Periodontal pack on single tooth retained by acrylic splint.
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Acrylic Resins↗
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Effect of luxation type on pulpal blood flow measurements: a long-term follow-up of luxated permanent maxillary incisors.
Laser Doppler flowmetry (LDF) is a non-invasive method to assess pulpal blood-flow (PBF). Dental injury has been associated with significant PBF reduction. The purpose of this study was to assess whether (i) the type of luxation trauma may affect PBF measurements and (ii) whether luxation type-related measurements may show short- and long-term changes of PBF values. In 41 trauma patients, 69 maxillary incisor treated by repositioning and splinting, and the respective contralateral homologous tooth were investigated by LDF to assess local PBF values. Perfusion units were recorded in four sessions, on the day of splint removal, and 12, 24 and 36 weeks after splint removal. Statistical analysis consisted of univariate analysis of variance for repeated measurements. For the LDF measurements, the main effect of the variable 'session' was not significant (P = 0.119). However, there was a significant 'session'/'luxation type' interaction (P = 0.000). Analysis of simple session-within-luxation type effects revealed intrusive luxations to be associated with a significant decrease in PBF values (P = 0.000), while subluxations (P = 0.568), lateral luxations (P = 0.980), extrusive luxations (P = 0.910), and avulsions (P = 0.996) showed no significant difference between session-related values. The PBF measurements did not change over time for the contralateral incisors (P = 0.996). The LDF may become useful in the detection of pulpal ischaemic episodes in luxated maxillary incisors after repositioning and splinting. Further studies are warranted to assess the validity of the diagnosis of post-traumatic 'ischaemic episodes' by comparing it with histological tooth pulp changes, and by determining how well it may predict course and response to treatments in clinical trials.
Adolescent↗
Replantation of avulsed teeth. A review.
Time is a critical factor in successful replantation. The avulsed tooth is simply washed and replaced immediately. Where contamination with soil occurs anti-tetanus prophylaxis is given and some form of splinting is necessary for 3-4 weeks. Endodontic therapy is performed prior to replacement if there is a delay of more than two hours and where apex formation is complete it should be commenced within 10 days. Calcium hydroxide is useful as a root canal dressing and in controlling resorption. The value of immediate replacement and treatment should be publicised.
Adolescent↗
Laser Doppler flow investigation of fractured permanent maxillary incisors.
Laser Doppler flowmetry (LDF) is a non-invasive method to assess pulpal blood-flow (PBF). Dental injury has been associated with losses of pulpal sensibility. The purpose of this study was to assess the outcome of splint therapy on tooth fracture type-related PBF values. In 15 trauma patients, a single maxillary incisor treated by repositioning and splinting was investigated by LDF to assess local PBF values. Perfusion units were taken in four sessions, on the day of splint removel, and 12, 24 and 36 weeks after splint removal. Analysis of the tooth fracture type-related PBF measurements revealed root fractures to be associated with a significant decrease (P < 0.05) and uncomplicated crown fractures to be associated with a significant increase in PBF values (P < 0.05), while complicated crown fractures showed no significant difference between the session-related values (P > 0.05). The main findings of this study suggest splint therapy of root fractures of the central maxillary incisor to be associated with a short- and long-term decrease in PBF values. The LDF may become useful in the detection of transient ischaemic episodes and the identification of teeth at risk for adverse sequelae such as avascular necrosis and tissue loss.
Adolescent↗
A temporary-permanent splint.
A method of temporary permanent splinting has been presented which enables the clinician to stabilize anterior teeth aesthetically and rigidly without resorting to cast restorations. The method utilizes an acid-etch composite technique with T.M.S. Pins and has shown itself to be a rapid, cosmetic and durable alternative to either the temporary intra-coronal wire ligation or the more permanent gold prosthesis.
Acid Etching, Dental↗
Non-surgical management of an oro-antral fistula in a patient with HIV infection.
BACKGROUND: The risk of post-extraction complications is higher in patients who are immunosuppressed compared to other patients with normal immune function. In addition, invasive dental procedures are more likely to have serious complications in these patients. This case report demonstrates an effective non-surgical procedure to treat an oro-antral fistula in an HIV-infected man. METHODS: The oro-antral fistula was de-epithelialized under local anaesthesia and the patient wore a surgical splint continuously, removing it only for cleaning, for an eight week period. Chlorhexidine gel was regularly applied to the fitting surface of the splint and the oro-antral communication. The patient was reviewed on a regular basis. RESULTS: This procedure resulted in resolution of the patient's symptoms within two weeks. Complete healing of the oro-antral fistula was evident following eight weeks of wearing the surgical splint. CONCLUSIONS: This procedure provided an effective method of treating an oro-antral fistula in an immunocompromised patient without causing any detrimental effects to the patient's overall health. Adequate pre-surgical assessment of patients prior to extractions is important in all patients to help prevent the occurrence of such complications.
Adult↗
Splinting of teeth with fixed bridges: biological effect.
Forty abutment teeth with pathological mobility were splinted with telescoped removable bridges. During the first 4 weeks the bridges were fixed. From the beginning of the fifth week they were removed once a day. Mobility was measured prior to placing the bridges and at 4 and 10 weeks intervals. Average mobility of the abutment teeth and the control unsplinted teeth did not change significantly during the experimental period.
Adult↗
Anterior esthetic considerations when splinting teeth.
There are many techniques for stabilizing and splinting teeth. No matter which restorative technique is chosen, the technical elements of marginal fit, psychologic contour, cleansibility, and occlusion must be met. When the restoration is in the esthetic zone of the oral cavity, there is an additional element of achieving an acceptable cosmetic result. This article presents an overview of concepts to achieve acceptable esthetic results when teeth are joined together.
Cuspid↗
"The view" and the canine connection: an atlas of mandibular anterior tooth esthetics.
Restoring splinted mandibular incisors and canines with full crown restorations has always presented a challenge in creating an esthetic illusion of reality of normal individual teeth. This treatise is designed to present the rules for mandibular anterior esthetics that have been distilled from almost 4 decades of clinical practice of restoring dentitions that have been severely compromised by the deformities of disease or accident. The resultant formula systematically creates the desired results with a high degree of predictability.
Crowns↗
Replantation in general dental practice.
This paper presents a comparison of the outcome of two cases where teeth, avulsed in sporting accidents, were replanted in general dental practice and have been reviewed for 5 years. Avulsed teeth which were stored dry, had a long extra-alveolar period and were splinted for a longer period of time, ultimately underwent replacement root resorption (case 1). There was no evidence of resorption, after 5 years, in the tooth that was stored in the patient's own saliva and was replanted within 45 minutes of being avulsed (case 2). The replantation procedure for these two cases was based on recent literature, which is also reviewed in this paper, and a protocol for the management of avulsed teeth is suggested.
Adolescent↗
Splinting of avulsed central incisors with orthodontic wires: a case report.
A case of an 8-year-old boy who met with a road traffic accident causing trauma to the body and face and extrusion of the upper central incisors is reported. Laceration, oedema and limited mouth opening indicated the use of general anesthesia. During intubation the right central was avulsed accidentally and the left central further luxated and rotated. The avulsed central was reimplanted and the other one derotated and stabilised with orthodontic wire and brackets. Twelve weeks later the patients teeth were firm, immobile, radiographically normal and responded positively to vitality test.
Child↗
Conservative treatment of severely luxated maxillary primary central incisors: case report.
The treatment and follow-up evaluation of two orally luxated maxillary primary central incisors in a three-year-old girl is described. The injured teeth were displaced into a cross-bite with their mandibular opposing teeth. They were repositioned shortly after the injury and splinted with composite resin for two weeks. Oral hygiene instructions and antibiotic therapy were prescribed. Two weeks after the injury a necrotic pulp was removed and the root canals filled with a resorbable paste. Thirty months after the injury, the teeth and the surrounding tissues were clinically and radiographically asymptomatic and physiologic root resorption could be noted. The permanent successors erupted soon after natural exfoliation of the injured primary teeth. Only mild hypocalcified defects were observed on the permanent incisors.
Acute Disease↗
[Definitive injuries to the teeth. Lesions of hard tissue and pulp].
Tooth infraction and enamel fracture are the most simple traumatic crown lesions. When necessary the lesions can be covered with composite material. Follow-up of the traumatized tooth is necessary since pulp necrosis and obliteration can develop. In case of an uncomplicated fracture involving enamel and dentine immediate protection of the dentinal wound is important for the preservation of tooth vitality. In case of a negative vitality test, an endodontic treatment will be performed in case of a tooth with open apex only when supplemental clinical and or radiological signs of pulp necrosis are present. When a complicated enamel-dentine fracture is present, an endodontic treatment will be performed when root formation is complete. In case of a wide open apex, a pulp capping, partial pulpotomy or cervical pulpotomy will be performed in order to preserve vitality of pulpal tissues at the level of the root. Crown root fractures can be superficial, deep or vertical. In case of a superficial localisation of the fracture line, restoration with composite material or with the fractured tooth segment is indicated. Deep crown-root fractures can only be restored when the fracture line is localized not deeper than at 1/3 of the length of the root. In case of a vertical fracture, extraction is the only possibility. Root fractures on immature teeth are in most cases unilateral and have a good prognosis. In teeth with completed root formation, fractures at the level of the cervix have a poor prognosis. The fractured segment will be removed. Only when the remaining root segment is long enough, this part can be maintained. In case of a fracture at the mid-root level, repositioning and rigid splinting for a period of 8 weeks is necessary. When the tooth becomes non-vital, endodontic treatment is performed on the coronal part. Root fracture in the apical part does not necessary result in enhanced tooth mobility and immobilisation is not always necessary. Healing of a root fracture is only possible when the tooth is immobilized for a sufficiently long period. Regular control of tooth vitality is necessary since pulp necrosis can lead to an inflammatory reaction at the level of the fracture line.
Dental Enamel↗
An alternative method for splinting of traumatized teeth: case reports.
Injuries to the dentoalveolar complex are fairly common and can be caused by a number of reasons. There are many techniques for repositioning and stabilizing traumatically luxated or avulsed teeth. Many of the splinting techniques previously advocated were time-consuming. Not only were the splints difficult to fabricate and difficult to remove, they also contributed to injury of the soft and hard supporting tissues. Ribbond (Ribbond Inc., Seattle, Wash) is basically a reinforced ribbon which is made from ultrahigh molecular weight polyethylene fiber having an ultrahigh modulus. It is used in dentistry for various purposes. The use of Ribbond appears to be an adequate and easy method for stabilization and fixation. It can be used in the treatment of dental injuries. In this article the use of Ribbond for the treatment of dentoalveolar injuries is described.
Child↗
An alternative to splinting multiple implants: use of the ITI system.
The restoration of patients with dental implants presents many challenges. Some of the common concerns and problems are difficulty in achieving a passive-fitting cast framework and loosening of prosthesis-retraining screws or abutment screws when using external hex prosthesis connection systems. The ITI system uses a unique connection of the abutment to the prosthesis-anchoring component. Because of this unique connection, many problems encountered with external hex designs have been greatly reduced or eliminated by the ability to more easily restore individual teeth with individual implants. This article will present the rationale for restoration of a patient with implants using individual implant-supported restorations.
Dental Abutments↗
Autotransplantation of immature third molars: influence of different splinting methods and fixation periods.
Different data were published documenting the influence of fixation methods and periods on the outcome of autotransplantations of teeth. Besides studies reporting increased ankylosis and disturbances of pulpal revascularization following rigid or extended fixation, there are studies revealing no connection in this matter. The clinical and radiological results of 76 transplanted germs of third molars were to be assessed after a rigid fixation for 4 weeks or after a suture splinting for 7 days and compared with each other. The choice of fixation method depended on the initial stability of the transplant. After a mean observation period of 3.4 years (range 1.0-6.1 years), 92.9% of the teeth stabilized with a suture, but only 73.5% fixed with an acid-etch composite and wire splint could be classified as successful (P = 0.029). The significant increases in ankylosis (P = 0.036) and pulp necrosis (P = 0.041) were the factors for the less favorable results of the rigidly fixed teeth. Our data support the results of other experimental and clinical studies with regard to the negative influences of an extended and rigid fixation on the success of tooth transplantation. However, apart from a correlation with the method and period of fixation, we also suspect the influence of an incongruity between the transplant and recipient site.
Adolescent↗
Horizontal root fractures: a case report.
This case report describes the treatment of an upper right central incisor with an intra-alveolar horizontal root fracture at the level of the middle third and an upper left central incisor with the horizontal root fracture in the cervical third. The root fractures were reduced and rigidly splinted for 4 months. The endodontic therapy was instituted in the upper left central incisor because there was no possibility of fracture repair due to the proximity of the fracture and the gingival sulcus. As soon as the diagnosis of pulp necrosis was established in the upper left lateral incisor, the endodontic treatment was performed. After 3 years and 9 months check-up appointments showed healing in the middle root third of the upper right central incisor and it responded within normal limits to pulp testing. Thus, there is no need for endodontic therapy on this tooth.
Adolescent↗
Early functional loading using Brånemark dental implants.
The present review article discusses the one- and two-stage surgical protocol for dental implant placement as well as the critical amount of micromotion at the bone-implant interface to obtain proper osseointegration. The relevant literature supporting the hypothesis that "splinting of individual implants as soon as possible following installation via a rigid fixed device will most likely decrease the micromotion at the bone-implant interface thus facilitating proper bone healing (osseointegration)" is reported. As a consequence of this approach, the treatment period can be significantly reduced. Finally, the importance of an objective evaluation of the bone quality and initial implant stability is highlighted. The information thus obtained via tools already available will facilitate the decision as to whether to load implants immediately, early, or late, and the term "individual functional loading" is coined.
Dental Implantation, Endosseous↗