A brief presentation of how to band, when to band, why to band, where to band, its disdvantages and advantages along with technique. also describing briefly bonding, its mechanism how it is being done, advantages, disadvantages and techniques
4. INTRODUCTIONINTRODUCTION
BANDING
The chief parts of modern fixed appliances are tooth
bands and arch wires
Tooth bands are made up of metals and cemented to the
teeth and provides place for attachment of other auxiliaries
like brackets, buccal tubes, lingual buttons etc.
These auxiliaries can be either welded or soldered to the
bands. The tooth moving forces derived from the arch
wires are transmitted to the teeth through the bracket.
Saturday, February 11, 2017 4www.drdentiste.com
5. INDICATIONS FOR BANDINGINDICATIONS FOR BANDING
Teeth that will receive heavy intermittent forces against the
attachments. E.g.: upper I molars
Teeth that will need both labial and lingual attachments
Teeth with short clinical crowns
Tooth surfaces that are incompatible with successful bonding
Saturday, February 11, 2017 5www.drdentiste.com
6. RequisitesRequisites
Must fit the contours of the tooth as closely as possible,
there by enhancing the attachment to the teeth
Should not extend subgingivally any more than is
necessary for adequate retention on the teeth
Resistant to deformation under stresses in the mouth
Material should have enough springiness that it can be
forced over the height of contours of the teeth and spring
back slightly into undercut areas
As high polish as possible is placed on the surfaces to
reduce the adhesion of food debris
Saturday, February 11, 2017 6www.drdentiste.com
10. Selection of band materialSelection of band material
Incisor bands:
Band material is usually thinner. It varies from from
0.12 inch in width and 0.003-0.004 inch in thickness
Premolar bands :
0.004 thickness and 0.15 inch wide
Molar bands:
0.005-0.006 inch thickness and 0.18-0.20 inch wide
Preformed bands: Various sizes are available for different
teeth commercially with prewelded attachments
Saturday, February 11, 2017 10www.drdentiste.com
11. FABRICATING AND FITTINGFABRICATING AND FITTING
BANDSBANDS
Upper molar band is designed to be placed initially by hand
pressure on the mesial and distal surfaces bringing the band
down close to the height of the marginal ridges.
Then it is driven to place by pressure on the mesiobuccal and
distolingual corners.
Final seating is with heavy biting force on the distolingual
surface.
Saturday, February 11, 2017 11www.drdentiste.com
12. Lower molar bands are designed to be seated
initially with hand pressure on the proximal
surface and then heavy biting force along the
buccal but not the lingual margins.
Saturday, February 11, 2017 12www.drdentiste.com
13. Upper premolar bands are usually seated with
alternate pressure on the buccal and lingual
surfaces.
Lower premolar bands are designed for heavy
pressure on the buccal surface only.
Saturday, February 11, 2017 13www.drdentiste.com
15. CementationCementation
The most commonly used cements are zinc phosphate and
glass ionomer
A thick cement mix is loaded into the band in such a way that
all the interior surfaces are totally covered with cement, so
that there is no bare metal.
Now the upper aspect of the band is covered with gloved
finger and the band is pushed from above further apically
using digital pressure.
Patient is instructed to bite firmly but gently over the band.
Saturday, February 11, 2017 15www.drdentiste.com
16. BONDINGBONDING
For the patient to whom esthetics being the prime
consideration even during the treatment, the metallic look
of the orthodontic appliance has always been the bone of
contention.
Saturday, February 11, 2017 16www.drdentiste.com
17. ..
Advantages
It is esthetically superior.
It is faster and simple.
There is less discomfort for the patient
Arch length is not increased by band material.
Saturday, February 11, 2017 17www.drdentiste.com
18. It allows more precise bracket placement.
Bonds are more hygienic than bands Partially erupted teeth
can be controlled.
Mesiodistal enamel reduction ( proximal reduction) is
possible during treatment.
Attachments may be bonded to artificial tooth surfaces
(eg., amalgam, porcelain, gold) and to fixed bridge work.
Saturday, February 11, 2017 18www.drdentiste.com
19. Interproximal areas are accessible for composite
buildups.
Caries risk under loose bands is eliminated and
interproximal caries can be detected and treated.
No band spaces are present to close at the end of
treatment.
Brackets may be recycled, further reducing the cost.
Lingual brackets, invisible braces, can be used when
patient rejects visible orthodontic appliance.
Saturday, February 11, 2017 19www.drdentiste.com
20. Disadvantages of Bonding:
A bonded bracket has a weaker attachment than a cemented
band.
Some bonding adhesives are not sufficiently strong.
Better access for cleaning does not necessarily guarantee
better oral hygiene and improved gingival condition, especially
if excess adhesive extend beyond the bracket base.
Saturday, February 11, 2017 20www.drdentiste.com
21. The protection against the inter proximal caries of well
contoured cemented band is absent.
Bonding is more complicated when lingual auxiliaries
are required or where headgears are attached.
Rebonding a loose bracket requires more preparation
than rebanding a loose band.
Debonding is more time consuming than debanding,
since removal of adhesive is more difficult than removal
of cement
Saturday, February 11, 2017 21www.drdentiste.com
22. Bonding procedures can be performed in 2 ways
Direct bonding
Indirect bonding
Direct bonding:
This procedure is quite simple and involves following
steps
CLEANING
ENAMEL CONDITIONING
SEALING
BONDING
Saturday, February 11, 2017 22www.drdentiste.com
23. Cleaning
This requires rotary instruments, either
a rubber cup or a polishing brush.
Saturday, February 11, 2017 23www.drdentiste.com
24. MOISTURE CONTROL:
After the rinse, salivary control and
maintenance of a completely dry working
field is absolutely essential.
Its presence may prevent the good bond
between the sealant and bonding agent
Saturday, February 11, 2017 24www.drdentiste.com
25. Lip expanders and / or cheek retractors
Saliva ejectors
Tongue guard with bite blocks
Salivary duct obstructors
Gadgets that combine several of these (saliva ejector,
tongue holder, and bite block).
Cotton or gauze rolls
Antisialagogues
Saturday, February 11, 2017 25www.drdentiste.com
26. Enamel pretreatment
The conditioning solution or gel (usually 37%
phosphoric acid ) is then lightly applied over the
enamel surface with a foam pellet or brush for 15 to
30 sec.
When etching solutions are used, the surface must
be kept moist by repeated applications. To avoid
damaging delicate enamel rods, care must be taken
not to rub the liquid on to the teeth.
Saturday, February 11, 2017 26www.drdentiste.com
27. At the end of the etching period the etchant is rinsed off
the teeth with abundant water spray.
Salivary contamination of the etched surface must not be
allowed. ( If it occurs rinse with water spray or re - etch for
a few seconds; the patient must not rinse.)
Saturday, February 11, 2017 27www.drdentiste.com
28. Should the etch cover the entire facial enamel or only
a small portion outside the bracket pad?
Clinical experience indicates that etching the
entire facial enamel with solution is harmless at least when
a fluoride mouth rinse is used regularly.
Saturday, February 11, 2017 28www.drdentiste.com
29. Studies and clinical experience indicate that 15-30 secs
adequate for etching most young permanent teeth.
However important individual variation exists in enamel
solubility between patients, between teeth and within the
same tooth
Saturday, February 11, 2017 29www.drdentiste.com
30. Bond strength varied from 29.3Kg/cm2for the 15 sec etch
to 92.3 Kg/cm2 for 60sec
Based upon the established requirement of 60-80Kg /cm2
to meet clinical needs 30sec etch procedure is suggested
for clinical trail
Saturday, February 11, 2017 30www.drdentiste.com
31. Is etching time is different for young and old teeth?
For deciduous teeth, no difference was found in effect
between the etching periods.
For young permanent teeth, 15 seconds of etching created
more retentive conditions than 60 seconds.
For old permanent teeth, the reverse was found. The most
retentive conditions were found for the deciduous teeth,
regardless of etching time.
Saturday, February 11, 2017 31www.drdentiste.com
32. Is prolonged etching necessary when teeth are pretreated
with fluoride?
extra etching time is not necessary when teeth have been
pretreated with fluoride.
When in doubt, check that the enamel looks uniformly dull
and frosty white after etch. If it does, surface retention is
adequate for bonding.
Teeth with higher concentration fluoride are generally
considered resistant to etching than normal teeth and may
require extended etching time
Saturday, February 11, 2017 32www.drdentiste.com
33. Is etching permissible on teeth with internal white
spots?
Caution should be exercised when etching over acquired
and developmental demineralization's.
It is best to avoid it.
If this is impossible, a short etching time, the application of
sealant, and the use of direct bonding with extra attention
to not having areas of adhesive deficiency are important.
The presence of voids, together with poor hygiene, can
lead to metal corrosion and staining of underlying
developmental white spots.
Saturday, February 11, 2017 33www.drdentiste.com
34. Possible iatrogenic effects of acidPossible iatrogenic effects of acid
etching of enameletching of enamel
Fracture and cracking of enamel upon debonding
Increased surface porosity – possible staining.
Loss of acquired fluoride in outer 10µm of enamel surface.
Loss of enamel during etching.
Resin tags retained in enamel – possible discoloration of
resin.
Rougher surface if over-etched.
Saturday, February 11, 2017 34www.drdentiste.com
35. SELF ETCHING PRIMER
Developed by Watanabe and Nakabayashi. It is a aqueous
solution of 20% phenyl – P in 30% HEMA.
An acidic primer combines the etchant with the primer in
one application, Contains both acid (Phenyl – p) and the
primer ( HEMA and dimethacrylate).
Clearfil liner bond V (Kuraray)Clearfil liner bond V (Kuraray)
Mega bond (Kuraray)Mega bond (Kuraray)
Prompt – L – Pop ( 3M UniteK )Prompt – L – Pop ( 3M UniteK )
First step (Reliance)First step (Reliance)
Transbond Plus ( Unitek 3m )Transbond Plus ( Unitek 3m )
Ideal 1 (GAC )Ideal 1 (GAC )
One up Bond F ( TokuyamaOne up Bond F ( Tokuyama
Saturday, February 11, 2017 35www.drdentiste.com
37. Bond strength
Adequate and acceptable bond strength.
No statistical difference with conventional composite resin
adhesive system.
Varies from 8 – 20 MPa.
A delay in bonding after SEP application further increases
the bond strength.
Saturday, February 11, 2017 37www.drdentiste.com
38. Sealing
The sealant coating should be thin and even, because
excess sealant may induce bracket drift and unnatural
enamel topography when polymerized.
Sealants provide enamel cover in the areas of adhesive
voids especially valuable with indirect bonding
Saturday, February 11, 2017 38www.drdentiste.com
39. Moisture insensitive primers (MIP)
Hydrophilic primers that can bond in the wet fields
Bond strengths are significantly lower under wet field than
in dry conditions
For optimal results MIP should be used with their respective
adhesive resins
Saturday, February 11, 2017 39www.drdentiste.com
42. REMOVAL OF EXCESS
Excess must be removed with the scaler
before the adhesive has set or it must be
removed with bur after setting.
Saturday, February 11, 2017 42www.drdentiste.com
44. Indirect bonding withIndirect bonding with
silicone impression traysilicone impression tray
Take an impression and pour up a stone model
Select brackets for each tooth
Apply a small portion of water soluble adhesive on each tooth
Position the brackets on the model, check all the
measurements and allignments, reposition if needed
Saturday, February 11, 2017 44www.drdentiste.com
45. Press the putty on to the bonded brackets
Form the tray , allowing sufficient thickness for
strength.
After silicone tray has set, immerse the model and tray
in hot water to release the brackets from the stone
Remove any remaining adhesive under running water
Trim the silicone and mark the midline
Saturday, February 11, 2017 45www.drdentiste.com
46. For silicone tray fabrication, mix material according to
manufacturers instructions
Prepare the patients teeth as for a direct application
Mix adhesive, load it in a syringe apply a sufficient portion to
the bonding bases
Seat the tray on prepared arch and hold with firm and steady
pressure for 3 min
Remove the tray after 10 min
Complete the bonding by careful removal of excessive flash
Saturday, February 11, 2017 46www.drdentiste.com