THE EDITOR'S CORNER

I want to try something that I haven't seen done before. I will go to my files and extract some information about some aspect of treatment and establish some kind of a standard that you can compare yourself to if you want to. It is not intended to set myself as a standard of excellence, but only as a standard for comparison. I will select a part of treatment measurable in terms of numbers, time, distance, or occurrence. I will describe the technique used and report my measurements. I will try to be accurate in my reporting. If you choose to, you can select similar material from your files, make the same measurements, and compare the results.

I want to begin with a simple problem--loose bands.

To get some figures on this subject, I went to my files and selected a file drawer at random. I pulled out the first 20 record cards and carefully recorded from the beginning of treatment, the number of bands used; the number of months that they were on the teeth; the number of loose bands during treatment; and the total number of bands, including loose bands, that were recemented during treatment.

If the bands are not all cemented and removed at the same time, it takes a little more time to record the bands and band-months. Just be sure to record as accurately as you can, the time in months that the bands are actually on the teeth. When these times are totaled, you arrive at the total band-months that the bands were cemented to the teeth.

For the twenty cases picked at random there were 345 bands cemented for a total of 5774 band-months. 23 bands became loose and 49 bands, including the loose ones, were recemented. The average band was on for 16.7 months. 7 cases had no loose bands, 8 cases had one loose band, 4 cases had 2 loose bands, and one case had 7 loose bands.

A resume of the actual figures is as follows:

Procedures and Techniques Used

The following are the procedures and techniques that were used in obtaining the results reported:

I use all preformed bands with prewelded brackets on all but the molar and cuspid bands.

I use very little separation for fitting and cementing bands.

All bands are seated with hand pressure. I have yet to hammer a band on a tooth.

I use Stratford Cookson cement. I mention this for your information only, and not because I know this to be superior to other cements.

I cement few bands at a time. When I am ready to cement, I routinely place all bands to be cemented onto the teeth prior to cementing. Since I do not separate very much, this makes room for the bands and makes their placement easier when they are cemented. I then remove the bands singly and/or in groups as I cement them.

In a typical cementing sequence in extraction cases, I cement first one lower molar band and then the other. Then I cement the four lower incisors. This procedure is repeated for the upper arch. The patient is then referred for the extraction of the first bicuspids. An appointment is made a few days after the extractions and the second bicuspid and cuspid bands are cemented in groups of two.

If I have difficulty placing a band because of a tight contact, I place medium elastic thread separation and proceed with the other cementings. By the time I return to the tooth requiring separation, there is usually enough room to complete the cementation. There are cases which are exceptions to this procedure because of numerous tight contacts and especially in some non-extraction cases. Cementing a full set of bands takes about 2 to 2½ hours.

In the cementing procedure itself, the teeth are isolated with cotton rolls, dried with air, the bands cemented, the area covered with a gauze sponge, and the patient "rests" on the sponge until the cement has hardened. Most of the excess cement comes off with the sponge. The rest is removed with a scaler.

Bands are checked at each visit. Bands are recemented when they are loose; when too much cement lining has been lost (determined visually or with an explorer); when a bracket has been bent and the band pulled away from the tooth or when a bent bracket needs to be retied; when I want to change the position of the bracket. I never straighten a bent bracket without recementing the band. I never recement a loose-fitting band. I either repair it by shimming or remake it.

I do not routinely remove and recement bands for caries checks. This is not merely rigidity on my part. I did make it a practice to do so at one time and I did not find that I was making any significant contribution to the orthodontic treatment or to the health of the teeth. To the contrary, removing bands routinely is very hard on the bands, on the teeth, on the patient, and on the orthodontist. I recorded my observations for thousands of band removals in terms of new cavities and decalcifications and I concluded that, in my office, the procedure of routine band removal was not only unnecessary, but contraindicated. So, I do not do any periodic band removals for caries check-ups, summer vacations, etc. I am very attentive to proper fit, proper cementation and proper checking of bands. I try not to place bands until I am ready to use them and I try not to lose time during treatment or prolong the time when bands are on the teeth. I will leave for another occasion a report on my experience with new caries and decalcification under and around bands.

This report is not intended to be scientifically significant. I tried, in using only 20 cases from a random drawer of treatment record cards, to come up with some kind of a standard for comparison and to encourage you to try this simple evaluation on 20 of your own cards.

If you have some significant observations or comments, some better statistics or some different procedures that you particularly favor, let us know about them. But, above all, try this comparison test. If your statistics are significantly worse than these, look to your procedures compared to those I described.