Band Loop Space Maintainer

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Band Loop Space Maintainer

• Jabbarifar Pedo- Technique Lab
• 2009

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Progression of Skills
Space Maintainer
Flame Soldering
Wire Bending
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Background Information

• The most common situation requiring the use of a
  band loop space maintainer is the premature loss
  of a first or second primary molar.

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What You Need Today!

• your patient (maxillary model)
• 14 metal impression tray
• green stick compound
• alginate (provided)
• band adapter/band seater/band removing pliers
  (optional)
• bird beak, 3 prong, wire cutters
• soldering materials
• molar band (RU 34)

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Band Selection

• Select smallest band that will fit over the
  height of contour of the tooth
• First seat band with digital pressure

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Band Adaptation

• Utilizing band seater with the lead peg on the
  occlusal margin of the band fully seat the band

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Band Adaptation

• Utilizing the band adapter adapt margins to the
  tooth morphology

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Properly Adapted Molar Band

• Occlusal margin of band is apical to the proximal
  ridges
• Gingival margin of the band is in the gingival
  sulcus
• Band is snugly adapted to the tooths surface
• Band is out of occlusion

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Band Removal

• Utilize the band removing pliers
• Pliers have a plastic covered knob which is
  placed on the occlusal surface of the tooth and
  the sharp lower edge is placed under the gingival
  margin of the band
• Pliers are squeezed which raises the band onto
  the upper beak of the pliers

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Compound Index

• Make compound index
• lubricate tooth
• do not overheat compound
• Compound index should completely cover occlusal
  surface of band, extending 2mm past the band
• if index is too large it will be dislodged when
  impression tray with alginate is placed

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Alginate Impression

• Take alginate impression
• Compound index should come off tooth and be
  embedded in the alginate impression
• Check that the occlusal margin of the band is
  clearly reproduced
• Remove band and orient in compound index
• Stabilize band with sticky wax
• on buccal and lingual at the occlusal aspect of
  band

Sticky Wax
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Pour Impression

• Use white plaster
• if you are going to abrade cast might want to use
  stone
• Prepare flat base so that cast does not rock
  during fabrication of appliance

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Draw Design of Band Loop Space Maintainer on Cast

• The mesial end of the loop contacts the distal
  surface of the first primary molar at a point
  just below the height of contour
• The wire should be above the gingiva at the point
  of contact with the abutment tooth

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Design of Band Loop Space Maintainer

• The central portion of the loop is shaped wide
  enough to allow the full eruption of the
  permanent tooth
• the bucco-lingual width of a maxillary premolar
  is 9mm
• The loop should be contoured to follow the
  edentulous ridge, but 1mm off the tissue
• The anterior curve of the loop is shaped to
  approximate the shape of the distal surface of
  the abutment tooth and to match its width

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Bending the Wire

• Cut about a 3 inch segment of .036 wire
• At the midpoint of the wire make a w shaped
  curve

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Check Anterior Curve

• Check the curve against the abutment tooth on the
  cast to see that it is approximately the width of
  the first primary molar and does not extend
  beyond the disto-buccal line angle

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Lowering the Sides

• Position the pliers with the single beak on the
  gingival surface of the wire under the center of
  the w shaped curve
• Squeeze pliers gently

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Check Resultant Bend
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Mesial End of Distal Legs

• Form a gradual curve to parallel the gingival
  crest of the alveolar ridge by walking the 3
  prong pliers distally over the wire
• Complete one leg before proceeding to other leg

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Mesial End of Distal Legs

• Continue bending in small increments until the
  desired arc is achieved
• The wire should be approximately 1mm off the
  tissue

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Step Bend

• Mark wire far enough mesially to allow the
  finished s-bend to be completed before reaching
  the band.

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Step Bend

• Place the conical beak of the bird beak pliers on
  the occlusal portion of the wire and bend the
  distal portion of the wire upward against the
  conical beak

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Step Bend

• Place the conical beak of the bird beak pliers on
  the gingival portion of the wire and bend the
  distal portion of the wire downward against the
  conical beak

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Step Bend

• Purpose of S-bend
• allows transition of wire from the ridge to band
  without impinging on the gingival tissues

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Distal Ends

• Bend distal ends of loop to rest passively
  against the junction of the middle and occlusal
  third of the clinically exposed band

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Distal Ends

• Use simple bends to contour the wire so it
  contacts the band near the mesial line angle and
  remains in contact for the full length of the
  band
• Cut away any excess wire or plaster that
  interferes with fitting

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Completed Wire
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Completed Wire
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Prepare to Solder

• Stabilize the wire in position on the cast with
  wax
• Wet anterior end of cast to prepare it for the
  application of plaster which will be used to
  secure the loop
• Apply creamy mix of quick setting plaster

Plaster
Wax
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Prepare to Solder

• When plaster has reached its initial set, remove
  sticky wax
• Remove the plaster from the inside of the bands
  adjacent to the soldering sites
• Remove all particles of wax, plaster and debris
  from soldering site

Plaster
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Criteria for Solder

• The solder
• encircles the wire
• extends the full length of the contact area
  between the wire and the band
• The occlusal and gingival margins of the band are
  free of solder
• The surface of the solder joints are free of
  pitting and voids
• The wire mesial to the solder joints has not been
  annealed

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Polishing

• Use a heatless stone to reduce the distal ends of
  wire to form to a smooth curve continuous with
  the band
• The ideal solder joint is concave
• If a minimum of solder has been used, the joints
  will be concave and solder will not extend to the
  margins of the band
• Appliance is finely polished, cleaned and dried

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Band
Distal Cross-section
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Summary

• With correct diagnosis and implementation of wire
  bending and soldering techniques, the potential
  problems associated with premature loss of a
  primary molar can be successfully averted.

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Questions ?