BANDING AND BONDING INN ORTHODONTICS

A BRIEF DESCRIPTION OF BANDING AND BONDING PROCEDURE IN ORTHODONTICS. WHAT TO USE , WHEN TO USE? ADVANTAGES AND DISADVANTAGES

1. BANDING AND BONDING
DR KAPIL SAROHA
BDS, MDS
ORTHODONTICS AND DENTOFACIAL ORTHOPEDICS
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2. CONTENTS
•BANDING
•Introduction
•History
•Indications
• Requisites
• Technique
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3. •BONDING
•History
•Advantageous
•Disadvantageous
•Technique
•Recycling
•Other applications of bonding
•Recent advantageous in bonding system
•Conclusion
•References
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4. INTRODUCTION
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
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5. HISTORY
• MAGILL was the I to use plain band cemented to the teeth.
• Steel replaced the gold as common orthodontic material, pinched bands are welded
rather than soldered.
• Preformed steel bands came into widespread use during the 1960s and are now
available in anatomically correct shapes for all the teeth.
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6. INDICATIONS 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

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7. REQUISITES
•Must fit the contours of the tooth as closely as possible, there
by enhancing the attachment to the teeth
•Should not extend sub-gingivally any more than is necessary
for adequate retention on the teeth
•Resistant to deformation under stresses in the mouth
•Made up of an alloy that is resistant to tarnish 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
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8. TECHNIQUE:

Procedure : Separation
Selection of band material
Fabrication and fitting
Cementation

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9. SEPARATION :
2 MAIN METHODS FOR SEPARATION
SEPARATING SPRINGS :

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10. •Elastomeric separators;
which surrounds the contact point and squeeze the teeth apart over period of few
days
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11. SELECTION OF BAND
MATERIAL
•Incisor bands:
Band material is usually thinner. It varies 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
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12. FABRICATING AND FITTING BANDS
•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.
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13. •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.
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14. •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.
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15. •Band material of adequate length is taken and the 2
ends are welded together. The ring of band material is
passed through the separated interproximal contact
around the tooth to be banded. Band is tightly drawn
around the tooth to form ring. The neck of the band is
spot welded to retain the tight fit. The excess band
material is then cut off and ends are adapted close to
the band. The bent portion is spot welded . The weld
spots and rough margins are smoothened and polished.
Ideally well contoured band should be able to retained
on its desired position without any aid of cement.
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17. CEMENTATION
•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.
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18. ORTHODONTIC SEPARATORS
AND BANDS
•Bacteremia
•Transient
•Nejat et al (1999) – 7.5% patients revealed bacteremia after banding
•Organisms isolated - S. sanguis and Strep. mitis
•Risk for the medically compromised
•Antibiotic prophylaxis
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19. BONDING
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.
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20. •History:

Acid etching was demonstrated by M. G. Buonocore in 1955 using 85%
phosphoric acid for 30 sec

Newman (1965) was the first to apply all these findings and bonded
orthodontic brackets

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21. .
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.
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22. •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.
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23. •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.

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24. •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.
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25. •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
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26. •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
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27. Cleaning
• This requires rotary instruments, either a rubber cup or a polishing brush.
• Studies have shown enamel loss due to prophylaxis.
•Mark Daniel pus et al ( AJO 1980) showed that 10.7µm of enamel loss during initial
prophylaxis with bristle brush was greater than the 5.0µm lost when a rubber cup as
used and the difference was statistically significant.
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28. •Enamel conditioning:
Moisture control
Enamel pretreatment
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

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29. •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
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30. •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.
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31. •Gwinnet and Silverstone et al described 3 patterns of etching
•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.)
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32. •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
•Phosphoric etch of sufficient time can compensate
for those individual whose enamel is more acid
resistant
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33. •
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
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34. •Is etching time is different for young and old teeth?
•K J. Nordenvall et al (AJO 1980) did a comparison between
the effects of 15 and 60 seconds of etching with a 37 percent
phosphoric acid solution on enamel surfaces of deciduous and
young and old permanent 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.
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35. •Is prolonged etching necessary when teeth are pretreated
with fluoride?
M. Brannstrom et al(1982 AJO) suggested that
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
Bond strengths to a group of severely and moderately
fluorotic teeth even with additional time for, were about
40% lower than bond strengths to normal teeth .
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36. Although group of mildly to moderately fluorotic teeth from young adults showed
similar bond strengths when compared to normal teeth

Will incorporation of fluorides in the etching solution will decrease the bond
strength?
Fluoridated phosphoric acid solutions and gels provide an etching effect
similar to nonflouridated ones and give adequate bond strength in direct bonding
procedures.
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37. •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.
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38. •How much enamel is removed by etching and how deep are
the histological alterations?
Are they reversible? Is etching is harmful?
A routine etching removes 3 to 10 μm of surface
enamel. Another 25 μm reveals subtle histological alterations
creating necessary mechanical interlocks.

Mark Daniel et al (AJO 1980) found that a 90 second
etch with phosphoric acid resulted in mean loss of 6.9µm with
no significant difference between liquid and gel.

Deeper localized dissolutions will generally cause
penetration to a depth of about 100µm or more.
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39. •Although laboratory studies indicate that the enamel alterations are largely
reversible ( though not completely ) it can be stated that the overall effect of
applying etchant to healthy enamel is not detrimental.
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40. POSSIBLE IATROGENIC EFFECTS OF
ACID ETCHING 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.
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41. •SELF ETCHING PRIMER
•An acidic primer combines the etchant with the primer in one application, Contains
both acid (Phenyl – p) and the primer ( HEMA and dimethacrylate).
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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

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43. 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.
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44. •Julio P et al (Angle Orthod 2006)
•Scanning electron microscopy Evaluation of the bonding mechanism of self etching primer
on enamel showed that SEP was more conservative and produced a smaller amount of
demineralization and less penetration of adhesive in the enamel surfaces when compared
with the conventional phosphoric acid system
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45. •Enamel loss at debonding time;
• At debonding time, more adhesive remains on the
enamel surface after the use of conventional acid
etching technique than after the use of self etching
primer.
•Enamel cleaning with tungsten carbide bur,
debonding pliers, or the ultrasonic scaler, more
enamel was removed in conventional acid – etching
group than in self etching primer group
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46. •Effect of contamination
•Saliva has no effect on bond strength of SEP.
•SEPs have maximum bond strength under dry and
wet condition.
•Conventional primer didn’t offer clinically adequate
bond strength in cases of moisture contamination.
•Both MIP and SEP showed adequate bond strength
superior to that of conventional primer in case of
moisture contamination.
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47. •Disadvantages
•The solution must be refreshed continuously because its liquid formulation cannot
be controlled.
•Residual smear layer may remain in between adhesive material and dentine.
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48. 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
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49. •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
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50. Bonding

Direct technique in which the brackets are placed
directly on the enamel surface by the operator, as
was initially described by Newman.
•The second method of bracket placement is the
indirect technique, which was first described by
Silverman et al
The recommended bracket bonding procedure consists
of the following steps

1.TRANSFER
2.POSITIONING
3.FITTING
4.REMOVAL OF EXCESS
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51. TRANSFER:
•The bracket is gripped with a pair of cotton pliers or a reverse action tweezer (bracket
holding forceps) and the mixed adhesive is applied to the back of the bonding base.
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52. POSITIONING:
•A placement scaler, such as the RM 349 or one with
parallel edges is used to position the brackets
mesiodistally and incisogingivilly and angulate them
accurately.
•The placement scaler with parallel edges allows
visualization of the bracket slot relative to the incisal
edge and long axis of the teeth, with the scaler
seated in slot.
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53. FITTING
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54. •REMOVAL OF EXCESS

•Excess must be removed with the scaler before the adhesive has set or it must be
removed with bur after setting.
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55. INDIRECT BONDING
•Several techniques for indirect bonding are available.
Most are based on the procedures described by
Silverman and Cohen ( JCO 1976).
•H. Stuart ( Jco 2003 ) suggested most indirect bonding
techniques are successful in accurately placing brackets
but can be expensive, complex and time – consuming.
So he introduced a simplified method that has reduced
lab cost and chair time.
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56. INDIRECT BONDING WITH
SILICONE 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
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57. •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
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58. •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
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60. Recycling
• Commercial process employ heat to burn off the resin followed by electro
polishing to remove the oxide buildup or solvent stripping combined with high
frequency vibrations and only flash electro polishing
• Reports have suggested that after thermal treatment there is decrease in
corrosion resistance and hardness
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61. LINGUAL BRACKET BONDING
The development was pioneered in Japan
by Fujitha
It is difficult , time consuming the working position is awkward
Advantages
Enamel demineralization is better controlled and of less consequence on
the lingual tooth surfaces
Lip posture is seen correctly
Precise detailing of tooth position can be made without the distraction of
brackets and wires
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62. •Customized brackets are produced after scanning the malocclusion model
after various perspectives, using high resolution optical three dimensional
scanner.
•The brackets are designed individually in the computer, are optimally
positioned and subsequently are fabricated using CAD-CAM
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63. •Rebonding
The loose bracket is removed from the archwire
Ligatures on 2 neighboring brackets are cut and the archwire is placed on the
top of these brackets
Any adhesive remaining on the loose bracket is removed with T C bur
The tooth is then etched, after sealing the bracket is rebonded
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64. CONCLUSION
Direct bonding in orthodontics has almost completely
taken over banding except in some special situations
Cases with severe crowding or those which require
torquing are easier to handle /perform if teeth are
banded
Bonding of brackets has changed the practice of
orthodontics and has become routine clinical procedure
in a remarkably short time
Modification of technical devices, sealants, adhesives,
attachments and procedures are continuing.
Careful study of the available information by the
orthodontist will be mandatory in keeping up with
progress
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65. •REFERENCES
•Begg Orthodontic Theory and Technique , Third Edition
•William R Proffit ,Contemporary orthodontics Third Edition
•Thomas M Graber , Robert L, Vanarsdall , Orthodontics :Current Principles and
Technique Fourth Edition
•Robert E Moyers Handbook of orthodontics Fourth Edition
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66. T
BY –
DR. KAPIL SAROHA
BDS, MDS
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DENDEN ISTIST