I hear and see this a lot from orthodontists – colleagues, peers, friends, my associates and especially recent graduates/residents. For some reason most orthodontists truly believe:

“If I bond all the 7s then I’ve met the standard of care and I’m rendering good treatment AND those who don’t bond every single second molar are second rate.”

Where this ubiquitous law of orthodontics comes from is not clear but I suspect it has a great deal to do with our collective desire for a foolproof, cookbook approach that will work for every case. Of course this doesn’t exist outside textbooks or residency programs…

I know what you’re thinking. Obviously Burris is lazy and doesn’t bond all the 7s because he’s a terrible orthodontist. Well, maybe. But perhaps there are other reasons for not bonding every single second molar. Let’s look at a few possibilities:

  1. Patient comfort or lack thereof. Patients hate second molar brackets and especially hate the wire sticking out of the back of them.
  2. If a second molar is well aligned, why the heck would you bond it?
  3. Dwight Damon has long advocated (and rightly so) cutting the 7s loose before running elastics. If this is possible then let’s take that one step further.
  4. If the 7s become crooked during treatment it is very easy to bond and roll them into position with a round NiTi. So why not wait until that is necessary? Why not remove the brackets on the 7s once they are straight for patient comfort?
  5. I often see cases where the orthodontist is so obsessed with bonding 7s that they forget to make space for, expose and ligate an impacted canine – does this still count as top shelf treatment?

I know it’s difficult to extract all that stuff we had crammed into our heads in dental school and residency. Thirteen years out and I’m still working on it daily. Just yesterday I played the parrot and automatically repeated something everyone says… only to have Marc Ackerman smack me in the face saying, “What the heck does that mean?!?”. I didn’t have an answer. The point being that just because everyone else does it one way and everyone agrees that it’s THE way doesn’t mean it’s logical, practical, efficient or effective. You’re smart. Think for yourself. Consider crazy things like patient comfort when working on your clients. They will appreciate it, you’ll still get great results (perhaps even better due to better compliance) and your business will thrive!

Dang, I just realized that I’m totally off base with this piece because most of you still torture your patients with separators and bands! Banding molars IS lazy!!

12 thoughts on “Bonding All 7s Doesn’t Make You A Great Orthodontist

  1. 💯. Or another scenario: if bonding U7’s will cause an open bite!? No thank you.

    1. true that. bonding 7s on an adult patient with minimal overbite is always risky! good call

  2. Ben, solid post. Always love to play common sense police with you!
    I would add another important thing about standard of care myths:
    Pediatric Dentists and GP’s have been taught by orthodontists that all 7’s are bracketworthy. So if, for good reason (e.g.-anterior open bite) you don’t add to the appliance, these “colleagues” will often salivate on the opportunity to tell you that your work is sub par!
    Remember the old soda add, let me loosely paraphrase:
    [Don’t] Make 7′[s]…[an] Up yours!

  3. I totally agree. I don’t normally deal with 7’s until the last several months of treatment for pt comfort reasons and the fact that most 7’s align in a few weeks on a “step back from square wire” to round wire. I also don’t mess with well aligned 7’s. I also agree with the statement that open bite tendency cases can be mismanaged with extruded 7’s. That being said, I run into lower 7’s that are mesio-angular impacted and kick my butt for months until I either have them removed or get them into occlusion.

    1. Totally agree on all points. Especially on removal of mesially impacted 7s.

  4. So right Ben: “because most people believe it to be standard of care, we ALL should do it.” Until 200 years before Christ, the majority of the Earthlings believed that the Earth was flat. Even though the majority believed it, didn’t make it a truth. The earth was rond none the less. These paradigms that we cling on to are often BS.

  5. Leaving the lower 7’s alone tells you where the original arch form was. Its a metric, a placeholder. I use it as a guide, then bond it only if its needed (typically to help me open a deep bite, NOT to necessarily align it).

  6. I had as staff member say a patients mom said a GP told a patient that I wasn’t a good orthodontist because I hadn’t bonded the 7’s. I was totally furious. However, I calmed down and first called the GP. He said he never said it, it might have been a hygienist. Then I called the parent. She said she never said it. I explained that the teeth were in good alignment and not quite ready for a bracket ( I look at 7’s on a case by case basis). She was fine. The staff member overreacted and caused unnecessary problems by exaggerating a concern.

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