In my practice, I will do almost anything to avoid banding a molar. Ok so if it's a gold crown I'll try a bracket once (believe me I've used metal primers, diamond burs, cyanoacrylate, everything!) and if it comes off it gets a band. But any other time molars get molar tubes. And don't even get me started on bicuspids. I think I've banded 2 in 18 years! Here's why to me molar tubes are far superior:
Placement- Nothing speeds up treatment (or complicates it) more than the precise positioning of brackets and tubes. It can be the number one overhead reducer in a practice in the form of reducing treatment time. Bands just aren't as accurate.
Hygiene/Caries- Besides being very difficult to clean around, if the band cement gets contaminated or washed out, the risk of caries is super high. Often you don't know they are loose until it's too late.
Inventory- I don't want to have a jillion (yes jillion) sizes and brands of bands all over the place. It's a huge cost to stock them, and then when you change companies you don't know what sizes are compatible, etc. Plus they're an expensive per band!
Chair time/patient experience- Separators take time and can be an emergency appointment. The assistant has to fit all the bands so when you finally come to the chair there are like 22 of them scattered around with spit all over them. It's gross! Plus, it's too old school. It doesn't project an image of the efficient, streamlined practice. I have parents and adult patients say all the time "this is too easy, when I was young they had to fit these huge metal rings around my teeth!" and I say "yes, we don't use bands here unless we absolutely have to." (I use them for RPE's)
Spaces after Debond- There's not much getting around it. With bands, after the braces are off there are going to be food traps. Most may go away over time and I guess you can close them with a Hawley (does anyone use Hawleys anymore?), but a stubborn food trap is a B*** to close post-Ortho and the General Dentists/Hygienists tend to frown on them...
Okay, this post is getting long I could add a few more things but those are the most important to me.
Now, of course, molar tubes have some issues too. Like they come off! And whatever you do don't bond them lower to keep them out of occlusion! (See "precise bracket placement"). So you need to use BT's (additional 'glue spots' on selected teeth- to be discussed in future blogs) if you are going to use molar tubes. And yes there is a cost if they come off (replacement tube, chair time, emergency appt) but if you pay $1 tube (see Cxorthosupply.com- blatant commercial) and do some things to minimize breakage the benefits still BY FAR outweigh the disadvantages!
So bond those molars for fast, accurate, hygienic treatment!
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