We|come Doctors .Soon to 8e!

Crthodonnc 8and|ng 101:

racnca| 1|ps for the Genera|
Dennst
uecember 2011
WesLern unlverslLy of PealLh Sclence
College of uenLal Medlclne
resenLed by ur. Andrea L. leaLher,
CrLhodonusL,
ulplomaLe Amerlcan 8oard of CrLhodonusLs
Learnlng Cb[ecuves
revalence of 8and usage and Why!
Learn commonly used CemenLs for 8ands
8andlng 1echnlques and 1lps
Learn 1echnlques for Separauon for 8ands
Learn 8andlng rocedures & 1echnlques
know when Lo 8equlre remedlcauon
Learn Some Speclal 8andlng roblems
Learn abouL uebondlng
When should l band a LooLh?
lf you do orLhodonuc LreaLmenL for
your pauenLs.
When wlll l band a LooLh?
uo whaL orLhodonusLs do?
2008 ICC S1UD CI Ck1nCDCN1IC
DIAGNCSIS AND 1kLA1MLN1
kCCLDUkLS
2008 reva|ence of
8and|ng rocedures:
revalence of 8anded 1eeLh:
1
sL
molars 30
2
nd
molars 16 for u7 & 23 for L7
remolar <10
8andlng ls currenLly decllnlng.
8ondlng ls more frequenLly done.
Why 8andlng ls on Lhe uecrease?
Cral hyglene
uecalclcauon!
CosLly 2 sLock
uncomforLable
Separauon
2 appolnLmenLs

8u1 >>>> 1hey're SLronger!
2008 ICC racnce rocedures Survey
kCU1INL 8ANDING
2008 2002 1996 1986
Maxlllary second molars 13.9 24.1 27.7 23.2
Max|||ary hrst mo|ars S2.3 76.2 90.8 92.2
Maxlllary second premolars 7.3 13.9 23.8 40.7
Maxlllary rsL premolars 6.0 6.4 9.4 21.0
Mandlbular second molars 22.8 36.7 31.4 31.4
Mandlbular rsL molars 49.0 72.8 89.3 91.0
Mand second premolars 9.2 16.0 26.2 42.3
Mandlbular rsL premolars 6.2 6.3 8.9 22.0
386 169
-36
8ouune 8ond|ng Molars:
8ondlng: 08 02 96 86
Maxlllary second molars 41.2 21.7 nA nA
Maxlllary rsL molars 48.7 21.8 nA nA
Mandlbular second molars 32.3 30.4 nA nA
Mandlbular rsL molars 48.0 21.7 nA nA
96
189
200
Are second molars belng
sLralghLened? 2008
13.9 8anded Mx 2nds
41.2 8onded
37 of upper 2nds
are rouunely allgned

22.8 8anded Md 2nds
32.3 8onded
73.1 of lower 2nds
are rouunely allgned



lnnovauons maklng 2
nd
molar
allgnmenL easler: 8and or 8ond
lluLed enLrances.
x brackeLs
Pydrophlllc bondlng maLerlals.
Culcker archwlre placemenL wlLh SL8!
allows wires to flow
in easier
not sensitive in wet
environment
Why don'L orLhos band or bond ALL
second molars?
Already sLralghL.
noL fully erupLed &.
refuse exL 8's
8efuse surglcal
uncoverlng
local osLeosclerosls
oor CP
oor Compllance
lndlcauons for laclng 8ands:
SACL MAln1LnAnCL ALlAnCLS!!!!
Peavy lnLermluanL forces - PC
Lablo-llngual auachmenLs
ShorL Cllnlcal Crowns
ueep blLe, brachycephallc pauenLs

8and lowers more frequenLly Lhan
uppers
8and the one that breaks!


My approach Lo 2
nd
Molars:
AL sLarL of case .. C8..
AL end of Lhe case - open blLe cases, oral
hablLs, laLe erupuon cases.
ldeal C8 & C!
Well allgned" [ case sLarL.
Cverlay wlres and 3 monLhs Lo nlsh!
uon'L Lell your pauenLs, ur. leaLher forgoL Lo puL braces on your
back LeeLh. Make sure she does LhaL aL Lhe nexL appolnLmenL."
hone call ls needed lnsLead.
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
8andlng CemenLs
WhaL should l conslder uslng?
Do what orthodonnsts do!
2008 ICC Study:
reva|ence of 8AND CLMLN1S
2008
Class lonomer (Cl) 37.3
8esln relnforced LlghL cure Cl 32.7
Compomer 20


70
Zlnc phosphaLe 3.6
old cement; still
used in other
countries
AdvanLages of Class lonomers:
Adheres Lo meLal and enamel
8eleases & upLake lluorlde
lnhlblLs mlcroblal acuvlLy
AccepLable sLrengLh.
ulsadvanLages of Class lonomers:
ShorL worklng ume
Sensluve Lo MolsLure
lallure ls aL Lhe 8and - CemenL lnLerface
80 sLrengLh ln 20 mlnuLes.24 hours Lo max sLrengLh!
1hls can be a slgnlcanL dlsadvanLage!
8esln Modled ClC - lu[l CrLho LC
LlCP1 Cu8L CLASS lCnCML8 CLMLn1"
CC holds Lhe paLenL!
Allows for snap seL"
8apld sLrengLh developmenL
Cl CemenL ls aL same sLrengLh as 8MCl [ 24
hours!
CosLs slgnlcanLly more Lhan regular Class
lonomer CemenLs!
Class lonomer vs. 8eslnModledCl
55 55555
$110
$220 -297
8ouune lnlual 8andlng CemenL - Cl
owdery calclum-alumlnum
uoroslllcaLe glass
Carboxyllc acld copolymer
1 scoop Lo 2 drops, draw upward 1" sLrand
Cemenung Acuve Appllances &
8ecemenLs
Cuad Pellx
LSL Advanclng Loops
1he new Comer!
Compomers
Compos|te + G|ass Ionomers
Cur strongest Cement & hardest to
remove!
LlghL Cure Cne-SLep Compomer:
olyacld-modled composlLe resln
Pydrophlllc componenLs:
Cause waLer Lo be drawn lnLo Lhe maLerlal
followlng cure!
llourlde upLake & release, 8uerlng CapaclLy.

uecllne ln physlcal properues when waLer ls
presenL aL Lhe ume Lhe maLerlal seLs up.
lnLeresungly..
Compomers are sLronger Lhan glass lonomers
ln a compleLely dry eld!
Poldlng arches LhaL conunuously come loose!
use for CemenLed acuve appllances llke Lhe
Peadgears.
WhaL's wrong w/Compomers?
Weaker Lhan Cl ln weL eld. lsolauon needed!
narder to c|ean up and
harder to remove when
done!!!!
Cur Compomer: 8ank Lok"
2-asLe vs. LC CosL Comparlson:
8 syr|nges w]6cc = 48 cc 6 syr|nge w]Scc = 30 cc
8oLh cosL $103
LlghL cure or
Chem Cure
LlghL cure
only!
8LUL or Wh|te
CemenL where you don'L ever wanL Lo
8emove Lhe brace: Mr C[oka
good for unerupted
canine cases you
want to get out
CrLho CemenL Summary:
Class lonomer owder/Llquld - 8ouune, muluple
bands, no severe mallgnmenL.
CC lu[l CrLho LC - lmmedlaLe forces, severe
mallgnmenL or repalrs where LeeLh have moved! Lx:
Loose LSL used Lo correcL a upped molar or sprlng Lo
move an lnclsor!
Cne SLep LlghL Cure Compomer - 8and Lok
8onded blLe planes
Max band sLrengLh needed.
CerlsLore - band or bond removal noL needed
C.. CemenL Summary:
1. Class lonomer - llrsL cemenLauons of llxed Space MalnLalners
2. 8esln Modled Cl - full sLrengLh needed nCW!
3. Compomer - roughest kids = breakage!!!
oorer brushers.
1emporarlly openlng Lhe blLe :
18AuMA
Lndo cases - no grlndlng on Lhe enamel!
PoL LooLh"
4. CersLore lf you never need Lo remove a band or brackeL.
8andlng 1echnlques & 1lps:
Separauon
llmng 8ands
CemenLauon
Cleanup
8onded 8lLe lanes
Soluuons Lo Speclal roblems
Separauon:
1hree maln Lypes:
Sprlngs
LlasLomerlc
1hreads
Anublouc premedlcauon
use radlopaque seps.
Clearly record where Lhey were placed.
CounL Lhem golng ln and comlng ouL!
lf unaccounLed for oer a compllmenLary lm.
8ecord any refusals.
lf mlsslng nd and reLrleve.
Cnly 2 weeks.
Llasuc SeparaLors: Separaung ller
Llasuc SeparaLors: lloss Lechnlque
SAILS1 1C DC! I USL 1nIS 1LCnNIUL
1 Spr|ngs - 2 wks needed
(1 Crthodonncs, Ind|ana)
Use oss p|ease! kep|ace w]e|asnc sep aher one week
Loop formlng pller, or opucal
pller and noL a 8lrd 8eak!
put a piece of floss
around it (ligate)
loop forming plier
optical plier
you want to use a
plier with longer beak
1hread .023" or .030" hollow Lube or
wlLh rough surface Lo prevenL sllp.
dont use brass
separators
When ls remed needed?
lor SeparaLors?
Anyth|ng that causes b|eed|ng |n the mouth:
SeparaLors
llmng or cemenung 8ands
8emovlng 8ands or banded appllances
uebondlng
CurrenL 8ecommendauons APA:
rosLheuc cardlac valve
revlous endocardlus
unrepalred cyanouc congenlLal hearL dlsease,
lncludlng pauenLs wlLh palllauve shunLs and condulLs
CompleLely repalred congenlLal hearL dlsease wlLh
prosLheuc maLerlal or devlce, wheLher placed by
surgery or caLheLer lnLervenuon, durlng Lhe rsL 6
monLhs aer Lhe procedure
8epalred congenlLal hearL dlsease wlLh resldual defecLs
aL Lhe slLe or ad[acenL Lo Lhe slLe of a prosLheuc paLch
or prosLheuc devlce
Cardlac LransplanL reclplenLs wlLh cardlac valvular
dlsease
remed nC1 needed for:
8ouune anesLheuc ln[ecuons Lhrough
nonlnfecLed ussue
1aklng denLal radlographs
lacemenL of removable prosLhodonuc or
orLhodonuc appllances
Ad[usLmenL of orLhodonuc appllances, bondlng
of orLhodonuc brackeLs
Sheddlng of declduous LeeLh
8leedlng from Lrauma Lo Lhe llps or oral mucosa.
APA AugusL 2007. Avallable aL hup:// www.amerlcanhearL.org/
presenLer.[hLml?ldenuer=3004339.
CrLho rocedures 8equlrlng Anublouc
rophylaxls:
laclng separaLors
8anded appllances, noL bonded.
uebondlng & removal of banded appllances.
noL needed for archwlre ad[usLmenLs, Laklng
lmpresslons, or x-ray lms, placlng reLalners.
lf ln doubL call Lhe cardlologlsL!
And Lhose 'speclal' momenLs???
ou or your sta d|d not check the chart before p|ac|ng
separators ..premed was needed and not taken!
Should you have pauenL rlnse wlLh Chlorhexldlne?
8acLeremla?
2.3 lncldence
noL decreased w/0.2 Chlorhexldene
Invesnganon of 8acterem|a Aher
Crthodonnc 8and|ng and Deband|ng
Io||ow|ng Ch|orhex|d|ne Mouth Wash
App||canon Angle CrLhodonusL, vol 71, no 3,
2001 L8vL8ul, ACA8, l`SCu uLn, kAul8
1alklng olnL:
Mrs. AcosLa, !uan needs Lo Lake hls premed as soon as you geL home, can LhaL
be done rlghL away? Pe was supposed Lo Lake lL before Lhe spacers were placed.
1haL wlll never happen agaln, ever. lease accepL my apologles. 1hls ls hlghly
unllkely Lo cause a problem. lease call your physlclan for hls advlse."
roLecuon of Lhe pauenL ls mosL lmporLanL Lhlng!
Cvervlew of SLeps ln 8andlng:
use mlcroeLched or equlvalenL band
Clean Lhe LooLh w/genLle pumlce & waLer slury
SelecL and llL band
8emove band Lo cemenL
Alcohol lnslde of 8and & Alr ury
lsolaLe Lhe LooLh and alr dry
CemenL
Clean up
Selecung ?our 8and SLock:
use prewelded, mlcroeLched band
ulmpled deslgn or slmllar . or.
mlcroeLch yourself
Laser eLched ldenuers are besL.
Converubles? hase l or full Lx?
Llngual seaung lug, please. noL a
cleaL
not necessary
laln 8ands for Appllances:
1emper or Suness
So
Medlum
Su
LxLra Su
noL mlcroeLched or prepared!
ldenuer noL laser eLched!
dont want band to
fall over on you
when placing!
stamped on will
come off/fade away
and cause a lot of
inconvenience!
uouble 1ube Molar 8and:
make sure band has a good
purchase point, make sure its
wide enough to use band seater
to put in place
1rlple 1ube - MosL exlble!
My upper 8and ueslgn:
llrsL Molars 1rlple Lube upper assembly
Converuble sloL
PC Lo Ccclusal
removable blLe plaLes
urchase polnL for overlay wlres
Auxllllary Lube for laLe erupung 2
nd
or overlay wlres
Pook for elasucs
Second Molars - slmple Lube, uLed enLrance,
hook
All llngual seaung lugs cenLer of band.
umlce Slurry Lo Clean Lhe 1eeLh
llmng 8ands:
reselecL o sLudy models
8eshape Lhe band Lo L.
SeaLed by pauenL's blLe
CorrecL sequence.
start with one that
fits all around tooth
lace from llngual Lo buccal on lower
arch!
I|oss through tube.
I|nger pressure a|one
CeL lL Lo Lhe M & u
conLacLs
1hen plck up blLe
suck.
ulerenL Shapes Lo Lhe ups?
AuLoclavable
8|te Snck 8and Seater
use with palm
pressure
llmng a Molar 8and:
1hen lL ls drlven Lo place by pauenL's blLe on
Lhe meslobuccal and dlsLollngual surfaces.
Allgn w/marglnal rldges
Lven 8uccal and llngual cusp ups buccal and
comparlng buccal Lo llngual
llmng a Molar 8and:
1he hna| seanng |s w|th heavy b|nng force on
the d|sta|.
8and [usL below marglnal rldges ouL of Lhe
blLe.
Sequence for llmng Md 8ands:
8|ue = I|nger
pressure
ked = 8|te
Snck

V|ew
sequence
w|th
owerpo|nt
an|manon.
1. press down on
distal then 2. press
down on mesial
last place to seat
band is DB
8lue = Pand ressure
8ed = 8lLe Suck
Sequence for llmng Maxlllary 8ands:
hardest part to seat
is the distal part so
want to start + end
here
My lower molar bands:
1
sL
molar - converuble slngle Lubes w/hook
2
nd
molars - slngle Lubes w/hook
8oLh wlLh seaung lug on mld-llngual
WhaL's rlghL here?
WhaL's wrong here?
open margin
Speclal roblems ln llmng 8ands:
Mlsslng Cpposlng 1eeLh:
uouble 8lLe Suck 1rlck!
An excepuon: Class ll molar
Mes|a| bucca| cusps
shows more.
lnfra-erupLed 1ooLh Lo Lhe ulsLal:
Cver conLour Lhe glnglval
w/Powe pller.
Crlnd 8ands!
noL Lhls!
1hls klnd of Crlnd 8ands!
Crlnd 8and Ldges Lo llL:
necessary wlLh a shorL cllnlcal crown due Lo
carles or crown fracLure or severe wear.
Pow oen????
Cnce per year..
auenL Won'L 8lLe uown!
?ou shouldn'L be dolng Lhese cases!!! Whew!
Send Lhem Lo me, please.
Pandlcapped pauenLs
Mlsslng many LeeLh
8ehavloral problems ln chlldren
Lvery ume l glve ln and leave a band ln a
non-ldeal posluon, lL comes loose!
?oung MouLhs!
Crlnd o Lhe blLe suck Lo mlnlmal Lhlckness!
CrLho 1echnology $20 Lx s&h
use a half brackeL welded Lo band
8emove & Clean wlLh Alcohol
lsolaLe LooLh & Alr dry
CemenLauon rocedure:
1wo-SLep AdapLauon
lesLoon Lhe band!
lace as prevlously shown.
We remove Lhe cemenL exudauon beLween LooLh
and band w/damp couon roll or LooLhbrush.
ln Lhe second sLep, we use Lhe blLe suck Lo seaL
Lhe band ln lLs nal posluon.
Paulk le Lo push band lnLo creases.
llnlsh wlLh a dry couon roll Lo seal Lhe marglns.
lesLoon Lhe 8and [ glnglval:
CemenL
Clean up Couon 8oll or 18
SLep 1wo - nal posluon:
8oone Cauge
Crmco Cauges:
arallel Lo Llngual & 8uccal Cusp 1lps
Cnce cemenLed - CusLom ConLour
8and .. Paulk le
Llke So:
lLCSS!
Scaler Lo clear away glnglval cemenL.
ueclde: WlLh or wlLhouL a blLe plaLe?
1
sL
Molars 2nd Molars
1echnlque 8onded 8lLe 8lock:
8and Lok by 8ellance
20 second llghL acuvauon
nC aer LasLe or odor!
eLroleum [elly on opposlLe arch
Shape w/nger coaLed Lhls as well or w/sealanL.
Can be added Lo aL nexL appolnLmenL.
1akes a |ong nme Lo grlnd lL o and ouL of
grooves! Self LLchlng rlmer.
1he 8onded 8lLe 8lock
no ledges for Lrapplng food or bacLerla.
Clear Lhe lower auachmenLs below.
Check anLerlor for adequaLe blLe
openlng! Add on as needed.
18AuMA!
C.. Lakes Lhe LeeLh ouL of occluslon
wlLh a bonded 88. no grlndlng!
Speclal 8andlng roblems:
1. Loose 8ands
2. uecalclcauon under loose bands
3. 2
nd
molar lmpacLs on Lhe rsL molar band
Clve me your besL guess!
Whlch arch has Lhe mosL band fallures?
Whlch LooLh has 1
sL
, 2
nd
and 3
rd
hlghesL fallure
raLes?
Should you L a new band wlLh
each loose band?
lf brackeLs and bands can be removed
wlLhouL damage Lhey can be cleaned,
sLerllled, and reused wlLhouL rlsk Lo Lhe
pauenL, ln exacLly Lhe same way as oLher
medlcal devlces." roL

uecalclcauon under loose band:
Molar lmpacLed on 8and:
2
nd
molar lmpacuons are rare:
.03 - .04
lmproperly ued bands
Lg Space beLween 6&7
Carles!
lnadequaLe Md growLh
revenuon of meslal drl
lnLo Leeway space.
seudopockeL
1reaLmenL for lmpacLed 7:
lace a spacer &/or
8emove 6 band
8ond Lhe rsL molar and...
klck Lhe molar back
Soldered sprlng Lo Lhe band
Auxllllary sprlng
LxLracL 7 brlng ln Lhe 8 or.
1ransplanL 8 lnLo 7 sockeL!
push
pull
auxiliary spring
kickback molar
upright distal tooth
.or . whaL makes sense here?
lnformed ConsenL SLaLemenL:
Any of Lhe unerupLed LeeLh may lmpacL on
Lhelr own or on Lhe braces
and requlre surglcal exposure by an oral
surgeon speclallsL and/or orLhodonuc
LreaLmenL aL a separaLe expense."
Space malnLalner
"|ease s|gn here..."
uebandlng:
A Safer Debond|ng]Deband|ng
1echn|que

A Safer Debond|ng]Deband|ng 1echn|que
VCLUML 32 : NUM8Lk 06 : AGLS (374-37S)
1998
8CN CnAN kCC, DDS, MSD
CnUN-nSI CnUNG, DMD, MS
lnslsL on 43 of Lhe pauenL by new
employees (or yourself) when
dolng debandlng procedures!
Lower molars
remove from
buccal rsL.


upper molars
from Lhe palaLal
rsL.


And ...

AlLernaLe 8uccal & Llngual.
Meslal, dlsLal, buccal, llngual. unul lL genLly falls
o Lhe LooLh and ln beLween your pler beaks.
And lf Lhe pauenL ls uncomforLable:
uebondlng roblems:
aln on band removal.buccal llngual buccal
llngual buccal llngual.as many umes as lL
Lakes!
Max 8ands from palaLal rsL.
Mand 8ands from buccal rsL.
And lf Lhe pauenL swallows Lhe band, wlre,
llgaLure ue, eLc. whaL do you do?
Advlse pauenL or parenL
8ecommend Lhey call Lhelr physlclan
uocumenL Lhls ln your charL
Call Lhem laLer Lo see whaL Lhe physlclan sald.
uocumenL Lhls ln Lhe charL.
Clean up Lhe 1eeLh!
Learnlng Cb[ecuves
revalence of 8and usage and Why!
Learn commonly used CemenLs for 8ands
8andlng 1echnlques and 1lps
Learn 1echnlques for Separauon for 8ands
Learn 8andlng rocedures & 1echnlques
know when Lo 8equlre remedlcauon
Learn Some Speclal 8andlng roblems
Learn abouL uebondlng
Cul and 8reak 1lme!
1hank God!