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Interproximal reduction in orthodontics: a survey of specialist orthodontists and patients
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Date
2021-08-08
Authors
Donovan, Joey
Journal Title
Journal ISSN
Volume Title
Publisher
University College Cork
Published Version
Abstract
AIMS:
[1] To assess interproximal reduction (IPR) practices of specialist orthodontists in the Republic of Ireland (RoI).
[2] To evaluate patient perceptions of IPR as part of orthodontic treatment.
SUBJECTS AND METHODS: Ethical approval was granted by the Cork Teaching Hospitals Clinical Research Ethics Committee. Orthodontists on the Irish Dental Council’s specialist register and consecutive patients receiving IPR in Cork University Dental School and Hospital’s Postgraduate Orthodontic Unit were surveyed. Two de novo questionnaires were developed, pre-tested, piloted and distributed either electronically or by post to orthodontists and completed in-person by patients. Data with respect to demographic details, IPR use and technique employed, as well as patient perception were collected in the orthodontist survey. The patient survey collected demographic details, knowledge and perceptions of IPR. Descriptive statistics, Chi-squared tests, two-sample test comparison of means and correlation coefficients were used in analyses, with significance set at p≤0.05. Thematic analysis was performed independently by two assessors for qualitative questions in the Patient Questionnaire.
RESULTS: Responses were received from 105 specialists (75%). Nearly all (98%) performed IPR, 44% reported increased use in the past five years. Handheld strips were most popular (37%), followed by burs (17%). Instrument use in postgraduate training was associated with subsequent use in practice (p<0.001 for abrasive strips in a holder; p=0.003 for burs). Lower labial segment teeth were most frequently reduced. IPR was most often employed with aligners (59%), pre-adjusted edgewise (33%) and self-ligating appliances (30%). Adult patients, followed by adolescents in the permanent dentition were most likely to be prescribed IPR, for the purposes of reshaping triangular teeth or restorations, resolving mild crowding and addressing tooth-size discrepancies or black triangles. Enamel removal, typically 0.3mm per surface anteriorly and 0.4mm per surface posteriorly, created 2-4mm of space in each arch (60%) and was done in <5 minutes (45%) over multiple visits (82%) without routinely recontouring, polishing or treating the teeth afterwards. Written information was not given (90%) and only 12% reported prior patient awareness of IPR. Pain was the most common risk discussed, although reported patient perception of pain (9%) was less than for discomfort (48%) with 71% indicating patient preference of IPR over extractions.
Thirty patients (13 males and 17 females, mean age 16.2 ± 1.75 years) completed the questionnaire. Few (17%) had heard of IPR, but all reported understanding after explanation. Most (93%) ‘did not mind’ having IPR, 37% regarded it as ‘uncomfortable’ and 13% ‘painful’ (mean 2.3/10 on a visual analogue scale) and all would prefer IPR to extraction. Themes patients would tell a friend or family member about IPR were: pain, discomfort, comparison to extraction, speed, benefits, bleeding and side effects but would reassure and recommend the procedure.
CONCLUSIONS:
[1] Specialist orthodontists in RoI routinely performed IPR using handheld strips, mostly in the lower labial segment of the adult or adolescent permanent dentition, as part of aligner or fixed appliance treatment to reshape triangular teeth or restorations, resolve mild crowding and address tooth-size discrepancies or black triangles.
[2] Conservative enamel reduction of <0.5mm per surface, creating 2-4mm of space per arch, in <5 minutes over multiple visits without subsequently polishing, recontouring or treating enamel was most commonly adopted.
[3] Patients were rarely given written information on IPR, were perceived by orthodontists to be unfamiliar with IPR prior to treatment, found the procedure uncomfortable rather than painful and preferable to extractions.
[4] Patients themselves were unfamiliar with IPR but found it easy to understand, did not mind having IPR done, found it uncomfortable rather than painful, expressed a preference for IPR over extraction and would provide mostly positive feedback on the procedure to others.
Description
Keywords
IPR , Orthodontics , Interproximal reduction , Patient reported outcomes , Survey
Citation
Donovan, J. 2021. Interproximal reduction in orthodontics: a survey of specialist orthodontists and patients. PhD Thesis, University College Cork.