[Splinting mobile teeth by extending the root axis].
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A list of what was once advocated when performing a replantation versus what is done now follows: 1. It used to be advocated always to curettage the socket after removing the tooth. Now clinicians know not to touch the walls of the socket and only to aspirate gently the apical region if needed. 2. After removal, the tooth used to be held in gauze, desiccating viable PDL cells. Now the tooth is kept bathed in an emesis basin filled with HBSS, which maintains the viability of the PDL for 30 minutes. 3. All clinicians were able to do was visual inspection; now the microscope is used to illuminate and magnify the working area. 4. Splinting was done on every case; now clinicians rarely splint after replantation. 5. Narcotic pain medication was prescribed routinely; now clinicians premedicate with chlorhexidine rinse, anti-inflammatory medication, and sometimes antibiotics, rarely using narcotics. With increased understanding of the periodontium and improved techniques, replantation should no longer be viewed as a treatment of last resort, but rather a successful treatment alternative.
Developments in biomaterials in the field of adhesion have made possible a less invasive dentistry. Improvements in adhesive polymers along with the analysis of certain failures in resin-bonded prostheses have suggested the micropreparation of abutment teeth. A long-term study of resin-bonded prostheses and splints was undertaken. The success rate of this protocol is presented for a study period of 10 years (1984 to 1993). These results indicated that the resin-bonded prosthesis is a viable option in patients who are missing one or two teeth. Of 145 prostheses, 11 failed, resulting in an overall survival rate of 83% (Kaplan-Meier test). Furthermore, the study confirmed that, for splints, preparation is important to counter the major stresses related to tooth mobility in patients with periodontal disease.
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Successful treatment of the avulsed tooth with immature root development is dependent on both pulpal and periodontal responses. The pulpal reaction is often one of revascularization with subsequent replacement of the necrotic pulp tissue. Continued root development and further calcification of the existing root structure are often seen with revitalization. The periodontal response to avulsion is dependent on the vitality of the periodontal ligament cells on the root surface. Normal healing occurs when the vitality is maintained, while replacement resorption results when the vitality is lost. Replantation after a short extra-alveolar period appears to provide the best prognosis for long-term retention of the avulsed tooth.
A vital periodontal membrane (PDM) is of ultimate importance for a successful periodontal healing of auto-transplanted teeth. It has been suggested that a damaged PDM may heal during an intermediate tissue culture period. In the present study, 26 canines, bicuspids and third molars were surgically removed and cultivated in a modified Eagle's medium for 3 to 17 weeks. The teeth were then transplanted to their new positions. 11 out of 18 (61%) transplanted teeth with complete root formation and 7 out of 8 (88%) transplanted teeth with incomplete root formation healed with an apparently normal periodontal ligament. 5 teeth, all canines, became ankylotic. Tissue cultivation of teeth to be transplanted resulted in approximately the same healing rate as has been reported for autotransplanted teeth without the tissue culture procedure.
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Dental literature covers a wide range of implant-based denture supports. Based on static/dynamic as well as preventive periodontal considerations, rigidly anchoring the removable superconstruction of hybrid dentures using secondary splinting of four implants with telescope crowns or readymade cap-andpost systems, is generally appropriate in cases where the lower jaw is toothless. This makes possible an impeccable bridgeshaped design for the main part of the dentures, with wide-open inter-implant rincing areas. Clinical experience has shown that, in comparison to bridge dentures or rigid bridgework, secondary splinting in reconstructions greatly simplifies oral hygiene, particularly for elderly patients.
Dental literature covers a wide range of implant-based denture supports. Based on static/dynamic as well as preventive periodontal considerations, rigidly anchoring the removable superconstruction of hybrid dentures using secondary splinting of four implants with telescope crowns or readymade cap-andpost systems, is generally appropriate in cases where the lower jaw is toothless. This makes possible an impeccable bridge-shaped design for the main part of the dentures, with wide-open inter-implant rincing areas. Clinical experience has shown that, in comparison to bridge dentures or rigid bridgework, secondary splinting in reconstructions greatly simplifies oral hygiene, particulary for elderly patients.
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