while the teeth are in a kind of crowded state. And this is where it becomes tricky. This is where I think you can only really use strips, and discs. And maybe if you know the Swingle system I’ll tell you about at the end. If you’re clever about it, you could do it. But really, this is where strips are champion, because you can wrap the strip around and really make sure that the part of the tooth that you’re actually stripping away is the correct part of the tooth, is the proximal, the mesial or the distal of the tooth. Too many people will do random stripping, and as long as they have that space between the teeth, they think they’re done but no. IPR is always planned from where the future contact will be. So that’s from the proximal, this you know, the mesial and distal, not the facial-mesial, not the lingual-mesial, the actual, you know, mid-mesial area and the mid-distal area. So it’s really important to wrap around the strip perpendicularly to the tooth that you’re removing. The other thing you could also use in those scenarios is discs. I’ll talk about that very shortly when I talk about discs. 

Now the problem with IPR I mean that they’re versatile, because you can get different coarses and get different thicknesses. Two problems for IPR one a common one, which I used to believe as well, is that okay, I know that the red perforated diamond IPR strip is 0.1 millimeters in thickness, ie, if I get this in between the teeth, I know this strip is occupying the width of 0.1 millimeter. So I used to think that, okay, if I can get this in, if I can just do a bit of stripping, it’s very easy to get 0.1. And then I thought, okay, if I now double this strip up, so you fold a red strip in half, and then technically you have 0.2 millimeters of metal there. So then when you put that in a contact and you start stripping, it’s kind of logical to think that okay, now you have 0.2 millimeters of space. It’s very far from the truth, actually, when you actually go ahead and measure with the IPR gauge, you’ll notice that okay, you probably don’t have 0.2, you probably have like, you know, 0.15 or something. So just because you can get that thickness of IPR strip in, it doesn’t mean you have that amount of space, because you have to account for the PDL movement. You know, when you’re putting something between the teeth, there’s PDL, so they move out of the way, and that makes you think that you have more space than you actually do. And of course, the other downside of strips is the time it takes like, fine. If you want to do 0.1, even maybe 0.2, you know, going through a sequence and polishing, it’s okay. But anything more than 0.2. And stripping will give you RSI, will give some serious, repetitive strain injury, your patients will not be thanking you. It’s not that comfortable. It’s horrible noise. And it’s just too much time especially we’re doing multiple contacts

Stripping appointments in the past, when I’ve done stripping only and I’ve gotten multiple contacts, and I’ve done attachments at that appointment. You know, that could be a 90 minute appointment, right? That’s far too long. I think now I reflect back and I think wow, I was spending too much time doing attachments IPR, it is just not efficient enough. And I’m hoping to cover some other ways of doing it, which can make our IPR more efficient. Now, so if I was to give you a sort of score, I would say for safety, IPR strips are a five out of five, okay? you know, no matter how crowded you are, if you use a nice a thin strip and you go very delicately, and you’ve got full control with two hands, and you’ve got the patient’s got the opera gate on which to move their lips out the way, I think to do iatrogenic damage is very difficult to do ie so low risk for damage. It’s, you know, yes, you can make the gums bleed and stuff, but that’s okay. I had a mentor who taught me that blood is lubricant. Okay, so when you do IPR, I use blood as my lubricant so I wouldn’t worry about gingival bleeding. Patients don’t really complain that much, that is painful. It’s just annoying. But overall, I think it’s safe because you can’t ledge. So safety five out of five. Efficiency is where the downfall is off strip. So efficiency is I’d give it like two out of five, okay? The real reason I’m giving it to a not a one is because you can get some quite meaty, thick IPR strips double sided. So if you haven’t got that well aligned contact then you can get some really, you know, fats strips and that can help you in getting some degree of efficiency. But again, you have to work your way up to that. And finally, the quality I would say is four out of five. To actually achieve the nice quality. You have to have the whole sequence of strips and then go back can polish and stuff to get really good quality of IPR. It just takes too much time. But I think every person doing orthodontics should have some strips in their possession, it’s probably gonna be used for every time you’re doing an IPR. So if I only had one thing in my stock, it will be strips. 

Thankfully, you know, just like we don’t have one bur for every prep, we don’t have one bur for every scenario, we have different types of bur. I think with IPR, we should be having different equipment, especially for doing a fair bit of orthodontics to make IPR more efficient. Okay, so, next thing I’m gonna discuss is burs. Okay, so remember, we talked about burs, people say don’t ever use it posteriorly. Don’t ever use it anteriorly. Well, when we’re going to supposed to use it? Okay, I’ve broken both those rules before. And I use a high magnification, I use 7.5 magnification with lighting. And yes, I have caused a ledge before, thankfully, a minor one, okay? Thank goodness. But you have to be super careful. The bur,the mosquito bur is just so rigid, right? So you have to be really careful, and how to be along the so correct long axis and have a patient who’s perfectly still, and maybe don’t have too much coffee that day. Like my principal was a huge, is a huge fan. You know, Hap is a huge fan of using burs. I am okay with it. I was very nervous about the beginning. But now that I’ve done it for some years, I’m happy. But I do worry about you know, the tiny little veering off left or right, and it can go horribly wrong. And I’ve seen some, you know, we’ve all seen those radiographs of ledges, right? How scary are those images of ledges, right? So we have to be really careful. 

And in the video, I show you how I use the bur, especially if I was to describe it in this podcast, you kind of do a brushing stroke labially, you do a brushing stroke palatally, keeping the long axis of the contact, okay, and then that leaves a very thin amount of enamel in the middle of the contact, which is really easy to strip away. So you can literally get the green coarse strip at that point and just strip it away. And it all just flies off. And so it is extremely efficient. So let’s talk about this, okay? Efficiency wise, it’s a five, okay? There’s no doubt about it. If you know what you’re doing, and you’re happy to use burs, and you’ve got a well aligned contact, then it’s a five out of five. But that’s the thing, you kind of need a well aligned contact, like you can’t have one tooth that’s a little bit buccal and one tooth that’s a little bit lingual, and you can’t really do IPR. And well, you can, you can’t really use a bur really well there, the way you’d have to do it is you’d have to measure the tooth beforehand, then use the bur to remove some enamel and then measure the tooth again, but it just disorients you, so it’s much better to use a bur, if you’ve got a well aligned contact already. And then you can race through it and try and remove even amounts of tooth structure, if that’s your aim amongst the two teeth in the contact. 

So burs five out of five efficiency, safety, I’m going to give it a two and a half. Because you can ledge, you can veer off to one side. And you will notice in the video actually when I show this that the problem is that because the bur is a wider in one portion and thinner at the tip, you do get like the correct amount IPR more coronally, and maybe you’re a little bit deficient, gingivally. And then I had to go back and use the strips to get a nice sort of consistent, equal amounts of IPR all the way through the contact. So I would say safety is 2.5. Because aside from the risk of ledgering, there’s also the risk of trauma to the tongue, the cheek, the lip, whatever can come in the way and obviously the gingiva as well. So that’s why it gets 2.5 for safety. And for quality, I’m going to give it three because although you can get quite a lot of space really quickly so that’s a good thing for quality, we want the correct amount of space. The bad point is that it’s very difficult to use burs to finish and polish. So then what are you gonna do you’re gonna go back and use your strips anyway. So you’re relying on strips for the actual polishing and contouring and finishing so it’s not great, the quality of the IPR can suffer a bit, it can make teeth look like tombstones, right? Because it really flat, so you had a lot of work afterwards with discs and maybe sof-lex discs and strips to get a nice curved polish tooth surface as it should be. So quality will be around about a three out of five and and as I mentioned before, sometimes you get more IPR higher up the tooth and less IPR gingivally. So that is an issue as well. 

The next one to discuss is discs. Now, I rediscovered disc recently and I was like yes, I’m so happy and I find that once I’ve done the initial space opening with a strip because obviously you have to create the space to allow your disk to fit in. So imagine you got a well aligned contact between the lower Centrals for example. I will create a little bit of space like you know 0.1 millimeters with the strips and then I’ll put a wooden wedge gingivally to help get a bit more separation. And then I’ll use my IPR disc which is like a perforated diamond disc and I’ll do like a brushing stroke upwards, up and down, trying to keep the long axis of the tooth, but also to de-triangulize the tooth. Imagine you got lower incisors that are fan shaped, I want those fan shapes incisors to be a bit more parallel shaped incisors, because I want less black triangles. So that’s usually part of the strategy of IPR, you’re trying to change the shape, not only create the space, but also change the shape of the teeth, so the disc can be good. And where I found discs really useful is that scenario I mentioned earlier, where you got a bit of crowding. So one tooth is very labial and one tooth is very lingual, so you can’t really access the contact isn’t? There’s no contact to stick your strip in. But what you can do is you’ve got beautiful access to the mesial, or distal surface of a tooth or both teeth. And so what I would do is I would measure using like a measuring gauge, a digital caliper, let’s say the tooth is 6.5 millimeters in width. And then I will use the disc to remove some tooth structure mesially, let’s say, and then I will re-measure the tooth, and maybe now is going to be 6.3. So I know I’ve done 0.2 millimeters of IPR there without getting even involved in the contact because I know that’s where my future contact will be. Does that make sense? You’re not just randomly creating space, you’re creating the space from where the future contact will be.

You have to be really careful with disc because you can go off on a slant and that makes a really ugly IPR. The lower incisor will look as though is deficient and you have to maybe you know, put some composite there or something to make it look like the correct shape. So be careful. And the other danger is making the teeth again like a bur, looking like a tombstone, right? Because these discs are very rigid. You can’t really use them with great ease for polishing and finishing. You’re still relying on your strips to get that polishing, although you can get finer discs, just because the rigidity of it doesn’t lend itself well to polishing and finishing. And of course, the elephant in the room here is safety concerns. Like if you go into a room of orthodontists and you talk about discs, you get some real horror stories that you talk about people’s their lips being lacerated, tongues destroyed. Like this usually gives orthodontists a lot of palpitations, and there are some systems out there, like we just got a disc and a guard attached to it for protection, which makes sense, but I don’t know how much that limits your visibility. And I had an opportunity to try this. But the guard wasn’t the right shape as the disc, so we couldn’t actually use it on the day. But overall, the main thing to remember is there are huge, huge safety concerns. Mostly because this thing is spinning really fast, it’s really sharp, and it can do some real damage real quick. So be very careful if you use going to use disc. In fact, it’s probably a reason not to use discs, because of the danger aspect and the whole slanting issue and doing ugly IPR and the fact that you need something else to polish anyway. 

So discs, I would give a safety rating of two out of five, I would give it two out of five, be very careful. Efficiency, I’d give four out of five, you can be very quick. And quality again, three out of five just like the burs because you get this tombstone type appearance, which is very straight. So you need to go back and do lots of finishing and contouring. 

And finally, we’re now going to talk about the oscillating handpiece. Okay, so this handpiece that they showed me is called the Swingle. And I was able to demonstrate it and you have to watch a video. It’s really clever, because the file that you put in, it’s got a metal base, which can bend, you can bend this metal. And I absolutely fell in love with this feature. Because now around canines for example, you can actually bend the IPR file. And it was just genius way to create space. And that’s why I think these single sided files in an oscillating handpiece are really, really fantastic. So what is an oscillating handpiece, so it basically is a handpiece that oscillates, it creates these vibrations, so you put a file inside you put in the contact, and you don’t have to move your hand. The handpiece does all the work. Now, how much work does it do? Well, interesting stat, five seconds of this file in this oscillating handpiece called the Swingle. So five seconds of the Swingle between the tooth, the file has traveled three meters in five seconds. So in a minute, it’s traveled 36 meters. So in a minute of IPR, that file has actually moved 36 millimeters. So that’s good because when even when using strips, or even when you’re brushing your teeth is the changes of direction that give you the result ie when you’re brushing, you’re changing directions constantly. And that produces plaque removal. And when it comes to IPR  strips, if you was going very slowly back and forth, then that’s not going to be as efficient as when you’re going really quickly back and forth, back and forth because there’s a change in direction that does the damage if you like so that’s what we want to do. We and the good thing about the handpiece of Swingle is it does all that for you. So it’s an oscillating function that creates the efficiency.

Now after using the Swingle I have to say I am converted. I found it really quick. So in the demo video, which you’ll see I compared burs versus discs versus strips and the Swingle. And The Swingle as an example of an oscillating handpiece was hands down the best way of doing IPR. Because it was efficient, it was really quick, but it was really safe. And what’s safe, because I had full control. And it’s safe because I was able to bend the metal part to actually get the right contour. And then bend it back the other way. That was genius for me. That one of my buddies, though, the host of Ortho in Summary podcast for Faruk Ahmed, who is like one of my ortho mentors, he is a huge fan as well, and he loves the space opener. So remember to, just like a disc, right? If you want to get a disc between the teeth each create the space for the disc. So the way you create the space for a file is that you put a space open a file inside the Swingle. And that’s got like a serrated saw. And then (buzz sound) was that through and it creates a space to now allow you to put the next file in, and the next file go (buzz sound) and go all the way down. And the next file (buzz sound) all the way down really quickly. And now suddenly, you’ve got like, you know, 0.2 0.3 millimeter of IPR in quick time. 

But then the real clever thing about this system is the finishing and polishing files. They really, this company intensive, they’re basically, they may not be the market leader in diamonds and IPR and whatnot, but they focus on quality diamonds, so all the burs everything they make, it’s all about quality. And they’ve taken that to the Swingle because it allows you to really work through the finishing and polishing. So they’re very passionate about creating well polished, but efficient IPR. So they’ve got these finishing and polishing files, which you take away all the hard work, so you don’t have to be there with strips for too long. You know, now that you have this handpiece, you’ve got the Swingle, you stick in the finishing and polishing file, you bend the file, and you put it in and a few swipes, and it does all the work because remember, it’s moving three meters in five seconds, it’s doing all that movement for you. And that’s what makes it really efficient. So, for me, the experience of using an offsetting handpiece, like the Swingle was brilliant. So I’m going to get one, the practice agreed to get one, and I’m going to give it a four out of five for safety. The only reason I didn’t give it five out of five for safety was because at one point I had to really get it under the gingiva just to counter it. And you know, my brother-in-law was, yeah, that was a little bit uncomfortable. You can hear his thoughts and stuff. But that’s what he said. But that was only because I was going subgingival. But I feel as though with the serrated saw, the space opener, if you are not careful, if you as the operator is not careful, because it’s a bit of a learning curve, then then you can potentially ledged the tooth. So you have to be a little bit careful here. 

And just like all the other forms of IPR, other than strips, you have to have fairly well-aligned contacts to do the IPR. So I’m going to talk about that in just a moment. But safety four out of five. Efficiency four out of five. The reason I didn’t give it five out of five was because you still have to use a few different files, right? So you go for the space opener, then you go for like the 40 microns, then you go for the 80 microns. And actually, when Debbie from TOC was showing me these files, I was thinking 80 microns, like is that, how thick is that? I don’t understand. So obviously I was being stupid because 80 microns tells you about the coarseness of the file, the thickness of the file varies. So for example, that the 60-micron file from the Swingle, double-sided is 0.28 millimeters. So it’s 60 microns, which is the sort of coarseness of it, but the thickness of it is 0.28. So this is great for if you’re doing let’s say, you know 0.3, 0.4, or even 0.5 millimeters of IPR, you can put this disc in or even the 80-micron disc in which 0.31 millimeters, okay, so 0.31 millimeters. And if you want to do really efficient IPR of 0.4, 0.5 millimeters, their sort of tagline, their sort of marketing is that you do half an hour’s worth of IPR in one minute, half an hour’s worth of IPR in one minute. And I think I definitely experienced that. 

Now, I know the finishing and polishing takes a few extra steps because you have to add in the, you know, the finishing file and the polishing file, but it’s so worth it. Because the quality of the IPR was absolutely brilliant. I had a look at the end. And I thought, wow, this is the right amount of space was really important. But it’s anatomically correct as well, because of the way that you can bend the file. So for the quality of IPR, it gets five out of five. So safety, efficiency, four out of five. Quality five out of five. If I was to recommend one thing, and obviously you need to have strips, I think, because when you got crowded situations, there’s nothing to do other than using strips. Maybe if you want to use the disc in the way that I described earlier, that’s fine, but just be very careful using discs. But essentially, the things you need to have is strips. And then if I had to have one more method of IPR in the practice, especially if you’re doing a lot of it, but you want to save time so that 90-minute appointment would become hopefully a 45 minute appointment. And you would get, you know, if feasible, you could do all the IPR in one go if feasible. Now we’ll talk about that a little bit as well. So I would say the Swingle would be the best bet. So strips and the swingle, for me is going to be the recipe of success with IPR going forward. And I know loads of other dentists who have already been enlightened about this, they’ve already railing on about how good the Swingle is. So I’m a little bit late to the party. But I’m excited to keep the party going now and using the Swingle because I just think it’s gonna really save me a lot of time to my IPR appointments. 

So I hope you enjoy that overview of the different things that are used for that video. And I urge you to, you know, watch that video, but just a little bit on IPR planning, because we need to be a little bit clever in the way that we plan that IPR and also just a footnote here, really important. One of the most common questions I get from dentists who are starting orthodontics is they’ll send me a ClinCheck plan. And they say Jaz, how do I do 0.5 millimeters of IPR in this one area, like lower left bicuspid and canine or something? And they’re like, how do I do it? I’m like, Well, you do know you don’t need to do all the IPR in one go? They like, Oh, really? So when on the ClinCheck in appointment three, it flashes 0.5, Oh I need to do the IPR, it doesn’t mean I need to do the entire 0.5 at that visit, what it means that you should create some space because if you don’t create some space there, there’ll be a collision, the teeth will collide, they will get in the way of each other, and then your movements will come less predictable. So it’s totally cool to do 0.2 millimeters of IPR. And then some weeks later, do another 0.1 or 0.2, and do it sequentially. But if you’ve got the contact well aligned, then it just makes sense to do some strips, or use the space open of the Swingle and then go up to 40 microns, 80 microns, and polish and you’re done, okay? So it’s very appealing to me as a busy dentist who wants to reduce the time of IPR, but not sacrifice the quality to use an oscillating handpiece like that, and I would be inclined to do all the IPR when I can. 

Now you can be clever when you’re planning your IPR, with your aligner company of choice or Invisalign, whoever you can tell the technician on the other side, say that I only want to do IPR when the contacts are aligned, right? So you have to accept some degree of Round Tripping here. But if you can get away with the biotype of a patient with a little bit round tripping, then you can make your sort of workflow and sequencing much easier and just do all the IPR once all the contacts are well aligned, which will be really efficient. The other thing to consider is if you’ve got lots of areas of you know, 0.2 0.2-0.2-0.2 everywhere, consider converting those, you know, four 0.2 IPRs into two 0.3 and 0.2, if feasible, okay, obviously got a look at the shapes of the teeth, because that’s one contact now you don’t have to do any IPR on. So if you look at upper arch, lower arch, can you buddy up the IPR if the tooth anatomy allows it, so you don’t have to, so you have to do less contacts, because every time you do a new contact, you have to go through a sequence. So that’s how another way we can make our IPR more efficient when it comes to planning. 

So hope you found that a little overview that discussion about IPR, for some of you that that will be teaching you to suck eggs because you’re already quite proficient at doing IPR. And maybe you’re doing orthodontics for years. But I think the person who may have really benefited from this is the young dentist who’s new to the world of orthodontics, and it starts to get sweaty palms just like I did when it comes to IPR which case you should definitely check out the video because got the full sequence for how to use each piece of equipment and the Swingle in action. So just want to thank TOC Dental for coming down bringing their burs, strips, the Swingle, the discs, and allowing me to film that and to support the podcast in the way that they have done through allowing me to make this episode for you guys. So I’ll be putting a link to TOC Dental, please show them your warmth and support for this episode if you’ve gained from it. And again, thanks so much for listening all the way to the end was quite intense that one. My head’s hurting a little bit and hope to catch you in the next one guys. Thank you so much.

Hosted by
Jaz Gulati

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