ProxiBur for Clear Aligner Treatment: A Case Study and Steps for Perfect IPR!

Introduction 

As a dentist for 30 years, I have had the pleasure of growing my techniques and procedures chairside, using the full line of Garrison products along the way.  I can honestly say that the Garrison company have consistently been working to improve their products to make our lives as dentists easier and deliver more proficient and efficient patient care.  The new IPR ProxiBur™ are no different.  After using this product, along with FitStrip™, Proxistrips and IPR gauges, I will be utilizing the accuracy of this bur kit with all my IPR cases for clear aligner therapy.  I have been using clear aligner therapy for ortho cases and to set up restorative cosmetic cases since 1998.  As a younger dentist, I used burs for the larger spaces required for IPR and then polish with finishing strips.  

The smaller spaces, mainly in the anterior, I would use FitStrip™ or Proxistrip to create the space and then polish with the finishing strips.  I would use the IPR gauge often trying to stay consistent with my reduction, with no “guarantee” at the end.  Sometimes, the reduction was tight with the gauges and sometimes it was more than I needed.  I got better at the IPR game along the way. In those earlier years, I added a few of my choice burs to help me get to FitStrip™ and ProxiStrip faster and my patients seemed to feel a little more at ease in the chair during use of FitStrip™ and ProxiStrip.  However, after treatment and noticing on x rays that my IPR looked a little bit more like a straight cut through the enamel rather than properly shaped anatomical IPR, I looked to improve my technique for IPR.   

So, I modified my technique for patients to feel more relaxed in the chair while I would “shape” their teeth with FitStrip™ , Proxistrip, burs, and back to strips and measure with the gauges and maybe select another bur to make it faster for me and more efficient so the patient would not be in the chair so much time, but at least I was getting more anatomical in my IPR.  

Basically, I was learning to trust myself to become consistent with my system I had created, and it worked for me.  I even mastered this protocol so why change, right?   

I would consider myself a quick adapter to technology, but I also like to see proof before using procedures and techniques in dentistry throughout these 30 years of practice, before I incorporate them into my daily routines.  I think I have trusted myself with what works in my hands, especially if I modified some technique or procedure to fit my needs as a dentist. Also, I told myself coming out of dental school that I never wanted to be a “dental dinosaur”, meaning that I would always be learning in dentistry, not stay the same but to consistently seek to improve.  That is one of the main reasons I have used Garrison!  The consistency of never settling on a product line the company has gifted to us as dentists.   

Garrison has created a set of diamond burs designed specifically for IPR.  The bur block has diamonds of accurate thickness and shapes for IPR use when precision of clear aligner therapy is of most importance to prevent additional treatment to finish cases and when planning for cosmetic restorations.

Background  

This case features a 27-year-old female patient in clear aligner therapy.  IPR is required before aligner 7 to create enough space for correction of crowding and root torque for tooth #26.  Accuracy of IPR is important, to prevent refinement 
of treatment due to finishing the case with open contacts OR insufficient movements to finish treatment due to lack of interproximal reduction.  Garrison has created yet another way to treat patients with accuracy of IPR.

Figure 1: The amount of IPR indicated at this stage for the patient	Figure 2: Initial picture of teeth prior to IPR	Figures 3a-3d: Using the first bur (the smallest portion of the PRXR03S)
Figure 3b	Figure 3c	Figure 3d
Figure 4: Checking of accuracy with IPR gauge (FPSGAUGE)	Figure 5: Using the IPR FitStrip™  (FPSXFDS-4) to maintain accuracy and polish	Figure 6a: Using the next bur  (PRXR03M) following the same path as previous bur
Figure 6b	Figure 6c	Figure 6d
Figures 7a-7c: Checking the accuracy with IPR gauge (FPSGAUGE) on each area of IPR	Figure 7b	Figure 7c
Figures 8a-8b: Using contour bur  (PRXR04F) to finish out shape of each area for best contact after ortho movements	Figure 8b	Figure 9: Finishing with the FitStrip™ (single-sided FPSXFSS-4)
Figure 10:  Shape of #26 prep op	Figures 11a-11b: Two planes of reduction necessary due to the angle of position in the arch for #26 distal with burs PRXR03S and PRXR03M	Figure 11b
Figure 12: Finished IPR of #26 after using these burs and strips for accurate reduction	Figure 13: Finished IPR as required for this case on the mesial and distal interproximal of #23 and #26	Figures 14a-14b: Using fluoride varnish after IPR
Figure 14b	Figure 15: Accurate fit of the clear aligners

Conclusion 

ProxiBur™ is another consistent step of improving the IPR process from Garrison. The ProxiBur™ kit is made to simplify workflow, improve consistency and accuracy of the IPR technique for every type of dentist and improve patient treatment and comfort. 

he benefits of the ProxiBur™ are: 1) accurate with the thickness of FitStrip™ and measurement gauges up to 0.65 mm reduction.  2) process flows from one bur to the next maintaining an accurate reduction guide plane. 3) contouring is easier with the contouring bur and ease of entry for FitStrip™. 4) durable for multiple use. 5) the sizes are clearly shown on the bur block making it easier for staff to aid in 4 handed assisting and restocking of the bur block.