The

Galler Spacing Technique

(GST)
Manual

By: David Galler DMD

EDITED by: Caroline Quiong DDS MS

1
Table of Contents:
1. INTRODUCTION TO CLEAR ALIGNER
THERAPY
2. HISTORY OF IPR
3. THEORY
4. COMPLICATIONS
5. CURRENT TOOLS AND
TECHNIQUES
6. GOALS
7. TOPICAL ANESTHETIC
8. GALLER SPACING TECHNIQUE
9. STEP BY STEP PROCESS
10. DISCUSSION
2
Introduction to Clear Aligner
Therapy
With the advent of new technology and techniques to achieve
minor orthodontic movement in the 21st Century, more adults are
choosing to improve their smiles with orthodontics. Statistics
indicate that approximately 70% of the adult population has some
amount of spacing, crowding, or malocclusion
(Dentalproducts.com Jan 2010).

Previously, only a limited group of adults would be willing to

endure the wires and brackets of fixed orthodontics (1 in 2500
adults- goftp.com) — because although extremely effective,
cosmetics had to be compromised.

With the revolutionary breakthroughs of the orthodontic

“aligner”— clear, removable, hard plastic designed to precisely fit
over teeth to move teeth— nearly clear orthodontic movement is
now possible.

With this new approach, the orthodontist and the general

dentist now have the ability to achieve minor orthodontic
movement without severely compromising cosmetics. Today,
these new devices and technology can be implemented to
improve the Standard of Care regarding the treatment of adult
dentition.

3
In the past, correcting spacing problems in cosmetic dentistry
primarily involved bonding or the placement of porcelain veneers
to improve the appearance of a patient’s teeth. Minor
orthodontic movement with fixed brackets and wires in the
anterior region is also another approach that can be utilized to
correct such spacing problems.

Now, with the introduction of clear, orthodontic aligners, the

implementation of the orthodontics itself can also be considered
in a way “cosmetic”. Many previously unaesthetic smiles can be
‘made-over’ using just clear aligner technology and represents a
far less invasive approach to treating spacing problems than with
prosthodontics.

In addition, minor orthodontic movement can also be used to

enhance and simplify future cosmetic and restorative treatment
plans. There are even times when it is imperative that a dentist
use some form of minor orthodontics to enable a restorative
treatment plan to succeed. (NYSDJ, Jan 2009)

Knowing how to implement minor orthodontic movement is

quickly becoming a necessary component in the methodology of
today’s quality dentist. Even dental schools are placing added
focus on its usage. Currently, 36 of the 58 dental schools in the
United States offer their students education on some form of
clear aligner orthodontic movement. It’s those dentists who are

4
comfortable, confident and above all capable of utilizing such
technology who will be among the future leaders of dentistry.

5
 HISTORY OF IPR
In most cases of crowding, an essential step required to achieve
minor orthodontic movement is a procedure called InterProximal
Reduction or IPR.

Dr. Jack Sheridan, DDS, MSD, is credited as the inventor of a way

of removing enamel to resolve moderate crowding, while
eliminating the problem of excess space associated with
extractions or the vexation of coordinating expanded arches. Dr.
Jack Sheridan was the first to implement IPR in a process he called
“Air Rotor Stripping” or (ARS).

Dr. Sheridan used this technique to create space in combination

with fixed appliance therapy to treat cases of crowding. Simply
put, Dr Sheridan advocating “stripping” the enamel from
premolars in order to create space in the dental arch using air
driven dental handpieces.

After much debate and research, this procedure has been

adapted to meet many of today’s orthodontic needs and is now
commonly referred to as simply IPR. Most clear aligner adult
orthodontic cases of crowding rely heavily on IPR to create
needed space for tooth movement.

This manual WILL NOT discuss the issues related to ‘stripping’

teeth and the short and long term effects of removing enamel.

6
We will only reference the reader to studies that have
conclusively proved the system is 100% safe and effective. (ADD
STUDIES FROM RAINTREE SLIDES)

The problem with IPR is that it is very technique sensitive and if

done incorrectly can lead to a number of iatrogenic problems.
Improperly performed IPR is considered to be the second most
common cause of failure in clear aligner minor orthodontic
movement case with the most common cause of failure being
compliance.

Another problem is that most dentists though familiar with the

concepts of IPR have very little training on how to perform it
correctly and reliably. The IPR visit can also be anxiety-inducing
for the patient as well. To be accepted and successful, minor
orthodontic movement should be as non-invasive and pain-free as
possible.

The premise behind IPR is fairly straightforward— to create

needed space to relieve crowding— however the techniques and
tools needed to perform IPR can also be tricky. With the advent
of new tools for IPR and novel protocols in their implementation
like the Galler Spacing Technique (GST), IPR can now be an easy,
exact, pain-free, and stress-free procedure for the doctor and
patients alike.

This manual will describe the theory, protocols and tools used in
the Galler Spacing Technique (GST). Disadvantages of the current

7
systems will be explored and patient management tips will be
highlighted. Upon completion of learning the Galler Spacing
Technique (GST), the dentist will feel comfortable and confident
in performing necessary IPR on any patient at any time, in any
given situation.

8
 THEORY

One of the most common malocclusions seen in adult dentitions is

crowding. This can present as overlapped or rotated teeth in the
anterior mandible or maxilla. (Figure 1 and 2)

. 2

Crowding results when there is inadequate intra-arch space

available to accommodate the mesio-disto width of all of the
teeth in the respective arch. Correcting this crowding is a main
goal of orthodontics and cosmetic dentistry.

There can be underlying skeletal abnormalities or jaw shape/ size

discrepancies that contribute to this malocclusion.

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There are generally 4 ways to correct crowding:
1) Distalization,
2) Expansion/Proclination
3) Extraction
4) IPR.

One or a combination of these methods is generally used to

correct a crowded malocclusion. For the purposes of this manual,
we will not include cases where surgical or prosthodontic
intervention is necessary.

Distalization is often used to treat adolescent dentition when an

underlying Class II or Class III molar relationship is present. Here,
the corresponding upper or lower teeth in the arch are moved
posteriorly towards the distal to establish a more ideal Class I
molar relationship (Figure 3). More space is created in the arch
thus more room is available to align and level all of the teeth in
the anterior region. Distalization is generally used with fixed
appliance therapy.

10
Expansion and Proclination refer to increasing the width of the
arch to accommodate the teeth. For example, picture the
mandibular or maxillary arch as a semicircle, here the
circumference dictates how much room there is for the respective
teeth (Figure 4).

IF Diameter = 1 IF Diameter = 2
Then Circumference = Then Circumference =
3.14 6.28

C=πD C=πD

We know that the circumference(C) of a circle is equal to Pi (π)

multiplied by the diameter (D) of that circle (C=πD). Therefore, if
we increase the diameter of that circle we will increase the
corresponding circumference by a factor of π. Simply put, when

11
we expand or procline teeth within an arch we are increasing the
amount of space present in that arch. The additional space
created can be used to alleviate dental crowding. (FIGURE 5)

Extraction can also be used to create more space in the dental

arch. Removing a tooth in an overly crowded dental arch will
immediately alleviate the problem (Figure 6). The space created
by the removal of a tooth can be utilized by the adjacent teeth.
Surrounding teeth can rotate, shift, and gravitate into the new
area.

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InterProximal Reduction can also be used to correct crowding by
creating more space in an arch. This space is achieved through
the reduction of tooth enamel interproximally. For example, if
there is .5mm of overlap present among several teeth in the
anterior, needed space to relieve this crowding can be created by
removing .1mm of interproximal enamel on several teeth in the
region. The teeth can then be rotated or pushed into their proper
alignment. There are many tools and techniques that can be used
to ‘strip’ a portion of the enamel from the teeth. It is the mastery
of the proper tools and techniques for IPR that gives the dentist a
very significant advantage in treating cases involving minor
orthodontic corrections.

There are many clinical applications for IPR— the most common
being for the correction of crowded dentition. Other applications
as they relate to clear aligner technology will also be reviewed in
the “Clinical Applications” section of this book.

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 COMPLICATIONS
As previously mentioned the second most common cause of
failure in minor orthodontic movement therapy is insufficient or
improperly performed IPR. With such a significant potential for
error, it is not surprising that many dentists tend to shy away from
using IPR.

This mindset, however, is the wrong approach; because the

advantages of proper IPR use are not only important, but can be
vital to predictable teeth movement. Instead, the approach
should focus on devising a more reliable and precise system to
performing IPR by using the proper tools and the Galler Spacing
Technique (GST).

Let’s briefly review some of the more common pitfalls involved

with improper IPR technique.

Incorrect Reduction
The process of IPR is very technique sensitive— even minor
imprecision in enamel reduction can lead to a wide array of
problems. This can include over reduction and under reduction of
the corresponding area.

For example— If a case requires .4mm of reduction between

teeth #21 and #22 and the dentist removes .6mm of enamel,
there will be residual space left in between the teeth at the end of

14
treatment. That space can become a cosmetic problem or an area
of open contact and food impaction.

Likewise, if the dentist reduces only .3mm interproximally there

will be insufficient space for proper alignment and the teeth will
contact prematurely, thus some crowding will remain.

Iatrogenic
It is also very possible for the dentist to cause harm to the patient
or to the teeth inadvertently. This can involve damaging the
adjacent soft tissues such as the tongue, gingiva or cheek. Cutting
one of these unintentionally during the process of IPR can cause a
lot of unnecessary pain and discomfort to the patient.

One of the worst possible scenarios that can happen with IPR is
ledging. Ledging occurs when the dentist gouges the tooth and
creates a defect in the enamel. Instead of simply removing
enamel along the long axis of the tooth, a “ledge” is created
interproximally and the tooth will need restorative repair. (Figure
7)

15
Changing Contours of the Tooth
Each tooth has a specific anatomy and contours that gives it that
“natural look”. Keeping these proportions and measurements are
absolutely essential to any cosmetic case. When these principles
have been compromised, teeth can often appear unaesthetic and
become troublesome.

If IPR is performed incorrectly, it is very easy to remove essential

tooth structure. Removing a tooth’s natural line angles can
greatly compromise the cosmetic appearance of that tooth— this
happens frequently when dentists use high speed handpieces to
relieve overlapped teeth. In an attempt to remove the contact
points of several teeth, dentists often will access through the
tooth’s buccal or lingual walls with a high speed handpiece and
bur. (Figure 8)

Destruction of Tooth Contour

Buccal

Tooth Tooth
#24 #25

Lingual

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This can result in the inadvertent loss of essential tooth structure
and contours. Unfortunately, this loss can never be reacquired or
at least not easily. Regardless of how straight and aligned the
teeth may become, the final case will never regain its natural
esthetic qualities.

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 CURRENT TOOLS AND
TECHNIQUES
All of the challenges that we face with IPR today stem from the
tools and techniques that we use to create space in the arch. The
theory and physics are sound, but it’s the current instruments and
their methods of implementation that are actually part of the
problem. Once different tools and techniques are established
that help us to avoid all of the current pitfalls and apparent
dangers associated with the procedure, then can IPR become the
central focus for achieving space in any minor orthodontic
movement case.

Let’s review the three most commonly used tools for IPR today—
 The high speed handpiece
 The low speed handpiece
 Finishing strips

High speed Handpiece

One of the most popular methods for performing IPR is to use a
bur on a high speed handpiece. A groove is cut in between the
teeth to open the required space.

There are several major problems that plague dentists who

employ this technique. The most serious of which is ledging.

18
Because there is a constant cutting capability with the high speed
bur, the potential for damaging the adjacent teeth is very
possible. This often occurs when attempting to perform IPR
between teeth that are overlapped.

Another problem encountered with the high speed handpiece, is

that it is ‘one size fits all.’ A good practitioner needs the ability to
create anywhere between .1mm and .5mm of interproximal
space. While employing the high speed handpiece, it is difficult to
create varying amounts of space. Since the thinnest part of the
bur must pass freely through the contact point to create the
opening, the dentist is limited to the thickness and size of the bur
tip. Thus, if the thickness of the bur is .4mm, the dentist will
automatically create a minimum .4mm opening in every
interproximal space!

Also, patient comfort can be compromised. There is significant

noise and vibration generated by the dental handpiece and that
can serve as a source of anxiety and discomfort to the patient. As
mentioned previously, for minor orthodontic movement to be
widely accepted, the process and associated procedures should
be as non-invasive and pain-free as possible.

Low Speed Handpiece

Another common tool for IPR is a rotating disc or file on a low
speed handpiece. This technique is loaded with potential hazards
and problems that are similar to many of the complications
mentioned above inherent to the high speed handpiece and bur.

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Due to the end cutting nature of a spinning disc it is quite simple
to ‘slice’ the side of the tooth. This frequently occurs when
stripping teeth that are overlapped.

However, the most difficult part of using a low speed handpiece

and rotating disc is the awkwardness and hazards(!) associated
with handling a straight nose cone inside the mouth. There are
not many procedures which indicate the use of the straight nose
cone intraorally. Not only is it awkward and difficult to maneuver,
but there’s also significant potential to “nick” the soft tissues
adjacent to the teeth being reduced. This can include the tongue,
gingival and buccal mucosa, and the borders of the lips. If the soft
tissue is cut, the visit can be a painful experience for the patient
and a stressful (and messy!) one for the doctor.

Finishing Strips
The third most notable tool in use today for IPR is a long finishing
or polishing strip to break the interproximal contact. The best
feature of this method is that there is no possibility of ledging the
neighboring teeth. The strips are strictly side-cutting and pose no
threat of damaging the adjacent teeth.

The biggest problem with strips is that they can only cut minimal
amounts of tooth structure. Due to the limitations of the grit of
each strip, it is considered a near impossibility to achieve an
opening of more than .15mm. This restricts the dentist in many of
the uses of IPR if larger openings are needed.

20
This method, though safe and simple is also very time-consuming.
Much valuable chair time and energy are expended to create even
the smallest of openings. And, for the reasons listed above this
technique is very limited and only applicable when minute IPR is
needed.

21
 Goals of IPR
All of these shortcomings point towards the need for a new
system that does not rely on these particular tools and
techniques. Considering these factors, it’s obvious that a new,
better IPR system is greatly needed. Now that we’ve reviewed
the disadvantages of the current commonly used IPR tools, let’s
review the necessary and desirable characteristics we would want
in the new “ideal” IPR system:

 We would like a system that makes it impossible to

ledge or damage the adjacent teeth. It should be
side-cutting; give the dentist good control and
preserve the cosmetic integrity of the treated teeth.
 We need a system that is very safe and that won’t
damage the surrounding soft tissues. We want to
be as concern-free and as anxiety-free as possible
and not have to worry about injuring the adjacent
gums, cheek, lips or mucosa. And, we want to
ensure a quick and comfortable visit for the patient.
 An ideal IPR tool should be easy to handle,
straightforward to use and also dependable. We
need a system and method that are simple and safe
to use even in difficult spots like in between
overlapped teeth.
 We want to be able to perform IPR precisely and
concisely. For this, the system should have a built-in
ability to control the exact amount of interproximal
22
 space created. And, a system with an inherent
capacity to avoid the potential for over reduction
and under reduction of the teeth is critical.
 We want a device that is preferably handheld and
dentist-controlled. It should be easy to handle, safe
for the doctor and patient and as unencumbersome
to the dental visit as possible.
 It should give the dentist the ability to produce a
range of interproximal openings and thus allow the
practitioner increased versatility and efficiency.
 The system and tools should be inexpensive, easy to
sterilize, simple to store, and cost-effective.

If all of these characteristics can be encompassed in a single IPR

system, then a truly uncomplicated, precise and concise, stress-
free and anxiety-free IPR visit is finally possible.

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 Topical Anesthetic
The procedure of IPR is often one that will irritate the gingiva of
the patient. Regardless of any technique used, the gingival area is
susceptible to being cut or ‘poked’ by the instrument being used.
The ginigiva around crowded teeth is usually inflamed hyperemic
and sensitive. It is therefore imperative to employ some form of
anesthetic for the patient.

Using regular injection anesthetic to anesthetize the area is

frowned upon. The discomfort caused to the patient is a problem
and the resultant anesthesia is more than is truly needed.

Popular topical anesthetics are often messy and not very

effective. The most common form is 2.5% Benzocaine. This is
often insufficient and has a very short working time.

There is a pharmacy in New York that makes a gel called IPR GEL.
It is composed of 10% Lidocaine, %10 Prilocaine, and 4%
Tetracaine. This combination is extremely potent.

Simply place some of the gel on the gingiva of the area that needs IPR, and
after 5 minutes the area will be completely anesthetized. This will allow
the practitioner to safely and efficiently perform IPR without the patient
experiencing any discomfort.

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Topical Anesthetic
 BEST ON MARKET
 IPR GEL
- 10% Lidocaine 10% Prilocaine 4%Tetracaine

New Utrecht Pharmacy

New York 718-436-9300

25
 Galler Spacing Technique
After having discussed the ideal system and goals, we need to find materials and a
system that meets those requirements. There are many products on the market
that can be used.

GST relies on a combination of two products that creates the easiest and most
predictable results.

The products are different strips that are used by hand to create space in
between teeth. They are abrasive along the sides. When passed between teeth,
they will remove enamel from the surrounding teeth. They come in different sizes
and grit.

Their mechanism of action is to remove friction in between teeth. As the abrasive

side rubs against the tooth, it removes a very fine layer of enamel. This in turn
creates space between adjacent teeth.

They are not end-cutting and the “edge” is completely smooth. This will totally
eliminate the possibility of ledging a tooth. Simply put, they cannot cut in a
downward motion! They cut simply by rubbing against a surface of the tooth.

They are manufactured in increasing size of thickness and increasing grit.

Therefore, as one moves up the sequence from least coarse to most coarse, the
metal is actually getting thicker and the grit is getting coarser.

Increasing thickness allows the practitioner to constantly sense the size of the
space being created. At each level, the new ‘strip’ engages tightly into the
contact. This creates a simple measuring technique that eliminates the need for a
separate measuring device.

Knowing the space created by each residual strip provides, in effect, its own built
in gauge. Now, the doctor simply needs to follow the sequence until he/she
creates the desired opening (previously calculated) to solve the crowding in the
arch.

26
For example, after mastering the GST, one knows that if a .2mm space if desired,
the practitioner needs to have a RED IDEAL STRIP pass through the contact point.

Increasing grit allows the practitioner to cut enamel at each level. As a coarse file,
is passed through a tight opening, the abrasive sides of the strip removes enamel,
this in turn creates the corresponding larger space desired.

Simply following the sequence of strips allows the practitioner to easily create any
space deemed necessary.

The two products are Qwik Strips made Dr Louie Khouri and Ideal Ortho Strips
invented by Dr Steven Navarro.

QWIK STRIPS AND IDEAL STRIPS

STARTERS FINISHERS

Neither of these products were manufactured to be used in the manner that GST
calls for. However, they are easy and effective to use.

We will break up our treatment into two phases:

Phase One creates the initial opening in a very conservative and delicate way
using Qwik Strips.

27
Phase Two bring the opening to the desired amount efficiently using the
IDEAL Ortho Strips.

QWIK STRIPS

Qwik Strips are manufactured with abrasive sand paper along the sides. There is
an even smooth grit that allows for very easy cutting in even the tightest contact.
The YELLOW- least coarse- size will fit into virtually any contact, even if they are
tightly overlapped.

Because they are not end cutting, there is no possibility of ledging when using
them interproximally. The friction of their abrasive side against tooth structure
removes a very fine amount of enamel.

They are manufactured in single sided, double sided and curved configuration. In
the Galler Spacing Technique, one only utilizes the single sided strip. This strip
slides easily into any potential interproximal area and makes spacing very simple.

The double sided strips are not as efficient at removing large bulk tooth structure
as their counterparts- the IDEAL strips. It is for this reason that we use the single
sided Qwik Strips to start the process, and the double sided IDEAL strips to
create the larger spaces.

Qwik Strips excel at getting into very tight contacts where access is difficult. Their
easy design and comfortable grip allow the dentist to easily slide them in-
between any contacts. The abrasive side removes tooth structure which in turn
creates the desired opening. Using them in sequence from YELLOW-RED-BLUE-
GREEN will create an opening of just under .1mm.

Although that amount of space seems insignificant with regards to a crowded

dental arch, it allows the doctor to have easy access to the contact area with the
larger more efficient tools.

IDEAL Strips

IDEAL strips are manufactured to be put into a reciprocating handpiece that slices
in between teeth. Disadvantages of using the motor system are that firstly, one

28
loses the manual dexterity in feeling the space opening at each level of grit and
secondly, the cumbersome nature of the handpiece adds anxiety to the patient
and makes it difficult to maneuver.

IDEAL Strips are available in 7 different increasing sizes of thickness and grit. This
allows the practitioner to increase the size of the space simply by following the
sequence.

Each time a new ‘strip’ is used in the sequence, the practitioner feels friction
owing to the increasing size of metal thickness. The increasing coarseness of grit
allows the practitioner to remove ever increasing layers of enamel.

The overall result is a very controlled way to remove enamel in a neat orderly
efficient manner. There is no possibility of damage to collateral tooth structure
because the ‘strips’ will only remove enamel based on friction. Once the friction is
no longer present they will not remove enamel. This eliminates the common
complication of excess tooth structure being removed

When used properly they will accurately tell you how big the corresponding
aperture is. This can be determined by studying the color of the strip that can
pass freely in the contact without binding. Therefore, use of a cumbersome, time-
consuming gauge becomes obsolete. (FIGURE 11)

IPR BEFORE AND AFTER

0.4mm

29
 STEP BY STEP PROCESS
PHASE ONE

THE STARTERS:

1) The system uses the Qwik Strips to start the process.

2) These are taken in the dentists hand and gripped in a thumb forefinger
grasp.

30
3) THEY COME IN FOUR DIFFERENT SIZES:
a. YELLOW- LEAST COURSE
b. RED- MEDIUM COARSE
c. BLUE- MORE COARSE
d. GREEN- MOST COARSE
4) THEY ALSO HAVE:
a. SINGLE SIDED (preferred)
b. DOUBLE SIDED
c. CURVED SINGLE SIDED

VARIETY

31
STEP ONE:
DETERMINE THE AMOUNT OF SPACE NEEDED INTERPROXIMALLY

STEP TWO:
APPLY TOPICAL ANESTHETIC TO PAPILLA AND SURROUNDING GINGIVA

STEP THREE:
GRIPPING THE SINGLE SIDED YELLOW QWIK STRIP WITH THUMB-FOREFINGER, PASS
GENTLY THROUGH THE CONTACT OF THE TOOTH. ONCE THERE IS NO RESISTANCE, STOP!
(You do not need to continuously sand the tooth once there is no friction!)

Yellow QWIK STRIP

FIND EASIEST FITTING

QWIK STRIP AND SLIDE EASILY
THROUGH CONTACT

STEP FOUR:
GRIPPING THE SINGLE SIDED RED QWIK STRIP WITH THUMB-FOREFINGER, PASS GENTLY
THROUGH THE CONTACT OF THE
TOOTH. ONCE THERE IS NO
Red QWIK STRIP RESISTANCE, STOP!

32
FIND EASIEST FITTING
QWIK STRIP AND SLIDE EASILY
THROUGH CONTACT
STEP FIVE:
GRIPPING THE SINGLE SIDED BLUE QWIK STRIP WITH THUMB-FOREFINGER, PASS GENTLY
THROUGH THE CONTACT OF THE TOOTH. ONCE THERE IS NO RESISTANCE, STOP!

BLUE QWIK STRIP

FIND EASIEST FITTING

QWIK STRIP AND SLIDE EASILY
THROUGH CONTACT

STEP SIX:
GRIP SINGLE SIDED GREEN QWIK STRIP AND GENTLY PASS THROUGH THE CONTACT. ONCE
THERE IS NO FRICTION STOP!

33
 GREEN SINGLE SIDED QWIK STRIP

WILL CREATE JUST

UNDER .1MM

END PHASE ONE

EVEN THE TIGHTEST CONTACT AND EVEN THE MOST OVERLAPPED TEETH ARE NOW OPEN.
YOU MAY NOW PROCEED TO USE THE NEXT MATERIAL THAT WILL CREATE YOUR DESIRED
OPENING. THE OPENING RIGHT NOW IS LESS THAN .1mm.

PHASE TWO
Phase Two use the IDEAL Strips. These are more coarse then the Qwik
Strips and cut more efficiently. They can usually not be used to start
because they will not fit into tight or overlapped teeth. The Strips must
be sequentially to ensure patient comfort and maximum efficiency.

34
1) They come in 7 sizes:
a. WHITE- CREATES A .1MM OPENING (Least Coarse)
b. YELLOW- CREATES A .15 MM OPENING
c. RED – CREATES A .2MM OPENING
d. GRAY – CREATES A .3MM OPENING
e. GREEN- CREATES A .4MM OPENING
f. BLACK- CREATES A .45MM OPENING
g. BLUE- CREATES A .5MM OPENING (MOST COARSE)

2) They are available in only Double-Sided. They were

designed to fit into a slow speed handpiece, but work
excellently when gripped with fingers.

35
STEP ONE:

36
Grip the WHITE Ideal Strip between the forefinger and thumb
and pass through the contact gently. Stop when there is no
FRICTION. DO NOT SAND THE TOOTH CONTINOUSLY.

THE INTERPROXIMAL AREA NOW MEASURES EXACTLY .1mm

EVERYTIME!!

37
STEP TWO:

Now grip the YELLOW IDEAL Strip in thumb-forefinger and pass

through the contact until there is no friction present. This will
create a .15mm opening.

STEP THREE:

Grip the RED IDEAL Strip and pass through contact till there is
no resistance. The interproximal space is now an EXACT .2mm
opening.
38
39
STEP FOUR:

If desired space is .3mm continue with GRAY IDEAL Strip.

STEP FIVE:

If desired opening is .4mm continue with Green Ideal Strip. This

might require a little bit of pressure to help to create this

40
space. In this step only, additional cutting can be accomplished
by leaning the GREEN IDEAL instrument against the tooth.

41
STEP SIX AND SEVEN:

Continuing with the BLACK and then the BLUE Ideal Strips will
give you the desired .5mm opening.

END OF PHASE TWO IPR.

42
 Discussion:
At this point, the dentist has achieved the space required to aid
in minor orthodontic movement. There is no possibility of
ledging since the instruments are not end-cutting. They can be
used between any overlapped teeth at any time. There is no
concern over any damage to surrounding tissues, or excessive
destruction of tooth or enamel. Using these tools is one way to
create fast, effective, low risk IPR.

In practicality, the Qwik Strips wear out after 1-2 patients and
should then be discarded. They should be disinfected and
autoclaved after each use. When the grit on the tool appears
faded away it is no longer effective and should be discarded.

Sometimes, when the contacts between the teeth are very

light, the practitioner may be able to start phase one using the
Blue Qwik Strip, instead of the Yellow Qwik Strip.

The IDEAL Strip can be used on 2-3 patients depending on the

amount of IPR performed. They should be disinfected and
autoclaved after each use. The WHITE (.1mm) strip usually
exhibits the most amount of wear and bends after excessive
use. If the metal grip bends or breaks, the tool should be
discarded immediately.

43
 There is no set way to grip the IDEAL strips, they may be
gripped in thumb-forefinger manner lengthwise, or like a
hatchet by gripping the handle with thumb forefinger.

It is critical to remember that the strips must be used in

incremental fashion. One cannot, start in the middle of the
sequence; you must use all the files in order, from least coarse
to most coarse.
Because the strips do not bend, there is no possibility of removing
collateral tooth structure. The strips will only cut where there is contact in
between the teeth. When there is no contact in between teeth the strips will
not cut.

They will, therefore, not inadvertently remove line angles and other key
components of tooth anatomy. We had previously mentioned that one of the
complications of improper IPR was changing the contour of the tooth.

By learning the sizes and corresponding color schemes of the various

strips, one can eliminate the need for a separate measuring gauge.

With GST, one can safely open contacts between teeth without risk of
damaging soft tissue and changing tooth contour and form.

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