Traumatic intrusion of permanent teeth. Part 3. A clinical study of the effect of treatment variables such as treatment delay,method of repositioning,type of splint,length of splinting and antibiotics on 140 teeth

Abstract – A prospective study of 140 intruded permanent teeth was examined for the following healing complications: pulp necrosis (PN), root resorption (RR; surface, inflammatory and replacement resorption), and defects in marginal periodontal bone healing (MA). The occurrence of these healing complications was related to various treatment factors such as treatment delay, method of repositioning (i.e. expecting re‐eruption, orthodontic reposition and surgical reposition), type of splint (rigid, semirigid and flexible), length of splinting (days) and the use of antibiotics. Treatment delay, i.e. before and after 24 h, had no effect upon healing. Active repositioning in individuals with incomplete root formation (surgical or orthodontic) had a negative effect upon the three healing parameters compared with spontaneous eruption. In teeth with complete root formation and an age of 12–17 no repositioning was still the best treatment in regard to MA. In individuals older than 17 years of age, cases were not anticipated to spontaneously erupt and in these cases, the general choice of treatment was either active orthodontic or surgical repositioning. The former procedure appeared in this treatment scenario to slightly reduce the risk of MA complications. However, this treatment procedure was also found to be more time demanding (an average of 22 consultations for orthodontic repositioning compared with 17 consultations for surgical repositioning). If a surgical repositioning was performed, the type of splint (i.e. flexible, semirigid or rigid) appeared to have no significant effect on the type of healing. The same applied to the length of splinting time (shorter or longer than 6 weeks). No effect of dentin covering procedures for associated crown fractures (enamel–dentin fractures) could be demonstrated. Likewise, antibiotics had no apparent effect upon healing. In conclusion, in patients with intruded teeth with incomplete root formation, spontaneous eruption should be expected. In patients with completed root formation and with an age of 12–17 spontaneous eruption can still occur, but must be monitored very carefully. In older patients (i.e. >17 years) with completed root formation, either surgical or orthodontic extrusion should be attempted. The latter procedure appeared to lead to a slight reduction (not significant) in the risk of MA complications. The extent and direction of the intrusion may however favour surgical repositioning.     

Community Implementation of a Prehospital Spinal Immobilization Guideline

Objective: The purpose of this study was to qualitatively describe the underpinnings of the successful implementation of a collaborative prehospital spinal immobilization guideline throughout the emergency medical services (EMS) community in two counties in Colorado. We also describe lessons learned that may be beneficial to other communities considering similar initiatives. Methods: Qualitative data were collected from key informants who were directly involved in the implementation of a new prehospital spinal immobilization guideline among four community hospitals in two different hospital systems and the associated EMS providers within the two counties. We interviewed a purposively selected sample of emergency department (ED) physicians and other ED staff, hospital decision makers, EMS educators as well as fire department and EMS medical directors. Data were collected and reviewed until saturation was achieved. We conducted qualitative analysis to summarize and synthesize themes. Results: Ten key informants were interviewed, at which point saturation was achieved and several clear themes emerged. Participants described successful community-wide guideline implementation despite a history of competition, isolation, and conflict between the various EMS organizations and hospitals on past EMS and trauma initiatives. Factors related to success included the nearly universal perception that the initiative was “cutting edge” and thus an important paradigm shift in care for the community, as a whole. Participants reported the ability of community stakeholders to jointly assure a collaborative approach, characterized by intensive education for EMS personnel and others involved, and the ability of the community to together secure the new equipment required for success. Conclusions: Key informants described a convergence of factors as leading to the successful implementation of a prehospital spinal immobilization guideline. Lessons learned regarding how to overcome a tradition of competition and isolation to allow for success may be useful to other communities considering similar initiatives.     

Comparison of three conservative treatment protocols in carpal tunnel syndrome

The aim of this study was to investigate and compare the therapeutic effect of three different combinations in the conservative treatment of carpal tunnel syndrome (CTS) by means of clinical and electrophysiological studies. The combinations included tendon- and nerve-gliding exercises in combination with splinting, ultrasound treatment in combination with splinting and the combination of ultrasound, splinting, tendon- and nerve-gliding exercises. A total 28 female patients (56 wrists) with clinical and electrophysiologic evidence of bilateral CTS were studied. In all patient groups, the treatment combinations were significantly effective immediately and 8 weeks after the treatment. The results of the long-term patient satisfaction questionnaire revealed that symptomatic improvement is more prominent in the group treated with splinting, exercise and ultrasound therapy combination. Our results suggest that a combination of splinting, exercise and ultrasound therapy is a preferable and an efficacious conservative type of treatment in CTS.     

Rehabilitation Regimens Following Surgical Repair of Extensor Tendon Injuries of the Hand—A Systematic Review of Controlled Trials

There is no consensus on the most effective rehabilitation regimen following extensor tendon repair of the hand. This systematic review evaluates the outcomes of the various regimens. The Cochrane, MEDLINE, EMBASE, CINAHL, AMED, PEDro, OTseeker databases were searched for any prospective randomised clinical trials comparing rehabilitation regimens for acute extensor tendon injuries in adults. Five papers met the inclusion criteria. The regimens were static immobilisation, dynamic splinting and early active motion (EAM). There was no standard format of reporting. The sample size ranged from 27 to 100 patients. The duration of follow-up ranged from 8 to 24 weeks. Overall, patients’ total active motion improved with time. Early mobilisation regimens (active and passive) achieve quicker recovery of motion than static immobilisation but the long-term outcome appears similar. Given the comparable outcomes between dynamic splinting and EAM, we therefore favour EAM which is simpler and more convenient.

Electronic supplementary material

The online version of this article (doi:10.1007/s12593-012-0075-x) contains supplementary material, which is available to authorized users.     

Effect of splinting and exercise on intraneural edema of the median nerve in carpal tunnel syndrome--an MRI study to reveal therapeutic mechanisms

Splinting and nerve and tendon gliding exercises are commonly used to treat carpal tunnel syndrome (CTS). It has been postulated that both modalities reduce intraneural edema. To test this hypothesis, 20 patients with mild to moderate CTS were randomly allocated to either night splinting or a home program of nerve and tendon gliding exercises. Magnetic resonance images of the wrist were taken at baseline, immediately after 10 min of splinting or exercise, and following 1 week of intervention. Primary outcome measures were signal intensity of the median nerve at the wrist as a measure of intraneural edema and palmar bowing of the carpal ligament. Secondary outcome measures were changes in symptom severity and function. Following 1 week of intervention, but not immediately after 10 min, signal intensity of the median nerve was reduced by ≈ 11% at the radioulnar level for both interventions (p = 0.03). This was accompanied by a mild improvement in symptoms and function (p < 0.004). A similar reduction in signal intensity is not observed in patients who only receive advice to remain active. No changes in signal intensity were identified further distally (p > 0.28). Ligament bowing remained unchanged (p > 0.08). Intraneural edema reduction is a likely therapeutic mechanism of splinting and exercise.