+orthodontic banding 101

8/3/2019 +Orthodontic Banding 101

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WelcomeDoctorsSoontoBe!


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Orthodon4cBanding101:

Prac4calTipsfortheGeneralDen4st

December2011

WesternUniversityofHealthScience

CollegeofDentalMedicine

PresentedbyDr.AndreaL.Feather,OrthodonEst,

DiplomateAmericanBoardofOrthodonEsts


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LearningObjecEves

PrevalenceofBandUsageandWhy! LearncommonlyusedCementsforBands BandingTechniquesandTipsLearnTechniquesforSeparaEonforBands

LearnBandingProcedures&Techniques

KnowwhentoRequirePremedicaEon

LearnSomeSpecialBandingProblems LearnaboutDebonding


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WhenshouldIbandatooth?


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IfyoudoorthodonEctreatmentfor

yourpaEents.

WhenwillIbandatooth?

DowhatorthodonEstsdo?


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2008JCOSTUDYOFORTHODONTICDIAGNOSISANDTREATMENT

PROCEDURES

2008PrevalenceofBandingProcedures:


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PrevalenceofBandedTeeth:

1stmolars 50% 2ndmolars 16%forU7&23%forL7

Premolar


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WhyBandingisontheDecrease?

Oralhygiene DecalcificaEon! Costly2stock Uncomfortable SeparaEon

2appointments

BUT>>>>TheyreStronger!


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2008JCOPrac4ceProceduresSurvey

ROUTINEBANDING

2008 200219961986

Maxillarysecondmolars 15.9%24.1%27.7%25.2%

Maxillaryfirstmolars 52.3 76.2 90.8 92.2Maxillarysecondpremolars 7.5 13.9 23.8 40.7

Maxillaryfirstpremolars 6.0 6.4 9.4 21.0

Mandibularsecondmolars 22.8 36.7 51.4 51.4

Mandibularfirstmolars 49.0 72.8 89.5 91.0

Mandsecondpremolars 9.2 16.0 26.2 42.5

Mandibularfirstpremolars6.26.3 8.9 22.0

386169

-56%


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RouEneBondingMolars:

Bonding: 08 02 96 86

Maxillarysecondmolars 41.221.7NA NA

Maxillaryfirstmolars 48.721.8NA NA

Mandibularsecondmolars52.330.4NA NA

Mandibularfirstmolars 48.021.7NA NA

96189200%


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Aresecondmolarsbeing

straightened?2008

15.9%BandedMx2nds

41.2%Bonded

57%ofupper2ndsarerouEnelyaligned

22.8%BandedMd2nds

52.3%Bonded

75.1%oflower2ndsarerouEnelyaligned


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InnovaEonsmaking2ndmolar

alignmenteasier:BandorBond

Flutedentrances.bracketsHydrophilicbondingmaterials.QuickerarchwireplacementwithSLB!

allows wires to flow

in easier

not sensitive in wet

environment


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WhydontorthosbandorbondALL

secondmolars?

Alreadystraight. Notfullyerupted&

refuseext8sRefusesurgical

uncovering

Focalosteosclerosis PoorOH PoorCompliance


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IndicaEonsforPlacingBands:

SPACMAINTNANCAPPLIANCS!!!! HeavyintermiantforcesHG Labio-lingualaachments ShortClinicalCrowns Deepbite,brachycephalicpaEents

Bandlowersmorefrequentlythanuppers

Bandtheonethatbreaks!


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Myapproachto2ndMolars:

Atstartofcase.OR. Atendofthecaseopenbitecases,oral

habits,lateerupEoncases.

IdealOB&OJ Wellaligned@casestart. Overlaywiresand3monthstofinish!

DonttellyourpaEents,Dr.Featherforgottoputbracesonyour

backteeth.Makesureshedoesthatatthenextappointment.

Phonecallisneededinstead.

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


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BandingCements

WhatshouldIconsiderusing?

Dowhatorthodon4stsdo!


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2008JCOStudy:

PrevalenceofBANDCEMENTS 2008

Glassionomer(GI) 37.5%

ResinreinforcedLightcureGI 32.7

Compomer 20%

70%

Zincphosphate 5.6

old cement; still

used in other

countries


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AdvantagesofGlassIonomers:

Adherestometalandenamel Releases&uptakeFluoride

InhibitsmicrobialacEvity Acceptablestrength.


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DisadvantagesofGlassIonomers:

ShortworkingEme SensiEvetoMoisture FailureisattheBandCementInterface 80%strengthin20minutes24hourstomaxstrength!Thiscanbeasignificantdisadvantage!


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ResinModifiedGICFujiOrthoLC

LIGHTCURGLASSIONOMRCMNT

GCholdsthepatent! Allowsforsnapset Rapidstrengthdevelopment GICementisatsamestrengthasRMGI@24

hours!

CostssignificantlymorethanregularGlassIonomerCements!


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GlassIonomervs.ResinModifiedGI

$$ $$$$$

$110

$220-297


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RouEneIniEalBandingCement-GIPowderycalcium-aluminum

fluorosilicateglass Carboxylicacidcopolymer

1scoopto2drops,drawupward1strand


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CemenEngAcEveAppliances&

Recements

QuadHelix

LSLAdvancingLoops


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TheNewComer!

CompomersComposite+GlassIonomers

OurstrongestCement&hardesttoremove!


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LightCureOne-StepCompomer:

Polyacid-modifiedcompositeresin

Hydrophiliccomponents:

Causewatertobedrawnintothematerialfollowingcure!

Flourideuptake&release,BufferingCapacity.

DeclineinphysicalproperEeswhenwateris

presentattheEmethematerialsetsup.


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InteresEngly.

Compomersarestrongerthanglassionomersinacompletelydryfield!

HoldingarchesthatconEnuouslycomeloose! UseforCementedacEveapplianceslikethe

Headgears.


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Whatswrongw/Compomers?

WeakerthanGIinwetfield.IsolaEonneeded!Hardertocleanupandhardertoremovewhen

done!!!!


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OurCompomer:BankLok

2-Pastevs.LCCostComparison:

8syringesw/6cc=8cc 6syringew/5cc=30cc

Bothcost$105

Lightcureor

ChemCureLightcure

only!

BLUEorWhite


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Cementwhereyoudonteverwantto

Removethebrace:MrGjoka

good for unerupted

canine cases you

want to get out


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OrthoCementSummary:

GlassIonomerPowder/LiquidRouEne,mulEplebands,noseveremalignment.

GCFujiOrthoLCImmediateforces,severemalignmentorrepairswhereteethhavemoved!x:LooseLSLusedtocorrectaEppedmolarorspringto

moveanincisor!

OneStepLightCureCompomerBandLok Bondedbiteplanes Maxbandstrengthneeded.

Geristorebandorbondremovalnotneeded


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BandingTechniques&Tips:

SeparaEon FingBands CementaEon Cleanup BondedBitePlanes SoluEonstoSpecialProblems


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SeparaEon:

Threemaintypes: Springs lastomeric Threads

AnEbioEcpremedicaEon Useradiopaqueseps. Clearlyrecordwheretheywereplaced.

Countthemgoinginandcomingout! Ifunaccountedforofferacomplimentaryfilm.Recordanyrefusals.

Ifmissingfindandretrieve.

Only2weeks.


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lasEcSeparators:SeparaEngPlier


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lasEcSeparators:Flosstechnique

SAFESTTODO!IUSETHISTECHNIQUE

you want to use a


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TPSprings2wksneeded

(TPOrthodon4cs,Indiana)

Useflossplease!Replacew/elas4csepajeroneweek

Loopformingplier,oropEcal

plierandnotaBirdBeak!

put a piece of floss

around it (ligate)

loop forming plieroptical plier

plier with longer beak


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Thread.025or.030hollowtubeor

withroughsurfacetopreventslip.

dont use brass

separators


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WhenisPremedneeded?

ForSeparators?

Anythingthatcausesbleedinginthemouth:Separators

FingorcemenEngBands

RemovingBandsorbandedappliances

Debonding


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CurrentRecommendaEonsAHA:

ProstheEccardiacvalve PreviousendocardiEs UnrepairedcyanoEccongenitalheartdisease,

includingpaEentswithpalliaEveshuntsandconduits

CompletelyrepairedcongenitalheartdiseasewithprostheEcmaterialordevice,whetherplacedbysurgeryorcatheterintervenEon,duringthefirst6monthsaertheprocedure

RepairedcongenitalheartdiseasewithresidualdefectsatthesiteoradjacenttothesiteofaprostheEcpatchorprostheEcdevice

Cardiactransplantrecipientswithcardiacvalvulardisease


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PremedNOTneededfor:

RouEneanestheEcinjecEonsthroughnoninfectedEssue

Takingdentalradiographs

PlacementofremovableprosthodonEcororthodonEcappliances

AdjustmentoforthodonEcappliances,bondingoforthodonEcbrackets

Sheddingofdeciduousteeth Bleedingfromtraumatothelipsororalmucosa.AHAAugust2007.Availableathp://www.americanheart.org/

presenter.jhtml?idenEfier=3004539.


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OrthoProceduresRequiringAnEbioEc

Prophylaxis:

Placingseparators Bandedappliances,notbonded. Debonding&removalofbandedappliances.

Notneededforarchwireadjustments,taking

impressions,orx-rayfilms,placingretainers.Ifindoubtcallthecardiologist!


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Andthosespecialmoments???

Youoryourstaffdidnotcheckthechartbeforeplacing

separators.premedwasneededandnottaken!

ShouldyouhavepaEentrinsewithChlorhexidine?


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Bacteremia?

2.5%incidence Notdecreasedw/0.2%ChlorhexideneInves4ga4onofBacteremiaAjer

Orthodon4cBandingandDebanding

FollowingChlorhexidineMouthWash

Applica4onAngleOrthodonEst,Vol71,No3,

2001RVRDI,ACAR,ISGUDN,KADIR


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TalkingPoint:

Mrs.Acosta,Juanneedstotakehispremedassoonasyougethome,canthat

bedonerightaway?Hewassupposedtotakeitbeforethespacerswereplaced.

Thatwillneverhappenagain,ever.Pleaseacceptmyapologies.Thisishighly

unlikelytocauseaproblem.Pleasecallyourphysicianforhisadvise.

ProtecEonofthepaEentismostimportantthing!


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OverviewofStepsinBanding:

Usemicroetchedorequivalentband Cleanthetoothw/gentlepumice&waterslury SelectandFitband Removebandtocement AlcoholinsideofBand&AirDry Isolatethetoothandairdry Cement Cleanup


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SelecEngYourBandStock:

Useprewelded,microetchedband Dimpleddesignorsimilaror

microetchyourself

LaseretchedidenEfiersarebest. ConverEbles?PhaseIorfulltx?

LingualseaEnglug,pleasenotacleatnot necessary


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PlainBandsforAppliances:

TemperorSEffnessSoMediumSEffxtraSEff

Notmicroetchedorprepared!

IdenEfiernotlaseretched!

dont want band tofall over on you

when placing!

stamped on will

come off/fade away

and cause a lot of

inconvenience!


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DoubleTubeMolarBand:

make sure band has a good

purchase point, make sure its

wide enough to use band seater

to put in place


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TripleTubeMostflexible!


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MyUpperBandDesign:

FirstMolarsTripletubeupperassembly ConverEbleslot HGtoOcclusal

removablebiteplates Purchasepointforoverlaywires

AuxilliarytubeforlateerupEng2ndoroverlaywires HookforelasEcs

SecondMolarssimpletube,flutedentrance,hook AlllingualseaEnglugscenterofband.


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PumiceSlurrytoCleantheTeeth


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FingBands:

Preselectoffstudymodels Reshapethebandtofit. SeatedbypaEentsbite Correctsequence.

start with one that

fits all around tooth

Pl f li l b l l


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Placefromlingualtobuccalonlower

arch!

Flossthroughtube. Fingerpressurealone

GetittotheM&Dcontacts

ThenpickupbitesEck.


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DifferentShapestotheEps?


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Autoclavable

BiteS4ck BandSeater

use with palm

pressure


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FingaMolarBand:

ThenitisdriventoplacebypaEentsbiteonthemesiobuccalanddistolingualsurfaces.

Alignw/marginalridgesvenBuccalandlingualcuspEpsbuccaland

comparingbuccaltolingual


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FingaMolarBand:

Thefinalsea4ngiswithheavybi4ngforceonthedistal.

Bandjustbelowmarginalridgesoutofthebite.


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SequenceforFingMdBands:

Blue=Finger

pressure

Red=BiteS4ck

View

sequencewith

Powerpoint

anima4on.

1. press down on

distal then 2. press

down on mesial

last place to seat

band is DB


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Blue=HandPressure

Red=BiteSEck

SequenceforFingMaxillaryBands:

hardest part to seat

is the distal part so

want to start + end

here


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Mylowermolarbands:

1stmolarconverEblesingletubesw/hook 2ndmolarssingletubesw/hook BothwithseaEnglugonmid-lingual


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Whatsrighthere?


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Whatswronghere?open margin


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SpecialProblemsinFingBands:


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MissingOpposingTeeth:


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AnexcepEon:ClassIImolar

Mesialbuccalcusps

showsmore.


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Infra-eruptedToothtotheDistal:

Overcontourthegingival

w/Howeplier.


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GrindBands!

Notthis!


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ThiskindofGrindBands!


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GrindBanddgestoFit:

Necessarywithashortclinicalcrownduetocariesorcrownfractureorseverewear.

Howoen????

Onceperyear.


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YoungMouths!

GrindoffthebitesEcktominimalthickness!


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OrthoTechnology$20+tx+s&h


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Useahalfbracketweldedtoband


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Remove&CleanwithAlcohol


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Isolatetooth&Airdry


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CementaEonProcedure:


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"Two-StepAdaptaEon"

Festoontheband! Placeaspreviouslyshown. WeremovethecementexudaEonbetweentooth

andbandw/dampcoonrollortoothbrush.

Inthesecondstep,weusethebitesEcktoseatthebandinitsfinalposiEon.

Haulkfiletopushbandintocreases. Finishwithadrycoonrolltosealthemargins.


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FestoontheBand@gingival:


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Cement


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CleanUpCoonRollorTB

fi l


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StepTwofinalposiEon:


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G


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BooneGauge

O G


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OrmcoGauges:

P ll l Li l & B l C Ti


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ParalleltoLingual&BuccalCuspTips

Once cemented Custom Contour


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Oncecemented CustomContour

Band.Haulkfile

Lik S


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LikeSo:


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FLOSS!Scalertoclearawaygingivalcement.

D id With ith t bit l t ?


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Decide:Withorwithoutabiteplate?

1stMolars 2ndMolars

T h i B d d Bit Bl k


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TechniqueBondedBiteBlock:

BandLokbyReliance 20secondlightacEvaEon NOaertasteorodor! Petroleumjellyonoppositearch Shapew/fingercoatedthisaswellorw/sealant. Canbeaddedtoatnextappointment. Takesalong4metogrinditoffandoutof

grooves!SelftchingPrimer.

Th B d d Bit Bl k


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TheBondedBiteBlock

Noledgesfortrappingfoodorbacteria.

Cl th l h t b l


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Cleartheloweraachmentsbelow.

Checkanteriorforadequatebite


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q

opening!Addonasneeded.

TRAUMA!


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TRAUMA!


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G.P.takestheteethoutofocclusion


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withabondedBB.Nogrinding!

Special Banding Problems:


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SpecialBandingProblems:

1. LooseBands2. DecalcificaEonunderloosebands3. 2ndmolarimpactsonthefirstmolarband

Give me your best guess!


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Givemeyourbestguess!

Whicharchhasthemostbandfailures? Whichtoothhas1st,2ndand3rdhighestfailure

rates?


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Shouldyoufitanewbandwith

eachlooseband?Ifbracketsandbandscanberemovedwithoutdamagetheycanbecleaned,

sterilized,andreusedwithoutrisktothe

paEent,inexactlythesamewayasothermedicaldevices.Proffit

DecalcificaEon under loose band:


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DecalcificaEonunderlooseband:

MolarImpactedonBand:


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2ndmolarimpacEonsarerare:

.03-.04%

Improperlyfiedbands

LgSpacebetween6&7

Caries!

InadequateMdgrowth

PrevenEonofmesialdri

intoLeewayspace.

Pseudopocket

Treatment for impacted 7:push


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Treatmentforimpacted7:

Placeaspacer&/or Remove6band Bondthefirstmolarand... Kickthemolarback

SolderedspringtothebandAuxilliaryspring

xtract7bringinthe8or Transplant8into7socket!

pull

auxiliary spring

kickback molarupright distal tooth

or what makes sense here?


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orwhatmakessensehere?

f d


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InformedConsentStatement:

Anyoftheuneruptedteethmayimpacton

theirownoronthebraces

andrequiresurgicalexposurebyanoral

surgeonspecialistand/ororthodonEc

treatmentataseparateexpense.

Spacemaintainer

Pleasesignhere..


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ASaferDebonding/Debanding


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Technique

ASaferDebonding/DebandingTechniqueVOLUME32:NUMBER06:PAGES(37-375)

1998BONCHANKOO,DDS,MSD

CHUN-HSICHUNG,DMD,MS


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Insiston45*ofthepaEentbynew

employees(oryourself)whendoingdebandingprocedures!

Lower molars


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Lowermolars

removefrom

buccalfirst.

Uppermolarsfromthepalatal

first.

And..

Alternate Buccal & Lingual


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AlternateBuccal&Lingual

Mesial,distal,buccal,lingual.UnElitgentlyfalls

offthetoothandinbetweenyourpierbeaks.

And if the paEent is uncomfortable:


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AndifthepaEentisuncomfortable:

Debonding Problems:


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DebondingProblems:

PainonbandremovalbuccallingualbuccallingualbuccallingualasmanyEmesasit

takes!

MaxBandsfrompalatalfirst.MandBandsfrombuccalfirst.


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AndifthepaEentswallowstheband,wire,

ligatureEe,etcwhatdoyoudo?

AdvisepaEentorparent

Recommendtheycalltheirphysician

DocumentthisinyourchartCallthemlatertoseewhatthephysiciansaid.

Documentthisinthechart.

Clean Up the Teeth!


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CleanUptheTeeth!

Learning ObjecEves


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LearningObjecEves

PrevalenceofBandUsageandWhy! LearncommonlyusedCementsforBands BandingTechniquesandTips

LearnTechniquesforSeparaEonforBandsLearnBandingProcedures&TechniquesKnowwhentoRequirePremedicaEonLearnSomeSpecialBandingProblems

LearnaboutDebonding

Quiz and Break Time!


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QuizandBreakTime!

ThankGod!

+orthodontic banding 101

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