When orthodontic braces are needed to straighten your teeth, the most popular way to attach the braces to the teeth is with bonded attachments. However, there are some instances when the placement of orthodontic bands is preferable to the use of bonded attachments. Orthodontic bands are made from stainless steel and fit securely around the tooth, almost like a ring on a finger. They are especially helpful when the patient has teeth which have not grown fully into the mouth, which may be difficult to isolate; when other appliances, such as headgear, are required; or when dealing with teeth that have large amalgam fillings.
First appointment: Placement of separators
The goal of the first appointment, is to simply create space around the tooth to be banded, so that the band can be seated properly in the second appointment. To create this space, the dentist will place a small elastic separator in between the tooth to be banded, and any adjacent teeth.
To do this, the dentist will have you sit comfortably in the dental chair, and recline the chair back, so that he or she has an unobstructed view of your mouth. Then the dentist will use separating pliers to gently fit the elastic separator in between the teeth. You will feel the elastic slide in between your teeth. This isn’t painful, but it might be slightly uncomfortable, like when you get popcorn stuck in between your teeth. The dentist may need to put in several elastic separators, depending on the tooth to be banded, and whether there are teeth on either side of the tooth to be banded.
Once all of the separators are in place, the dentist will show you where the separators are located. You should be able to see the top of the separator, stuck in between your teeth, when viewed in a mirror with your mouth open wide. The dentist will instruct you that, if necessary, soreness can be treated with over-the-counter pain medication. You can continue to brush normally with the separators in place, but you should avoid flossing the area, so they don’t come loose. Also, you should avoid eating sticky foods, such as chewing gum. If you notice that any separators are missing, or if you experience excess pain or swelling, please contact the dentist immediately. Your dentist will then schedule you in for another appointment, one week later, for the band placement.
Second appointment: Band Placement
After one week with the separators in place, sufficient space will have been created for the band, and you will return for the second appointment. At this appointment, the band will be cemented on the tooth, and the rest of the orthodontic work can take place.
Orthodontic bands come in a variety of sizes, so the proper band size needs to be selected. Your dentist will use your plaster study model to estimate the most appropriate size. Once a band is selected the treatment can begin.
The dentist will have you sit comfortably in the dental chair, and recline the chair back, so that he or she has an unobstructed view of your mouth. The dentist will then gently remove all of the elastic separators from between your teeth, using an instrument called a “periodontal probe”.
The selected band is then placed on your tooth to verify that the correct size has been chosen. To do this your dentist will use light finger pressure to initially seat the band. Then, he or she will place an instrument called a “bite stick” on top of the band. The dentist will instruct you to gently bite down. The force of the bite pushes the band onto the tooth. This step may need to be repeated until the band is seated correctly on the tooth. Once the band is in place, your dentist will verify that it fits properly. If the band does not fit properly, it will be removed from the tooth, and a different band will be chosen and placed on the tooth. This is repeated until the correct size of band is found. Your dentist will note the final band size in your patient record after gently removing it from the tooth, in preparation for cementation.
Before the band is cemented into place, your dentist will polish the surface of the tooth to be banded with a gritty substance known as pumice. This is done in order to thoroughly clean the tooth, prior to cementation of the band. After this your dentist will mix the cement, which is an adhesive called “glass ionomer cement”. A mixing spatula is used to fully cover the interior surface of the band with the cement. Then the dentist will properly seat the band onto the tooth, once again using “light finger pressure” first, and then the “bite stick”. Excess cement is wiped away using a piece of gauze or a cotton roll before the cement sets. After 5 to 10 minutes the cement will have set, and your dentist can then remove any excess cement that may remain. Dental floss will be used to remove any cement that is found between the teeth, and an instrument called a “Mitchell trimmer” is used to remove cement from the tooth and around the band.
Once all of the bands are cemented in place, your dentist will proceed with the next stage of your orthodontic treatment. The bands will stay on until the treatment is completed in about 12 to 18 months. During this time you should avoid any sticky or hard foods, and be sure to brush and floss with care. Your dentist will also explain that there may be some irritation felt on the inside of the cheek, due to the rubbing of the band. In some cases, he or she will provide you with orthodontic wax, which can be placed on the hook of the band to help alleviate this irritation. If necessary, any soreness can be treated with over-the-counter pain medication. However, if the soreness persists, or if the band becomes loose or misplaced, you should contact your dentist immediately for a consultation.