I decided to write about the topic of bands and molar tubes after a colleague who works in periodontics asked me about this topic. Many blog readers have also asked about bands and molar tubes in their comments.
How the two methods differ
What is a molar tube?
Certain attachments are placed on molars that are different from the brackets used on the rest of the teeth; these are the tubes. The molar tube has a hole through which the wire is inserted and threaded. The bracket has a slot and the wire is simply inserted without having to thread it; then it is ligated using a ligature or by a self-ligating or self-closing system.
Molar tubes can be secured by bonding them directly onto the teeth, or a kind of metal ring can be placed around each molar, a band, to which the tube is welded. The tube itself can be individual/single, double, or triple (according to the number of holes that it has).
Advantages and disadvantages of orthodontic bands and tubes
Both methods can be used with good results; however, the tubes (without bands) present many advantages over the bands:
- More hygienic– they do not enter the space between the teeth, and therefore do not provoke accumulation of food or bacterial plaque.
- They do not require separating elastics– in order to secure the bands, small spaces must be created between the molars by using separating elastics. Separating elastics are placed a few days before the bands have to be bonded.
- Faster and easier to bond
- They can be cemented on using the technique of indirect bonding, not so with bands (a very important point that influences the precision and ease of placement)
- At the end of the treatment there are no residual spaces when the appliances are removed.
Personally, in my daily practice, I limit the use of orthodontic bands to:
- Appliances that need bands for their anchorage as an expander: Forsus, palatal bar, etc.
- Situations where the tooth surfaces do not allow effective bonding, for example, steel or gold crowns.
You have to understand how bands first came to be used, in order to decide to stop using them as an orthodontist. Formerly, techniques for bonding directly to tooth enamel did not exist, or they produced very poor results. All brackets (not only the tubes) were secured with bands. With the appearance of new bonding systems, adhesion to tooth enamel offers very good results and makes it possible to attach or cement brackets directly to the enamel without any problem. Tubes can also be bonded this way with excellent results and with many advantages (as seen above), making bands obsolete and unnecessary (needed only in a few specific instances).
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