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To Bond or Not To Bond

To Bond Or Not To Bond Second Molars

by Michel Champagne, BA, DMD, MAGD, IBO, CDE

When we normally do Phase I treatment the second molars have not yet erupted. Even at the end of the mixed dentition period they often cannot be bonded. The clinician will not be able to include them at that time. Months go by and they finally come into full eruption. Only in a few situations can we leave them out of the system but most of the time they have to be included except if they are in perfect occlusion and present no anchorage value for the case. When you think they can be included, ask yourself : ‘’Will their position improve if I bond them’’. If the answer is no, it will be the exception to the rule not to bond them. Another reason not to bond them would be that you do not have the possibility to put the bracket in the right position at a specific time and you decide to delay.

In all other situations, it is better to include them for the following reasons:

  1. For anchorage value, not only in consolidation but also to help stabilize the first molar when an elastic force is placed on the first molar (Image 1).
  2. To help in the parallelization of the molar roots.
  3. To help in the bucco-lingual alignment of the molars (Image 2).
  4. To get proper alignment of the marginal ridges (Image 3).
  5. Allow the proper alignment of upper second molars in such a way that there is no occlusal interference in balancing movement.

We still have the hyperdivergent cases, where everyone wants to control molar height to avoid supra eruption of the second molars. Here is where not all clinicians agree on the technique. Some will bond the second upper molars more occlusal to get them out of occlusion and  others will leave them out of the base arch and use a sectional wire between the 6 and 7, at one point of time when they need to perfect their position. The base arch from 6 to 6 will be one of sufficient size to stabilize the 6’s and the sectional wire will go from 6 to 7 and it may include some bends. In other situations were the vestibular dept allows it a base arch with a loop between the 6 and 7 can be used if you have a door on the molar bracket.

  Image 1

 Image 2

 Image 3