the attachments on first molar play a vital role in the initiation as well as the overall outcome of the treatment.

1. GOOD AFTERNOON
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Banding versus Bonding

2. BANDING VERSUS BONDING OF FIRST
PERMANENT MOLARS: A MULTI-CENTRE
RANDOMIZED CONTROLLED TRIAL.
- Mariya Nazir
-Tanya Walsh
-Dee Fox
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Banding versus Bonding

3. prolouge
 The terminal attachment of the fixed appliance are
placed on molar teeth; commonly the first permanent
molars.
 These attachments can take the form of a cemented
molar band or a bonded molar tube.
 The active phase of the fixed treatment takes at least
two years to complete.
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Banding versus Bonding

4.  To reduce the likelihood of emergency visits, improve
patient experience and avoid lengthy treatment times
it is important that these attachments have low failure
rates.
 Many orthodontists continue to favour molar bands
due to beliefs regarding lower failure rates and
reliability.
 Advocates of molar tubes claim these attachments are
more efficient and convenient, allow for easier
maintaince
of
oral
hygiene
and
reduce
demineralization of enamel.
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Banding versus Bonding

5. Banding versus bonding of first permanent
molars: a multi-centre randomized controlled
trial
 It comprises of 11 words- short.
 It is not specific.
 Title is incomplete as it suggest nothing about
the parameters being untertaken in the study.
 There is no terminology as multi- centre
randomized controlled trial.
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Banding versus Bonding

6. Proposed alternative title
 Effect of banding versus bonding on permanent
first molar, in consideration with loss of the
attachment given, patient discomfort and enamel
demineralization – a randomized controlled trial.
19 words
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Banding versus Bonding

7. INTRODUCTION
 Introduction is meaningful.
 Introduction is concise.
 It is built on the existing literature.
 Citations that are reported, are relevant and
pertinent to the study and followed with correct
references in the list.
 Purpose of the study is clearly mentioned in the
introduction. Banding versus Bonding
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8. Material and methods
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Banding versus Bonding

9. Material and methods
Inclusion criteria
 Patient aged between 10 and 18 years old.
 Patient starting orthodontic treatment with
upper and lower fixed appliances ( pre-adjusted
edgewise).
 Patient and parent informed and written consent.
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10. Material and methods
EXCLUSION CRITERIA
 Lack of consent.
 Absence of or planned extraction of first permanent
molars.
 First molars with evidence of dimeralization or
hypoplastic enamel.
 Pateints requiring orthognathic sugery.
 Occlusions that required extra-oral or intra-oral
anchoraage reinforcement (headgear,platal
arch, lingual arch) or precluded the use of bonds e.g.
use of quad helix.
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11. Material and methods
 Clinical sequence followed:
 Consent and registration.
 Baseline variables recorded including patients
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age,gender, intervention group and malocclusion
type.
Patients who were to receive bands had separators
placed 1 week followed by cementation. (n=40)
For patients allotted to bonded group, molars were
isolated with cotton rolls and suction and after
etching the molar tubes with mesh bases were
bonded to the molar teeth. (n=40)
The remaining of the upper and lower fixed
appliances was then placed in the usual way by the
clinician.
All patients were instructed to avoid hard, sticky or
sweet foods. Requested to use a 0.05% sodium
fluoride mouthwash daily for the duration of their
treatment.
Banding versus Bonding

12. Material and methods
 Stopping crietria
 Repeated failure to attend appointments.
 Repeated breakages or general lack of co-
operation.
 Poor oral hygiene.
 Presence or development of clinically significant
demineralization, root resorption and/or caries.
 Patient/parent request to stop treatment for any
reason.
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Banding versus Bonding

13. Material and methods
CLINICAL OUTCOME MEASURES
A. The primary outcome measure was molar band or
bond failure.
At review intervals , outright bond or cement
failure resulting in frank loss of the attachment
or attachment loosening due to partial bond or
cement failure, were both recorded as failure.
When a failure was recorded the same type of
attachment was replaced for further analysis.
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Banding versus Bonding

14. Material and methods
 B. Post treatment demineralization was assessed at
debond by direct visual examination, using modified
International
Caries Detection and Assessment
System (ICDAS).
SCORING:
Code 0 : Sound tooth surface.
Code 1 : First visible change on enamel upon drying.
Code 2 : Distinct visible change in enamel when viewed
wet.
Code 3 : Localized shallow enamel breakdown due to
caries with no visible dentine.
Code 4 : Localized deeper enamel breakdown due to
caries with no visible dentine.
Code 5 : Distinct cavity with visible dentine.
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15. Material and methods
C. patient comfort on first visit.
Patient discomfort was measured on a 7 point LIKERT
scale.
 0 None
- No symptoms.
 1-3 Mild
- The reaction is transient and easily
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tolerated, not requiring any treatment.
 4-6 Moderate - The reaction caused discomfort

and interrupted usual activities. Some

form of treatment was required.
7 Severe
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- The reaction caused considerable
interference with usual activities and may
have been incapacitating, requiring
treatment.
Banding versus Bonding

16.  The research protocol was approved by the local
ethical committee.
 Informed and written consent was obtained
before the treatment was started.
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Banding versus Bonding

17.  It is an experimental study.
 Pre-test, post- test comparisons are used.
 It is a randomized study.
 It is a double blind study.
 It is a parallel study and not a split- mouth study thus
reduces the bias which may be produced by cross over.
 Sample size was not calculated and was randomly selected.
 Inclusion criteria's are too narrow.
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Banding versus Bonding

18.  Authors selected a sample of 80 patients without
considering the gender factor.
 It’s a well known fact that the pain and discomfort
threshold differs in males and females and can’t be
generalized for the population.
 The modified ICDAS that was used
the modified one.
 Which relied on the
Visual examination and not the
microscopic examination.
 In addition only buccal surface of molars
is considered.
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Banding versus Bonding

19.  The Likert scale that is used for the discomfort
evaluation is a verbal scale.
 It is well known fact that perception of pain may vary
from person to person.
 And also between gender.
 The age of the selected sample is from 10-18 years.
 With adult orthodontics becoming so common. With
such narrow range of age
selection the results cannot be
generalized for a population.
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Banding versus Bonding

20. Results
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Banding versus Bonding

21. Results
A. Failure outcomes
Failure at tooth level
Failures
n (%)
No Failures
n (%)
Total
n (%)
Bands
4(2.6)
148(97.4)
152(100)
Bonds
28 (18.4)
124(81.6)
152(100)
The proportion of first time attachment failure
was greater in molar bonds(18.4%) than molar
bands (2.6%)
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Banding versus Bonding

22. Results
B. Discomfort outcomes
There is no statistically significant difference in
the discomfort levels recorded at first review
following attachment placement between the
molar band and molar bond groups in terms of
upper arch or lower arch.
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Banding versus Bonding

23. Results
C. Demineralization outcome
 44 (60%) pateints developed some degree of
demineralization.
 16 (36%) banded patients developed
dimeralization.
 Compared to 28 (64%) bonded patients who
developed dimeralization.
No patient developed frank carious lesion
corresponding to code 3,4,5.
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Banding versus Bonding

24. Discussion
 The molar band failure rate in this study (2.6%)
compares favourably with the findings of other
workers.
 Additionally, the molar bond failure rate (18.4%)
was lower than that reported by other
comparative studies.
 This 16% difference inn failure suggest that
bands are more reliable first permanent molar
attachment than bonds during fixed appliance
outcome.
 No patient experienced frank enamel breakdown.
Majority of enamel lesions will remineralize with
low dose fluoride.
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Banding versus Bonding

25. Discussion
 It would be tempting to postulate banding would
be more uncomfortable for patients as the
attachment physically surrounds the whole tooth
and placement can involve trauma to the gingiva.
However , no difference was demonstrated
between bands and bonds, low levels of
discomfort was reported and patient tolerated
both the attachments well.
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Banding versus Bonding

26. Discussion
 The current available text demonstrates that all
failures of attachment loss occurred within 6
months of treatment.
 Whereas this present study demonstrated that
all failures occurred within 13 months of
commencing treatment.
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27.  Strengths of this study
- parallel design was used instead the
split mouth design. Split mouth design allowed the
patient to be their own controls but had a
disadvantage of possible cross- over effects, one
cement contaminating the other material’s
performance.
 Weakness of the study:
- other workers have demonstrated the
influence of malocclusion and socioeconomic
background on the number of attachment
failures.
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Banding versus Bonding

28.  Authors have also mentioned about the direction
of future research in this area.
 Future studies on the basis of gender, age and
socio-economic status are required.
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Banding versus Bonding

29. Conclusion
 First molars bonds have a higher failure rate
than first molar bands.
 Bonded first permanent molars demonstrated
higher levels of post-treatment demineralization
than banded first molars.
 No difference in discomfort were experienced
by patients when banding or bonding first
permanent molars as part of fixed appliance
treatment.
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30. Review of literature
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31. Success and Failure of Banding and
Bonding. The Angle Orthodontist: April
1982, Vol. 52, No. 2, pp.113-117.
ELIAKIM MIZRAHI
A clinical comparison of the frequency of
cementation failure with orthodontic attachments
secured to teeth by banding or bonding. Lowest
failure rates were found with banding.
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Banding versus Bonding

32. A comparison of enamel dimenralization
after cementation with four different
cements: in vitro study
Santosh Kumar Goye, Parveen Neela
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The teeth bonded with three fluoride releasing
cements demonstrated lesser depth of enamel
demineralization as studied with penetrating dye
than the cement without fluoride release.
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33. Comparison of the Effect of Three
Cements on Prevention of
Enamel Demineralization Adjacent to
Orthodontic Bands
Mehdi Kashani,Sareh Farhadi,Neda Rastegarfard
 The use of RMGI cement seems to present
significantly better prevention of enamel
demineralization adjacent to orthodontics bands.
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Banding versus Bonding

34. Enamel Demineralization
ORTHODONTIC CYBER JOURNAL
The best preventive strategy would appear to be
an assessment of risk factors prior to
bonding, coupled with fluoride mouth
rinses, reinforcement of oral hygiene and dietary
advice throughout the course of treatment.

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Banding versus Bonding

35. Modified composite or conventional glass
ionomer for band cementation? A
comparative clinical trial
 T.J. Gillgrass, P.C.M. Benington,J. Newell,W.H. Gilmour
 (American Journal of Orthodontics and Dentofacial Orthopedics
 Volume 120, Issue 1, July 2001, Pages 49–53)
 One hundred forty band pairs were cemented in 98
subjects. Overall band failure rates of 5% and 2.8%
were recorded for the modified composite and the
conventional glass ionomer, respectively.
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36. Critical reflection
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37. Critical reflection
 This article is very relevant for our day to day
clinical practice.
 For extending this study to all fixed orthodontic
patients, further study with calculated and higher
sample size.
 This study has evaluated banding of first permanent
molar versus bonding the same on just three
parameters , more extensive study needs to be
undertaken with increased number of parameters.
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38. Critical reflection
 In further studies the gender has to be considered while
calculating pain and discomfort perception.
 While making the caries assessment, instead of visual
examination, microscopic examination of the lesion in
question should be done.
 With adult orthodontics becoming common, he age
criteria should be made broad in the further studies.
 Socioeconomic status should be considered while
conducting as such further studies.
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39. Refrences
 Gillgrass TJ, Benington PC, Millet DT: Modified composite
or conventional glass ionomer for bnd cementation? A
comparative clinical trial.
Am J Orthod Dentofacial
Orthop 2001:120;49-53.
 Millet DT,Letters S,Roger E,Cummings A,Love J. bonded
molar tubes an in vitri evalation. Angle Orthod 2001:71;38085.
 Millet DT,Duff S, Morrison L, Cummmings A. In vitro
comparison of orthodontic band cements. Am J Orthod
Dentofacial orthop 2003;123:15-20.
 Marcusson A , Norevll LI, Persson M. white spot reduction
when using glass ionomer cementfor bonding in
orthodontics: a longitudinal and comparative study: Eur J
Orthod 1997;19:233-42.
 Orthodontics cyber journal.
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40. 
Thank you.


Sneh Kalgotra
PG Student

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