My ortho gave me the London Look with IPR.

Updated 2/21/13***

Interproximal Reduction

(For my foreign readers, this is a screenshot from a makeup commercial here in the states. You can watch it here:

Once again, I am frustrated only for a new reason:  My orthodontist’s shoddy interproximal reduction job (aka IPR).  I’m nearly four trays into my refinement (11 upper & 7 lower) and I still look like I’ve been blessed with Michael Strahan’s genes.

After my lower arch was “finished”, my teeth were still slightly crooked.  I had three over-correction aligners which were supposed do exactly that: over-correct the teeth.  I was apparently then supposed to wear the last three in reverse order but lo and behold, at the end of these special aligners, my teeth were still not in perfect alignment even though I never wore them in reverse.  The alignment wasn’t my main concern though… it was the black triangles that had formed after years of having crowded teeth.  Loss of gingival papilla (interdental papilla) is very common when teeth are straightened after being crooked and/or overlapping for years thus creating a triangle-shaped gap towards the gum line.  Because of the way teeth are shaped, they’re more likely to only make contact toward the biting surface, but not at the gum line.

Since my orthodontist had performed a problem-free IPR  job the first time, I had the idea that we could do even more IPR in refinement to minimize the triangles and bring my teeth as close together as possible.  After all, the first time she only took off a minuscule amount which wasn’t even in my plan and within two weeks, my teeth scooted in together nicely.

After all was said and done, I still had a large black triangle that was pretty visible and definitely stood out.  I was convinced that we could afford to do more, so I brought this idea up to my doctor.  She happily agreed.

When I went back to get my new aligners a month and a half ago, I received more interproximal reduction and walked out of the office looking like this:

IPR damage

I’ve sharpened the area for clarity.  Pictures – especially cell phone pictures – don’t show just how bad it actually is.

And this is how my mouth still looks today.  The space may have closed ever so slightly but that certainly doesn’t appear to be the case.  I know it might be closing though, because the back of my bottom lip no longer gets wedged between my teeth when I accentuate the f in my not-so-uncommon f-bomb tirades.  Usually when I’m driving.  I’m lucky I haven’t been shot yet.  But seriously, I literally had cuts on the inside of my lip where my flesh would get caught and pulled down between these teeth.  The gap doesn’t look any smaller to my naked eye so perhaps the razor edge of my deformed tooth has worn down some?  I don’t know.

I am upset about my mouth not limited to these reasons:

1.  The IPR was done from behind me to the side.  Meaning exactly that- she stood behind me and to the side.  Perhaps this is normal practice… I’m just trying to find a reason why my tooth is now shaped like it is.  A corner of one of my incisors is shaved off so even if we are able to pull these teeth together, they won’t fit nicely without looking stupid. I’m only assuming this is the reason why the gap isn’t vertical, but angled off to one side.  Bonding may be my only option to having that corner filled in.  Either that or more enamel-stripping IPR.  I hope I’m wrong.  And just fyi- bonding is the stuff they use to fix busted up teeth.  It looks all fine and great at first but doesn’t whiten with bleach so you’re stuck with the color you get, and it requires a lifetime of maintenance.  I know.  My husband has a gigantic triangle of bonding in the middle of his two front teeth where he bit the handlebar of his bike years ago.

Whoops!  Bonding broke off??  Guess I’m headed back to the dentist!! La-dee-daaaah!  I LOVE blowing money!! $$$$$

2.  I’m no pro, but I’ve read in a couple places that professionals (and not all dental professionals are professionals at IPR) should only do minimal interproximal reduction at a time…. meaning only grinding away a fraction of what is required for specific overall movements corresponding with the respective trays laid out in the plan.  The space she grinded out between my teeth this most recent time was 0.3mm (IPR is measured in 1/10th mm increments).  Rather than having me come in for brief appointments to remove 0.1mm at a time (and effectively monitoring the tooth movement), she went ahead and banged it out all at once.  Why not knock a bunch of birds out with one stone, right?  These days, I walk around with The London Look.  I am most certain we could have kept the appearance of my teeth aesthetically pleasing if they were to make time for me in their office.  After all… I’m only spending six thousand dollars. To be fair, part of that money went to my first provider back in Texas.  But still.

Here are three links that I just found about how professionals should go about performing interproximal reduction and also how to space out their IPR appointments.  Perhaps these are only “techniques” and suggestions, but damn, this sure looks like I could’ve benefited if my provider had used a few of these pointers.

•    First example

•    Second example, and link from Aligntech Institute

•    Third, and most informative example

I like slide 10 of the second link, this actually makes the whole thing lose a bit of it’s credibility:  “WARNING: The images you are about to see are very graphic and may be inappropriate for some dentists above the age of 13.”   Really?  I guess it’s only truly appropriate for all the prepubescent dentists out there.


When I had sat down to write the first part of this post, I had just put in aligners #4 and I could tell immediately that these were definitely doing some moving to my lower teeth (great!).  It’s been a few days and my gapped out bottom teeth have made a significant move closer together.  Not only that, but one of these two problem teeth is now rotated into proper alignment, thus revealing what I had feared:  my orthodontist did in fact hacksaw into my other tooth.  Luckily it is only really noticeable from certain angles.  I’ll attach some pictures and do my best to explain how it happened.

Here is my whole face for context.

And here’s a cropped portion of this same picture.  If you click on it, one, it’ll open in a new tab, and two, it’ll get huge… just warning you.

You can clearly see what I’m talking about, right?  So, what I think she did was she filed down vertically, pulled out the strip, put it back in and began sawing some more, only this time at an angle and then stopping… oh, you knooow…just whenever she realized she was sawing into my other fucking tooth!!!  It makes sense.  And I’m pissed.  I now have a what they like to call, an “interproximal ledge” on my innocent bystander incisor.  This not only looks horrid, but it can also cause problems for me for the rest of my life by giving plaque bacteria a lovely little place to thrive.  I discovered the term “iatrogenic damage” and if you ask me, I think it fits my situation nicely.  The ONLY way to correct this is with more IPR.

Iatrogenic: Induced in a patient by a physician’s activity, manner, or therapy. Used especially of an infection or other complication of treatment.

Damage: Physical harm caused to something in such a way as to impair its value, usefulness, or normal function.

Here is a second , more straight-on angle.  It’s not quite as noticeable from a distance in pictures, but it certainly is visible when I’m talking to someone.

I didn’t go into this whole Invisalign process with the expectation of perfect teeth.  I understand that these small things are hardly noticeable to anyone who isn’t scrutinizing, however they drive me absolutely crazy and to me, it truly is upsetting.  I feel like my bottom teeth are permanently damaged and I just want to scream.  Hey, it could always be worse, right?  Hopefully my next blog post won’t be titled, “Accidentally Ate The Cement Steps” over big picture of me sporting three and a half teeth.


8 thoughts on “My ortho gave me the London Look with IPR.

  1. Awwww you sure do know how to make a girl’s day! Unfortunately, my ortho only halfway admitted that she messed up and offered to fix it with more IPR and new impressions of course accompanied by more attachment removal and even MORE waiting. I’ll get into that later though… It will most certainly be in my next post! Thank you for reading my blog!

  2. i’ve got 3 black triangles on my lower teeth and i’m beginning to be not happy about that. I’ve got about 16 more weeks on my Invisalign treatment. I cannot go through the rest of my life with these 3 black triangles in the middle of my teeth, right!?. I’m only 40 and still fuckin’ fabulous! Thank god the Invisalign retainers cover them for now. I thought i did all my research on Invisalign before spending $6,000 (like you) only to discover the term “black triangle” ! WTF!

      • I had my visit with my ortho and he says that they don’t look bad. i do trust him and his opinion. I agree they don’t look that bad, but I’m just surprised that after correcting a couple of problems with Invisalign, I developed another. But my teeth do look and feel way better. I’m down to my last few trays, so the next time I see him he will remove the attachments. I’m very excited about that. Love your blog and your sense of humor. I especially love the pic of you and your cat with the caption “FML” Hilarious!

      • ps. he also said that it’s better to have them look natural then to have them shaved down and squeezed together because then i would have to go through another round of Invisalign trays to adjust the bit of the whole mouth, not just the bottom teeth. I’ve already been on this Invisalign ride for a year and a half. I want my mouth back. ha ha!

  3. Did you ever get this fixed by your ortho? The same thing just happened to me – trying to stay positive and not freak out since it’s on the bottom and not as noticeable if it had happened on the top. I’m wondering if it’s correctable?

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