Embracing a New Era
When delivering orthodontic treatment, especially your first full band and bracket placement, we understand your anxieties about this initial step of treatment. However, we are here to help and reduce your stress, no worries; at Gerety Orthodontic Seminars, we have outlined some tips that can prevent some of the most common mistakes and make this first appointment as stress-free as possible for both you and the patient.
Before your patient arrives:
As with any dental procedure, your setup and preparation is the most important element of the procedure. A normal tray set up for band and bracket placement will include: mouth mirror, bracket placement tweezers, operative or cotton pliers, Boone gauge, explorer, mechanical lead pencil, perio probe or Bracketizer instrument, spatula, small and large Mathieu, schure band seater and band biter. Peripheral materials will include: flour of pumice and prophy angle, check retractors, tongue away bite block, suction tubing, etchant and cotton rolls, direct bond brackets with safe-t-tray, molar bands, bonding adhesive paste and liquid booster, curing light, fluoridated glass ionomer cement and mixing pad.
Using the safe-t-tray will allow you to place your brackets in their specified spot and position them in the orientation and sequence you will use to bond them. The adhesive disks prevent the brackets from moving around on the pad. When organizing the brackets on the tray, refer to the patient chart for the bracket positioning details you should follow. This way, you can place the correct brackets properly on the correct tooth, in the correct position.
Both Doctor and Assistant should jointly review the patient’s treatment chart to discuss the particulars for the patient. Direct bond brackets or bands on molars. Are all teeth going to be bracketed? Using clear or stainless steel brackets? Is the bracket placement for deep bite or open bite? Is occlusal composite needed for bite opening? Glide Ties or ligature wires? What archwire sequence is dictated?
Using the study models, make a preliminary size selection. Check the size of the band in the mouth. Always select a larger size band than you feel you will actually need to check the contacts. Passively seat the band on the tooth to make sure the contacts are free and adequate separation has been achieved. A proper size band should go over all four cusps but should not seat completely down on the tooth with just finger pressure. Once you have determined the correct size, use the Schure band seater to seat the band mesial and distal in a rocking motion. Using the nylon bite block, ask the patient to gently bite facial and lingual to complete the seating process. Check slot position and bracket height using the Boone gauge. When you are satisfied with the position of the bracket, crimp any excess band material over the occlusal surface. This excess material will need to be trimmed away. On the maxillary molars especially, it will almost always be necessary to trim the distal occlusal band material. Leave the bands in position on the teeth during the bonding procedure and cementation will be easier. It is advantageous to use packaging tape, wax, or some type of parafilm as a seating aid to insure the cement flows around the entire band surface. It also makes passing the band from assistant to doctor easier.
Pumice the teeth using standard rubber cup and pure flour of pumice mixed with water to form a paste. Rinse thoroughly and place the bite block with saliva ejector and cheek retractors. Place the acid etch gel on the upper arch on all teeth that are to be bracketed. Etch for twenty seconds and rinse thoroughly and dry. (Primary teeth need to be etched 60 seconds). Using a lead pencil, draw the long axis lines and the horizontal lines for the height of the brackets (you will be using your Boone gauge to scar a line on the tooth before you actually mark this horizontal line with the pencil). Read your product directions for the type bonding adhesive you are using. All products differ. Paint the etched surface of the tooth with the primer sealant or adhesion booster. If using a light cure paste, there is no need to cure the liquid. The paste is placed directly on the bracket pad with no primer on the bracket. The paste can be placed on all the brackets ahead of time as long as you keep them covered and not in direct light. Place the bracket with paste on the primed tooth and position correctly. Compress the bracket firmly against the tooth. Excess bonding material should extrude around the edges of the bracket. Using an explorer, remove any undesired excess material. Cure for the prescribed amount of time for your curing light and go to the next tooth. Follow the same procedure for each tooth. It is most likely that you will be able to paint 2-3 teeth or perhaps even a quadrant of teeth if you have adequate isolation. Place each bracket individually and check your long axis using a mouth mirror and check the height using the Boone gauge.
Once you have completed bonding all teeth on the upper, follow the same procedure for the lower arch. Using light cure adhesive makes it possible to engage the archwires immediately after curing.