Changes in periodontal parameters of splinted versus non-splinted posterior teeth during ten years of supportive periodontal therapy - A retrospective evaluation

OBJECTIVES

To compare periodontal parameters of splinted posterior teeth versus control teeth over ten years of supportive periodontal therapy (SPT) and to assess the survival rate of splints.

MATERIAL AND METHODS

Retrospective data of 372 SPT-patients was screened for splints (composite/fiberglass-reinforced composite) in the posterior (molars/premolars) which were inserted at least ten years before due to increased tooth mobility. For each splinted tooth (test), a corresponding control tooth had to be present at the first SPT-session after splint insertion (T1). Data was assessed at T1 and ten years later (T2). Possible influencing covariates for splint survival (mobility degree/Eichner class) were tested by Cox regression. The change in clinical attachment level (ΔCAL), probing pocket depth (ΔPPD) and the testing of possible influencing covariates was analyzed by using mixed linear regression.

RESULTS

Twenty-four patients (32 splints, 58 splinted teeth) were included. Ten test and two control teeth were lost. No differences were observed between ΔCAL and ΔPPD of test teeth compared to control teeth (ΔCAL -0.38 ± 1.90 vs. 0.20 ± 1.27 mm; ΔPPD -0.17 ± 1.18 vs. 0.10 ± 1.05 mm). Twenty-two splints fractured during the observation period (survival-rate: 31%). Mobility degree and Eichner class did not influence time until fracture.

CONCLUSIONS

Splinting of periodontally compromised and mobile posterior teeth does not have any disadvantage regarding the clinical periodontal situation when regular SPT is applied. However, splint fractures occur very often.

CLINICAL RELEVANCE

Splinting of posterior teeth is a treatment option in addition to active periodontal therapy when patients are disturbed by tooth mobility but splints have a high susceptibility to fracture.

Delayed Replantation Of Avulsed Tooth With 22 Hours Dry Time: Four Years Follow-Up Of A Viable Treatment Modality

Avulsion is the complete displacement of tooth out of its socket. It is the gravest form of dental traumatic injury which accounts for 0.5-3% of the total dental traumatic injuries of the permanent teeth and most commonly involves the maxillary central incisors. The treatment is immediate tooth replantation or if that is not possible then storing tooth in an appropriate storage medium and attending dental clinic at the earliest. The present case report describes the replantation of maxillary left central incisor tooth that was avulsed. The tooth was out of the socket for 22 hours without any storage medium. Tooth was replanted after the removal of non-viable periodontal tissues; splinting was done for 4 weeks and endodontic treatment was initiated after 7 days. The tooth was stable and functional with mild discoloration and ankyloses at four years follow up, which is considered a desirable treatment outcome after delayed replantation.

Removal of composite-bonded trauma splints using the Fluorescence-aided Identification Technique (FIT)

Accident-related dental dislocations must be considered as part of an emergency treatment. The use of tooth-colored fixation composites makes the splint seem less noticeable in everyday life. However, this makes it more difficult to remove without damaging the tooth's enamel surface. In order to better visualize the transition between composite and the tooth , the fluorescent properties of some composites can be advantageous. This article will explain the individual steps of a rapid and minimally invasive splint removal, using the so-called Fluorescence- aided Identification Technique.

[Aesthetic effect of orthodontics treatment combined with periodontal splint in the treatment of fan-shaped displacement of anterior teeth caused by periodontitis]

PURPOSE

To explore the aesthetic effect of orthodontics treatment combined with periodontal splint in the treatment of fan-shaped displacement of anterior teeth caused by periodontitis.

METHODS

Fifty patients with fan-shaped displacement of anterior teeth caused by periodontitis in PLA air force hospital from January 2013 to October 2018 were selected and randomly divided into the control group (n=25) and the experimental group (n=25). Patients in the control group were treated with conventional periodontal splint, while patients in the experimental group were treated with combined orthodontic treatment on the basis of the control group. Florida periodontal probe exploration depth (PD), gingival index (GI), attachment loss (AL), sulcus bleeding index (SBI), plaque index (PLI) and mobility were observed and compared before and 1 month after treatment between both groups. The levels of serum inflammatory factors interleukin-4 (IL-4), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), C-reactive protein (CRP) and osteocalcin (OC) were measured and compared by ELISA before treatment and 1 month after treatment in both 2 groups. The data were analyzed with SPSS 21.0 software package.

RESULTS

Compared with before treatment, PD and GI in both groups decreased significantly after treatment, and significantly lower in the experimental group than that in the control group (P<0.05); the levels of AL, SBI, PLI and tooth looseness in both 2 groups were significantly lower after treatment, and significantly lower in the experimental than in the control group (P<0.05); compared with before treatment, the levels of IL-4, IL-6, TNF-a and serum CRP in both 2 groups were significantly lower after treatment, and the experimental group was much lower than that in the control group (P<0.05). The level of osteocalcin in the experimental group was significantly higher than that in the control group at different time points after treatment (P<0.05). The level of osteocalcin in the experimental group reached its peak one day after treatment, and then gradually declined, the preoperative level was basically restored 7 days after treatment.

CONCLUSIONS

Using orthodontics combined with periodontal splint in the treatment of fan-shaped displacement of anterior teeth caused by periodontitis has a remarkable effect. The symptoms of periodontitis can be effectively improved, the teeth can be effectively corrected and facial profiles of the patients can be improved.

Efficacy of flapless intentional replantation with enamel matrix derivative in the treatment of hopeless teeth associated with endodontic-periodontal lesions: A 2-year prospective case series

OBJECTIVE

In this prospective case series, the effects of flapless intentional replantation (IR) with root surface conditioning with enamel matrix derivative (EMD) was evaluated for the treatment of periodontally-endodontally involved hopeless teeth.

METHOD AND MATERIALS

A total of 17 teeth (17 patients, aged 40 to 73) with ≥ 10 mm attachment loss and radiographic bone loss to the apex were included in the study. The affected teeth were atraumatically extracted using a flapless approach, then granulation tissues, calculus, and necrotic cementum on the root surfaces were removed. EMD was applied for 5 minutes to the root surfaces. The teeth were reinserted to the socket without any bone grafts and splinted.

RESULTS

After 2 years, clinical healing was uneventful in 16 cases and the radiographs revealed no root resorption or ankylosis. IR with EMD treatment provided statistically significant reduction in probing depth (6.4 ± 2.6 mm), gain in clinical attachment level (5.9 ± 2.5 mm), and gain in radiographic bone level (48.2 ± 26.1%) compared to baseline values (P < .01).

CONCLUSION

Within the limitations of the study, flapless IR with EMD treatment appeared to act as an alternative strategy to extraction of severely compromised teeth with endodontic-periodontal lesions beyond the root apex.

Multi-unit implant impression accuracy: A review of the literature

BACKGROUND

Accurate implant impressions are critical for the achievement of passive fit of an implant prosthesis which in turn contributes to the long-term success of the implant treatment. There is inconclusive evidence on the techniques and materials used for making multi-unit implant impressions.

OBJECTIVE

To evaluate the scientific data related to different aspects of multi-unit implant impression accuracy and draw useful conclusions from the review for application in clinical practice.

METHOD AND MATERIALS

Studies from 1990 to November 2012 were evaluated. Papers examining implant impression accuracy for two or more implants were selected for review. Case reports, technique articles, and incomplete studies were excluded. Fifty-nine studies were selected in total for evaluation, three among them clinical and the rest in vitro.

RESULTS

Fifteen studies compared PVS (polyvinyl siloxane) and PE (polyether), 11 found no differences between the two materials in terms of impression accuracy. Thirty studies analyzed the splint effect, 13 found splinting better and 13 others elicited no differences between splinting and non-splinting. Among the 25 studies examining pickup and transfer impression techniques, 12 favored pickup over transfer and 11 found no differences between the two. Twelve studies assessed implant angulation effects and found significant differences in accuracy for 20- to 25-degree angulation, and no differences for 5- to 15-degree angulation for most studies, except two.

CONCLUSION

PVS and PE were the preferred impression materials for multi-unit implant impressions. The evidence on splinting was inconclusive and the data supporting splint to non-splint were neutral. Pickup was the better performing technique than transfer, especially with increased number of implants. Implant angulation of 20 to 25 degrees negatively affected the multi-unit implant impression accuracy.

Stress distribution in reduced periodontal supporting tissues surrounding splinted teeth

The aim of this study was to analyze the distribution of occlusal stresses for splinted and nonsplinted mandibular anterior incisors and to compare different splinting materials. A mandibular model was generated from a patient's computed tomography scan using three-dimensional (3D) software. The mandibular model presented with four periodontally compromised incisors and two canines with optimal bone support (two-thirds crown-root ratio). Three different splint materials (composite resin, metal-reinforced, and fiber-reinforced) were selected. Vertical and transverse loads were applied, and stress levels around the periodontal structures and splint materials were analyzed with 3D finite element analysis. The results showed that when bone levels around teeth decreased, the stress on the canine increased. Tested splinting materials were successful in stress distribution, and metal was better than the other splinting materials at distributing the stresses.

Treatment of horizontal root fractured central incisors and 30 months follow up: 2 case reports

BACKGROUND

Horizontal root fractures are rare in comparison to other types of injuries and according to the literature account for between 0.2%?7% of all traumatic tooth injuries.

CASE REPORTS

Case 1: A 12-year-old girl was referred to our clinic with a complaint of tenderness and mobility as a result of an orofacial injury in her permanent upper left central incisor. A horizontal fracture was diagnosed on the middle third of the root during radiographic examination. Case 2: A 12-year-old boy was referred to our clinic with an injury to his upper left central incisor. During radiographic examination a horizontal fracture was diagnosed on the middle third of the root. Semi-rigid splints were applied to the teeth for 4 weeks without further treatment in both of the cases and they were followed-up for 30 months. At the end of the 30th month, the teeth were vital and they had no clinical signs nor symptoms. Also the radiographic examination showed healing with hard tissue in the fracture line for both of the cases.

CONCLUSION

Using semi- rigid splints without any further treatment resulted with hard tissue healing in both of the cases and was successful for the treatment of horizontal root fractures.

Perception regarding factors related to periodontal therapy among general dental practitioners of Belgaum city - a questionnaire survey

PURPOSE

To assess the perception regarding periodontists and periodontal therapy among general dental practitioners (GDPs) of Belgaum city.

MATERIALS AND METHODS

A questionnaire study was conducted among 120 GDPs of Belgaum city comprising 13 closed-ended questions. The questions addressed the following variables: demographics of the dentist, service as GDP, periodontal services provided by the GDP and periodontal services referred to the periodontists.

RESULTS

One hundred GDPs responded to the survey. 83% had specialists visit their practice and 78% felt the need for having a consultant periodontist attached to their practice. The procedures performed by the general dental practitioners were as follows: scaling (100%), scaling and root planing (78%), splinting (61%), gingivectomy (47%), ap surgery (24%), frenectomy (33%), crown lengthening (23%), root coverage procedures (12%), bone grafts (8%) and implants (8%). The procedures for which GDPs preferred the service of periodontists include bone grafts (87%), ap surgery (80%), root coverage procedures (77%), crown lengthening (63%) and others. 90% agreed that expertise is required for performing surgical periodontal procedures. 86% agreed that periodontists are competent to treat periodontal diseases. 38% to 55% noticed failures in periodontal procedures even after making use of a periodontist's service. 72% did not provide implant care in their clinic. 84% felt the role of periodontists was limited to post placement maintenance.

CONCLUSION

A variety of periodontal services were offered by GDPs. The most common services were non-surgical in nature.

[Clinical effect of sequential therapy for maxillary central incisor with horizontal mid-root fracture]

OBJECTIVE

To evaluate the clinical effect of sequential therapy for traumatized maxillary central incisor with horizontal mid-root fracture.

METHODS

Twenty maxillary central incisors with horizontal mid-root fracture following dental trauma were included in our study. The distance between root fracture plane and root apical segment was more than 5 mm. The sequential therapy included stabilizing the traumatized incisor with a flexible splint after repositioning the coronal segment of the tooth, temporarily filling with calcium hydroxide after root preparation, sealing the root apex with warm gutta-percha obturation technique and internal fixation with fiber post combined with composite resin adhesion. The patients were followed for 6 to 24 months.

RESULTS

Two cases healed without sign of fracture line and eighteen cases healed with sign of fracture line. No case failed. Abnormal mobility and translocation, percussion pain, gingival swelling, sinus tract and periodontal pocket were not observed in all the traumatized teeth.Radiology showed normal root apex and periodontium.

CONCLUSIONS

Sequential therapy for maxillary central incisor with horizontal mid-root fracture could acquire a satisfactory therapeutic effect.

Epidemiology, diagnosis, and treatment of temporomandibular disorders

Temporomandibular disorder (TMD) is a multifactorial disease process caused by muscle hyperfunction or parafunction, traumatic injuries, hormonal influences, and articular changes. Symptoms of TMD include decreased mandibular range of motion, muscle and joint pain, joint crepitus, and functional limitation or deviation of jaw opening. Only after failure of noninvasive options should more invasive and nonreversible treatments be initiated. Treatment can be divided into noninvasive, minimally invasive, and invasive options. Temporomandibular joint replacement is reserved for severely damaged joints with end-stage disease that has failed all other more conservative treatment modalities.

[Biomechanical basis splinting of loose teeth while preserving their mobility at physiological]

The aim of this study was biomechanical rationale for splinting mobile teeth with periodontitis according to the height and slope of teeth crowns, their degree of mobility, and type of occlusion. The research studied the effect of axial vertical and horizontal loads on the functioning of the proposed method of splinting. Set clear indications and contraindications for the use of the method of splinting. Biomechanically proven unreasonableness includes teeth with III degree of mobility in the splinted construction. Clinical variant of splinting is only possible at the height of the anatomical crowns of the teeth of at least 7 mm, otherwise the preferred laboratory methods for the manufacture of tires.

The incidence of centric slides in healthy individuals and TMD patients

Controversy exists as to whether centric slide is an etiological factor for temporomandibular disorders. In this cross-sectional study the magnitude of centric slides, obtained with 2 different articulations and one with a millimetre ruler was compared. The study enrolled a group of 27 healthy individuals and 83 TMD patients, the latter divided in 3 groups of 26, 28 and 29 subjects with the RDC/TMD diagnoses of myofascial pain, osteoarthritis and disc displacement without reduction, respectively. Measurement reliability of a chinpoint guided articulation was compared with a musculoskeletally stable articulation, obtained using a leaf gauge. Next, centric slide was measured, if any, intraorally with a millimetre ruler and in both articulations measuring the difference between centric relation and the maximal intercuspal position. A mandibular full-arch Tanner type stabilisation splint was fabricated for each of the TMD patients. After splint treatment, new casts were obtained and mounted using both methods to locate centric relation. The magnitude of centric slide intraorally and in both articulations was reassessed. For the analysis of the variables a mixed-model procedure was applied (alpha = 0.05). At baseline and upon conclusion of splint treatment all groups exhibited centric slides with large standard deviations (ranging from 1.03 +/- 0.83 to 1.97 +/- 1.3 millimetre). In the mixed-model procedure a significant difference in magnitude existed between the millimetre ruler and both the chinpoint guidance as well as the leaf gauge articulation (P < 0.001). No correlation between centric slide and TMD could be demonstrated.

Efficacy and compliance in treatment of sleep apnea with Herbst mandibular advancement splints (OHA version)

The benefits of the Herbst thermoformed advancement splint in the treatment of obstructive breathing disorders during sleep have been assessed in numerous studies. Unfortunately, like all other mandibular advancement devices, patients fail to wear it regularly in the long-term. Injuries, discomfort or pain caused by errors in manufacture or adjustment are generally blamed for this. After a critical review of the literature, some solutions are proposed to improve production of the orthesis and patient management.

One-year assessment of surgical outcomes in Class III patients using cone beam computed tomography

The purpose of this study was to apply a novel method to evaluate surgical outcomes at 1 year after orthognathic surgery for Class III patients undergoing two different surgical protocols. Fifty patients divided equally into two groups (maxillary advancement only and combined with mandibular setback) had cone beam computed tomography (CBCT) scans taken pre-surgery, at splint removal, and at 1-year post-surgery. An automatic cranial base superimposition method was used to register, and shape correspondence was applied to assess, the overall changes between pre-surgery and splint removal (surgical changes) and between splint removal and 1-year post-surgery at the end of orthodontic treatment (post-surgical adaptations). Post-surgical maxillary adaptations were exactly the same for both groups, with 52% of the patients having changes >2mm. Approximately half of the post-surgical changes in the maxilla for both groups were vertical. The two-jaw group showed significantly greater surgical and post-surgical changes in the ramus, chin, and most of the condylar surfaces (P<0.05). Post-surgical adaptation on the anterior part of the chin was also more significant in the two-jaw group (P<0.05). Regardless of the type of surgery, marked post-surgical adaptations were observed in the regions evaluated, which explain the adequate maxillary-mandibular relationship at 1-year post-surgery on average, with individual variability.

[Evaluation of the fiber-reinforced composite periodontal splint on fixing loose teeth with severe periodontitis]

PURPOSE

To evaluate the clinical effects of fiber-reinforced composites for splinting loose teeth after periodontal treatment.

METHODS

Patients with severe periodontitis (104 teeth) were randomly divided into fiber-reinforced composites group (58 teeth) and wire-ligation fixation group (46 teeth). After periodontal treatment, the loose teeth were fixed by fibre reinforced composites and wire-ligation. After 1 year of clinical observation,probing depth(PD), attachment loss(AL), gingival sulcus bleeding index (SBI)and plaque index(PLI)were measured. The data was analyzed with SPSS13.0 software package.

RESULTS

Six months after fixation, PD and AL became shallower (P<0.05), however, no significant difference was observed in SBI and PLI in the experimental group. In the control group, PD and AL became shallower, SBI and PLI values were higher (P<0.05). SBI and PLI in wire-ligation fixation group were higher than that in fibre reinforced composites group six months after fixation (P<0.05).

CONCLUSIONS

High-strength fibers in the periodontal splint is effective for loose tooth fixation in patient with severe periodontitis.

Traumatic injuries of permanent teeth among 6- to 12-year-old Iraqi children: a 4-year retrospective study

PURPOSE

The purpose of this retrospective study was to identify the types, causes, and other factors associated with traumatic dental injuries (TDIs) in the permanent teeth of children in Mosul, Iraq.

METHODS

Data were collected from the dental records of 6- to 12-year-old children with TDIs who attended the Pediatric Dental Clinic at the Mosul University School of Dentistry between October 2006 and October 2010. The gathered data included: demographic information, when and where the injury occurred, type of dental injury, cause of injury, and the time elapsed between the TDI and dental care. Data were evaluated using the chi-square test.

RESULTS

A total of 294 children with TDIs were examined and treated. The highest frequency of TDIs was among 12-year-old children (29%), with more males being affected (P<.001). The most common type of injury was enamel-dentin fracture (56%). The most frequent cause of TDIs was falls (53%). The majority of the injuries happened outdoors (55%), and 37% of the cases occurred in the Fall. Only 5% of patients sought dental care within 24 hours of the injury.

CONCLUSION

This 4-year retrospective study showed that the majority of children with TDIs sought dental treatment after one month of the injury. Educating parents and teachers about the benefits of trauma prevention and immediate treatment of injuries is a must.

Management of symphysis fracture in a 3-year-old child with prefabricated acrylic splint and circum-mandibular wiring

Pediatric mandibular fractures are often the sequelae of facial skeletal injuries in patients with trauma and frequently require hospitalization. Due to the retrusive mid-face position relative to the calvarial prominence, facial fractures are rare in children younger than 5 years of age. Although rare, they most often occur as a result of motor vehicle accidents. The purpose of this report is to describe the management of a mandibular symphysis fracture in a 3-year-old boy with displacement between the primary mandibular left central and lateral incisors. The fracture was reduced and the fractured segment was stabilized under general anesthesia with a prefabricated acrylic splint with circum-mandibular wiring. Children have greater osteogenic potential and faster healing rates than adults; therefore, anatomic reduction in children is best accomplished earlier.

Intra-alveolar root fracture in primary teeth

PURPOSE

The purpose of this study was to assess the effectiveness of long-term resin wire splinting in the management and prognosis of intra-alveolar root fracture (IARF) in the primary teeth.

METHODS

The study population comprised 10 patients with 16 root fractures in their primary anterior teeth. Based on the trauma chart and radiographs, the data were organized and collected according to: age; gender; injured tooth; clinical appearance and location of IARF; splinting period; resorption rate of fractured fragment; and follow-up period.

RESULTS

Based on the information obtained in an inquiry, the mean age of the subjects was approximately 44.3 months old and root fractures occurred 2.3 times more often in males than females. IARF in the primary teeth usually occurred in the middle area. The mean splinting-period was 5.1 weeks, and all teeth were followed up for a long-term period lasting between 14 and 36 months. Total resorption of the fractured root fragment was observed within 10 months.

CONCLUSION

The root-fractured primary teeth can be maintained by reduction of tooth mobility and immobilization with a semi-rigid splint.

Evaluation of splinting implant impression techniques: two dimensional analyses

This paper aims to evaluate the effect of splinting during implant impression. A master model with two fixtures at the sites of 45 and 47 was used. 20 impressions were made for all four techniques: (A) indirect; (B) direct, unsplinted; (C) direct, splinted; and (D) direct, splinted, sectioned, and re-splinted. Splinting was undertaken with autopolymerizing acrylic resin (AAR). Horizontal distance between fixtures was compared using a digital caliper. The difference in distance were analysed with one-way ANOVA. Group A showed a significantly lowest accuracy among all techniques (p < or = 0.05). There was no significant difference of accuracy among the groups using direct techniques (p > or = 0.05). Group D was more accurate compared to group B and C. We conclude that splinting of impression copings would be beneficial to obtain an accurate impression.

Emerging therapies for the management of traumatized immature permanent incisors

Early loss of immature permanent teeth due to pulpal necrosis secondary to trauma can have dire consequences for a child's growth and development. The treatment alternatives include surgical endodontics, traditional calcium hydroxide apexification, and mineral trioxide aggregate (MTA) apexification. These options pose potential complications, including: arrest of root development; weakened dentinal walls; and increased potential for fracture. Revascularization of the dentin-pulp complex is a new approach that involves disinfecting the root canal system followed by tissue repair and regeneration while allowing for continued root development and thickening of the lateral dentinal walls through deposition of new hard tissue. The purpose of this report was to present the revascularization of an immature permanent maxillary central incisor that had evidence of external root resorption. Six months later, internal bleaching was performed to remove cervical discoloration from the triple antibiotic paste. At 18 months, the tooth remained vital and had evidence of continued root development.

Comparison of strains for splinted and nonsplinted screw-retained prostheses on short implants

PURPOSE

Because the evidence regarding the efficacy of splinting short implants on strain distribution is limited, this study aimed to measure and compare the strains generated by splinted and nonsplinted screw-retained implant crowns for short implants with internal connections.

MATERIAL AND METHODS

Computed tomographic scan data of a patient missing all mandibular molar teeth were digitized using a software program, and stereolithography was then used to produce an acrylic resin cast. Two 4- x 6-mm implants were placed in the left side. One set of splinted crowns and one set of nonsplinted crowns were made to fit the two implants using screw retention. Three-dimensional image correlation was used for full-field measurement of strains and provided a synchronized stereo view of the cast during the experiment. Cameras recorded changes in random dot patterns that had been applied to the surface of the cast as the prostheses were loaded up to 400 N in vertical and oblique directions using a universal testing machine. Testing was repeated three times for splinted and nonsplinted crowns. An image correlation algorithm used the dot pattern to define correlation areas. Coordinates of these areas were determined for each recorded photograph and used to calculate the strains. Strain distribution data were compared for maximum and minimum principal strains.

RESULTS

Qualitative data showed evidence of increased load sharing for splinted, screw-retained prostheses regardless of the direction of the load applied. However, the only statistically significant difference between the two prosthesis types occurred for peak maximum principal strain under oblique loading.

CONCLUSIONS

Splinting short implants may provide a more even strain distribution during functional loading. Clinical corroboration of these findings is needed.

Crown lengthening with removable orthodontics: a combined approach for ideal esthetics

Cases in which a single tooth is in need of crown lengthening while remaining esthetically pleasing represent a unique challenge. A case is presented here in which crown lengthening in a challenging esthetic situation on a canine was achieved through forced eruption with a removable orthodontic appliance. The case was considered a success by both the clinician and the patient. Fabrication of the acrylic stent is a simple procedure that can be completed chairside, and the patient's acceptance of the appliance as well as the overall cost and time invested made this a very convenient alternative. The report emphasizes the general dentist's complete control over each treatment sequence.

A comparative study of temporary splints: bonded polyethylene fiber reinforcement ribbon and stainless steel wire + composite resin splint in the treatment of chronic periodontitis

The present clinical study was undertaken to determine the effects of splinting overunsplinted mobile teeth following periodontal surgery and compared the efficacy of two splinting materials, i.e. Ribbond ribbon + Composite with Stainless steel wire + Composite.

MATERIALS AND METHODS

Total of 30 patients (20 experimental and 10 control) formed the study group. Entire study was extended over a period of 12 weeks for each patient and treatment plan was divided into 8 phases. Healing response was monitored and application, durability, biocompatibility of splint material was assessed.

RESULTS

Splint had a promising and beneficial effects on anterior teeth exhibiting Grade I to Grade II degrees of mobility. Experimental group showed a greater reduction in tooth mobility compared to control group. There was no significant difference in plaque index and Ribbond Ribbon reinforced with composite resin was an excellent material for application, patient comfort, resistance to fracture, biocompatable and esthetic acceptability.

CLINICAL SIGNIFICANCE

Splinting is recommended as an adjunct to periodontal surgery in the treatment of hypermobile teeth, especially in cases where patient discomfort is a prominent factor.

Reattachment of fractured fragment of an anterior tooth: case report and nine-year follow-up

This article reports the treatment and follow-up of a 10-year-old boy who had a politraumatic accident that resulted in severe displacement and fracture of the maxillary right central incisor. After clinical and radiographic examination, the tooth fragment was bonded with adhesive and the tooth crown underwent nonrigid splinting. Follow-up appointments were scheduled once a week during the first month, once during the second month, and every three months thereafter. Each follow-up appointment included a clinical examination, followed by radiographic and pulp sensitivity tests. After the fifth year, pulp necrosis was diagnosed following a sensitivity test and a periapical radiograph. Endodontic treatment was performed; the chemical-mechanical preparation and root canal fillings used calcium hydroxide paste manipulated with saline solution. The abovementioned paste was replaced twice during the first month; after that, propylenoglycol was used as the vehicle for manipulating the calcium hydroxide. The filling paste was replaced whenever the radiographic image showed resorption of the paste. The root canals were filled definitively seven years postaccident. Nine years postaccident, clinical and radiographic examination revealed a normal aspect.

Rehabilitation of periodontally compromised teeth with fiber-reinforced composite resin: a case report

The rehabilitation of prosthetic spaces resulting from severe periodontitis represents a challenge in terms of functional and esthetic aspects. Generally, tooth extraction is followed by alveolar ridge volume reduction, which increases the esthetic problem. The aim of this article is to report the integration of esthetics and functional parameters in the oral rehabilitation of extracted periodontally compromised mandibular central incisors through the construction of a direct glass fiber-reinforced composite fixed partial denture (DFPD). After periodontal therapy, the patient received a periodontal subepithelial graft, enabling an increase in the thickness and height of the alveolar ridge. The DFPD was fabricated with the use of extracted teeth. Mandibular canines and lateral incisors received cavities 2 mm deep and wide. After fiber insertion, tooth adaptation, and composite resin coverage, the teeth were finished and polished. Results showed an excellent esthetic result with stabilization and function of the remaining periodontally affected teeth.

Treatment outcome of 42 replanted permanent incisors with a median follow-up of 2.8 years

AIM

To evaluate the treatment outcome of avulsed and replanted permanent incisors.

MATERIAL AND METHODS

42 avulsed and replanted permanent incisors in 37 individuals were followed over a median observation period of 2.8 years (range: one year to five years). The mean age was 16.3 years at the time of replantation, with 81% of patients being younger than 20 years.

RESULTS

The tooth survival rate after replantation was 83.3% (35/42 teeth). Periodontal healing was observed in 20 teeth. External root resorption was the most frequent complication and was found in 22 of the 42 avulsed teeth: 21 teeth had replacement resorption. Of these 21 teeth, 14 teeth were still in situ at time of recall examination, seven teeth had to be extracted during the follow-up period due to progressive replacement resorption. One tooth had surface resorption. In contrast, infection-related resorption could not be observed in this sample. With regard to periodontal healing, no differences were found between teeth with short (less than 14 days) versus prolonged duration of splinting. Higher incidence of replacement resorption correlated with the extended duration of non-physiologic extraoral storage.

CONCLUSION

Use of a strict endodontic treatment protocol after replantation minimized the risk of infection-related root resorption. The occurrence of replacement resorption was mainly influenced by the duration of the non-physiologic extraoral storage time and storage medium.

Flexible wire composite splinting for root fracture of immature permanent incisors: a case report

Root fracture injuries affect up to 7% of permanent teeth, and injury in teeth with immature root formation is even rarer. The purpose of this paper was to report the case of a 7-year-old girl who experienced pain in her permanent maxillary central incisors following a fall from a bicycle. A radiographic examination revealed immature maxillary central incisors with mid-root oblique and horizontal root fractures. Splinting was performed, and the child was observed under a regular follow-up regime. After 18 months, clinical examination showed normal tooth color and position, with a positive response to the pulp test. This case report also aims to provide an insight into the splinting duration and various splinting techniques and how this can affect the prognosis.

[Prosthetic rehabilitation of patients with parodontitis based upon the use of 3D-technologies--clinical case example]

Clinical case of prosthetic rehabilitation of patient (female) with generalized parodontitis complicated by defects and deformations of dentitions was offered. Using 3D-technologies position of teeth was corrected with the help of a series of temporary transparent splints-modifiers with subsequent guy splintage and esthetic 3D-planning of front teeth forms. Teeth forms correction was made by composite using preliminary prepared templet.

A minimally invasive approach to restore function and esthetics in periodontally involved teeth

The objective of dental treatment is the elimination of the etiologic factors, the rehabilitation of function and esthetics, and, when possible, the maintenance of vitality and structure of the natural dentition. After the loss of the periodontal support, as a consequence of periodontal disease, it may be necessary to splint the residual teeth in order to improve their stability, and sometimes it is also necessary to modify the morphology to optimize the final esthetic outcome. In many periodontally treated teeth, prosthodontic treatment on the residual dentition will be required with an important loss of tooth structure as an unavoidable consequence. This procedure frequently requires endodontic treatment of the residual abutments in order to obtain the necessary space for replacement materials. Similar objectives could however be achieved through an alternative therapy where the esthetic remodeling of the teeth and the closure of the interproximal spaces is obtained with composite resin materials. The objective of this article is to present an alternative protocol to optimize the functional and esthetic result of periodontally treated cases, where the most frequent complication is the increased length of the clinical crown. This is obtained by utilizing a different conservative approach, which has as its main objective the stabilization of the residual teeth, the maintenance of their vitality, and the achievement of the best esthetic result possible.

Tooth replantation as an alternative to dental implantology in adolescent patients

A 16-years old female patient was referred to our observation in July 2006, 14 days after an accident, with traumatic intrusive luxation of the right upper central incisor that caused the nasal floor and buccal cortical bone fracture. While the extraoral examination showed the traumatic lesions of the upper lip, the intraoral examination revealed intrusive luxation, pain and high mobility of the tooth, and bleeding of the adjacent oral tissue. The treatment protocol consisted in surgical buccal bone removal, tooth extraction, retrograde root-canal filling, and tooth repositioning in occlusion with a resilient splinting. After 8 weeks the splinting was removed, and clinical and radiological examinations were taken 3, 6, 9, 12, and 24 months after surgery. At the 24 months follow-up the root showed no radiographic signs of inflammation, resorption or ankylosis, and the function of the replanted tooth was fully maintained. Tooth replantation can be considered an effective alternative to dental implant, when the latter is contraindicated in young patient with incomplete skeletal development. The long-term success of the procedure will likely require a multidisciplinary approach.

Biomechanical responses of endodontically treated tooth implant-supported prosthesis

INTRODUCTION

This study was designed to investigate the biomechanical interactions in endodontically treated tooth implant-supported prosthesis with variations in implant system and load type by using the nonlinear finite element (FE) approach.

METHODS

The computed tomography (CT), micro-CT image process, and computer-aided design systems were integrated to construct the FE models containing 1-, 2-, and 3-piece implants splinted to the second premolar. Realistic interface conditions within the implant system were simulated by using frictional contact elements, and mechanical responses in terms of von Mises stress were computed for all models.

RESULTS

The simulated results indicated that splinting an endodontically treated tooth to a neighbor implant decreased stress values in dentin and post but increased stress of implant and bone. The oblique occlusal forces increased the stress values relative to those of axial analogs. A splinted system with a 2-piece implant increased stress on the bone and decreased stress on the prosthesis compared with that of the 1-piece implant.

CONCLUSIONS

Splints with 1-piece implant prosthesis, without eccentric occlusal contacts, have better mechanical responses than those of 2- or 3-piece implants when connected to an endodontically treated tooth restored with post core and crown.

Multidisciplinary treatment of a complicated crown-root fracture

Complicated crown-root fractures are challenging for pediatric dentists to treat. Many treatment strategies have been proposed, each with their own advantages and disadvantages. The purpose of this report was to suggest a new method to treat a complicated crown-root fracture using fragment reattachment with the aid of a splint and an intracanal fiber post. It is recommended that the fractured fragment be stabilized to its original position instead of being extracted if the biological width is minimally invaded. Furthermore, the use of an intracanal post is recommended to reinforce the root in a horizontal root fracture.

Case studies in modern molar endodontic access and directed dentin conservation

The following case studies provide insight into the integration of the principles set forward in the preceding article. Each case is evaluated first on the endorestorative principles that form the basis of the modern endo-endorestorative-prosthodontic continuum. Case 1 is provided by Dr Clark, and cases 2 to 6 are provided by Dr Khademi.

Permanent teeth with horizontal root fractures after dental trauma. A retrospective study

The purpose of the present retrospective study was to evaluate the post-traumatic healing of the pulp and periodontium of 32 permanent teeth with horizontal root fractures. Twenty-nine patients, 8-48 years old, who presented at our department with a root fracture between January 2001 and April 2007, participated in the study. Root-fractured teeth with a loosened or dislocated coronal fragment were repositioned and splinted for 14-49 days (average: 34 days). In cases of severe dislocation of the coronal fragment, prophylactic endodontic treatment was performed. Follow-up examinations were conducted routinely after 1,2,3,6, and 12 months. For this study, follow-up took place for up to 7 years post trauma. Of 32 root-fractured teeth, 29 (91%) survived. 10 teeth (31%) exhibited pulpal healing; 13 teeth (41%) were prophylactically endodontically treated within 2 weeks of injury. At the fracture line, interposition of calcified tissue was evident in 6 teeth (19%), and interposition of granulation tissue was observed in 8 teeth (25%). The prognosis of the root-fractured teeth was good, and one-third of the teeth with root fractures possessed a vital pulp at the final examination.

A patient-based model study of fixed splinting of premolars with reduced periodontal support

The aim of this patient-based study was to assess the effect of fixed splinting of mandibular premolars having reduced alveolar support on load distribution in the periodontium. A patient's mandibular second premolar with considerably reduced alveolar bone height was restored using a metal-ceramic restoration splinted with the adjacent first premolar; an acceptable 3-year maintenance period was observed. A patient-based three-dimensional finite element model was constructed using the morphological measurements obtained from the diagnostic cast and radiographs. The model incorporated in vivo occlusal records and was used to analyze stress and strain in the periodontium for splinted and nonsplinted simulations. Modified models were also created to explore the effects of relative bone height on the stress and strain distributions. The maximum principal stress and strain on the periodontium of the second premolar were considerably higher before splinting than after splinting and were close to strain levels indicative of potential bone microdamage. In contrast, the stress and strain in the first premolar increased after splinting. The modified models showed that the increased vertical gap of alveolar height between the splinted teeth was another factor to increase the load in the first premolar. Since the prosthodontic procedure employed is not routinely used, the results cannot be generalized. However, it is suggested that fixed splinting can decrease the periodontal load on premolars with reduced periodontal support, but may increase the load on the splinted tooth.

Management of untreated traumatized permanent incisors with crown and root fractures: a case report

Dental trauma can lead to a wide range of injuries of which crown and root fractures are examples. This report describes the management of previously untreated crown- and root-fractured maxillary permanent incisors in an 18-year-old patient. The patient underwent no treatment for 8 years and then presented with the complaint of recurrent pain and swelling. Intraoral examination showed crown fractures in the maxillary right central and left lateral incisors, while radiographic examination revealed large radiolucent lesions related to the periapical area of these teeth and a horizontal root fracture in the middle third of the maxillary left central incisor. Endodontic therapy and periapical surgery were performed for the persistent periapical periodontitis associated with the crown-fractured teeth. Connective tissue healing was detected for the root-fractured tooth. However, because of its proximity to periapical lesions, this root-fractured tooth was also included in the periapical surgery. Follow-up 1 year later showed clinical and radiographic healing.

Management of a horizontal root fracture: a 17-year follow-up

Intra-alveolar root fractures in immature permanent teeth are relatively uncommon and often present a complicated and unpredictable prognosis. This case report documents how conservative treatment was used for the successful management (and long-term follow-up) of immature teeth with a horizontal root fracture.

Resin-bonded cast splints for loosened abutment teeth to anchor a removable partial denture: a case report

This case report describes a technique to stabilize loosened abutment teeth by seating resin-bonded cast splints with rest seats and surveyed guide planes to anchor a removable partial denture. This technique can achieve sufficient stability of the abutment teeth and proper support and bracing of the removable partial denture with minimal intervention.

Long-term provisional rehabilitation of function and esthetics using an extracted tooth with the immediate bonding technique

Extracted teeth can be bonded directly to adjacent teeth as a noninvasive long-term provisional tooth replacement. In this case report, step-by-step clinical procedures are described for using an incisal splint to simplify and ensure a precise repositioning of the extracted tooth after removal of its root. The essential steps include (1) fabrication of an incisal splint, (2) tooth extraction, (3) root removal and pontic contouring, and (4) direct bonding of the natural pontic. Using this technique, a long-term provisional fixed tooth replacement with an acceptable functional and esthetic outcome can be obtained.

Non-surgical management of an oro-antral fistula in a patient with HIV infection

BACKGROUND

The risk of post-extraction complications is higher in patients who are immunosuppressed compared to other patients with normal immune function. In addition, invasive dental procedures are more likely to have serious complications in these patients. This case report demonstrates an effective non-surgical procedure to treat an oro-antral fistula in an HIV-infected man.

METHODS

The oro-antral fistula was de-epithelialized under local anaesthesia and the patient wore a surgical splint continuously, removing it only for cleaning, for an eight week period. Chlorhexidine gel was regularly applied to the fitting surface of the splint and the oro-antral communication. The patient was reviewed on a regular basis.

RESULTS

This procedure resulted in resolution of the patient's symptoms within two weeks. Complete healing of the oro-antral fistula was evident following eight weeks of wearing the surgical splint.

CONCLUSIONS

This procedure provided an effective method of treating an oro-antral fistula in an immunocompromised patient without causing any detrimental effects to the patient's overall health. Adequate pre-surgical assessment of patients prior to extractions is important in all patients to help prevent the occurrence of such complications.