The effect of splint material and thickness on tooth mobility after extraction and replantation using a human cadaveric model

Although current guidelines for the treatment of traumatic injuries recommend the use of 'flexible' splints, the precise definition of what is considered flexible versus rigid has not been rigorously defined, leaving the clinician with a wide range of options for this critical factor. The purpose of this study was to quantify and compare the effect of eight different splints on tooth mobility after extraction and replantation using a human cadaveric model. Following strict selection criteria including complete root maturation, lack of periodontal disease, normal bone levels, and crown integrity, a maxillary central incisor was atraumatically extracted and splinted with eight different splints. The experimental splints included a 30-pound test monofilament nylon-composite splint and six wire-composite splints made of wires of 0.012' (0.3 mm), 0.016' (0.4 mm), or 0.020' (0.5 mm) diameter stainless steel (SS) or nickel titanium (NT). A direct composite splint represented the most rigid type of splint. These eight splints were applied five times each, and tooth mobility was measured before and after each splint was applied. The average splint effect, defined as the difference between the presplint and the postsplint measurements quantified using the Periotest, was calculated for each splint and compared. No significant differences were found between the nylon-composite and the wire-composite splints. There was significantly less tooth mobility with the direct composite splint compared to all other splints. In conclusion, the results of this study suggest that nylon and SS or NT wires up to 0.016' diameter are significantly more flexible than direct composite splints and thus may be better suited for the splinting and management of traumatized teeth.     

Rigidity of various fixation methods used as dental splints.

Horizontal and vertical rigidity of teeth fixed with seven types of dental splints were evaluated by two tooth mobility measuring devices. Altogether 21 dissected sheep mandibles including soft tissues were used for the experiments in which Fermit, flexible wire-composite, Kevlar, Fiber, Protemp, rigid wire-composite and Triad Gel splints were applied to four incisors. The mean rigidity of the central incisors within the splint was measured by means of Mühlemann periodontometer (horizontal mobility) and Periotest (horizontal and vertical mobilities). Mobility values of teeth before splinting were used as covariants and the values with the splints were illustrated as adjusted mobility. Statistical significance between the rigidity of various splints was analyzed by an unpaired t-test. It was shown that the most rigid splints both in horizontal and vertical directions were Triad Gel, rigid wire-composite and Fermit splints. Kevlar and Fiber splint allowed more horizontal movement than other splints. Protemp and flexible wire-composite splints proved to produce adequate lateral support for the fixed teeth and allowed vertical flexibility which is experimentally known to improve periodontal healing of luxated teeth.     

Rigidity of various fixation methods used as dental splints

Abstract Horizontal and vertical rigidity of teeth fixed with seven types of denial splints were evaluated by two tooth mobility measuring devices. Altogether 21 dissected sheep mandibles including soft tissues were used for the experiments in which Fermit, flexible wire-composite, Kevlar, Fiber, Protemp, rigid wire-composite and Triad Gel splints were applied to four incisors. The mean rigidity of the central incisors within the splint was measured by means of Mühlemann periodontometer (horizontal mobility) and Periotest (horizontal and vertical mobilities). Mobility values of teeth before splinting were used as covariants and the values with the splints were illustrated as adjusted mobility. Statistical significance between the rigidity of various splints was analyzed by an unpaired t-test. It was shown that the most rigid splints both in horizontal and vertical directions were Triad Gel, rigid wire-composite and Fermit splints. Kevlar and Fiber splint allowed more horizontal movement than other splints. Protemp and flexible wire-composite splints proved to produce adequate lateral support for the fixed teeth and allowed vertical flexibility which is experimentally known to improve periodontal healing of luxated teeth.     

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.     

Rigidity of commonly used dental trauma splints

Abstract – Background/Aims: The stability of immobilization devices varies from flexible to rigid, depending on the trauma. We evaluated the rigidity of various commonly used splints in vitro Material and Methods: An acrylic resin model was used. The central incisors simulated injured teeth, with increased vertical and horizontal mobility. The lateral incisors and canines stimulated uninjured teeth. Tooth mobility was measured with the Periotest^® device. Vertical and horizontal measurements were made before and after splinting, and the difference between values was defined as the splint effect. We evaluated 4 composite splints, 3 wire‐composite splints, a titanium trauma splint, a titanium ring splint, a bracket splint, and 2 Schuchardt splints Results: For all injured teeth and all splints, there was a significant splint effect for the vertical and horizontal dimensions (P < 0.05). For injured teeth, the composite splints produced the largest changes in vertical tooth mobility; wire‐composite splints 1 and 2, using orthodontic wires, produced the smallest vertical splint effects. For uninjured teeth, the Schuchardt 1 splint and the bracket splint produced the largest splint effects; wire‐composite splints 1 and 2 produced only a slight change in tooth mobility. Composite splints 2 and 3 produced the largest horizontal splint effects for injured teeth, and the 4 composite splints produced the largest horizontal splint effects for uninjured teeth. The most horizontally flexible splints were the titanium trauma splint and wire‐composite splints 1 and 2. Conclusions: According to the current guidelines and within the limits of an in vitro study, it can be stated that flexible or semirigid splints such as the titanium trauma splint and wire‐composite splints 1 and 2 are appropriate for splinting teeth with dislocation injuries and root fractures, whereas rigid splints such as wire‐composite splint 3 and the titanium ring splint can be used to treat alveolar process fractures.     

Development of new artificial models for splint rigidity evaluation

Abstract – Aim: We developed two versions of an artificial model and assessed their suitability for splint rigidity evaluation. These models allowed the simulation of traumatically loosened teeth and the use of the acid‐etch technique for splint application. Materials and methods: A straight and half‐round arch bar model with bovine tooth facets were manufactured. Using the Periotest method, tooth mobility was evaluated before (PTVpre) and after (PTVpost) splinting. Two types of previously investigated wire‐composite splints, WCS1 (Dentaflex 0.45 mm; Dentaurum) and WCS2 (Strengthens 0.8 × 1.8 mm; Dentaurum), were applied (n = 10) to each model. The relative splint effect (SpErel = ΔPTV/PTVpre) was calculated, and the working times for the models and splints were evaluated. Student’s t‐test and the Mann–Whitney U‐test were employed with Bonferroni correction for multiple hypotheses. Results: When comparing the relative splint effect of the ‘injured’ central incisors between the models within one splint type, differences were only found for tooth 21 (WCS2; P < 0.008); for comparisons of splints within one model type, differences were detected for both incisors and model types (P < 0.008). With the straight model, significantly less working time was necessary (P < 0.05). Conclusion: Using these models for in vitro splint rigidity evaluation, the splints can be applied with the acid‐etch technique and tooth mobility can be individually adjusted. WCS1 is considered flexible compared to the more rigid WCS2. The results from the straight and the round model were predominantly closely related to each other. In terms of working time, the straight model is superior to the round model.     

可摘式钛合金牙周夹板对慢性牙周炎松动牙的固定

目的 探讨可摘式钛合金牙周夹板对慢性牙周炎松动牙的临床固定效果。方法 将30例需做可摘式牙周夹板的慢性牙周炎患者随机分两组，每组15人。即实验组：制作钛舍金牙周夹板23件，固定松动牙115颗；对照组：制作钴铬合金牙周夹板2l件，固定松动牙106颗。戴用夹板前后均以LHLY型牙动度位移测量仪记录患者牙齿松动度数值的变化，用以比较两种牙周夹板的疗效。结果 两组患者分别在戴用牙周夹板1月、3月、半年、1年后进行复查，用测量仪所测牙齿松动度数值均较治疗前不同程度减小，临床有效率均为93％。但钛合金夹板和钴铬合金夹板对牙周病松动牙的固定疗效比较无差异。结论 可摘式钛合金牙周夹板对牙周病松动牙有良好的临床固定效果，是牙周病治疗理想的修复方法。但是钛合金夹板是否比钴铬舍金夹板对牙周病松动牙的固定疗效更好尚需要进一步研究。     

Influence of wire extension and type on splint rigidity – evaluation by a dynamic and a static measuring method

Abstract – Objectives: To evaluate the influence of wire dimension and wire length on the splint rigidity of wire‐composite splints in vitro. Materials and Methods: A custom‐made artificial model was used. The central incisors simulated ‘injured’ teeth with increased mobility, and the lateral incisors and canines served as ‘uninjured’ teeth with physiological mobility. To assess horizontal and vertical tooth mobility before and after splinting, the Periotest and Zwick methods were applied. Teeth 13–23 were splinted using wire‐composite splint 1 (WCS1; Dentaflex 0.45 mm) and wire‐composite splint 2 (WCS2; Strengtheners 0.8 × 1.8 mm). Splint length was varied by successively shortening the wire. The influence of wire dimension was tested using t‐test and Wilcoxon–Mann–Whitney test with the Bonferroni‐Holm procedure (α = 0.05). To test the influence of wire length, anova and Kruskal–Wallis tests as well as Tukey range and Wilcoxon test with Bonferroni‐Holm procedure were applied (α = 0.05). Results: Wire dimension significantly influenced splint rigidity (P < 0.05). The wire length significantly influenced the splint rigidity of WCS1 in the horizontal dimension and WCS2 in the horizontal and vertical dimensions (P < 0.05). Splint rigidity was significantly reduced when splinting only ‘injured’ teeth compared with splints including ‘uninjured’ adjacent teeth (P < 0.05). No differences were found between splints including one or two ‘uninjured’ teeth on each side (P > 0.05). Conclusion: WCS1 is flexible compared with the more rigid WCS2. The wire length influences the rigidity. To ensure adequate fixation and reduce the risk of enamel damage during splint removal, the splint should include only one ‘uninjured’ tooth bilaterally.     

Rigidity evaluation of quartz‐fiber splints compared with wire‐composite splints

Abstract – Aim: To evaluate the influence of reinforcement material on in vitro dental splint rigidity. Materials and Methods: A custom‐made artificial model was used. The central incisors simulated ‘injured’ teeth with increased mobility, and the lateral incisors served as ‘uninjured’ teeth with physiologic mobility. The Periotest and Zwick methods were used to assess horizontal and vertical tooth mobility before and after splinting, and relative splint effect (SpErel) was calculated. Teeth 12–22 were splinted using two wire‐composite splints (WCS), WCS1 (Dentaflex 0.45 mm), and WCS2 (Strengtheners 0.8 × 1.8 mm) as well as four quartz‐fiber splints, QS1 (Quartz Splint UD 1.5 mm), QS2 (Quartz Splint Rope 1.5 mm), QS3 (Quartz Splint Woven 2.5 mm), and QS4 (dry fibers 667 tex). The influence of the splint type was evaluated using anova , Tukey range, and the Dunnett‐T3 test (α = 0.05). To test the influence of initial tooth mobility, the t‐test was applied (α = 0.05). Results: Reinforcement materials significantly influenced splint rigidity (P < 0.05). The horizontal and vertical SpErel of WCS1 compared with WCS2 and QFSs1–4 was statistically significant (P < 0.05). Significant differences were found when comparing the horizontal SpErel of WCS2 with WCS1 and QSs1–4 (P < 0.05). SpErels of the ‘injured’ and ‘uninjured’ teeth showed significant differences (P < 0.05). Conclusion: WCS1 is flexible compared with the more rigid WCS2 and QSs1–4. Initial tooth mobility influences SpErel. The flexible WCS1 can be recommended for splinting dislocation injuries whereas the semi‐rigid/rigid WCS2 and QS1–4 can be used for horizontal root fractures and alveolar process fractures. The QS1–4 provide good esthetic outcome.     

Direct application of fiber-reinforced composites in splinting in a case of periodontitis. II

Attachment loss through advanced periodontitis results in tooth mobility, and then loss of teeth. To prevent progression it is needed to eliminate any exciting agent and correct functional disorders in consequence of disease. Regeneration of periodontium is impossible and mastication is difficult because of tooth mobility. Long-term maintenance of mobile teeth is doubtful. We have to prevent the extraction of these teeth to stabilise them by a splint made of material that is inexpensive, reparable, provides sufficient support for the artificial tooth. Fiber-Reinforced Composite (FRC) fulfills the above requirements. In their case-reports the authors demonstrate the practical application of splinting with FRC materials. In these cases the FRC splints are not only periodontal splints but they act as orthodontic retainers or supports for an artificial tooth.     

尼龙丝与钢丝树脂夹板两种固定外伤松动牙的效果比较

目的对比研究尼龙丝、钢丝树脂夹板固定外伤松动牙的临床疗效。方法实验组使用尼龙丝树脂夹板固定法，对照组使用钢丝树脂夹板固定法，随机各固定外伤松动牙40颗。对比观察使用两组固定方法后，外伤牙的松动度在拆除夹板时、1个月以后、3个月以后的变化情况以及两组固定方法所需的平均操作时间。应用SPSS10．0软件对相关数据进行统计学检验。结果实验组与对照组的外伤松动牙，经固定治疗后松动度均明显下降，达到了固定的效果。比较使用两组固定方法在上述3个时间观察点上患牙松动度的下降值在统计学上均无显著性差别（P〉0．05）；比较两组固定方法的平均操作时间，实验组所需操作时间明显短，两组在统计学上差别显著（P〈0．01）。结论同样能达到固定外伤松动牙的效果，使用尼龙丝树脂夹板固定省时。     

Bite force on single as opposed to all maxillary front teeth

The relation of number of teeth to maximal clenching force was tested in 10 healthy female dental students. The maximal force in the interincisal position was tested by spreading the load with individual acrylic splints over a varying number of teeth in the anterior region. In the maxilla, one splint covered teeth 13–23; another covered tooth 11. In the mandible, one splint covered teeth 33–43 in all experiments. The maximal force in the incisal position was measured 10 times, five times with each splint. The maxillary splints were changed in random order. The tactile sensibility of tooth 11 and its antagonists was tested before and immediately after interincisal force measurements. A highly significant difference between maximal forces was seen in comparing biting between a single tooth and multiple teeth. In addition, bite force also showed a significant increase in both single tooth and multiple teeth successive biting trials during the experiments. Tactile sensibility between d 11 and its antagonist was not altered by the maximal bite force trials.     

Longitudinal measurements of tooth mobility during orthodontic treatment using a periotest

The present study was designed to investigate the alteration of tooth mobility through orthodontic treatment using a Periotest. Eighty-three crowding cases without severe skeletal discrepancies were used as subjects. For each subject, the mobility of the central and lateral incisors on both arches (U1, U2, L1, and L2) was measured immediately before and after orthodontic treatment (T1 and T2 stages) and after retention (T3 stage) by use of a Periotest. No significant differences of all the measurements were found between the left and right sides. At T1 stage, the mean values were 10.8, 10.4, 9.3, and 7.4 for U1, U2, L1, and L2, respectively. At T2 stage, the Periotest values for all the teeth increased in comparison with those at T1 stage, and significantly decreased at T3 stage compared with those at T2 stage. Negative correlations were found between the Periotest value and age, which imply that tooth mobility decreases with age. The durations of treatment and retention had low correlation with the change of tooth mobility for all the teeth. It is suggested that the tooth mobility before treatment and after retention may be one of the useful indicators for determination of the retention period.     

前牙外伤两种固定方法的比较

目的 :对比弹性粘结与机械性结扎固定前牙外伤的临床效果。方法 :研究组使用弹性粘结法固定外伤松动牙37颗,对照组使用机械性结扎法固定松动牙39颗,对比观察使用2种固定方法后,外伤牙在不同时间点松动度下降值、牙周指数、平均操作时间以及有效率方面差异。结果:两组松动度均明显改善,在牙周指数、平均操作时间及有效率方面,研究组均显著优于对照组。结论:弹性粘结即玻璃纤维联合树脂固定前牙外伤具有效果显著、对牙周健康无明显影响、操作时间短的特点,值得临床推广。     

Tooth mobility after periodontal surgery.

Changes in tooth mobility after surgical crown lengthening procedures were examined with a modern electro-mechanical instrument (Periotest) in a total of 37 teeth in 14 patients between the ages of 18 and 55 years. Seven teeth were incisors, three canines, thirteen pre-molars and fourteen were molars. Periotest values, probing depths, bleeding indices and plaque indices were recorded after the initial preparation stage of the periodontal treatment, and further Periotest values and plaque and bleeding indices were recorded at intervals up to 3 months after surgery. In each category of teeth there was a progressive increase in tooth mobility starting immediately after surgery and peaking about the seventh day. The mobility then declined steadily to approach the base line again at about 3 months. There were statistically significant differences in mobility after surgery between tooth types (p < 0.01). Gender and age did not significantly affect the values. The pattern of post-surgical tooth mobility can be closely correlated with the known biological events of post-surgical healing.     

Study on prosthodontic procedure in patients with unilateral cleft lip and palate--effects of various extensions of splint on tooth-borne ability of teeth adjacent to the cleft

It is mandatory that the prosthodontic devices for the cleft palate patients not only prevent the relapse of the corrected arch and teeth by orthodontic and/or surgical intervention but also equilibrate the tooth-borne ability between the upper and the lower jaw. The purpose of this paper is to set up a criterion for the extension of the splint from the point of the tooth-borne ability. Four patients with unilateral cleft lip and palate were examined for the maximal biting force at the tooth adjacent to the cleft in each alveolar segment in the case of various extensions of the splints. The findings were as follows: 1. The maximal biting force increased significantly in every splint, compared with the non-splint. 2. The maximal biting force increased significantly in the splints where the neighbouring tooth in the same segment was involved, compared with that in the splints where only the tooth adjacent to the cleft was involved, even if the tooth in another segment increased in number for splinting. 3. The maximal biting force did not increase significantly in most splints where three teeth in the same segment were involved, compared with that in the splints where two teeth in that segment were involved.     

Mobility and percussion sound of healthy upper incisors and canines

Abstract In order to evaluate the correlation between mobility and percussion sound, 126 upper incisors and canines in 21 student volunteers were measured by means of the Periotest (Siemens), by evaluating the percussion sound subjectively and by analyzing its spectrum. The attenuation time and frequency of the sound were measured for each tooth, A logical mobility and percussion sound existed in accordance with the sizes of the teeth. Spearman correlation coefficients close to 1.00 were noted in individual cases between the Periotest and the three other tests describing the percussion sounds.     

Use of a removable splint in the treatment of subluxated, luxated and root fractured anterior permanent teeth in children

Aim: The aim of this study was to evaluate the prognosis of subluxated, luxated and root fractured teeth in children treated by removable splints, designed to stabilize mobile anterior teeth and eliminate occlusal trauma due to malocclusion. Material and methods: A total of 227 traumatized anterior teeth (91 subluxated, 105 luxated and 31 root fractured teeth) treated with a removable splint were observed for 3 years. The traumatized teeth were from 79 children aged between 6–12 years (mean 8 years 5 months). If a traumatized tooth was extremely mobile, a fixed splint was first made before the impression was taken for the removable splint. Two weeks after completion of the removable splint treatment, an impression was taken again to evaluate the occlusal relationship of pre‐ versus post‐treatment of removable splint. Results: The treatment period with a removable splint averaged 3 weeks in subluxated teeth, 3–5 weeks in luxated teeth, 4–6 weeks in apical third root fracture injuries, and more than 5 weeks in middle third root fracture injuries. All the subluxated teeth and 74.1% of the luxated teeth maintained their pulp vitality during the 3‐year follow‐up period. Two of 21 (9.5%) apical third root fracture teeth and three of five (60%) middle third root fracture teeth had pulp necrosis in the coronal fragments. Internal resorption was not found in any of the traumatized teeth. External replacement resorption was not found in subluxated and luxated teeth. All the root fractured teeth displayed transient external resorption around the fracture lines. The surface resorption appeared to be self‐limiting and not to threaten the retention of the tooth. Inflammatory resorption was observed in teeth with pulp necrosis, but in all cases this was reversed with endodontic treatment. Eight of 23 (39%) apical third root fractured teeth displayed replacement resorption in their apical fragments, but the resorption was not serious enough to extract the tooth. No obvious alteration in the occlusal relationship was found comparing pre‐ and post‐treatment casts. The removable splints appeared to positively affect healing after traumatic injuries, as evidenced by the low number of complications at the 3‐year follow‐up period.     

Mobility and percussion sound of healthy upper incisors and canines.

In order to evaluate the correlation between mobility and percussion sound, 126 upper incisors and canines in 21 student volunteers were measured by means of the Periotest (Siemens), by evaluating the percussion sound subjectively and by analyzing its spectrum. The attenuation time and frequency of the sound were measured for each tooth. A logical mobility and percussion sound existed in accordance with the sizes of the teeth. Spearman correlation coefficients close to 1.00 were noted in individual cases between the Periotest and the three other tests describing the percussion sounds.     

Periotest for measuring periodontal characteristics–Correlation with periodontal bone loss

The Periotest measures the reaction of the periodontium to a defined percussive force. The percussion is applied to the tooth by an electronically controlled tapping head. Information on structural change is obtained by measurement of both the elastic and viscous characteristics of the periodontium. The latter prevent oscillations of the tooth in the alveolar bone. A value is calculated and is displayed as a "Periotest value". The following research report shows the relation of Periotest values to bone loss. Bone loss was quantitatively determined for 2312 teeth from orthopantomographic radiographs and for 900 teeth exposed to intra-oral films using the standard paralleling technique. A differentiation was made between vertical and horizontal bone loss. Clinical mobility index, pocket depth, gingival recession and papillary hemorrhagic index were also measured. There was a strong association between the Periotest value and bone loss. These results suggest that Periotest evaluation provides an objective indication of the extent of periodontal bone loss.