Comparison of a new dental trauma splint device (TTS) with three commonly used splinting techniques

Abstract – Splinting is the standard of care for stabilization of replanted or repositioned permanent teeth following trauma. The present experimental study compared four dental trauma splints in 10 volunteers. The evaluated splints included a wire-composite splint (WCS), a button-bracket splint (BS), a resin splint (RS), and a new device (TTS=Titanium Trauma Splint) specifically developed for splinting traumatized teeth. All splints were bonded to the labial surfaces of the maxillary lateral and central incisors. Splints were left in place for 1 week. After splint removal, the next splint was placed after a 1-week rest period. The sequence of splint application was randomized for each individual. The following parameters were assessed: tooth mobility with horizontal and vertical Periotest values (PTV) before and after splint application and splint removal, respectively; probing depths, plaque and bleeding on probing indices before splint application and removal, and chair time needed for splint application and removal. After splint application, horizontal PTV were significantly lower in central incisors for BS compared to TTS ( P =0.04), and for RS compared to TTS ( P =0.005) and to WCS ( P =0.006). Reduction of lateral tooth mobility (=splint effect) expressed by the difference between horizontal pre- and postoperative PTV was significantly greater in RS compared to TTS and WCS ( P <0.05) for central as well as for lateral incisors. However, changes of vertical tooth mobility were not significant across the splinting techniques. Periodontal parameters remained unchanged, reflecting the excellent oral hygiene by the study subjects. The chair time needed for splint application was significantly shorter for TTS ( P <0.01). In conclusion, all tested splints appeared to maintain physiologic vertical and horizontal tooth mobility. However, the latter was critically reduced in RS splints.     

Comfort and discomfort of dental trauma splints – a comparison of a new device (TTS) with three commonly used splinting techniques

Abstract  – The present experimental study compared four dental trauma splints in 10 volunteers. The evaluated splints included a wire-composite splint (WCS), a button-bracket splint (BS), a resin splint (RS), and the newly developed titanium trauma splint (TTS). All splints were bonded to the labial surfaces of the maxillary lateral and central incisors and left in place for 1 week. After splint removal, the next splint was placed after a 1-week rest period. The sequence of splint application was randomized for each individual. The following subjective parameters were assessed using a visual analogue scale: sensitiveness of splinted teeth, irritation of the gingival margin, irritation of the lips, impairment of speech, eating and oral hygiene. The results show that the application of BS leads to a significantly higher irritation of the lips and greater impairment of speech compared to other splints ( P  < 0.05). The RS leads to an increased and significantly higher irritation of the gingiva ( P  < 0.05) owing to a significant increase in cleaning difficulties ( P  < 0.05). In conclusion, WCS and TTS appear to be more accepted splints according to a subjective assessment by 10 volunteers.     

松牙固定钛链用于儿童上颌外伤松动前牙固定的临床研究

目的:评价松牙固定钛链用于儿童外伤松动前牙固定的临床效果。方法:采用随机同期对照方法,纳入符合条件的30例连续病例(4～12岁;其中男25例,女5例;混合牙列26例,乳牙列4例);随机分为2组(每组15例),分别采用松牙固定钛链(实验组)与弓丝托槽(对照组)技术固定。测量治疗前及固定术后4周的牙松动度、材料脱落牙位数、患者舒适指数、牙龈指数和医生操作时间,所得结果进行统计学分析。结果:实验组与对照组均能对松动牙进行有效固定;对有效固定患者数、材料脱落牙位数进行卡方检验,实验组与对照组之间的差异无统计学意义(P>0.05);而在患者舒适指数、牙龈指数和操作时间方面松牙固定钛链优于弓丝托槽技术(P<0.05)。结论:松牙固定钛链用于儿童外伤松动前牙固定效果可靠,且较舒适,对牙周刺激小,可节省操作时间。     

Replacement of severely traumatized teeth with immediate implants and immediate loading: literature review and case reports

One of the options for management of severely traumatized dentitions is to provide immediate implant placement with immediate loading. Three representative cases out of 15 patients with 23 traumatized teeth treated to date in our clinic are presented. None had labial bone fractures. The teeth were replaced with NobelReplace Groovy implants (Nobel Biocare, Gothenburg, Sweden) in the fresh sockets immediately after extraction. They were placed toward the palatal areas in the sockets and 3 mm below the gingival margins. If there were gaps between implants and sockets wider than 1 mm, particulate deproteinized bovine bone was grafted in the gaps. Immediately after placement, the implants were loaded with provisional prostheses. The final restorations were installed 3–4 months later. The patients were reevaluated clinically and radiographically 1–3 years after the final restorations had been placed. In all 15 patients, excellent functional and esthetic results were achieved. No implants showed radiolucency, peri‐implant suppuration, or mobility. The patients were satisfied with the results. Immediate implant placement with immediate loading is an option that provides good treatment outcomes and allows good functional and esthetic results, as well as addressing the social/psychological aspects of dental trauma.     

Biomechanical effects of splint types on traumatized tooth: a photoelastic stress analysis

Abstract –  This study was undertaken to assess the effect of splint type on stresses occurring around traumatized tooth by photoelastic stress analysis. Three semi-rigid splint types – a wire-composite splint, fiberglass splint and titanium trauma splint – were utilized for comparisons. Extracted left upper central and lateral incisors and the canine tooth of an otherwise healthy patient were embedded equidistantly in photoelastic resin. For all cases studied, a static axial and 20° oblique force of 100 N was applied on the lateral incisor in separate sessions. The experiments were undertaken without any splint application (unsplinted, control) after which the splints, adhesively bonded to the labial aspects of teeth, were consecutively tested. During each loading sequence, generation of isochromatic fringes was observed in the field of a polariscope, and photographed by a digital camera. Quantification of fringes was performed on magnified images, transferred to a PC. Under vertical loading, the highest stresses in the apical regions were observed for the unsplinted and ribbond-splint groups, whereas the lowest fringes occurred with the use of orthodontic wire as a splinting medium. Titanium trauma splint had absolutely no effect on reduction of stresses, as the fringe orders were slightly higher than the unsplinted lateral tooth. The use of orthodontic wire resulted in lowest fringe orders around the traumatized tooth.     

Management of Obstructive Sleep Apnea with a Mandibular and Tongue Advancement Splint (MTAS) in a Completely Edentulous Patient. A Clinical Report

Treatment of obstructive sleep apnea (OSA) in dentate patients using a mandibular advancement splint (MAS) from mandibular repositioners has been documented in detail. Nevertheless, studies about completely edentulous patients with OSA are sparse. This clinical report describes a clinical and laboratory method for producing a functional splint combining an MAS and a tongue-retaining device with an individualized tongue tip housing and discusses the rationale for using such a device.     

Fibrous dysplasia of the jaw bone: A review of 15 new cases and two cases of recurrence in Jamaica together with a case report

The authors reviewed 15 new cases of fibrous dysplasia of the jaw bone and two cases of recurrence seen in Jamaica between 1980 and 1995. Only cases which had a histological confirmation of fibrous dysplasia were included. The clinical behaviour and radiological findings of these cases were studied from the case files, either at the Cornwall Regional Hospital or the Kingston Public Hospital in Jamaica.     

Fibrous dysplasia of the jaw bone: A review of 15 new cases and two cases of recurrence in Jamaica together with a case report

The authors reviewed 15 new cases of fibrous dysplasia of the jaw bone and two cases of recurrence seen in Jamaica between 1980 and 1995. Only cases which had a histological confirmation of fibrous dysplasia were included. The clinical behaviour and radiological findings of these cases were studied from the case files, either at the Cornwall Regional Hospital or the Kingston Public Hospital in Jamaica.     

Regenerative endodontic treatment (revascularization) of immature necrotic molars medicated with calcium hydroxide: a case series

Introduction

Revascularization is an emerging regenerative treatment protocol with little published data available in immature molar teeth. The present case series demonstrates the outcome of revascularization treatment with intracanal medicament of calcium hydroxide in immature necrotic molars.

Methods

Immature necrotic permanent first molars (n = 6) of patients 8-11 years old were treated by a revascularization protocol that used 2.5% NaOCl irrigation, medication with calcium hydroxide placed in the coronal third of the root canals, induction of apical bleeding, and coronal sealing with white mineral trioxide aggregate. Among the treated teeth, 4 molars had undergone prior root canal instrumentation by the referring dentists. National Institutes of Health Image-J program with TurboReg plug-in was used for standardization of the radiographs and to determine the increase in root length and root width.

Results

After a follow-up period of 10 months, all teeth demonstrated radiographic evidence of complete periapical healing, progressive thickening of dentinal walls, and continued apical development in the absence of clinical symptoms. Two uninstrumented molars showed a positive response to cold testing at 9 months.

Conclusions

On the basis of a follow-up period of 10 months, the present cases demonstrate a favorable outcome of the revascularization procedure in immature necrotic molars by using calcium hydroxide medication in the coronal third of the root canals.     

慢性牙周炎伴前牙病理性移位的多学科联合治疗1例

目的 本文通过报道Ⅲ期B级牙周炎伴前牙病理性移位（pathological tooth migration, PTM）的治疗过程1例,希望为PTM的临床诊治提供一定参考。诊治经过：患者女性,28岁,哺乳期;因孕期牙缝逐渐变大影响美观,分娩后就诊。对本病例采用牙周序列治疗+多学科联合治疗。结果 牙周序列治疗后,牙周恢复健康稳定,修复治疗后患者对美观和功能较为满意,且修复体设计利于牙周长期稳定。结论 PTM患牙应综合多因素进行病因分析,根据不同的病因制定诊疗方案。     

Regenerative endodontic treatment (revascularization) for necrotic immature permanent molars: a review and report of two cases with a new biomaterial

Introduction

Revascularization is a valuable treatment in immature necrotic teeth that allows the continuation of root development. In this article we describe successful revascularization treatment of 2 necrotic immature first mandibular molars.

Methods

The clinical and radiographic examinations showed extensive coronal caries, immature roots, and periapical radiolucencies in mandibular first molars of a 9-year-old boy and an 8-year-old girl. The exam findings suggested revascularization treatment in both cases, which was started with irrigation of the canals by using NaOCl 5.25% for 20 minutes, followed by 3 weeks of triple antibiotic (metronidazole, ciprofloxacin, and minocycline) paste dressing. Next, the antibiotic paste was removed, bleeding was induced in the canals, and calcium enriched mixture (CEM) cement was placed over blood clots.

Results

In radiographic and clinical follow-ups both cases were asymptomatic and functional, periapical radiolucencies were healed, and roots continued to develop.

Conclusions

Revascularization is a realistic treatment in immature necrotic molars. In addition, placing CEM cement as a new endodontic biomaterial over the blood clot formed inside the canals provided good seal and favorable outcomes.     

纳米羟基磷灰石/聚酰胺(n-HA/PA66)凝胶重建牙槽嵴的动物实验研究

目的：研究n-HA／PA66凝胶注入牙槽嵴缺损后的重建效果及修复过程。方法：在犬两侧前磨牙区建立牙槽嵴缺损模型，在一侧缺损中注入n-HA／PA66凝胶，另一侧作空白对照。术后4，8，12，16周比较两侧牙槽嵴的高度并作组织学观察。结果：术后牙槽嵴表面形态良好。凝胶修复侧牙槽嵴明显高于对照侧(P＜0．05)。组织学观察，术后第4周凝胶周围尚未见成骨迹象；直至第16周时，包裹凝胶的肉芽组织才出现早期的片状钙化基质。结论：注射型纳米羟基磷灰石／聚酰胺凝胶可有效重建牙槽嵴。术后第16周凝胶周围开始成骨，与牙槽基骨形成骨性融合。     

Early Loading of Nonsubmerged Titanium Implants with a Chemically Modified Sand-Blasted and Acid-Etched Surface: 6-Month Results of a Prospective Case Series Study in the Posterior Mandible Focusing on Peri-Implant Crestal Bone Changes and Implant Stability Quotient (ISQ) Values

Purpose: The aim of this prospective case series study was to evaluate the short-term success rates of titanium screw-type implants with a chemically modified sand-blasted and acid-etched (mod SLA) surface after 3 weeks of healing.
Material and Methods: A total of 56 implants were inserted in the posterior mandible of 40 partially edentulous patients exhibiting bone densities of class I to III. After a healing period of 3 weeks, all implants were functionally loaded with a screw-retained crown or fixed dental prosthesis. The patients were recalled at weeks 4, 7, 12, and 26 for monitoring and assessment of clinical and radiological parameters, including implant stability quotient (ISQ) measurements.
Results: None of the implants failed to integrate. However, two implants were considered "spinners" at day 21 and left unloaded for an extended period. Therefore, 96.4% of the inserted implants were loaded according to the protocol tested. All 56 implants including the "spinners" showed favorable clinical and radiographic findings at the 6-month follow-up examination. The ISQ values increased steadily throughout the follow-up period. At the time of implant placement, the range of ISQ values exhibited a mean of 74.33, and by week 26, a mean value of 83.82 was recorded. Based on strict criteria, all 56 implants were considered successfully integrated, resulting in a 6-month survival and success rate of 100.0%.
Conclusion: This prospective study using an early-loading protocol after 3 weeks of healing demonstrated that titanium implants with the modified SLA surface can achieve and maintain successful tissue integration over a period of at least 6 months. The ISQ method seems feasible to monitor implant stability during the initial wound-healing period.