MANAGING THE ARCH CIRCUMFERENCE

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MANAGING THE ARCH CIRCUMFERENCE

• Band Adaptation and Impressions

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Stainless Steel Preformed Bands

• Bands are made by several manufacturers,
  excellent results are achieved with Unitek bands.
  Permanent first molar bands are used for
  fabricating the lingual arch and palatal (Nance)
  arch, and pedodontic molar bands are used for
  fabricating the band and loop.

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Select the Band

• From a kit of preformed bands, select the
  appropriate size band by estimation.
• If the band completely seats with finger pressure
  it it too large and a smaller size should be
  selected.
• If it is too small it will not be able to be
  seated such that the occlusal margin seats past
  the marginal ridge of the tooth.
• The proper size will fit snugly and and a band
  seater must be used to seat it completely.

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Seat the Band

• With finger pressure, push the band as far as it
  will go onto the tooth.
• Care should be taken to match the buccal of the
  band to the buccal of the tooth. The groove in
  the band occurs on the buccal of maxillary teeth
  and the lingual of mandibular teeth.

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Seat the Band

• Place the band seater on the top of the band and
  have the patient close, forcing the band farther
  onto the tooth.
• As the patient bites intermittently the band
  seater is moved around the band beginning with
  the lingual of the mandibular teeth and buccal of
  the maxillary until the band is completely
  seated.

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Seat the Band

• When properly seated
• the band should fit tightly,
• the occlusal margins should be just below the
  proximal marginal ridges, and
• the gingival margins should be in the gingival
  sulcus.

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Adapt the Margins

• Use the side of the band pusher and adapt the
  margins of the band into the larger grooves.

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Adapt the Margins

• Use the end of the pusher to adapt the margins
  into the smaller accessory grooves so that the
  margins of the band adapt closely to the tooth.
• The band pusher should be used carefully with
  appropriate finger rests in order that it does
  not accidentally slip injuring the gingival
  tissues.

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Adapt the Margins

• With adaptation properly
  accomplished
• the band is adapted to the morphology of the
  tooth,
• the explorer cannot easily engage any open
  margins, and
• the band is not in occlusal contact. (occlusal
  forces on the band will dislodge it)

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Impression

• A compound impression is preferred to an
  alginate one for two reasons
• 1. It is difficult to lute the band in place
  in an alginate impression. Luting the band to the
  impression is necessary to prevent dislodgment of
  the band while pouring the stone, with it
  subsequently being in a distorted position on the
  working.
• 2. The sharp edge of the band can cut through
  the alginate when being prepared for pouring,
  resulting in an inaccurate positioning of the
  band on the working case.

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Impression

• Soften red cake compound in a compound heater and
  place in an impression tray.
• Use quadrant tray for band and loop, and full
  arch tray for lingual/palatal arch.
• Allow the compound to harden completely before it
  is removed from the teeth.
• The impression is satisfactory if the anatomic
  structures to be contacted by, or adjacent to,
  the appliance are accurately reproduced.

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Band Removal

• A posterior band removing pliers and/or
  excavator is used to remove the band.
• A cotton roll should be place on the occlusal
  surface of the tooth unless the particular band
  removing pliers you are using has a soft plastic
  covering.
• The cotton roll or plastic tip prevents potential
  fracturing of occlusal cusps.

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Cast Recovery

• Remove the band from the tooth and place it
  into the compound impression in the position it
  occupied on the tooth. If not stable, lute the
  band to the impression with sticky wax.

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Sequencing Band Adaptation and Impression in the
Treatment Plan

• Whenever possible, the space manitainer should be
  fabricated and ready for insertion at the time
  the primary tooth is extracted.
• Restorations required on the tooth to be banded
  must be accomplished prior to the comentationof
  the space maintainer. A common situation is the
  placement of a lingual arch on two first
  permanent molars requiring occlusal and buccal
  restorations.

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Typical Treatment Plan

• One Appointment
• 19 O, B amalgam or composite
• 19/30 Bands adapted and impression
  for lingual arch
• L Extraction
• Next Appointment
• 30 O, B amalgam or composite
• S Extraction
• T Extraction
• 1930 Cement lingual arch