Banding versus bonding of molar bands in fixed Orthodontic treatment : a comparison.


Published on

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

Published in: Health & Medicine, Business
  • Be the first to comment

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide

Banding versus bonding of molar bands in fixed Orthodontic treatment : a comparison.

  1. 1. GOOD AFTERNOON 1/21/2014 Banding versus Bonding
  2. 2. BANDING VERSUS BONDING OF FIRST PERMANENT MOLARS: A MULTI-CENTRE RANDOMIZED CONTROLLED TRIAL. - Mariya Nazir -Tanya Walsh -Dee Fox   1/21/2014 Banding versus Bonding
  3. 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. 1/21/2014 Banding versus Bonding
  4. 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. 1/21/2014 Banding versus Bonding
  5. 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. 1/21/2014 Banding versus Bonding
  6. 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 1/21/2014 Banding versus Bonding
  7. 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 1/21/2014
  8. 8. Material and methods 1/21/2014 Banding versus Bonding
  9. 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. 1/21/2014 Banding versus Bonding
  10. 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. 1/21/2014 Banding versus Bonding
  11. 11. Material and methods  Clinical sequence followed:  Consent and registration.  Baseline variables recorded including patients     1/21/2014 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. 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. 1/21/2014 Banding versus Bonding
  13. 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. 1/21/2014 Banding versus Bonding
  14. 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. 1/21/2014 Banding versus Bonding
  15. 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  tolerated, not requiring any treatment.  4-6 Moderate - The reaction caused discomfort  and interrupted usual activities. Some  form of treatment was required. 7 Severe 1/21/2014 - The reaction caused considerable interference with usual activities and may have been incapacitating, requiring treatment. Banding versus Bonding
  16. 16.  The research protocol was approved by the local ethical committee.  Informed and written consent was obtained before the treatment was started. 1/21/2014 Banding versus Bonding
  17. 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. 1/21/2014 Banding versus Bonding
  18. 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. 1/21/2014 Banding versus Bonding
  19. 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. 1/21/2014 Banding versus Bonding
  20. 20. Results 1/21/2014 Banding versus Bonding
  21. 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%) 1/21/2014 Banding versus Bonding
  22. 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. 1/21/2014 Banding versus Bonding
  23. 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. 1/21/2014 Banding versus Bonding
  24. 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. 1/21/2014 Banding versus Bonding
  25. 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. 1/21/2014 Banding versus Bonding
  26. 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. 1/21/2014 Banding versus Bonding
  27. 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. 1/21/2014 Banding versus Bonding
  28. 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. 1/21/2014 Banding versus Bonding
  29. 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. 1/21/2014 Banding versus Bonding
  30. 30. Review of literature 1/21/2014 Banding versus Bonding
  31. 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. 1/21/2014 Banding versus Bonding
  32. 32. A comparison of enamel dimenralization after cementation with four different cements: in vitro study Santosh Kumar Goye, Parveen Neela  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. 1/21/2014 Banding versus Bonding
  33. 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. 1/21/2014 Banding versus Bonding
  34. 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.  1/21/2014 Banding versus Bonding
  35. 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. 1/21/2014 Banding versus Bonding
  36. 36. Critical reflection 1/21/2014 Banding versus Bonding
  37. 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. 1/21/2014 Banding versus Bonding
  38. 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. 1/21/2014 Banding versus Bonding
  39. 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. 1/21/2014 Banding versus Bonding
  40. 40.  Thank you.   Sneh Kalgotra PG Student  1/21/2014 Banding versus Bonding