FIXED SPACE MAINTAINERS
N.B. This procedure requires prior approval if patient has Medicaid coverage.
See Dr. Troutman (P&S 3-454)
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
- The teeth to be banded are scaled and a localized prophylaxis is performed
to remove plaque, calculus, and food debris.
- 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.
- The band is seated using finger pressure, then the band seater.
- 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
- 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.
- 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
- 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
- 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.
- The patient is dismissed. The next appointment should be made allowing
3 weeks for the laboratory to fabricate the appliance.
- 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.
- 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).
- 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.
- The abutment teeth are cleaned with a prophy cup and a slurry of pumice
after the plaque index and oral hygiene reinforcement is done.
- 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
- The abutment teeth are isolated with cotton rolls and dried. The appliance
- A luting mixture of glass ionomer (Ketac-cem) cement is mixed. The band(s)
are filled with cement.
- 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.
- 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.
- 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
- 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
- If appliance gets loose or breaks, patient is to come to Pediatric Dentistry
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
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