If you did your research on braces, you probably noticed some people wearing molar bands on their back teeth, while others had regular braces bonded on their molars. Molar bands seem uncomfortable and bulky, so why use them?
Molar bands aren’t necessary for everyone wearing braces, but they’re useful in many cases. Many orthodontic appliances, such as expanders, include molar bands, but your orthodontist can place bands on molars as part of braces as well. Molar bands can also be used on short or cracked molars.
In my practice, I’m not a big fan of molar bands as part of braces, especially since we have great alternatives nowadays, but I can see how they’re useful and why many orthodontists prefer them. In this article, we’ll discuss when and why we need to use molar bands as opposed to buccal tubes.
What are molar bands and how do they work?
Molars are very important teeth – they have a key role in occlusion – so it’s only natural that we engage them in orthodontic treatment. We do this through two types of braces: molar bands and buccal tubes.
Molar bands are as old as orthodontics, and bands on teeth have been reported as early as Egyptian and Roman times. In the early 1900s, before the invention of modern braces, all teeth were banded (imagine how uncomfortable that was!)
While unpopular with patients, molar bands do have their advantages – they’re strong, don’t break, rarely fall out, and are an essential component of most orthodontic appliances. But, because they’re bulky and difficult to clean, molar bands aren’t used in all cases, and we use buccal tubes instead.
The difference between molar bands and buccal tubes
Molar bands are rings made of stainless steel that go all around the tooth’s circumference. On the buccal side (toward the cheek), a molar band will have a metal tube soldered on – this tube will support the archwire.
On the lingual side, the molar bands sometimes have accessories, like cleats, which are helpful for engaging rubber bands or powerchains. This is especially useful for crossbite cases, or when we need to close large spaces.
The alternative to molar bands is buccal tubes, which are tiny braces shaped like a tube. Buccal tubes are bonded directly on the molar, which makes them fast and easy to use, as well as one size fits all. No more spacers and annoying band-fitting appointments.
Both buccal tubes and molar bands can have one or two slots; one slot for the main wire and one slot for an accessory (or piggyback) wire or an appliance such as a headgear or a lip bumper. You can even find triple-slot molar bands on the market, but they’re not as common.
The bottom line is buccal tubes are more comfortable and universal, and molar bands are more useful and sturdy, but both come with their own sets of advantages and disadvantages. I’ve tried to list the most common ones in this table:
|Molar Bands||Buccal Tubes|
|Need a fitting appointment and spacers placed in.||Don’t need a fitting appointment, can be bonded right away.|
|Are sturdy and don’t break as easily or fall off.||Break often from chewing hard foods, which leads to longer treatment.|
|Can have lingual accessories attached.||Lingual accessories need to be bonded separately.|
|Are hard to clean, and molars can develop cavities underneath.||Are easy to clean, and at lower risk for cavities.|
|Tubes are often bulky, gums can swell and become irritated|
|Easier to clean if bonded correctly, and gums won’t swell as often.|
|Better for short teeth, and protect cracked teeth.||Can’t be bonded on metallic restorations, risky to bond on large composite restorations.|
|When bands come out, there may be a residual gap that needs to be closed.||When buccal tubes come out, the treatment is complete.|
How do molar bands work?
Let’s start with how molar bands get fitted on your back teeth because that’s the main difference between bands and buccal tubes.
Since there’s very little room in between the molars, orthodontists need to use spacers as a first step to create space for molar bands. These spacers are tiny elastics that stretch and sit in between teeth, pushing them apart.
Spacers are not fun because they’re quite painful, but if you’re getting molar bands, be sure to expect them. I dedicated an entire article on spacers that you can read here.
After you’ve had your spacers for 7-14 days, it’s time for your band-fitting appointment. Bands come in all shapes and sizes, with one for each quadrant. Finding just the right one for your molar can take a little bit of time. Alternatively, your orthodontist may use a cast model of your teeth to test the right band size.
Finding the right molar band size is important – too small and it might sit too high, interfering with your bite, too large and it may sink low on your gums. Bands that are too big can cause cavities to develop because food can get stuck underneath if the bonding material isn’t spread evenly, not to mention they can come loose.
After the molar bands are fitted and cemented, you may be asked to refrain from eating for a couple of hours, so that the bonding material cures completely. Your orthodontist will insert the archwire inside the tubes, and from then on, your molar bands will act similarly to buccal tubes, applying orthodontic forces on the molars.
Does everyone need molar bands?
Not all patients need molar bands, but it’s usually the orthodontist’s decision whether to use them or not. Some old-school orthodontists really love their molar bands and place them on all their patients. Others only use them when absolutely necessary.
Molar bands usually go on the 1st molars, while the 2nd molars often receive buccal tubes. So you might have a variation of just a molar bands, just buccal tubes, or both molar bands and buccal tubes.
Here’s when to expect molar bands:
You’ve been told you’re about to get an orthodontic appliance on the roof of your mouth or underneath your tongue. Molar bands are necessary for:
- palatal expanders
- trans-palatal arches (TPAs)
- lingual arches
- bite plates
- lip bumpers
- habit appliances
- quad helix
You are not a good candidate for buccal tubes. You’ll be getting molar bands if:
- Your molars are very short
- Your molars have large restorations on them
- Your molars have metal restorations
- You keep breaking buccal tubes off
Your case is difficult and requires more force to be applied to the molars. Molar bands help apply orthodontic force more evenly:
- Molar protraction cases (when the molars need to be pulled forward)
- Premolar extraction cases
- Molar crossbite cases (lingual cleats are a very useful feature)
- Any situation where we want to avoid molar rotation.
Molar bands work great in challenging cases because they surround the teeth and apply force more evenly. They can also be custom-made for the patient in the lab, which creates an even better fit and reduces the risk of cavities.
Are molar bands painful?
After enduring the pain of spacers, you’re probably wondering if molar bands are painful too. Some patients get their molar bands straight away and skip the spacers, but that’s rare, and most teeth are too crowded or tight to allow that.
If you didn’t have spacers before your bands, expect some level of pain for 2-3 days. It will feel like you have something wedged between your teeth – because you do. Your molars will become more tender, and you won’t be able to eat that well. Stick to soft foods for the first week.
If you did have spacers, and now you’re having your molar bands fitted, it shouldn’t hurt at all. Your orthodontist will select the correct band and help seat it on your molar using an instrument called a ‘band pusher’. You will then need to bite on a bite stick to help the band go all the way in.
You may feel some discomfort when the molar bands get pushed underneath your gums, but it’s the same thing as getting a dental crown (though, if you’re young, you probably haven’t experienced that yet).
The pain from wearing spacers doesn’t go away instantly, so expect your molars to still be sore. Your molars will also be engaged in the archwire now, which will apply force and make all your teeth feel loose. It’s all part of the process, and some discomfort is perfectly normal.
How long do you need to wear molar bands?
If molar bands are used instead of buccal tubes, expect to wear your molar bands for the duration of the entire treatment – which is usually 18 to 24 months.
If your molar bands are part of an orthodontic appliance, they’ll come off as soon as that appliance comes off – usually 6 months or more.
Talk to your orthodontist if you find molar bands too uncomfortable and difficult to clean, or if your gums are swollen and bleeding – bands can often cause that. He might have an alternative for you and bond buccal tubes instead.
Molar bands are an important component of braces and orthodontic appliances, but not all patients will need to wear them. Ultimately, it’s up to your orthodontist and what he or she wants to achieve. Don’t be afraid to ask why molar bands are needed in your particular case.
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