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December 2011 Western University of Health Science College of Dental Medicine Presented by Dr. Andrea L. Feather, OrthodonEst, Diplomate American Board of OrthodonEsts
• 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 DecalciﬁcaEon! Costly 2 stock Uncomfortable SeparaEon – 2 appointments BUT >>>> They’re Stronger! .
7 51.4 21.1% 27.9% 24.0 72.2 90.4 51.5 13.2 16.8 40.0 Mand second premolars 9.2% Maxillary ﬁrst molars 52.5 91.9 23.0 Mandibular second molars 22.0 -‐56% 169 386 .3 8.7% 25.7 Maxillary ﬁrst premolars 6.2 Maxillary second premolars 7.8 92.0 6.4 9.5 Mandibular ﬁrst premolars 6.9 22.8 89.2008 JCO Prac4ce Procedures Survey ROUTINE BANDING 2008 2002 1996 1986 Maxillary second molars 15.2 42.4 Mandibular ﬁrst molars 49.8 36.2 6.3 76.0 26.
4 NA Mandibular ﬁrst molars 48.7 21.7 NA 86 NA NA NA NA 200% 189 96 .3 30.2 21.7 NA Maxillary ﬁrst molars 48.RouEne Bonding Molars: Bonding: 08 02 96 Maxillary second molars 41.8 NA Mandibular second molars 52.0 21.
3% Bonded 75.2% Bonded 57% of upper 2nds are rouEnely aligned 22.9% Banded Mx 2nds 41.Are second molars being straightened? 2008 15.1% of lower 2nds are rouEnely aligned .8% Banded Md 2nds 52.
• Fluted entrances. • 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 . • ½ brackets • Hydrophilic bonding materials.
• Not fully erupted &… – refuse ext 8’s – Refuse surgical uncovering • Focal osteosclerosis • Poor OH • Poor Compliance .Why don’t orthos band or bond ALL second molars? • Already straight.
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! .
“ Dr. best to put full brackets on upper/lower arch Don’t tell your paEents. • Overlay wires and 3 months to ﬁnish! 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. .nd Molars: My approach to 2 • At start of case …. Make sure she does that at the next appointment. late erupEon cases. • At end of the case – open bite cases. oral habits.” Phone call is needed instead. OR…. • Ideal OB & OJ • “Well aligned” @ case start. Feather forgot to put braces on your back teeth.
Banding Cements What should I consider using? Do what orthodon4sts do! .
2008 JCO Study: Prevalence of BAND CEMENTS 2008 Glass ionomer (GI) 37.6 Zinc phosphate old cement.5% Resin reinforced Light cure GI 32. still used in other countries 70% .7 Compomer 20% 5.
.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 minutes…24 hours to max strength! This can be a signiﬁcant disadvantage! .
Resin Modiﬁed 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 signiﬁcantly more than regular Glass Ionomer Cements! • • • • .
Glass Ionomer vs. ResinModiﬁedGI $$ $$$$$ $110 $220 -‐297 .
draw upward 1” strand .RouEne IniEal Banding Cement -‐ GI Powdery calcium-‐aluminum ﬂuorosilicate glass Carboxylic acid copolymer 1 scoop to 2 drops.
CemenEng AcEve Appliances & Recements Quad Helix LSL Advancing Loops .
The New Comer! Compomers Composite + Glass Ionomers Our strongest Cement & hardest to remove! .
Decline in physical properEes when water is present at the Eme the material sets up. . Buﬀering Capacity.Light Cure One-‐Step Compomer: Polyacid-‐modiﬁed composite resin Hydrophilic components: Cause water to be drawn into the material following cure! Flouride uptake & release.
InteresEngly…. . • Compomers are stronger than glass ionomers in a completely dry ﬁeld! • Holding arches that conEnuously come loose! • Use for Cemented acEve appliances like the Headgears.
What’s wrong w/Compomers? • Weaker than GI in wet ﬁeld. IsolaEon needed! • Harder to clean up and harder to remove when done!!!! .
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 .Our Compomer: “Bank Lok” 2-‐Paste vs.
Cement where you don’t 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. • Geristore – band or bond removal not needed . 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. • GC Fuji Ortho LC – Immediate forces. mulEple bands. no severe malignment.
Glass ionomer -‐ First cementaEons of Fixed Space Maintainers 2. Gerstore if you never need to remove a band or bracket. Compomer – roughest kids = breakage!!! Poorer brushers. .P. Temporarily opening the bite : TRAUMA Endo cases -‐ no grinding on the enamel! “Hot tooth” 4.G. Resin Modiﬁed GI – full strength needed NOW! 3. Cement Summary: 1.
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. Record any refusals. – If missing ﬁnd and retrieve. • Only 2 weeks. • Clearly record where they were placed. . – Count them going in and coming out! – If unaccounted for oﬀer a complimentary ﬁlm.
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 ﬂoss please! Replace w/elas4c sep ajer one week .
030” hollow tube or with rough surface to prevent slip.025” or .Thread . 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 .
whether placed by surgery or catheter intervenEon. during the ﬁrst 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 . including paEents with palliaEve shunts and conduits • Completely repaired congenital heart disease with prostheEc material or device.Current RecommendaEons AHA: • ProstheEc cardiac valve • Previous endocardiEs • Unrepaired cyanoEc congenital heart disease.
jhtml?idenEﬁer=3004539. bonding of orthodonEc brackets • Shedding of deciduous teeth • Bleeding from trauma to the lips or oral mucosa. Available at hhp:// www.americanheart.Premed NOT needed for: • RouEne anestheEc injecEons through noninfected Essue • Taking dental radiographs • Placement of removable prosthodonEc or orthodonEc appliances • Adjustment of orthodonEc appliances.org/ presenter. AHA August 2007. .
not bonded. Not needed for archwire adjustments.Ortho Procedures Requiring AnEbioEc Prophylaxis: • Placing separators • Banded appliances. • Debonding & removal of banded appliances. taking impressions. If in doubt call the cardiologist! . placing retainers. or x-‐ray ﬁlms.
And those ‘special’ moments??? You or your staﬀ did not check the chart before placing separators ….premed was needed and not taken! Should you have paEent rinse with Chlorhexidine? .
Vol 71. KADIR .Bacteremia? • 2. I˙S¸GU¨ DEN.2% Chlorhexidene Inves4ga4on of Bacteremia Ajer Orthodon4c Banding and Debanding Following Chlorhexidine Mouth Wash Applica4on Angle OrthodonEst.5% incidence • Not decreased w/0. 2001 ERVERDI. No 3. ACAR.
Please accept my apologies. That will never happen again.Talking Point: ProtecEon of the paEent is most important thing! “Mrs. ever. Acosta. Juan needs to take his premed as soon as you get home. This is highly unlikely to cause a problem. can that be done right away? He was supposed to take it before the spacers were placed.” . 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 .
microetched band • Dimpled design or similar … or… microetch yourself • Laser etched idenEﬁers are best.SelecEng Your Band Stock: • Use prewelded. • ConverEbles? Phase I or full tx? • Lingual seaEng lug. please… not a cleat not necessary .
Plain Bands for Appliances: • Temper or SEﬀness – Sow – Medium – SEﬀ – Extra SEﬀ Not microetched or prepared! dont want band to fall over on you when placing! IdenEﬁer not laser etched! stamped on will come off/fade away and cause a lot of inconvenience! .
make sure its wide enough to use band seater to put in place .Double Tube Molar Band: make sure band has a good purchase point.
Triple Tube – Most ﬂexible! .
• 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, ﬂuted entrance, hook • All lingual seaEng lugs center of band.
Pumice Slurry to Clean the Teeth
• • • • Preselect oﬀ study models Reshape the band to ﬁt. Seated by paEent’s bite Correct sequence.
start with one that fits all around tooth
• Finger pressure alone • Get it to the M & D contacts • Then pick up bite sEck. .Place from lingual to buccal on lower arch! • Floss through tube.
Diﬀerent Shapes to the Eps? .
Autoclavable Bite S4ck Band Seater use with palm pressure .
– Align w/marginal ridges – Even Buccal and lingual cusp Eps buccal and comparing buccal to lingual .Fivng a Molar Band: • Then it is driven to place by paEent’s bite on the mesiobuccal and distolingual surfaces.
• Band just below marginal ridges out of the bite. .Fivng a Molar Band: • The ﬁnal sea4ng is with heavy bi4ng force on the distal.
Sequence for Fivng Md Bands: Blue = Finger pressure Red = Bite S4ck View sequence with Powerpoint anima4on. press down on distal then 2. 1. 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 .
What’s right here? .
What’s 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 Won’t Bite Down! • You shouldn’t be doing these cases!!! Whew! Send them to me. it comes loose! . please. – Handicapped paEents – Missing many teeth – Behavioral problems in children Every Eme I give in and leave a band in a non-‐ideal posiEon.
Young Mouths! • Grind oﬀ 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: .
we use the bite sEck to seat the band in its ﬁnal posiEon. • We remove the cement exudaEon between tooth and band w/damp cohon roll or toothbrush."Two-‐Step AdaptaEon" • Festoon the band! • Place as previously shown. • Finish with a dry cohon roll to seal the margins. . • In the second step. • Haulk ﬁle to push band into creases.
Festoon the Band @ gingival: .
Clean Up Cohon Roll or TB .
Step Two – ﬁnal posiEon: .
Boone Gauge .
Ormco Gauges: .
Parallel to Lingual & Buccal Cusp Tips .
Haulk ﬁle .Once cemented – Custom Contour Band ….
Like So: .
FLOSS! Scaler to clear away gingival cement. .
Decide: With or without a bite plate? 1st Molars 2nd Molars .
Can be added to at next appointment. . Takes a long 4me to grind it oﬀ and out of grooves! Self Etching Primer.Technique Bonded Bite Block: • • • • • • • Band Lok by Reliance 20 second light acEvaEon NO awer taste or odor! Petroleum jelly on opposite arch Shape w/ﬁnger coated this as well or w/sealant.
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.
takes the teeth out of occlusion with a bonded BB. No grinding! .P.G.
2nd molar impacts on the ﬁrst molar band . Loose Bands 2. DecalciﬁcaEon under loose bands 3.Special Banding Problems: 1.
2nd and 3rd highest failure rates? .Give me your best guess! • Which arch has the most band failures? • Which tooth has 1st.
” Proﬃt . in exactly the same way as other medical devices. and reused without risk to the paEent.Should you ﬁt a new band with each loose band? “If brackets and bands can be removed without damage they can be cleaned. sterilized.
DecalciﬁcaEon under loose band: .
Improperly ﬁhed bands Inadequate Md growth Lg Space between 6&7 Pseudopocket Caries! .04% PrevenEon of mesial driw into Leeway space.Molar Impacted on Band: 2nd molar impacEons are rare: .03 -‐ .
push Treatment for impacted 7: • • • • Place a spacer &/or Remove 6 band Bond the ﬁrst 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? .
.” “Please sign 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.
DMD. MS .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.
Insist on 45* of the paEent by new employees (or yourself) when doing debanding procedures! .
Upper molars from the palatal ﬁrst.Lower molars remove from buccal ﬁrst.. . And ….
buccal. .Alternate Buccal & Lingual… Mesial. UnEl it gently falls oﬀ the tooth and in between your pier beaks. lingual. distal.
And if the paEent is uncomfortable: .
.Debonding Problems: • Pain on band removal…buccal lingual buccal lingual buccal lingual…as many Emes as it takes! – Max Bands from palatal ﬁrst. – Mand Bands from buccal ﬁrst.
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.And if the paEent swallows the band. ligature Ee. wire. . 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! .
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