Do Teeth Migrate After IPR or Extractions?

April 1, 2022 6:11 AM

I want my backward-slanting teeth brought forward. An orthodontist has told me that my teeth are crowded and that treatment would require “Interproximal Reduction” or IPR, getting sub-millimetre amounts shaved off the side of each tooth. The last time IPR came up in a question on here, someone mentioned that it “caused the teeth to migrate back”. This is exactly the opposite of what I’m aiming for! Is it true?

My top teeth seem to sit somewhat further back than normal and are also slanted backward at the front, which in turn constrains my lower jaw. I figure that at least the backward slanting could be fixed with braces or aligners. I’m in my 30s.

I’ve had an orthodontist assess me for Invisalign treatment, and I've been told IPR would be needed.

I can’t find any sources online confirming the idea that IPR would cause the teeth to migrate back but it does make a lot of intuitive sense. It would be consistent with the idea you’ll find on some corners of the internet that tooth extractions can subsequently cause everything to move backwards over time. Since IPR also “makes space” in the mouth, it seems like it should do the same thing. But is there any evidence for or against any of this with either extractions or IPR?

I did find a study showing that IPR doesn’t increase the risk of decay, so no concerns on that front, but I’m reluctant to do anything irreversible if there’s a risk that it might move all my teeth in the wrong direction, even slightly.

posted by PJMcPrettypants to Health & Fitness (3 answers total)

I'm not going to try to guess about IPR in too much detail ... if the teeth are crowded and need to be apart a little (allowed by the space created from IPR)in order to be brought forward/straightened, that makes nominal sense to uneducated me, however ...

I went through Invisalign with an amazing neurotic detailed genius of an ortho who was very very experienced with Invisalign in a very busy practice. I learned that while many dentists do Invisalign and many orthos do invisalign (especially with kids/teens), that there are many levels of expertise, training, and experience. I have so so many examples including trays that come not fitting quite right and the comfort in having an ortho who is confident in sending them back to be remade. My teen also did Invisalign and the process is heavily dependent on the ortho's expertise especially when the patient is an adult with different types of issues and responses to treatment.

So, I'd recommend that you see another ortho or two and look up the busiest ones in the area to see if they have more expertise/experience. The ones who have the scanners in their office versus doing molds also seems good to me.
posted by RoadScholar at 6:25 AM on April 1, 2022

Time to get a second opinion. The thing with teeth is, once something is removed, it's not coming back. I would try to keep as much as your whole teeth as possible. Spending a bit of money out of pocket for a second or third opinion on teeth is much cheaper than future fixes.
posted by tipsyBumblebee at 6:54 AM on April 1, 2022

IPR is pretty low risk. It's only taking enamel, and the calculation would be to determine how much space is needed to be gained and choose to gain that space from teeth with the most enamel to give. If there isn't enough to be gained by very conservative IPR, then extraction is an option.

In terms of relapse, that what retainers are for. To a great degree, one goal of ortho would be to create a relationship between the teeth that encourages retention of the result. Repositioning opposing and neighboring teeth correctly to create resistance to relapse. In the absence of this, removable, or sometimes fixed retainers are placed to keep teeth where they've been placed. Your orthodontist should absolutely have retention in mind when treatment planning your case.
posted by OHenryPacey at 10:30 AM on April 1, 2022