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Doctors Soon to Be!

Orthodon4c Banding 101: Prac4cal Tips for the General Den4st

December 2011 Western University of Health Science College of Dental Medicine Presented by Dr. Andrea L. Feather, OrthodonEst, Diplomate American Board of OrthodonEsts

Learning ObjecEves
Prevalence of Band Usage and Why! Learn commonly used Cements for Bands Banding Techniques and Tips
Learn Techniques for SeparaEon for Bands Learn Banding Procedures & Techniques Know when to Require PremedicaEon Learn Some Special Banding Problems

Learn about Debonding

When should I band a tooth?

If you do orthodonEc treatment for your paEents. When will I band a tooth?

Do what orthodonEsts do?

2008 Prevalence of Banding Procedures:

2008 JCO STUDY OF ORTHODONTIC DIAGNOSIS AND TREATMENT PROCEDURES

Prevalence of Banded Teeth:

1st molars 50% 2nd molars 16% for U7 & 23% for L7 Premolar <10% Banding is currently declining. Bonding is more frequently done.

Why Banding is on the Decrease?

Oral hygiene DecalcicaEon! Costly 2 stock Uncomfortable SeparaEon
2 appointments BUT >>>> Theyre Stronger!

2008 JCO Prac4ce Procedures Survey

ROUTINE BANDING 2008 2002 1996 1986 Maxillary second molars 15.9% 24.1% 27.7% 25.2% Maxillary rst molars 52.3 76.2 90.8 92.2 Maxillary second premolars 7.5 13.9 23.8 40.7 Maxillary rst premolars 6.0 6.4 9.4 21.0 Mandibular second molars 22.8 36.7 51.4 51.4 Mandibular rst molars 49.0 72.8 89.5 91.0 Mand second premolars 9.2 16.0 26.2 42.5 Mandibular rst premolars 6.2 6.3 8.9 22.0

-56%

169

386

RouEne Bonding Molars:

Bonding: 08 02 96 Maxillary second molars 41.2 21.7 NA Maxillary rst molars 48.7 21.8 NA Mandibular second molars 52.3 30.4 NA Mandibular rst molars 48.0 21.7 NA 86 NA NA NA NA

200%

189

96

Are second molars being straightened? 2008

15.9% Banded Mx 2nds 41.2% Bonded 57% of upper 2nds are rouEnely aligned 22.8% Banded Md 2nds 52.3% Bonded 75.1% of lower 2nds are rouEnely aligned

Fluted entrances. brackets Hydrophilic bonding materials. Quicker archwire placement with SLB!
allows wires to flow in easier

InnovaEons making 2nd molar alignment easier: Band or Bond

not sensitive in wet environment

Why dont orthos band or bond ALL second molars?

Already straight. Not fully erupted &
refuse ext 8s Refuse surgical uncovering

Focal osteosclerosis Poor OH Poor Compliance

IndicaEons for Placing Bands:

SPACE MAINTENANCE APPLIANCES!!!! Heavy intermihant forces HG Labio-lingual ahachments Short Clinical Crowns Deep bite, brachycephalic paEents

Band lowers more frequently than uppers Band the one that breaks!

nd Molars: My approach to 2

At start of case . OR. At end of the case open bite cases, oral habits, late erupEon cases. Ideal OB & OJ Well aligned @ case start. Overlay wires and 3 months to nish!
everything ortho does will cause open bite so be aware of this! even though you want to shift a few teeth! even though a few things look easy but it really isnt. best to put full brackets on upper/lower arch

Dont tell your paEents, Dr. Feather forgot to put braces on your back teeth. Make sure she does that at the next appointment. Phone call is needed instead.

Banding Cements

What should I consider using? Do what orthodon4sts do!

2008 JCO Study: Prevalence of BAND CEMENTS

2008
Glass ionomer (GI) 37.5% Resin reinforced Light cure GI 32.7 Compomer 20% 5.6 Zinc phosphate
old cement; still used in other countries

70%

Advantages of Glass Ionomers:

Adheres to metal and enamel Releases & uptake Fluoride Inhibits microbial acEvity Acceptable strength.

Disadvantages of Glass Ionomers:

Short working Eme SensiEve to Moisture Failure is at the Band Cement Interface 80% strength in 20 minutes24 hours to max strength!

This can be a signicant disadvantage!

Resin Modied GIC Fuji Ortho LC

LIGHT CURE GLASS IONOMER CEMENT GC holds the patent! Allows for snap set Rapid strength development GI Cement is at same strength as RMGI @ 24 hours! Costs signicantly more than regular Glass Ionomer Cements!

Glass Ionomer vs. ResinModiedGI

$$ $$$$$

$110

$220 -297

RouEne IniEal Banding Cement - GI

Powdery calcium-aluminum uorosilicate glass
Carboxylic acid copolymer

1 scoop to 2 drops, draw upward 1 strand

CemenEng AcEve Appliances & Recements

Quad Helix

LSL Advancing Loops

The New Comer!

Compomers
Composite + Glass Ionomers

Our strongest Cement & hardest to remove!

Light Cure One-Step Compomer:

Polyacid-modied composite resin Hydrophilic components: Cause water to be drawn into the material following cure! Flouride uptake & release, Buering Capacity. Decline in physical properEes when water is present at the Eme the material sets up.

InteresEngly.
Compomers are stronger than glass ionomers in a completely dry eld! Holding arches that conEnuously come loose! Use for Cemented acEve appliances like the Headgears.

Whats wrong w/Compomers?

Weaker than GI in wet eld. IsolaEon needed!

Harder to clean up and harder to remove when done!!!!

Our Compomer: Bank Lok 2-Paste vs. LC Cost Comparison:

8 syringes w/6cc = 48 cc 6 syringe w/5cc = 30 cc

Light cure or Chem Cure

Light cure only!

BLUE or White

Both cost $105

Cement where you dont ever want to Remove the brace: Mr Gjoka

good for unerupted canine cases you want to get out

Ortho Cement Summary:

Glass Ionomer Powder/Liquid RouEne, mulEple bands, no severe malignment. GC Fuji Ortho LC Immediate forces, severe malignment or repairs where teeth have moved! Ex: Loose LSL used to correct a Epped molar or spring to move an incisor! One Step Light Cure Compomer Band Lok
Bonded bite planes Max band strength needed.

Geristore band or bond removal not needed

G.P. Cement Summary:

1. Glass ionomer - First cementaEons of Fixed Space Maintainers 2. Resin Modied GI full strength needed NOW! 3. Compomer roughest kids = breakage!!! Poorer brushers. Temporarily opening the bite : TRAUMA Endo cases - no grinding on the enamel! Hot tooth 4. Gerstore if you never need to remove a band or bracket.

Banding Techniques & Tips:

SeparaEon Fivng Bands CementaEon Cleanup Bonded Bite Planes SoluEons to Special Problems

SeparaEon:
Three main types:
Springs Elastomeric Threads

AnEbioEc premedicaEon Use radiopaque seps. Clearly record where they were placed.

Only 2 weeks.

Count them going in and coming out! If unaccounted for oer a complimentary lm. Record any refusals. If missing nd and retrieve.

ElasEc Separators: SeparaEng Plier

ElasEc Separators: Floss technique

SAFEST TO DO! I USE THIS TECHNIQUE

Loop forming plier, or opEcal plier and not a Bird Beak!

you want to use a plier with longer beak

put a piece of floss around it (ligate)

loop forming plier

optical plier

TP Springs 2 wks needed (TP Orthodon4cs, Indiana) Use oss please! Replace w/elas4c sep ajer one week

Thread .025 or .030 hollow tube or with rough surface to prevent slip.

dont use brass separators

When is Premed needed?

For Separators?
Anything that causes bleeding in the mouth: Separators Fivng or cemenEng Bands Removing Bands or banded appliances Debonding

Current RecommendaEons AHA:

ProstheEc cardiac valve Previous endocardiEs Unrepaired cyanoEc congenital heart disease, including paEents with palliaEve shunts and conduits Completely repaired congenital heart disease with prostheEc material or device, whether placed by surgery or catheter intervenEon, during the rst 6 months awer the procedure Repaired congenital heart disease with residual defects at the site or adjacent to the site of a prostheEc patch or prostheEc device Cardiac transplant recipients with cardiac valvular disease

Premed NOT needed for:

RouEne anestheEc injecEons through noninfected Essue Taking dental radiographs Placement of removable prosthodonEc or orthodonEc appliances Adjustment of orthodonEc appliances, bonding of orthodonEc brackets Shedding of deciduous teeth Bleeding from trauma to the lips or oral mucosa.
AHA August 2007. Available at hhp:// www.americanheart.org/ presenter.jhtml?idenEer=3004539.

Ortho Procedures Requiring AnEbioEc Prophylaxis:

Placing separators Banded appliances, not bonded. Debonding & removal of banded appliances. Not needed for archwire adjustments, taking impressions, or x-ray lms, placing retainers. If in doubt call the cardiologist!

And those special moments???

You or your sta did not check the chart before placing separators .premed was needed and not taken!

Should you have paEent rinse with Chlorhexidine?

Bacteremia?
2.5% incidence Not decreased w/0.2% Chlorhexidene Inves4ga4on of Bacteremia Ajer Orthodon4c Banding and Debanding Following Chlorhexidine Mouth Wash Applica4on Angle OrthodonEst, Vol 71, No 3, 2001 ERVERDI, ACAR, ISGU DEN, KADIR

Talking Point:

ProtecEon of the paEent is most important thing!

Mrs. Acosta, Juan needs to take his premed as soon as you get home, can that be done right away? He was supposed to take it before the spacers were placed. That will never happen again, ever. Please accept my apologies. This is highly unlikely to cause a problem. Please call your physician for his advise.

Overview of Steps in Banding:

Use microetched or equivalent band Clean the tooth w/gentle pumice & water slury Select and Fit band Remove band to cement Alcohol inside of Band & Air Dry Isolate the tooth and air dry Cement Clean up

SelecEng Your Band Stock:

Use prewelded, microetched band Dimpled design or similar or microetch yourself Laser etched idenEers are best. ConverEbles? Phase I or full tx? Lingual seaEng lug, please not a cleat
not necessary

Plain Bands for Appliances:

Temper or SEness
Sow Medium SE Extra SE
Not microetched or prepared!

dont want band to fall over on you when placing!

IdenEer not laser etched!

stamped on will come off/fade away and cause a lot of inconvenience!

Double Tube Molar Band:

make sure band has a good purchase point, make sure its wide enough to use band seater to put in place

Triple Tube Most exible!

My Upper Band Design:

First Molars Triple tube upper assembly
ConverEble slot HG to Occlusal
removable bite plates Purchase point for overlay wires

Auxilliary tube for late erupEng 2nd or overlay wires Hook for elasEcs

Second Molars simple tube, uted entrance, hook All lingual seaEng lugs center of band.

Pumice Slurry to Clean the Teeth

Fivng Bands:
Preselect o study models Reshape the band to t. Seated by paEents bite Correct sequence.

start with one that fits all around tooth

Place from lingual to buccal on lower arch!

Floss through tube. Finger pressure alone Get it to the M & D contacts Then pick up bite sEck.

Dierent Shapes to the Eps?

Autoclavable
Bite S4ck Band Seater

use with palm pressure

Fivng a Molar Band:

Then it is driven to place by paEents bite on the mesiobuccal and distolingual surfaces. Align w/marginal ridges Even Buccal and lingual cusp Eps buccal and comparing buccal to lingual

Fivng a Molar Band:

The nal sea4ng is with heavy bi4ng force on the distal. Band just below marginal ridges out of the bite.

Sequence for Fivng Md Bands:

Blue = Finger pressure Red = Bite S4ck View sequence with Powerpoint anima4on.

1. press down on distal then 2. press down on mesial last place to seat band is DB

Sequence for Fivng Maxillary Bands:

Blue = Hand Pressure Red = Bite SEck

hardest part to seat is the distal part so want to start + end here

My lower molar bands:

1st molar converEble single tubes w/hook 2nd molars single tubes w/hook Both with seaEng lug on mid-lingual

Whats right here?

Whats wrong here?

open margin

Special Problems in Fivng Bands:

Missing Opposing Teeth:

Double Bite SEck Trick!

An excepEon: Class II molar

Mesial buccal cusps shows more.

Infra-erupted Tooth to the Distal:

Over contour the gingival w/Howe plier.

Grind Bands!
Not this!

This kind of Grind Bands!

Grind Band Edges to Fit:

Necessary with a short clinical crown due to caries or crown fracture or severe wear.
How owen????

Once per year.

PaEent Wont Bite Down!

You shouldnt be doing these cases!!! Whew! Send them to me, please.
Handicapped paEents Missing many teeth Behavioral problems in children

Every Eme I give in and leave a band in a non-ideal posiEon, it comes loose!

Young Mouths!
Grind o the bite sEck to minimal thickness!

Ortho Technology $20 + tx + s&h

Use a half bracket welded to band

Remove & Clean with Alcohol

Isolate tooth & Air dry

CementaEon Procedure:

"Two-Step AdaptaEon"
Festoon the band! Place as previously shown. We remove the cement exudaEon between tooth and band w/damp cohon roll or toothbrush. In the second step, we use the bite sEck to seat the band in its nal posiEon. Haulk le to push band into creases. Finish with a dry cohon roll to seal the margins.

Festoon the Band @ gingival:

Cement

Clean Up Cohon Roll or TB

Step Two nal posiEon:

Boone Gauge

Ormco Gauges:

Parallel to Lingual & Buccal Cusp Tips

Once cemented Custom Contour Band . Haulk le

Like So:

FLOSS!
Scaler to clear away gingival cement.

Decide: With or without a bite plate?

1st Molars 2nd Molars

Technique Bonded Bite Block:

Band Lok by Reliance 20 second light acEvaEon NO awer taste or odor! Petroleum jelly on opposite arch Shape w/nger coated this as well or w/sealant. Can be added to at next appointment. Takes a long 4me to grind it o and out of grooves! Self Etching Primer.

The Bonded Bite Block

No ledges for trapping food or bacteria.

Clear the lower ahachments below.

Check anterior for adequate bite opening! Add on as needed.

TRAUMA!

G.P. takes the teeth out of occlusion with a bonded BB. No grinding!

Special Banding Problems:

1. Loose Bands 2. DecalcicaEon under loose bands 3. 2nd molar impacts on the rst molar band

Give me your best guess!

Which arch has the most band failures? Which tooth has 1st, 2nd and 3rd highest failure rates?

Should you t a new band with each loose band?

If brackets and bands can be removed without damage they can be cleaned, sterilized, and reused without risk to the paEent, in exactly the same way as other medical devices. Prot

DecalcicaEon under loose band:

Molar Impacted on Band: 2nd molar impacEons are rare: .03 - .04%
PrevenEon of mesial driw into Leeway space. Improperly hed bands

Inadequate Md growth Lg Space between 6&7

Pseudopocket

Caries!

push

Treatment for impacted 7:

Place a spacer &/or Remove 6 band Bond the rst molar and... Kick the molar back

pull

Soldered spring to the band Auxilliary spring auxiliary spring

Extract 7 bring in the 8 or Transplant 8 into 7 socket!

kickback molar upright distal tooth

or what makes sense here?

Informed Consent Statement:

Any of the unerupted teeth may impact on Space m their own or on the braces aintainer and require surgical exposure by an oral surgeon specialist and/or orthodonEc treatment at a separate expense. Please sign here..

Debanding:

A Safer Debonding/Debanding Technique

A Safer Debonding/Debanding Technique VOLUME 32 : NUMBER 06 : PAGES (374-375) 1998 BON CHAN KOO, DDS, MSD CHUN-HSI CHUNG, DMD, MS

Insist on 45* of the paEent by new employees (or yourself) when doing debanding procedures!

Lower molars remove from buccal rst. Upper molars from the palatal rst.
And ..

Alternate Buccal & Lingual

Mesial, distal, buccal, lingual. UnEl it gently falls o the tooth and in between your pier beaks.

And if the paEent is uncomfortable:

Debonding Problems:
Pain on band removalbuccal lingual buccal lingual buccal lingualas many Emes as it takes!
Max Bands from palatal rst. Mand Bands from buccal rst.

And if the paEent swallows the band, wire, ligature Ee, etc what do you do?
Advise paEent or parent Recommend they call their physician Document this in your chart Call them later to see what the physician said. Document this in the chart.

Clean Up the Teeth!

Learning ObjecEves
Prevalence of Band Usage and Why! Learn commonly used Cements for Bands Banding Techniques and Tips
Learn Techniques for SeparaEon for Bands Learn Banding Procedures & Techniques Know when to Require PremedicaEon Learn Some Special Banding Problems

Learn about Debonding

Quiz and Break Time!

Thank God!