The indirect banding of teeth has seen several iterations over the past 15 years in orthodontics. This FAQ is to educate ODL doctors and staff to identify what cases are suitable for indirect banding by the lab.
Several options for banding an appliance will be explained below.
1.Traditional banding on a plaster model. This is the least common current practice. It is where the clinic sends ODL bands, and they are placed into the impression or have been already poured in plaster at the doctor's office. We typically see the least failure when it comes to fit with these types of banding procedures.
Pro's: Usually fits very well
Con's: Many practices are getting away from traditional plaster and impressions and moving to intraoral scanning; therefore this possibility is becoming less desirable.
- Indirect banding with doctor provided bands. This is where the practice has sent ODL an STL scan through easyrx. ODL receives the scan, then digitally ditches the model/specified teeth, we then 3D print the model and fit the bands that the doctor had fit on the patient to ensure proper fit. This requires the practice to mail the bands to ODL. This also requires the clinic to try bands on "in-house" so that they can send the correct bands to us.
Pro's: Great fit almost every time due to prior fitting. Think of this option like getting fitted for a suit before a wedding.
Con's: Hassle of having to mail something to the lab and of having to make time during an appt to fit bands. Many doctors use separators to fit these bands; this may or may not add another appointment to the process.
- Indirect banding with lab provided bands. This process has been the most desirable in the past 5 years due to ease on the clinician's side of not having to fit bands themselves. This is where the practice sends a scan, and the lab ditches the specified teeth and fits their own bands to the patient's dentition.
*** NOTE: WHEN SEATING LAB PROVIDED BANDS, ODL WILL NOT GUARANTEE BAND FIT IF TOOTH IS NOT FULLY ERUPTED.
Pro's: Convenience for practice in not having to fit patients with bands.
Con's: Lab has to do guesswork at how large or small dentition is subgingivally
- Laser Sintered Band, provided by the lab. This is the process of producing a digital shell around the specified banding tooth, that shell is then sent to a metal 3D sintering machine that takes metal powder and lasers to create layers of your metal band.
Pro's: Excellent fit almost every time if proper bonding procedure is followed. The doctor does not need to place separators because the band isn't going to be inserted subgingivally. This process reduces what is typically 3-4 appointments down to 2 appointments, saving you and your staff time and money. The other benefit is the ease and speed of insertion. Because these bands are only covering the clinical crown, the clinician can pop the bands on, with bonding material and cure, reducing patient discomfort.
Con's: Some cases don't have enough clinical crown showing for a band only to cover that area. Our suggestion in these cases is to either fit the band at the clinic and mail to the lab or to wait until the tooth has erupted more. Another option would be to band another more erupted tooth if possible, and the appliances allow for that option.
Note: Having brackets remain on a banded tooth can sometimes limit the capability of a laser sintered band due to it not covering the entire clinical crown. ODL can create the sintered band around the bracket, but this will reduce the size of your band. We can also digitally remove the bracket, but this could affect the fit of the band and make a guaranteed fit harder to accomplish.
Some further tips and thoughts on banding.
- If you have chosen not to use laser sintered bands and would like to go the indirect banding route, you may want to consider having a library of bands in your office. ODL will provide that library to you. This option would allow you to fit the band but not have to send it in the mail. We will carry that library also in our lab and once we receive the correct band size from the clinic we can transfer that data onto the RX for fabrication.
- For an extra fee, the lab can also 3D print your scan, dupe that printed model with plaster and band on the plaster model for teeth that the practice feels absolutely must be banded, even if the lab advises otherwise.
- Upon sending your first fixed, indirectly banded appliance through easyrx, ODL offers the courtesy service of fabricating two appliances on the same model to find the doctors' preference. Some doctors prefer a looser band, while others prefer the tightest possible band. We will send you two appliances, both can be fit onto the patient when they return, and the practice will then communicate the preferred band style to the lab for any future fixed appliances.
Below you will find some examples of a good and poor candidate for certain band preferences:
The following photos will illustrate a less than ideal tooth to be banded. On these teeth, we would either use a laser sintered band, have the clinic fit the bands in house and send them to us, Fit the bands in house and let us know the correct size from their in house library of bands, or make the band bigger than normal to account for any unknown subgingival dentition.
Poor candidates for banding indirectly:
The following would-be excellent candidates for any option in banding, whether it be indirect or laser sintered. You can see the tooth has fully erupted, most especially on the distal of the #6 Molar. Some clinicians decide to wait on treatment for a patient so that the tooth has adequate time to erupt. While we know when to band a patient is clinical, in some cases, it can be based on business strategy so that the practice doesn't lose a potential customer. The best strategy is to make sure your appliance is going to be the most effective 100% of the time.
Excellent candidates for banding indirectly:
A poor canidate for Laser sintered bands.
The following photo would not be a good candidate to use laser sintered bands on. Ideally, we would wait for more eruption. There is not enough dentition to expand.
Here are two examples of molars that we would consider the bare minimum of eruption needed for laser bands. Anything less than this wouldn't really work.