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 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.     

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.     

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.     

Comparison of the flexibility of various splinting methods for tooth fixation

An experimental model was constructed to test the flexibility of the arch bar splint and the Schuchardt splint as compared with a newly introduced wire-composite splint. Vertical movement in 4 flexible incisors was tested by producing compressive forces between 15-95 Newtons on the incisal edges. The thinnest wire-composite splint was also tested for lateral flexibility by producing palatal forces from 2 angles. Movement without the splint served as the control. The tests showed that a 0.3 mm thick wire-composite splint had the flexibility closest to the control, followed by the arch bar splint, and 0.4 mm and 0.5 mm wire-composite splints, while the Schuchardt splint virtually prevented vertical movement. Lateral movement was markedly reduced by the 0.3 mm wire-composite splint as compared with the control with both a 10 degree and a 45 degree force. The experiments showed that a 0.3 mm wire-composite splint can be regarded as acting as a functional fixation allowing slight vertical movement of the teeth during immobilisation; it should be recommended for tooth fixation whenever possible.     

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.     

An evaluation of the Periotest® method as a tool for monitoring tooth mobility in dental traumatology

Abstract – Background/aim: The Periotest^® method is a technique for the objective assessment of tooth mobility. The aims of this study were to determine normal Periotest^® values in the vertical and horizontal dimensions of periodontally healthy teeth in individuals aged 20–35 years and investigate the reliability of Periotest^® in terms of intra‐series and inter‐series reproducibility before and after applying a dental trauma splint in vivo. Materials and methods: Periotest^® values were measured in periodontally healthy dental students (n = 33; mean age 24.7 years) at reproducible measuring points in the vertical and horizontal dimensions, before and after splint insertion. Three readings were taken per series to observe the intra‐series reproducibility; three series were measured to test inter‐series reproducibility (Friedman‐test; P ≤ 0.001). Two different wire‐composite splints, 0.45 mm Dentaflex and 0.8 × 1.8 Strengtheners, were inserted and the Periotest^® values were measured. Results: The median Periotest^® values before splinting were: canines ‐2.5, lateral incisors ‐0.9, and central incisors 0.0 for the vertical dimension, and canines 1.1, lateral incisors 3.2, and central incisors 3.6 for the horizontal dimension. The intra‐series and inter‐series Periotest^® values were highly reproducible. Conclusion: The Periotest^® method provides highly reproducible results. Focused on dental trauma, the method can be applied diagnostically during the splint and follow‐up period and for evaluating splint rigidity.     

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.     

Splinting of traumatized teeth with a new device: TTS (Titanium Trauma Splint)

Abstract – Displacement injuries of permanent teeth are an increasing emergency in the dental office. Children and adolescents are particularly prone to dental trauma due to participation in risky activitiess. Repositioning or replantation with subsequent stabilization by a dental splint is the standard of care for most displaced or avulsed permanent teeth. Non-rigid fixation allowing physiologic tooth mobility has been shown to be desirable for periodontal healing. A flexible splint of short duration appears to reduce the risk of dentoalveolar ankylosis or external replacement resorption. Different splinting techniques are currently recommended for stabilization of repositioned or replanted teeth, including a wire-composite splint, an orthodontic bracket splint or a resin splint. Each splinting option has its specific advantages and shortcomings. This paper describes a new splinting technique which offers improved comfort and handling to the patient and dentist alike.     

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.     

Splinting of traumatized teeth with focus on adhesive techniques

Splinting of traumatized teeth is an important step in the treatment of periodontally injured teeth and a precondition of healing of the periodontal tissues. Although it has been shown in animal experiments that replanted teeth without splinting showed analogous healing outcomes compared to splinted teeth, the placement of a splint in dental trauma situations is warranted for medico-legal reasons, for the comfort of the patient, and for the avoidance of additional trauma during periodontal healing. Ideally, the splinting of traumatized teeth should be an easy and fast procedure for the dentist. Trauma splints should be comfortable and easy to keep clean for the patient. The splint should allow some physiologic mobility to promote healing of the periodontal tissues. The widely used and recommended wire-composite splint, with material variations, meets the ideal requirements of current splinting concepts in dental traumatology. Times of using destructive tissue-coverage splints are definitely gone. They are too rigid, compromise periodontal and gingival healing, and are uncomfortable to the patient. The objective of this article is to present the current concepts in splinting of traumatized teeth. The given recommendations about splinting techniques and splinting periods are based on experimental and clinical studies.     

Splints made of wire and composite: an investigation of lateral tooth mobility in vivo

Abstract In 103 posttraumatic splints, lateral tooth mobility was measured with Periotest immediately before and after the routine splint removal. The splints were made of composite resin and an 0.017×0.025″ orthodontic steel wire. 481 teeth were measured. A statistic evaluation revealed that the immobilisation effect did not exceed normal tooth firmness. Fixation to one neighbouring tooth had less effect than fixation to two. Adjacent tooth gaps reduced the effect. Splint extensions had no influence. With the use of the Periotest device, more than 50% of all teeth with a true mobility of 20 Periotest-units or more were detectable as mobile in spite of the fixed splint.     

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.     

Tooth splinting: a review of the literature and consideration of the versatility of a wire-composite splint

Abstract The principles of tooth luxation splinting have been changed since the animal and human tests conducted in the early 1970s showed that masticatory stimulus promotes healing of luxated teeth and normally exerted occlusal forces are able to prevent and eliminate small resorption cavities on the root surface. It has also been shown that fixation of only one week is enough to achieve the clinical healing of repositioned teeth. Apart from esthetic and hygienic components, present-day demands on tooth fixation techniques also include ease of construction and removal and the use of devices which allow slight movement of the fixed teeth. This paper presents the history of tooth splinting, our present-day knowledge of the subject, and introduces various splinting techniques. The wide range of indications for a flexible wire-composite splint are analyzed more thoroughly.     

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。     

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。     

Conservation of root‐fractured primary teeth—report of a case

A 3.5‐year‐old girl presented to our clinic experiencing pain in her maxillary central incisors following traumatic injury during a fall. Radiographic examination revealed both primary maxillary central incisors with mid‐root and apical third horizontal root fractures, respectively. Splinting with orthodontic brackets and stainless steel wire was performed. At 2 weeks, resorption of the apical fragments in both injured teeth was observed, and after 3 months, almost complete resorption was noted on radiographs. Tooth mobility at this point was back to physiologic levels and the splint was removed. After 2.5 years, the primary maxillary incisors were replaced by permanent incisors demonstrating normal tooth color, position, and root development. Although this case illustrated the favorable prognosis of two primary teeth with root fractures and severely mobile coronal fragments by a conservative approach, more scientific evidences are needed and frequent recalls are necessary when primary root fractures are attempted to be managed with splinting.     

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提要：牙齿松动是牙周病主要的临床症状之一。如何治疗松动牙、防止牙周炎进行性加重、尽可能地保存牙齿、促进牙周组织的重建再生,是牙周科医生致力于解决的主要问题。经牙周基础治疗、去除危险因素、消除牙周组织炎症并建立平衡牙合后,多数患牙的松动度可不同程度减轻。而松动度较大的患牙经牙周治疗也很难恢复正常,并影响咀嚼功能,产生继发性牙合创伤,使得牙周组织破坏、吸收加剧。对动度较大的松动牙进行固定,消除其创伤,减轻牙合力负担,使之行使正常咬合功能,牙周膜接受功能性刺激,从而促进牙周组织的修复和愈合。因此,松牙固定是牙周治疗的必要措施。牙周炎的松牙固定是将单根或多根患牙与健康牙通过夹板连接成一个稳固的“多根牙”,建立起一个新的咀嚼单位。本文对牙周病的松动牙固定、各类牙周夹板在临床上的使用及夹板固定技术做一介绍。     

The effect of splinting on tooth mobility. I. During initial therapy

The purpose of this study was to assess whether fixed splinting aided in the reduction of posterior tooth mobility during initial therapy. A "split-mouth" approach was used in order to compare splinted segments with similar unsplinted segments. Seven patients were selected, all of whom demonstrated chronic destructive periodontitis and mobile teeth. Initial therapy, consisting of oral hygiene instruction, root curettage and occlusal adjustment, was performed over a 2-week period. At the time of initial therapy, teeth in contralateral segments were splinted with an intracoronal wire-and-acrylic splint. Tooth mobility and gingival inflammation were recorded in all four segments every 3 weeks for a 15-week monitoring period following initial therapy. The splints were removed before each data recording session and then replaced and the occlusion refined. Prophylaxis and oral hygiene instruction were repeated every second week throughout the monitoring period. The reduction in the mobility of teeth splinted during the entire therapy period did not differ from the reduction observed in the unsplinted segments. The reduction in tooth mobility observed in both the splinted and unsplinted segments over the 17-week period can be attributed to the improved occlusal relationships and reduction in inflammation.