FIXED SPACE MAINTAINERS

N.B. This procedure requires prior approval if patient has Medicaid coverage. See Dr. Troutman (P&S 3-454)

Instruments needed:

In addition to above, for impression visit only:

stick wax, impression trays
beading wax, impression material (low heat cake compound) new line water bath (if using compound)
boxing wax, plastic bag (if using compound)

In addition to above, for cementation visit:

Glass ionomer cement (Ketac-Cem)
treated paper mixing pad
Columbia 15/30 scaler
carver

VISIT I:

1. The teeth to be banded are scaled and a localized prophylaxis is performed to remove plaque, calculus, and food debris.
   
   
2. Molar orthodontic band(s) is/are selected for the abutment teeth. The proper bands should fit the tooth as closely as possible. Properly fitting bands will be seated completely, extending about 1mm subgingival. They should not be able to be rotated on the teeth. At times, it will be impossible to fit bands well due to a lack of space. If bands will not seat through proximal contacts, separators (elastics) must be placed and a new appointment made for the following week.
   
   
3. The band is seated using finger pressure, then the band seater.
   
   
4. If compound is to be used for the impression, begin heating the material in the water bath. Set the bath to 140°. Place low heat cake compound (½ cake for band and loop, 1 cake for lower lingual arch, 11/2 cake for maxillary bilateral appliance) in a small plastic bag (preferably a "Ziploc" type bag). Add water to cover compound and seal bag. Place bag in filled water bath.
   
   
5. Once completely seated, the band is contoured to the tooth with the band pusher. The band pusher is used to eliminate all space between the band and the tooth. When using the band pusher to adapt the bands, a protective finger rest is critical.
   
   
6. For a bilateral appliance, a full arch tray is selected. For a unilateral appliance, a quadrant tray is adequate. The impression is taken with bands in place, using compound. Constant pressure is critical in taking an accurate impression.
   
   
7. Once set, the impression is examined to check that all teeth to be in contact with appliance are accurately represented. The bands should be clearly delineated. (Bands should not pull off in the impression; if they do, they are poorly adapted.)
   
   
8. The bands are gently removed from the teeth with the band remover. Care must be taken to avoid deforming a band. Bands are seated in the impression and stabilized with stick wax.
   
   
9. The patient is dismissed. The next appointment should be made allowing 3 weeks for the laboratory to fabricate the appliance.
   
   
10. The impression is poured up with stone. The model is carefully separated from the impression tray. If compound has been used, heat the model and tray in a water bath until the compound is softened but not sticky and carefully remove the tray and impression material. There is no need to remove the sticky wax unless you plan to solder the appliance yourself.
    
    
11. The bands are uncovered. The model is trimmed. The trimmed model and a completed prescription are reviewed by the instructor and are sent to the laboratory. (see sample laboratory prescriptions).
    
    
12. Seven days prior to the inserting visit, check if appliance is back from the lab. Remove the appliance from the model and check for smooth edges, adequate solder joints and absence of loose wires. If separators were needed to fit the bands, place separators again one week before cementation.
    
    VISIT II:
    
    
    
13. The abutment teeth are cleaned with a prophy cup and a slurry of pumice after the plaque index and oral hygiene reinforcement is done.
    
    
14. Rinse appliance thoroughly. Tie dental floss to the appliance to avoid accidental aspiration. The appliance is tried in and any necessary adjustments are made. The appliance must be passive; you should not have to manipulate the wire(s) of an appliance to insert it. The bands should seat to the original position and the arch wire should be well adapted to the soft tissues and abutment teeth.
    
    
15. The abutment teeth are isolated with cotton rolls and dried. The appliance is dried.
    
    
16. A luting mixture of glass ionomer (Ketac-cem) cement is mixed. The band(s) are filled with cement.
    
    
17. Each band is seated with moderate finger pressure and the band seater maintaining isolation. Immediately wipe away excess cement with a moistened 2x2 gauze. Adapt bands into grooves with band pusher or amalgam condenser.
    
    
18. The patient is to bite on cotton rolls, applying pressure to the bands until the cement is set. Once the cement is set, the excess is removed.
    
    
19. Home care instructions are given to the patient and parent orally (as below) and in writing:
    
    - No chewing gum or sticky candy.
    - Oral hygiene emphasized.
    - Appliance must be checked every 6 months (of loose bands, appliance breakage, and to time removal of
    appliance).
    - The patient may experience some initial minor discomfort.
    - Patient should use over-the-counter fluoride rinse (Act, Fluorigard) every night for as long as they wear
    the appliance.
    - If appliance gets loose or breaks, patient is to come to Pediatric Dentistry clinic immediately.

PROVIDE TO THE LAB FOR ALL CASES

1. Bands on the model if bands required.
2. Model labeled with patient's name and doctor's name.
3. Appliance design drawn on the model.
4. Any teeth to be extracted removed from model by doctor to simulate healed tissues.
5. Send the white (original) and yellow (work order) forms to the lab along with the model. The Pink form is the Doctor's copy and should be inserted in the chart.