Thursday, August 28, 2014


Consumer alert on the use of elastics as “gap bands”

The use of elastics in dentistry is not new. One of the earliest applications was to extract teeth in patients with bleeding disorders, cardiac problems, or mental deficiency. The practitioner simply placed a rubber band around the tooth to be extracted. The rubber band would slowly work its way down the sides of the tooth roots, destroying the bone and soft tissues, and the tooth would just fall out. Elastics have also been used in periodontal research in animals, to destroy the periodontal attachment between the bone and the cementum and produce inflammation and lesions similar to that seen in periodontitis.

So, why is a consumer alert needed today?

The answer can be found on the Internet. A recent search on the term “gap bands” produced links to sites selling elastics directly to consumers, for home use in closing a dental gap. The sites promoted the speed and benefits of this do-it-yourself orthodontic treatment, but spent very little time at all informing potential patients of the risks.

But the risks are quite real, as these images from a 1988 article in the Journal of Periodontology show. For the authors take on this topic 25 years later, see the Editorial in the September issue of the AJO-DO.

Fig. (Top row) A 7-year-old boy had acutely inflamed tissues and Class III mobility of the central incisors. The initial radiograph showed localized bone loss, confined to the distal aspects of the central incisors, with probing depths up to 10 mm.  (Bottom row). After 18 months of palliative therapy and splinting, close approximation of the root tips and arc-like pattern of bone loss was evident on the radiograph.  Given the poor prognosis of the central incisors, a decision was made to perform exploratory periodontal surgery, which revealed an embedded elastic band.
The first 3 images were originally published in the Journal of Periodontology and are reproduced
with permission from the American Academy of Periodontology. The final image was not part of the Journal of Periodontology article.

References and Information

Adcock, J.E.  Exfoliation of maxillary central incisors due to misapplication of orthodontic rubber bands.  Tex Dent J. 1999;116:8-13

Aiello, G. and D'Andria, A.  [Iatrogenic risks in orthodontic treatment]  Av Odontoestomatol 1991;7:549-551.  In Spanish

Almeida, R.C., Carvalho, Fde. A., Almeida, M.A., Capelli J. Jr., and Machado, W.A.  Controlled tooth movement to correct an iatrogenic problem.  Am J Orthod Dentofacial Orthop. 2011;139:271-278

Al-Qutub, M.N.  Orthodontic elastic band-induced periodontitis – A case report.  Saudi Dent J. 2012;24:49-53

Bantleon, H.P., Haas M., and Droschl, H. [Massive bone loss in the area of the upper anterior teeth due to subgingival elastic bands.] Z Stomatol. 1987;84:39-45.  In German

Bauer, J.C. et al. Dentistry for Children.  ed 5, page 197.  New York: Blakiston Division, McGraw Hill 1964.

Baumhammers, A.  Periodontal lesion from improper use of elastic bands in minor tooth movement.  Dent Digest. 1968;74:252

Birch, C.L. and Snider, F.F.  Tooth extraction in hemophilia.  JADA. 1939;26:1933

Caldwell, C.R., Worms, F.W., and Gatto, D.J.  Orthodontic and surgical intervention to arrest tooth loss secondary to subgingival elastic.  Am J Orthod. 1980;78:273-278

Cataldo, E. and Santis, H. Response of the oral tissue to exogenous foreign materials.  J Periodontal 1974;45:93-106

Caton, J.G. and Zander H.A.  Primate model for testing periodontal treatment procedures.  I: Histologic investigation of localized periodontal pockets produced by orthodontic elastics.  J Periodontol. 1975;46:71-77

Dalitsch, W.W.  Dental extraction in hemophilia.  JADA. 1934;21:1804-1811

Dalitsch, W.W.  Removal of teeth by exfoliation with elastic ligatures.  Dent Digest 1934;45:310-314

Davis, R.K. and Bacao L.J.  [Report of a case of serious destructive periodontal disease caused by use of an elastic to close a diastema.]  Rev Port Estomatol Cir Maxilofac. 1986;27:223-231.  In Portuguese

Deidrich, P., Rudzki-Janson, I., Wehrbein, H., and Fritz, U.  Effects of orthodontic bands on marginal periodontal tissues.  A histologic study on two human specimens.  J Orofac Orthop.  2001;62:146-156.

Ewart, N.P.  Severe localized periodontitis in an adult; Initiation by orthodontic rubber bands.  N Z Dent J. 1989;85:92-94

Finkbeiner, R.L., Nelson, L.S., and Killebrew, J.  Accidental orthodontic elastic band-induced periodontitis:  Orthodontic and laser treatment.  JADA. 1997;128:1565-1569

Haralabakis, N.B., Tsianou, A., and Nicolopoulos, C.  Surgical intervention to prevent exfoliation of central incisors from elastic wear.  J Clin Orthodont. 2006;40:51-54

Heijl, L., Rifkin, B., and Zander, H.  Conversion of chronic gingivitis to periodontitis in squirrel monkeys.  J Periodontol. 1976;47:710-716

Hogeboom, F.E. and Stephens, K.A.  The dangerous rubber band.  J Dent Child. 1965;32:199-201

Huang W.J., and Creath, C.J.  The midline diastema: A review of its etiology and treatment.  Pediatr Dent. 1995;17:171-179.

Kwapis, B.W. and Knox, J.E.  Extrusion of teeth by elastics: Report of two cases.  JADA 1972;84:629-631

Lin, Y.T., Huang, Y.L., Chang, S.H., and Hong, H.H.  Sequelae of iatrogenic periodontal destruction associated with elastics and permanent incisors:  Literature review and report of 3 cases.  Pediatr Dent. 2011;33:516-521

Lindhe, J. and Ericsson, I.  Effect of ligature placement and dental plaque on periodontal tissue breakdown in the dog.  J Periodontol. 1978;49:343-350

McQuillen, J.H.  Editorial. Care in the use of India-rubber rings.  Dent Cosmos. 1870;12:429-430

Marino, V.A., Fry, H.R., and Behrents, R.G.  Severe localized destruction of the periodontium secondary to subgingival displacement of an elastic band.  J Periodontol. 1988;59:472-477

Massler, M. and Aguirre, B.  Exfoliation of teeth by means of elastic bands.  J Dent Child. 1952;19: 56-59

Merlini C., Gallini G., and Canzi D.  [Severe iatrogenic lesions from the improper use of elastics in the correction of inter-incisive diastema.]  Mondo Ortod. 1983;8:35-41.  In Italian

Moghaddas, H. and Pezeshkfar, A.  Severe gingival recession caused by orthodontic rubber band: A case report.  J Periodontol Impl Dent. 2010;2:83-86

Naaman, N.B., Chaptini, E., Taha, H., and Mokbel, N.  Combined bone grafting and orthodontic treatment on an iatrogenic periodontal defect:  A case report with clinical re-entry.  J Periodontol. 2004;75:316-21

Nettem, S., Nettemu, S.K., Kumar, K., Reddy, V., and Kumar, P.S.  Spontaneous reversibility of an iatrogenic elastic band-induced localized periodontitis following surgical intervention-case report.  Malays J Med Sci. 2012;19:77-80

Olsen, C.B. and Pollard, A.W.  Severe bone loss caused by orthodontic rubber bands: Management and nine-year follow-up: Report of case.  ASDC J Dent Child. 1998;65: 25-28

Pan, W.L., Chan, C.P., and Su, C.P.  Localized periodontitis induced by rubber bands.  Report of two cases.  Chang Gung Xue Za Zhi. 1991;14:54-60

Pullinger, P.C. and Craig, G.G.  Loss of upper permanent central incisor teeth.  Case report.  Aust Dent J.  1976;21:395-396

Petschelt, A., Hickel, R., and Hirschfelder, U.I.  [Sequelae of unsecured elastic bands (the status after 7 years)]  Fortschr Kieferorthop 1989;50:377-383.  In German

Redlich, M., Galun, E.A., and Zilberman, Y.  Orthodontic-prosthetic treatment to replace maxillary incisors exfoliated because of improper use of orthodontic elastics:  A case report.  Quintessence Int. 1997;28;241-244

Regev, E., Lustmann, J., and Nashef, R.  Atraumatic teeth extraction in bisphosphonate-treated patients.  J Oral Maxillofac Surg. 2008;66:1157-1161

Rubel, I.  Avulsion of central incisors by elastic bands with subsequent orthodontic treatment.  JADA. 1980;100:211-212

Sanchez-Perez, A., Moya-Villaescusa, M.J., Gambin-Manzano, M.C., and Bravo-Gonzalez, L.A.  Loss of a clinical attachment level in a child; Differential diagnosis with aggressive periodontitis. Case report.  Br Dent J. 2006;201:281-282

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Schroeder, H. and Lindhe, J.  Conversion of stable established gingivitis into destructive periodontitis.  Arch Oral Biol. 1975;20:775-782

Tilk, M.A.  Endodontic treatment of an orthodontic elastic accident.  J Endod. 1978;4:91-92

Vandersall, D.C.  Localized periodontitis induced by rubber elastic: Report of case.  J Am Dent Assoc.  1971;83:1326-1328

Vandersall, D.C. and Varble, D.L.  The missing orthodontic elastic band, a periodontic-orthodontic dilemma.  JADA. 1978;97:661-663

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Waggoner, W.F. and Ray, K.D.  Bone loss in the permanent dentition as a result of improper elastic band use; A case report.  Quintessence Int.  1989;20:653-656

Warren, K., An unfortunate case of unsuccessful orthodontic treatment.  Br Dent J. 1988; 164:394-395

Zager, N.I. and Barnett, M.L.  Severe bone loss in a child initiated by multiple orthodontic rubber bands: Case report.  J Periodontol. 1974;45:701-704

Zilberman, Y., Shteyer, A., and Azaz, B.  Iatrogenic exfoliation of teeth by the incorrect use of orthodontic elastic bands.  JADA. 1976;93:89-93
Zilberman, Y. and Redlich, M.  Iatrogenic damage to maxillary central incisors due to improper us of orthodontic elastics.  Treatment solutions.  J Isr Dent Assoc. 1997;14:47


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