Effect of wire diameter and extent of wire composite splint on the mobility of luxated and anchor primary teeth: A typodont study

BACKGROUND/AIMS

The recommendations for splinting are well established for the injuries of permanent dentition; however, ambiguity still exists for the injuries in primary dentition. Hence, this study aimed to determine the most appropriate dimensions of stainless steel wire and its extent, for achieving the physiologic mobility in primary dentition.

MATERIAL AND METHODS

This study was designed as an in vitro experiment by using a typodont model of primary dentition. The baseline mobility of primary maxillary incisors was calibrated to the physiologic mobility of natural primary incisors by using a Teflon tape wrapped around the roots of resin teeth. Splinting was done using a stainless steel wire of 0.2 mm (Group I), 0.3 mm (Group II), and 0.4 mm (Group III). These groups were subdivided (a, b, and c) on the basis of the extent of the splint, and pre splint mobility (Pre-PV) and post-splint mobility (Post-PV) were tested by Periotest M. The splint effect was calculated by subtracting Post-PVs and Pre-PVs.

RESULTS

The normal values of mobility in healthy human volunteers ranged from 10.5 to 13. The overall splint effect was higher in Group III irrespective of the extent of the splint, whereas it was found to be the lowest in Group I (b and c). The splint effect increased with the extent of the splint in all the groups. Among all the groups, the splint effect on the anchor teeth was observed to increase with the extent of the splint and the diameter of the wire.

CONCLUSION

The mobility of the injured and anchor teeth splinted with 0.2-mm stainless steel wire was similar to the pre-splint and physiologic mobility. The most favorable extension was one tooth adjacent to the injured tooth on each side for both 0.2- and 0.3-mm wires.

A review of the iadt 2020 guidelines

Traumatic dental injuries (TDIs) are a relatively frequent occurrence, with roughly a third of adults experiencing a dental trauma at some time in their life.1 TDIs may present to dental professionals working within primary or secondary care settings. Patients presenting at the time of acute injury will require immediate management and careful long term follow up. Patients may also present later reporting a history of TDI, with developing complications and onward management required. To support dental care professionals, the International Association of Dental Traumatology's (IADT) Guidelines are available globally as a standardised tool to aid the assessment, management and follow up of dental trauma. These easy to access guidelines were updated in 2020 with four distinct publications:General Introduction,1 Fractures and Luxations,2 Avulsion of Permanent Teeth,3 and Injuries in the Primary Dentition.4 The current guidelines represent the best evidence based on available literature and expert opinion.1This paper aims to support dental professionals by specifically highlighting and describing updates in guidance, using the 2020 IADT published guidelines. By incorporating the 2020 guidelines into our everyday practice we aim to provide the most appropriate, standardised care, based on the highest level of available evidence to our patients.The full published guidelines are available free online via the IADT website.

Avulsion Injuries: Assessment and Management

Avulsion injuries, though relatively uncommon, are one of the most serious of dentoalveolar injuries. Replantation at the scene of the incident is almost always the treatment of choice whenever possible. This paper outlines a step-by-step approach for the management of avulsion injuries, including a splinting protocol. This aims to support general dental practitioners in feeling more confident with managing these injuries.

Fluorescence-aided identification technique using a low-cost violet flashlight and rotatory instruments for dental trauma splint removal

BACKGROUND/AIM

Removing resin composites used for bonding dental trauma splints may result in irreversible damage to the enamel. This in vitro study evaluated the influence of additional violet illumination and different bur types on damage caused to tooth enamel.

MATERIALS AND METHODS

Fifteen maxillary models with four bovine incisor teeth were prepared. All models were scanned using a laboratory scanning system (s600 ARTI; Zirkonzahn). Six experimental groups (n = 10) were generated by two study factors: lighting type (three levels), (1) low-cost (5-7 US$) violet LED flashlight (LUATEK, LT 408); (2) VALO Cordless light curing unit (Ultradent) with black lens; or (3) without additional illumination; and rotatory instrument (two levels), (1) diamond bur or (2) multifluted tungsten-carbide bur. New scanning was performed after splint removal, and the generated files were superimposed on the initial scans using Cumulus software. The light emitted by both violet light sources was characterized by using integrating sphere and beam profile. A qualitative and quantitative analysis of enamel damage and two-way ANOVA followed by Tukey's post hoc was used at an α = 0.05.

RESULTS

The use of low-cost violet flashlight that emitted the violet peak light at 385 nm and VALO Cordless with black lens at 396 nm resulted in significantly lower damage to the enamel surface than those in the groups without additional violet light (p < .001). An interaction between rotatory instruments and lighting was found. When no additional violet lighting was used, the diamond bur presented higher mean and maximum depth values.

CONCLUSIONS

Fluorescence lighting facilitated the removal of remnant resin composite dental trauma splints, leading to less invasive treatment. The diamond bur resulted in higher enamel damage than that affected by the multifluted bur when no violet lighting was used. A low-cost violet flashlight is a useful fluorescence-aided identification technique for removing resin composite dental trauma splints.

A Prospective Analysis of Patient Characteristics Affecting the Outcome of Dorsal Splinting for Soft Tissue Mallet Injuries

BACKGROUND

Much has been written about the diagnosis and treatment of soft tissue mallet injuries. However, there has been little regarding the characteristics of this injury affecting patients' prognosis. The purpose of this prospective study was to identify factors influencing the outcome of treatment of soft tissue mallet injuries.

METHODS

Patients diagnosed with soft tissue mallet injuries were enrolled prospectively in a protocol of dorsal splinting for 6 to 12 weeks, followed by weaning over 2 weeks and then evaluated at 6, 9, and ≥12 months.

RESULTS

Thirty-seven patients (38 digits) completed the study. Treatment success was defined as a final extensor lag of <15° and failure as a final extensor lag of ≥15°. Those failing splint treatment were older compared with those successfully treated. Patient compliance was significantly associated with a successful outcome. Factors that did not significantly affect success included time to treatment, initial injury severity, splinting duration, sex, and ligamentous laxity. Disabilities of Arm, Shoulder, and Hand scores >0 were not associated with treatment failure. Radiographic and clinical extension lag were statistically comparable.

CONCLUSIONS

This study shows strong association between the success of splint treatment, younger patient age, and compliance with the treatment protocol. Despite this finding, most patients did not report any functional limitations, irrespective of the treatment success. In contrast to prior results, time to treatment and initial extensor lag did not significantly affect treatment success.

Mobility Solutions After a Lower Extremity Fracture and Applicability to Battlefield and Wilderness Medicine

The potential for delayed evacuation of injured Service members from austere environments highlights the need to develop solutions that can stabilize a wound and enable mobility during these prolonged casualty care (PCC) scenarios. Lower extremity fractures have traditionally been treated by immobilization (splinting) followed by air evacuation - a paradigm not practical in PCC scenarios. In the civilian sector, treatment of extremity injuries sustained during remote recreational activities have similar challenges, particularly when adverse weather or terrain precludes early ground or air rescue. This review examines currently available fracture treatment solutions to include splinting, orthotic devices, and biological interventions and evaluates their feasibility: 1) for prolonged use in austere environments and 2) to enable patient mobilization. This review returned three common types of splints to include: a simple box splint, pneumatic splints, and traction splints. None of these splinting techniques allowed for ambulation. However, fixed facility-based orthotic interventions that include weight-bearing features may be combined with common splinting techniques to improve mobility. Biologically-focused technologies to stabilize a long bone fracture are still in their infancy. Integrating design features across these technologies could generate advanced treatments which would enable mobility, thus maximizing survivability until patient evacuation is feasible.

Management of a Radicular Cyst in Anterior Maxilla With Endosurgical Intervention Along With Use of Mineral Trioxide Aggregate (MTA) and Bone Graft: A Case Report

Radicular cysts are the most common cystic lesions that affect the jaws, which, though mostly asymptomatic, can be seen radiographically as an oval or pear-shaped unilocular radiolucency in the periapical region. Nonsurgical root canal procedures and periapical surgery followed by placement of bone substitute and bioceramic root-end filling material is generally the treatment of choice. This case report highlights the endosurgical management of long-standing trauma that led to a radicular cyst with respect to three maxillary anterior teeth in a young adult. The clinical and radiographic examination led to a provisional diagnosis of a radicular cyst, which was confirmed by biopsy. Non-surgical root canal treatment was performed with Mineral Trioxide Aggregate (MTA) as the apical barrier and surgical enucleation of the cyst was performed followed by placement of hydroxyapatite bone graft. Follow-ups till two years were done, which revealed the successful management of the case.

Management of Acute Carpal Tunnel Syndrome: A Systematic Review

Purpose

This review aims to compare recovery outcomes of conservative, early operative, and a combination of conservative and operative management for acute carpal tunnel syndrome (ACTS).

Methods

A literature search of PubMed, Scopus, and CINAHL from 1970 to 2022 was conducted using the keywords carpal tunnel syndrome and acute nerve compression. ACTS was defined as a case within 12 weeks of symptom onset. Primary data extracted included causes (traumatic or atraumatic), symptom duration (<1 day, 1-7 days, or 8-84 days), intervention (surgical, conservative, or conservative then surgical), follow-up duration, and outcome (full recovery or non-full recovery). Logistic regression analyses and χ2 tests were performed to investigate associations among these variables.

Results

A total of 197 patients involving 127 (64.5%) traumatic and 70 (35.3%) atraumatic cases were included. Forty-seven percent of patients were managed conservatively followed by surgery, 30% conservative only, and 23% surgery only. The traumatic group was associated with better recovery than the atraumatic group. Recovery outcomes were not associated with symptom duration or follow-up time. The choice of intervention was not associated with traumatic or atraumatic etiology, nor did it affect recovery outcomes in either group.

Conclusions

Traumatic ACTS is associated with better recovery outcomes than atraumatic etiologies. Surgical intervention was not found to be associated with better outcomes than conservative management, regardless of the etiologies. Further prospective studies are warranted to compare surgical versus conservative management.

Clinical Relevance

Currently, there are no guidelines for the best management of ACTS, and it is not known if early or delayed surgical treatment is optimal. This review compiles the current evidence and identifies gaps in the literature, highlighting the need for further investigation to provide the best clinical practice.

Effect of Splinting on Orthodontic Mini-Implant Tipping and Bone Histomorphometric Parameters: An In Vivo Animal Model Study

This study aimed to address the stability of orthodontic mini-implants submitted to an immediate orthodontic functional load, in splinted or unsplinted conditions, further characterizing the histomorphometric parameters of the neighboring bone tissue, in an in vivo experimental model. Mini-implants (1.4 × 6.0 mm) were placed in the proximal tibia of New Zealand White rabbits and immediately loaded with a 150 g force. Tissue healing was characterized within 8 weeks. Microtomography was used to assess the mini-implants' tipping and bone histomorphometric indexes. Loaded implants were evaluated in splinted and unsplinted conditions, with data being compared to that of unloaded mini-implants with the Kruskal-Wallis nonparametric test, followed by Dunn's multiple comparison tests. The splinting of mini-implants submitted to immediate orthodontic loading significantly reduced the tipping to levels similar to those of unloaded mini-implants. Immediate loading further increased the histomorphometric indexes associated with bone formation at the peri-implant region, in both splinted and unsplinted conditions, with no significant differences between the tension and compression regions. Accordingly, within this experimental setting, splinting was found to lessen tipping and mini-implants' displacement, without affecting the increased bone formation at the peri-implant region, induced by a functional orthodontic load.

Effect of splinting scan bodies on trueness of complete-arch implant impression using different intraoral scanners: an in vitro study

AIM

To evaluate the trueness of seven different intraoral scanners (IOSs) in making a complete-arch digital scan with and without splinting the scan bodies.

MATERIALS AND METHODS

A polyurethane cast of an edentulous mandible with four dental implant analogs was prepared. A reference scan was made using a laboratory scanner. The reference model was scanned with each of the seven investigated IOSs (control groups, n = 10 per scanner), and scanned again after splinting the scan bodies (study groups, n = 10 per scanner). Each scan was exported as a standard tessellation language (STL) file and transferred to a comprehensive metrology software program (Geomagic Control X). In order to measure the trueness, four points (A, B, C, and D) were determined on the scan bodies, and the distance between point A and the other points (DAB, DAC, and DAD) was measured. The measurements were tested for normality using the Kolmogorov-Smirnov test and probability plots. Trueness was compared using three-way analysis of variance (ANOVA), and pairwise comparisons were performed using the post hoc Tukey and paired sample t tests. Statistical analyses were two-sided, and the significance level was set at 5%.

RESULTS

Splinting the scan bodies improved the trueness values of the digital scans, while increasing the interimplant distance decreased them. A significant association was found between the trueness values and all three tested variables, including splinting the scan bodies, type of IOS, and interimplant distance (P < 0.001).

CONCLUSION

Based on the present findings, splinting the scan bodies can improve the trueness of complete-arch digital implant scans due to the improvement in morphologic landmarks by the stitching process, regardless of the type of IOS or the interimplant distance. (Int J Comput Dent 2023;26(1): 19-0; doi: 10.3290/j.ijcd.b2599297).

[Medical rehabilitation of patients with spinal muscular atrophy]

Rehabilitation of patients with spinal muscular atrophy (SMA) is a long-term strategy of healthcare service of Russian Federation, which is aimed at slowing down the progression of the pathological process, maximal reduction of disability and improving patients' quality of life. The development of targeted programs of medical rehabilitation for patients with SMA, aimed at the reduction of the disease's main symptoms, is relevant.

OBJECTIVE

To develop and scientifically establish therapeutic effects of complex medical rehabilitation of type II and III SMA patients.

MATERIAL AND METHODS

A prospective comparative study of the therapeutic effects of rehabilitation techniques, including 50 patients aged from 1.3 to 15.3 (average age 7.2±2.4 years) with type II and III SMA (ICD-10: G12), was done. Examined set included 32 patients with type II SMA and 18 patients with type III SMA. In patients of both groups had targeted rehabilitation programs (kinesiotherapy, mechanotherapy, splinting, use of spinal support, electric neurostimulation). Status of patients was determined by functional, instrumental and sociomedical research methods, the results of which were adequate statistically analyzed.

RESULTS

The comprehensive medical rehabilitation of patients with SMA demonstrated significant therapeutic effects with such manifestations as improvement of clinical status, stabilization and increase in joint motion, improvement of motor function of limbs' muscles, head and neck. Medical rehabilitation reduces the degree of disability, increases rehabilitation potential and the need for the technical means of rehabilitation in patients with type II and III SMA. Rehabilitation techniques help to achieve the main aim of rehabilitation - independence in daily living - for 15% of patients with type II SMA and for 22% of patients with type III SMA.

CONCLUSION

Medical rehabilitation of patients with type II and III SMA forms significant locomotor-corrective and vertebral-corrective therapeutic effects.

Comparison of accuracy of hexed and nonhexed pickup impression copings in a multiple variable impression setup for recording multiple straight and angulated implant positions: An in vitro study

Aim

The aim of this study was to evaluate and compare the accuracy of hexed and nonhexed pickup impression copings with and without splinting using polyether (PE) and polyvinyl siloxane (PVS) impression materials in open-tray technique in recording multiple straight and angulated implant positions.

Settings and Design

An accurate impression results in an accurate definitive cast, thus minimizing the incidence of prosthesis misfit. The critical aspect is to record the three-dimensional location of the implant in bone rather than reproducing fine surface details. Precise fit of a fixed implant-supported prosthesis depends on the accuracy of the implant analog location within the definitive cast. Factors which affect impression accuracy include implant angulation, impression material, impression copings, technique, and splinting.

Materials and Methods

A sample size of 80 study models fabricated from the impression of different groups was included. A reference master model based on All-on-4 implant concept with two parallel (implants 1 and 2) and two angulated (implant 3 at 17° and implant 4 at 30°) was fabricated using implant angulation guide. All impressions were recorded using open-tray impression technique. The groups were divided into two main groups of 40 samples each. Group A used hexed open-tray impression copings and Group B used nonhexed open-tray impression copings. Both the groups involved impression recording using splinted (Subgroup I) and nonsplinted impression copings (Subgroup II). Further, impressions in each subgroup were made using PE (Subsubgroups a) and PVS (Subsubgroup b). A total of eight subsubgroups with ten samples each were included. Impressions were recorded for each group and poured into Type IV die stone for fabrication of study models. After 24 h, the study models and reference master model were fitted with implant abutments for measurement with coordinate measuring machine.

Statistical Analysis Used

The mean differences of the interimplant distance R1 (1-2), R2 (1-3), R3 (2-4), and R4 (3-4) between the reference model and sample models in different subsubgroups were calculated and three-way analysis of variance test was applied with Tukey's post hoc tests.

Results

No significant difference was found in mean coronal deviations for distance R1, R2, and R3 (P > 0.05) between different study groups. P = 0.02 for R4 (distance between 17° and 30° implants) between impression materials subsubgroups suggested that significantly less distortion was created in location of highly angulated implants (>30°) using PVS impression material. Splinting and type of coping did not have a significant influence on impression accuracy. Increasing angulation decreased the accuracy.

Conclusion

PVS was found equivalent in accuracy to rigid PE for recording parallel or angulated implants. Impressions of implants with higher angulations were recorded more accurately with PVS. The study found no difference in accuracy with or without splinting. Furthermore, nonhexed impression copings facilitate easier and accurate recording of multiple angulated implant location in bone.

Dental trauma simulation training using four splinting models: A cross sectional study

BACKGROUND/AIM

Opportunities for dental students to obtain clinical experience in the management of traumatic dental injuries are scarce, and most dentists encounter difficulties with their first trauma patients after graduation. The aim of this study was to question students on the ease of handling of four types of flexible splints, with two common methods of bonding to the tooth.

MATERIAL AND METHODS

A total of 161 fourth year dental students completed a simulated treatment of an avulsed tooth using orthodontic wire, Twistflex wire, nylon fishing line, and Powermesh as splints. The bonding materials were composite resin (Spectra ST LV) or glass ionomer cement (GC Fuji LC Ortho). The students then answered 16 questions on a 5-point Likert scale, or with an open answer field.

RESULTS

Most students agreed (48.8%) or strongly agreed (31.3%) that the simulated trauma exercise assisted their learning. There was strong agreement (68.8%) and agreement (28.7%) that the simulation added value to their dental training compared to didactic training only. Similarly, 52.3% of participants strongly agreed and 40% agreed that they felt engaged in the learning activity. Only 53.8% of the participants agreed and 7.5% strongly agreed that the simulation felt realistic. Most students (56.2%) found a Powermesh/composite splint was the easiest to place, and nylon fishing line/GC Fuji LC Ortho splints was the least difficult to remove (35%).

CONCLUSION

Wire-free splints with composite bonding were judged as the easiest to place by students, while glass ionomer cement was the easiest to remove.

Comparison of the accuracy of fixture-level implant impressions using two different materials for splinting

Background. Various materials are used for splinting impression copings, the most common of which are auto-polymerizing resins. In this study, a new light-curing pattern resin (Jig-Gel) was investigated and compared with auto-polymerizing resins using two different splinting methods. Methods. After taking impressions with two different materials, a digital caliper with an accuracy of 0.01 mm was used for splinting and measuring the distances between the external parts of the analogs inside the plaster cast. The accuracy was also compared in five groups as follows; group 1: splinting of impression copings by auto-polymerizing acrylic resin, group 2: cutting the splinting of impres-sion copings with self-polymerizing acrylic resin, group 3: splinting of impression copings with a light-cured resin pattern (Jig-Gel), group 4: splinting of impression copings cut by a light-cured resin pattern, and group 5: impression with no splint. All statistical analyses were performed with SPSS 17. Statistical significance was set at P<0.05. Results. The highest impression accuracy was obtained in the group without cutting the splint of the impression copings using auto-polymerizing acrylic resin. Compared with the impression methods, impression making of non-splint samples in an impression coping was the least accurate, and the results for the two used methods were similar. Conclusion. The results of this study showed that the combination of the impression coping method and auto-polymerizing acrylic resin had the highest accuracy.

[Nasal septum perforation non-surgical treatment and preparation for plastic closure: literature review and own experience]

Nasal septum perforations complete elimination is possible only with surgical treatment. However, most of perforation symptoms and clinical manifestations can be reduced with conservative treatments, thus improving the patient's quality of life. This article presents a short review of publications and our own clinical examples of nasal septum perforation conservative treatment methods in children and adults. Palliative methods and preparing for surgical closure are described.

Conservative management of a cervical horizontal root fracture by long-term stabilisation: A case report

Cervical root fractures are often more difficult to manage than fractures of the apical and middle third of the root, due to the weak chance of healing with dental hard tissue between fragments, and the likelihood of subsequent infection of the root canal system. This case report describes the management of a cervical horizontal root fracture by repositioning the coronal fragment of a maxillary central incisor, and long-term splinting using a bonded lingual orthodontic retainer wire. Throughout the 7-year stabilisation period with clinical and radiographic follow-up, the tooth has remained asymptomatic with radiographic evidence of progressive pulp canal obliteration. In applicable cases, long-term stabilisation of the fractured coronal fragment with a fixed orthodontic retainer may offer a minimally invasive solution to maintain pulp vitality, function and aesthetics until cessation of growth or until a more comprehensive, multidisciplinary approach is required.

Conservative Non-Surgical Management of Horizontal Root-Fractured Maxillary Incisors in a Young Male with Angle Class II, Division 2, Malocclusion

Horizontal root fractures are a rare emergency in a dental office. The injury involves periodontal ligament, cementum, dentine and pulp. The healing is influenced by the location of the root fracture, the displacement of the fragments and the status of the pulp. This report presents a clinical case of horizontal fractures to both maxillary central incisors due to an act of violence. The type of occlusion has avoided a severe diastasis of the coronal parts with a subsequent damage to the pulp and periodontum. The fractures were treated with an orthodontic splint without any further therapy and hard tissue healing was observed. A careful diagnosis and well-timed treatment planning usually allow a cost-efficient and biologically-oriented therapy with a favorable outcome.

Etiology and Diagnosis of Permanent Hypoparathyroidism after Total Thyroidectomy

Postoperative parathyroid failure is the commonest adverse effect of total thyroidectomy, which is a widely used surgical procedure to treat both benign and malignant thyroid disorders. The present review focuses on the scientific gap and lack of data regarding the time period elapsed between the immediate postoperative period, when hypocalcemia is usually detected by the surgeon, and permanent hypoparathyroidism often seen by an endocrinologist months or years later. Parathyroid failure after thyroidectomy results from a combination of trauma, devascularization, inadvertent resection, and/or autotransplantation, all resulting in an early drop of iPTH (intact parathyroid hormone) requiring replacement therapy with calcium and calcitriol. There is very little or no role for other factors such as vitamin D deficiency, calcitonin, or magnesium. Recovery of the parathyroid function is a dynamic process evolving over months and cannot be predicted on the basis of early serum calcium and iPTH measurements; it depends on the number of parathyroid glands remaining in situ (PGRIS)—not autotransplanted nor inadvertently excised—and on early administration of full-dose replacement therapy to avoid hypocalcemia during the first days/weeks after thyroidectomy.

Dental trauma splint color preference of adults

The prevalence of dental trauma among children and adults is high. Most luxated teeth need splinting. The Titanium Trauma Splint (TTS) is a widely used appliance with good performance properties. Esthetics is increasingly important for most patients. Splints placed on the front teeth have a clearly visible impact on patients' appearance and, thus, on their quality of life during splint therapy. Therefore, the aim of the present study was to evaluate the esthetic preferences of adult patients with regard to different splint color and surface finish characteristics. TTS appliances were fabricated in four different colors (silver, gold, green and violet) and two different surface finishes (matt or polished) to yield a total of eight variants. The finished splints were applied to the teeth of a human model, photographed by a professional photographer, and printed as posters. Adults aged between 18 and 79 years were asked to complete a written survey containing items regarding their TTS color and surface preferences based on the posters with photographs as well as questions about previous tooth bleaching treatments, the importance of having esthetic teeth in general, and the prioritization of esthetic versus function-driven dentistry. Over 80% of participants preferred the silver matt splint over the other variants. Neither gender nor age nor other parameters had a significant influence on the choice of splint color or surface. Women placed greater importance on esthetic rather than function-driven treatment.

Effect of inciso-cervical position of wire-composite splint on the mobility of an avulsed permanent tooth: A cadaveric model study

Introduction

The wire composite splint as a general rule is placed on the middle third of labial surface of the tooth. This is due to ease of application, better isolation, and fewer chances of contamination. However, these assumptions are opinion-based, with no scientific evidence to support them. In addition, to best of our knowledge no research has been carried out to evaluate the effect of position of wire splints on the mobility of the affected tooth and anchor teeth.

Aim

The aim of this study was to evaluate the effect of the cervico-incisal position of splinting wire on the mobility of a replanted tooth and anchor teeth in a cadaveric model.

Methodology

Three cadavers (one female, 45 years old and two males, each 40 years old) were included in the study. periotest S was used to assess physiologic-tooth-mobility in three cadavers at baseline and after "extraction-replantation-wire-composite" splinting-protocol.

Results

Greatest splint effect for horizontal-mobility was found to be 9.33 ± 0.57 for Cadaver-I (incisal-third), whereas it was highest (3.66 ± 2.51) for vertical-mobility in Cadaver-II (cervical third).

Conclusion

Middle third position of wire composite splint have lowest splint effect on both horizontal and vertical mobility of replanted teeth, thus rendering the most favorable position for the establishment of physiologic mobility.

[Modern approach to the treatment of children with constant teeth avulsion]

THE AIM OF THE STUDY

Was to analyze treatment outcomes in children with constant teeth avulsion treated in Central Research Institute of Dentistry and Maxillofacial Surgery (CRIDMS).

MATERIALS AND METHODS

The study comprised 39 children aged 7-16 years treated in CRIDMS in 2015-2020. In 38 cases from 39 replantation was performed more than 24 hours after trauma. Because of delayed replantation endodontic treatment was needed in 35 cases from 38 (in one case the avulsed tooth was missing). In all 38 cases replantation was followed by splinting with either resin splint made according to original technique proposed by the authors or semi-flexible splints from orthodontic wire fixed with resin composite.

RESULTS

In one case from 39 the avulsed tooth was missing because a dentist the child first consulted was unaware of the possibility of replantation. In 38 children followed-up for 6-57 months the replanted teeth survived and were clinically asymptomatic. There were, however, obvious radiological signs of replacement resorption in 27 (71.1%) cases. Inflammatory resorption was detected in two cases (5.2%) with immature teeth undergoing apexification with calcium hydroxide.

CONCLUSION

Replacement root resorption after tooth avulsion may be seen as relatively favorable outcome preserving more bone tissue than early tooth removal. The rate of replacement resorption, however, would be less in less delayed replantation. The study results proved the necessity for additional education of parents and pediatric dentists on the first aid and treatment tactics for teeth avulsion.

Effect of implant angulation and depth on the accuracy of casts using the open tray splinted impression technique

The purpose of this study was to evaluate the accuracy of open tray dental implant impressions when the implants are placed with varying implant angulations and depths. Four partially edentulous models were fabricated using photopolymer resin, each having different angulation and depth of the implant analogs. A total of forty open tray elastomeric impressions were made which were poured in type IV die stone (n = 10). These casts were evaluated and compared for accurate reproduction of the spatial orientation of the implant analogs in the models using digitization in three dimensions. The results were analyzed using the independent T test. Statistically significant differences were observed when the casts were compared with their respective master models. These casts had the implant replicas placed deeper within the replicated soft tissue. Making accurate impressions in partially edentulous situations with dental implants placed with varying depth and angulation is critical and clinically demanding. There is a need for future in vivo research to identify methods and materials, exploring digital impression techniques as well, in order to make precise impressions.

Fractured alveolar process displacement evaluation-Effect of the rigidity of wire-composite splints

BACKGROUNDS/AIMS

Traumatic dental injuries with bone fractures require rigid splinting. The degree of rigidity of the wire-composite splints can be challenging. The aim of this study was to evaluate the effect of the rigidity of different wire-composite splints on alveolar process displacement.

MATERIAL AND METHODS

A model was created using polystyrene resin to simulate the anterior maxilla, bovine incisors to simulate maxillary incisors, and polyether impression material to simulate the periodontal ligament. An alveolar process fracture was created, while maintaining the labial bone connection with the PDL. Four wire-composite splints (0.3, 0.6, 0.9, and 1.2 mm in diameter) were compared with models without splints and with no fracture (n = 5). The alveolar process displacement was measured (3 times per model/per splint type) at the fractured and adjacent central incisor regions using a deflectometer (Instron) under functional cycling and static loading (100 N). Data (μm) were analyzed using RM ANOVA, followed by Tukey's HSD test (α = 0.05).

RESULTS

The displacement at the region of the adjacent incisor was not influenced by the splint during static and cycling load (P > .05). The Tukey test demonstrated that the model without splints had significantly higher alveolar process displacement at the traumatized teeth than that of all other splint models (P < .001). Increasing the wire diameter from 0.3 mm to 0.9 mm significantly reduced the alveolar process displacement (P < .001). No difference was observed between the 0.9 mm (P = .123) and 1.2 mm (P = .219) wire-composite splints irrespective of the measured tooth regions.

CONCLUSIONS

The rigidity of the wire-composite splint significantly influenced the mobility of the fractured alveolar process. The use of at least 0.9 mm wire was effective in reducing the fractured alveolar process displacement to a level that was similar to the adjacent teeth.

Photoelastic stress analysis of different types of anterior teeth splints

BACKGROUND/AIMS

Traumatic dental injuries are highly prevalent and are considered an important health problem. The aim of this study was to evaluate the in vitro stress distribution around simulated traumatized teeth subjected to different types of splints by photoelastic analysis.

MATERIALS AND METHODS

For each group, five models of maxillary and mandibular arches were made in photoelastic resin using prefabricated teeth models, which were fixed and adjusted in a semi-adjustable articulator. All splints were bonded with composite resin on the labial surfaces of the maxillary central incisors, the lateral incisors and the canine teeth, simulating trauma to the 11. The groups were divided according to the type of splint: control-without splint; rigid-brackets and 0.021 × 0.025 inch stainless steel wire; semi-rigid-brackets and 0.016 × 0.016 inch cobalt-chromium wire; fiber-fiberglass ribbon; and flexible-nylon thread. The groups were submitted to an occlusal force in a special device attached to a universal test machine in balanced, protrusive, and lateral occlusions. Then, the incisal edge of the 11 was ground to simulate infra-occlusion, and the tests were performed again. Five points were analyzed around tooth 11 with a polariscope, and the data were submitted to ANOVA and Tukey tests at a 5% level of significance.

RESULTS

When centric occlusion was analyzed by comparing normal occlusion to infra-occlusion, all groups showed high stress values in infra-occlusion with statistical differences-except for the control group. When lateral occlusion was analyzed, the nylon splint showed lower statistical differences compared with the control, fiberglass, and rigid splint groups, which did not differ between each other. The semi-rigid splint did not differ from any group.

CONCLUSIONS

Fiberglass and semi-rigid splints showed better stress distribution around the traumatized tooth under occlusal loads. The nylon splint showed characteristics of non-stress distribution.

Restoration of converging implants: Restorative complexity to facilitate retrievability

Implant treatment should be restoratively driven, however at times, ideal implant positioning may be sacrificed for surgical convenience at the expense of restorative complexity. A prosthesis incorporating a novel design was constructed to restore two converging implants placed in close proximity utilizing standard implant impression componentry and simple clinical stages. As the use of angulated screw channel technology was not possible, a customized cast “rest” abutment and overlying telescopic crown was fabricated that facilitated access for oral hygiene and retrievability as required. The complexity of the case design was transferred to the laboratory phases of construction. The case presented a satisfactory clinical outcome for an initially challenging implant presentation and reinforced the need to work closely with the laboratory technician.

An advanced stage of carpal tunnel syndrome - is night-time splinting still effective?

OBJECTIVES

There is no consensus on whether conservative treatment with night splints is indicated also in moderate and severe stages of carpal tunnel syndrome (CTS). The goal of this study was to compare the efficacy of night-time splinting at different stages of CTS.

MATERIAL AND METHODS

Forty-five patients with electrodiagnostic (EDX) features of CTS included in the study were divided into 2 groups based on nerve conduction studies. The patients in the first group had only median nerve sensory fiber involvement, whereas the patients in the second group had also motor fiber involvement. The custom-made volar night splint was the only treatment for all of the included patients. The patients were assessed before the fabrication of orthosis and after 12 weeks of its use. The parameters measured were hand grip strength and the<i> Visual Analogue Scale</i> for pain and paraesthesia. The patients further completed the <i>Boston Carpal Tunnel Syndrome Questionnaire</i> (BCTQ) and a shorter version of the <i>Disabilities of the Arm, Shoulder and Hand Questionnaire</i> (QuickDASH).

RESULTS

In the first group, a statistically significant improvement was established in paraesthesia and hand grip strength (p = 0.019, p = 0.024, respectively), but there was no statistically significant improvement in pain, and the results of both BCTQ and QuickDASH. In the second group, a statistically significant improvement was found in paraesthesia, the <i>BCTQ Symptom Severity Scale</i> and QuickDASH results (p = 0.008, p < 0.001, p = 0.011, respectively), whereas no statistically significant improvement was established in pain, hand grip strength and the<i> BCTQ Functional Status Scale</i>. However, when comparing the change in the outcome measures between the 2 groups, no statistically significant differences were found.

CONCLUSIONS

This study has shown that 12-week night-time splinting is beneficial not only for patients with mild CTS but also for those with advanced CTS, and those awaiting surgical treatment. Therefore, splinting is recommended for all patients with CTS. Int J Occup Med Environ Health. 2020;33(6):771-80.

Best Splinting Methods in Case of Dental Injury-A Literature Review

The objective of this manuscript was to review the literature on dental trauma splints and discuss materials used for splinting injured teeth in terms of their properties and conditions that are required for optimal stabilization. A literature search was conducted in the PubMed database with the keywords: "trauma splints", "dental trauma" and "traumatic dental injuries". The search was limited to English language publications. 42 publications fulfilled the inclusion criteria and were in accordance with the current recommendations. Optimal splinting of the teeth after trauma is one of the main predictors for pulpal and periodontal healing. The splints stabilize and protect the teeth, creating favorable conditions for the regeneration of the supporting tissues. Their application and removal should be easy and fast without any additional irritating of the surrounding tissues. The materials used to stabilize the injured teeth should keep the tooth in the original position, allowing for its physiological mobility.

Implant splinting in mandibular overdentures: a systematic review with meta-analysis of randomized clinical trials

OBJECTIVES

To evaluate the influence of implant splinting on peri-implant marginal bone level and implant failures in completely edentulous patients who have been rehabilitated with mandibular implant overdentures.

METHOD AND MATERIALS

A literature search of electronic databases (PubMed and Cochrane Central Register of Controlled Trials [CENTRAL]) was performed, with the last search conducted in July 2019. Randomized controlled trials with at least a 12-month follow-up period were selected. The review and meta-analysis were performed in accordance with PRISMA guidelines. Two comparisons were included in the meta-analysis: (1) Two-implant supported ball versus two-implant supported bar mandibular overdenture; (2): Two- versus four-implant supported bar mandibular overdenture.

RESULTS

Six randomized controlled trials fulfilled the inclusion criteria and were included in a quality assessment and meta-analysis. Pooled data revealed a nonsignificant difference in marginal bone level (I2 = 0%; P = 1; mean difference = 0.00; 95% CI -0.37 to 0.37) and implant failures (P = .24; risk ratio = 6.07; 95% CI 0.30 to 121.33) when two-implant ball overdentures were compared to two-implant bar overdentures. Similarly, there was no significant difference in marginal bone level (I2 = 59%; P = .59; mean difference = -0.16; 95% CI -0.73 to 0.41) or implant failures (I2 = 0%; P = .36; risk ratio = 2.03; 95% CI 0.45 to 9.16) when two- versus four-implant bar overdentures were compared.

CONCLUSION

Based on the findings of the meta-analysis, there is no influence of implant splinting on peri-implant marginal bone level and implant failures for completely edentulous patients rehabilitated with mandibular implant overdentures. However, this result should be interpreted with caution due to the limited number of analyzed studies, most of them considered at unclear risk of bias. Well-designed randomized controlled trials with follow-up periods of at least 5 years are highly recommended to establish evidence with regard to the influence of implant splinting on mandibular overdentures.

Evaluation and comparison of stress distribution around periodontally compromised mobile teeth splinted with different materials: Three-dimensional finite element analysis

Background

Progressive attachment loss around the teeth because of periodontal disease can result in increased tooth mobility. This adversely affects patient's comfort, function, and esthetics. Periodontal splinting helps in accomplishing stability by redistributing the functional and parafunctional forces. There are various materials that have been used for periodontal splinting. Fiber-reinforced composite, composite resin, and metal-reinforced composite are often used as splinting materials for periodontally compromised teeth. In our study, a comparison was done among these materials for their ability to distribute the stresses at different bone levels in mobile lower incisors splinted together with canines.

Materials and Methods

Five patients of age group 25-50 years with Grade 2 and 3 mobile incisors having 40% or more bone loss and firm canines with optimal bone support were selected. From the computed tomography scan of each patient, three models were developed demonstrating splinting of mandibular incisors and canines with metal-reinforced composite, fiber-reinforced composite, and composite resin. So in total, 15 models were developed and each one of them was subjected to vertical and transverse loads of 150 N. Pattern of stress distribution was observed in these models using three-dimensional finite element analysis.

Results

After splinting, the stress on the canine increased when bone levels around incisors decreased while stress on incisors reduced.

Conclusion

Tested splinting materials were successful in stress distribution, and metal-reinforced composite was found to be better than the other splinting materials.

Effectiveness of a programme comprising serial casting, botulinum toxin, splinting and motor training for contracture management: a randomized controlled trial

OBJECTIVE

To determine the effectiveness of a programme comprising serial casting, botulinum toxin, splinting and motor training in contracture management.

DESIGN

A randomized trial with concealed allocation and assessor blinding, a deferred treatment cross-over design within the control group, was conducted.

SETTING

Inpatient Brain Injury Unit of a rehabilitation centre.

SUBJECTS

A total of 10 patients with severe acquired brain injury (13 ankles).

INTERVENTIONS

The intervention group received botulinum toxin and then serial casting. The control group was placed on a wait list for six weeks (control phase) and then received the same interventions as the intervention group (intervention phase). Both groups received splinting and motor training following serial casting.

MAIN MEASURES

The primary outcome was passive ankle dorsiflexion range. Secondary outcomes included spasticity, ankle dorsiflexor strength, Functional Independence Measure score for the walking item and walking speed.

RESULTS

The mean between-group difference for passive ankle dorsiflexion range at completion of casting was 26° (95% confidence interval (CI): 17-35); at Week 2, after casting was 24° (95% CI: 14-33). The mean within-group differences for passive ankle dorsiflexion at completion of casting, Week 2 after casting and Week 8 after casting were 26° (95% CI: 20-31), 26° (95% CI: 18-33) and 24° (95% CI: 19-30), respectively. These improvements were sustained at Week 2 and Week 8 after casting.

CONCLUSIONS

A programme for contracture management comprising serial casting, botulinum toxin, motor training and splinting can be useful in improving joint range.

Three-dimensional printed degradable splint in the treatment of pulmonary artery sling associated with severe bilateral bronchus stenosis

Pulmonary artery sling is a congenital cardiovascular disease and is usually accompanied by tracheobronchial stenosis. Generally, infants diagnosed with pulmonary artery sling should have surgery. However, the treatment of tracheobronchial stenosis is still controversial. Our team developed a customised, degradable, three-dimensional printed splint and successfully applied it in the treatment of pulmonary artery sling associated with severe bilateral bronchus stenosis. We suggested that three-dimensional printing may be a novel and effective way to treat tracheobronchial stenosis and other diseases in children.

Radiographic Changes in Nonoperative Contralateral Knee After Unilateral Total Knee Arthroplasty

BACKGROUND

Some patients perceive symptomatic improvement in the contralateral knee after unilateral total knee arthroplasty (TKA). This so-called "splinting effect" has been observed but has not been radiographically evaluated.

METHODS

A retrospective review of patients with bilateral knee osteoarthritis treated with unilateral TKA was performed. Patients were subcategorized into 2 groups based on whether contralateral TKA was performed within the 2-year period. Contralateral radiographic measurements were performed.

RESULTS

Forty-four of 203 patients had contralateral TKA performed within 2 years. Preoperative parameters were significantly worse in the bilateral group. By 6 weeks postoperatively, mechanical axis plumbline improved approximately 1°, with more change in those patients with preoperative varus alignment. Larger delta changes were also present in bilateral group preoperative to 1-year radiographs for tibiofemoral angle and joint space widening.

CONCLUSION

In patients with bilateral knee osteoarthritis who undergo unilateral TKA, a splinting effect may be present and measurable radiographically with improvement of contralateral mechanical axis plumbline. Further research is necessary to determine whether this improvement may delay contralateral TKA implantation.

Surgical and Nonsurgical Management of Mallet Finger: A Systematic Review

PURPOSE

The current literature describes multiple surgical and nonsurgical techniques for the management of mallet finger injuries, and there is no consensus on the indications for surgical treatment. The objective of this study was to determine, through a literature review, if any conclusions can be drawn concerning the indications for surgery in mallet finger injuries; the treatment outcomes of surgical versus nonsurgical management; the most effective methods of surgical and nonsurgical treatment; and the most common treatment complications of mallet finger injuries.

METHODS

A systematic review of multiple databases was performed. English language clinical studies evaluating therapeutic interventions for mallet fingers that reported objective, standardized outcome measures were included. Basic science studies, cadaveric studies, conference abstracts, level V evidence studies, studies lacking statistical data, and tendinous injuries other than mallet fingers were excluded. Salvage procedures and studies evaluating exclusively chronic lesions were also excluded.

RESULTS

Forty-four studies that reported clinical outcomes for the treatment of mallet finger injuries, 22 evaluating surgical treatments and 17 studies investigating nonsurgical treatments were included. The average distal interphalangeal joint extensor lag was 5.7° after surgical treatment and 7.6° after nonsurgical treatment. Complication rates of surgical and nonsurgical interventions were comparable (14.5% and 12.8%, respectively). Five studies directly compared the outcomes of surgical with nonsurgical management, with mixed results and recommendations.

CONCLUSIONS

Both surgical and nonsurgical treatments of mallet finger injuries lead to excellent clinical outcomes. Insufficient evidence is available to determine when surgical intervention is indicated. Based on our literature review, it appears that these treatments are equivalent and should be individualized to the patient.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

Accuracy of a new elastomeric impression material for complete-arch dental implant impressions

AIM

The aim of the present study was to assess the accuracy of multi-unit dental implant casts obtained from two elastomeric impression materials, vinyl polyether silicone (VPES) and polyether (PE), and to test the effect of splinting of impression copings on the accuracy of implant casts.

METHODS

Forty direct impressions of a mandibular reference model fitted with six dental implants and multibase abutments were made using VPES and PE, and implant casts were poured (N = 20). The VPES and PE groups were split into four subgroups of five each, based on splinting type: (a) no splinting; (b) bite registration polyether; (c) bite registration addition silicone; and (d) autopolymerizing acrylic resin. The accuracy of implant-abutment replica positions was calculated on the experimental casts, in terms of interimplant distances in the x, y, and z-axes, using a coordinate measuring machine; values were compared with those measured on the reference model. Data were analyzed using non-parametrical Kruskal-Wallis and Mann-Whitney tests at α = .05.

RESULTS

The differences between the two impression materials, VPES and PE, regardless of splinting type, were not statistically significant (P>.05). Non-splinting and splinting groups were also not significantly different for both PE and VPES (P>.05).

CONCLUSIONS

The accuracy of VPES impression material seemed comparable with PE for multi-implant abutment-level impressions. Splinting had no effect on the accuracy of implant impressions.

12 years' preservation of maxillary permanent incisors with cervical root fractures adjacent to aggressive periodontitis: Report of a case

This case report presents long-term results following horizontal root fracture of both maxillary central incisors in a 19-year-old woman with aggressive periodontitis. Due to extensive marginal bone loss and the close proximity of the fracture lines to the bottoms of the periodontal pockets, the prognosis of both teeth was uncertain at the time of the accident. Nevertheless, a conservative treatment strategy consisting of splinting and nonsurgical periodontal therapy was initiated. Follow-up at 12 years after the start of treatment revealed a stable situation from clinical and radiologic perspectives. Permanent fixation to the adjacent teeth and regular supportive periodontal care were the basis for a favorable long-term prognosis.

Dental splints: types and time of immobilization post tooth avulsion

Avulsion is defined as the complete displacement of the tooth out of its socket with disruption of the fibers of periodontal ligament, remaining some of them adhered to the cementum and the rest to the alveolar bone. This condition is more frequent in young permanent teeth, because the root development is still incomplete. Splints are used to immobilize traumatized teeth that suffered damage in their structures of support, preventing their constant movement. The literature has shown that after replantation, it is necessary to use splints in order to immobilize the teeth during the initial period, which is essential for the repair of periodontal ligament; the use of semi-rigid splint is more indicated than the rigid one, and long periods of splinting showed that substitutive resorption or ankylosis is an expected complication. Thus, the aim of this review is to describe the different types of splints; their time of permanency, and its influence on the process of healing and reparation on the occurrence of substitutive resorption or ankylosis. It is very important to keep gathering knowledge about this content, since it has been proved that the approaches and the protocols keep changing over time.

Long-term stability of splinted anterior mandibular teeth during supportive periodontal therapy

OBJECTIVE

The aim of the study was to retrospectively assess the survival rate and stability of periodontally compromised and mobile anterior mandibular teeth after splinting in patients under supportive periodontal therapy (SPT).

MATERIALS AND METHODS

Thirty-nine patients with splinted anterior mandibular teeth and SPT (≥1 visit/year) for 3-15 years were re-examined. Periodontal status, patient and tooth-related factors were assessed retrospectively before (baseline) and 3 years after splinting (n = 39 patients, 162 splinted teeth). For patients with splints inserted for more than 3 years, retrospective data after 5 (n = 30), 7 (n = 24), 10 (n = 16), 12 (n = 8) and 15 years (n = 4) was included, if available. At baseline, splinted teeth included at least one tooth with increased mobility combined with clinical attachment loss (CAL) ≥ 5 mm and ≥50% relative bone loss (RBL). Baseline RBL of splinted teeth was assessed for all patients. Change in RBL was assessed after 10 years, if available.

RESULTS

No splinted tooth was lost within the first 3 years after splinting. One splinted tooth was lost 7 years after baseline and one 12 years after baseline. After 3 years mean(SD) periodontal probing depth of splinted teeth decreased from 3.39(1.41) mm to 2.12(0.37) mm and mean(SD) CAL from 5.61(1.66) mm to 5.09(1.67) mm and remained stable over the observation period. No change in RBL was observed over a 10-year period (p = .213). The survival rate of the splints until fracture or debonding was 74.4% after 3 years.

CONCLUSIONS

Periodontally compromised splinted teeth show a high survival-rate and periodontal stability during SPT.

Pilot report: non-operative treatment of Mayo Type II olecranon fractures in any-age adult patient

BACKGROUND

We report on the non-operative treatment of Mayo Type II olecranon fractures.

METHODS

Fourteen isolated Mayo Type II olecranon fractures were treated non-operatively, followed to discharge, and retrospectively reviewed. Treatment was splinting in extension followed by protected active motion beginning 3 weeks to 4 weeks post-injury. Mayo Elbow Performance Index (MEPI) and Shortened Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores were available in 86% and 64% of cases, respectively. Follow-up radiographs were obtained.

RESULTS

At discharge, the mean (SD) MEPI score was 95 (5). The mean (SD) elbow motion arc was 121° (21°). One patient re-fractured his elbow after discharge by falling on the ice. He recovered after open reduction and internal fixation. One patient (documented Marfan syndrome) developed an asymptomatic non-union. Excepting the patient who fell, no patient received additional care.

CONCLUSIONS

In this pilot report, Mayo Type II olecranon fractures were treated non-operatively to discharge. Good to excellent results were obtained in all patients according to the MEPI. Supportive care of these fractures should be comparatively studied. A downside risk to providing supportive care for these fractures was not identified.

Eva Vacuum-Formed Alternative Splinting of Alveolar Fractures in Primary Dentition: A Case Report

Alveolar fractures treatment includes repositioning of displaced segments and splinting. In children, splinting procedures may occasionally present clinical problems resulting from fewer teeth available for splinting or presence of occlusal disturbances. An alternative clinical approach for splinting in alveolar fractures of primary dentition is described.

CLINICAL CASE

A 4.5-year-old girl was referred to our clinic 8 hours after a fall accident. Clinical examination revealed mandibular alveolar process segmental fracture in the right canine area with frontal dislodgement of the labial cortical bone resulting to occluding inability. The area was anaesthetized, cleaned and the dislodged bone was manually repositioned, followed by an EVA copolymer splint for fixation as a result of patient's deep bite impeding regular wire-composite splint. The cap splint that was fabricated on a cast made after an alginate impression, was set on the mandibular dentition and immobilized in the primary molars with acid-etch adhesive and flowable resin composite. Following splint removal after 4 weeks and follow-up visits, successful healing was observed clinically and radiographically with no pathological signs and symptoms.

CONCLUSION

The described alternative splinting method in alveolar fractures of primary dentition is a valuable clinical tool for peediatric dentists, easily accepted by children in cases where regular splinting methods cannot be used.

Newborn Ear Deformities: Early Recognition and Novel Nonoperative Techniques

Congenital auricular anomalies are common sources of aesthetic concern and psychosocial distress for both children and their parents. Only one-third of these anomalies self-correct, leaving a large need for acceptable corrective methods. Otoplasty is often the standard treatment; however, newer nonsurgical methods, including splinting and molding in the neonatal period, have shown favorable results without the complications of surgical intervention and with the advantage of early intervention. These treatment options have not yet been widely adopted in Western countries due to delayed diagnosis of auricular deformities and confusion regarding treatment indications and technique.

Influence of Screw Surface Treatment on Retention of Implant-Supported Fixed Partial Dentures

The aim of this study was to assess the effect of a diamond-like carbon (DLC) coating on the removal torque of prefabricated implant screws after cyclic loading. Four groups with two crowns supported by two implants (n = 5) were obtained according to splinted and nonsplinted prosthesis, using titanium or DLC screws (splinted crowns with titanium screw [STi], splinted crowns with DLC screw [SC], nonsplinted crowns and titanium screw [NSTi], and nonsplinted crowns and DLC screw [NSC]). The prosthetic screws were tightened at 32 Ncm and retightened, and the specimens were submitted to 106 mechanical cycles (4 Hz/98 N). After cyclic loading, loosening torque was evaluated, and the final measurements were performed. Data were analyzed by two-way analysis of variance and Tukey's test (α = .005). There was statistically significance in the interaction of screw × splinting (P = .003). For the group that used titanium screws, NSTi showed smaller removal torque compared with STi. It was concluded that the use of the DLC coating screws in nonsplinted prosthesis maintain the torque after cyclic loading.

Casting and Splinting Management for Hand Injuries in the In-Season Contact Sport Athlete

Context:

Upper extremity injuries are extremely common in contact sports such as football, soccer, and lacrosse. The culture of competitive athletics provides an environment where hand injuries are frequently downplayed in an effort to prevent loss of game time. However, studies have shown that many sport-induced hand injuries do not actually require immediate surgical attention and can be safely treated through immobilization so that the athlete may complete the athletic season. In these cases, appropriate casting and splinting measures should be taken to ensure protection of the injured player and the other competitors without causing loss of game time.

Evidence Acquisition:

Articles published between 1976 and 2015 were reviewed to capture historical and current views on the treatment of hand injuries in the in-season athlete.

Study Design:

Clinical review.

Level of Evidence:

Level 5.

Results:

Although traditionally many sports-induced traumatic injuries to the hand held the potential to be season-ending injuries, experience has shown that in-season athletes do not necessarily need to lose game time to receive appropriate treatment. A thorough knowledge of converting everyday splints and casts into game day, sport-approved protective immobilization devices is key to safely allowing athletes with select injuries to play while injured.

Conclusion:

Protective techniques allow for maximum functionality during gameplay while safely and effectively protecting the injury from further trauma while bony healing takes place.

A Systematic Review on the Effect of Mechanical Stretch on Hypertrophic Scars after Burn Injuries

Objective/Background

To review the effect of mechanical stretch on hypertrophic scars after burn injuries.

Methods

A systematic review of all controlled trials related to the effect of mechanical stretch on post burn hypertrophic scars was conducted. Studies of conservative scar managements that applied mechanical forces parallel to the scar surface, including stretching exercise, massage, and splinting, were appraised. Eligible studies published in English between 1995 and 2016 were extracted from The Cochrane Library, MEDLINE, CINAHL, Science direct, SPORTDiscus, and Physiotherapy Evidence Database Scale (PEDro). The journals were further screened with inclusion and exclusion criteria. PEDro was selected for further analysis and appraisal.

Results

There were 853 articles identified. After a standardized screening mechanism stipulated, only nine full-text articles were selected for critical appraisal using PEDro. There were five articles of high quality, two of fair quality, and two of poor quality. Detailed training regime and outcomes of nine studies were summarised, including two studies with stretching exercise, six studies with massage, and one study with splinting. The physical parameters of scar assessments and the range of motion on affected areas were compared.

Conclusion

From extensive literature search, there was no strong evidence indicating the positive effect of mechanical stretch using stretching exercise, massage, or splinting on hypertrophic scars. A firm conclusion cannot be drawn for the discrepancy of outcome measures and varied effectiveness. Most of the included studies lacked objective evaluation or control group for comparison. Further high quality studies with larger sample size and using standardized measurements are needed.

Calcaneus Fractures: A Possible Musculoskeletal Emergency

BACKGROUND

Calcaneal fractures are commonly seen and treated in the emergency department. There are subsets of calcaneal fractures that pose a high risk to the adjacent soft tissue of the heel and can result in full-thickness tissue necrosis.

OBJECTIVE

To identify which calcaneal fractures need to be managed within hours and triaged to the orthopedic team and which can be temporized in a neutral or plantarflexed ankle splint and seen in an outpatient setting.

DISCUSSION

Tongue-type calcaneal fractures and tuberosity fractures must be triaged appropriately within the first few hours of presentation to prevent skin compromise. This requires the emergency physician to understand the radiographic morphology of the fracture as well as the clinical signs of skin compromise. Communication with the orthopedic surgery service is essential and splinting in a specific manner is important to stabilize the soft tissue envelope.

CONCLUSION

Recognizing the calcaneal injury pattern and implementing the correct treatment strategy is paramount to having successful patient outcomes. A delay or error in treatment can turn a closed fracture into an open fracture.

An Educational Intervention to Improve Splinting of Common Hand Injuries

BACKGROUND

Hand trauma is a top presenting complaint to hospital emergency departments (EDs) and can become costly if not treated effectively. The cornerstone for initial management of the traumatized hand is application of a splint. Improving splinting practice could potentially produce tangible benefits in terms of quality of care and costs to society.

OBJECTIVES

We sought to determine the following: 1) whether the present standard of ED splinting was appropriate and 2) whether a strategically planned educational intervention could improve the existing care.

METHODS

We used a pre- and postprospective educational intervention study design. In the preintervention phase, patients referred to our hand clinic were assessed for injury and splint type. Splinting appropriateness was evaluated according to a predetermined hand surgeons' expert consensus. Next, an educational intervention was targeted at all ED staff at our institution. Postintervention, all patients were again evaluated for splint appropriateness. A follow-up evaluation was performed at 1 year to see the long-term effects of the intervention.

RESULTS

The most common mechanism of injury of referred patients was falling (35%), and the most frequent injury was metacarpal fracture (40%). Splint appropriateness increased significantly postintervention from 49% to 69% (p = 0.048). At follow-up after 1 year, splinting appropriateness was 70% (p = 0.041).

CONCLUSION

Appropriate hand splinting practice is essential for hand trauma management. Our results show that an educational intervention can successfully improve splinting practice. This quality of care initiative was low-cost and demonstrated persistence at 1 year of follow-up.

Diet and Implant Complications

A hard or coarse diet may impart a substantial off-axial load to dental implant-supported prostheses and may induce a component, implant midbody fracture or late loss of integration. This may be especially true when there is a large crown to implant ratio. A patient who is able to generate an excessive bite force along with chronic cyclic loading with hard or coarse foods may have implant body or component fractures. There are no established parameters for crown to implant ratio or for detrimental bite loads. Implant longevity may be dependent on many factors, including the supporting bone quality and volume, crown to implant ratio, implant width and length, the prosthetic occlusal scheme and bite force/arch location, and the patient's dietary load.

A 22-year follow-up of an endodontic implant

Root fractures in the middle and apical thirds of the root are treated by repositioning and for approximately 6 weeks of immobilization while those in the cervical third are immobilized for 3 months. Even though the results are good, some root-fractured teeth are lost and replaced by dental implants or fixed partial dentures. One historic but effective treatment option for those root fractures with unfavorable crown to root ratios is an endodontic implant in middle and apical third root fractures. This method offers immediate stable fixation of a crown and its coronal root segment to the underlying alveolar bone. This report documents the long-term survival of a tooth treated with an endodontic implant. A 25-year-old male patient presented following a bicycle accident with a dislocated unfavorable root fracture in the middle third. The crown with the coronal root segment was secured to the bone using a commercially available endodontic implant. The apical part of the root was removed. Although the clinical and radiological follow-up results of the endodontic implant demonstrated a good clinical function and little bone loss, the implant ultimately had to be removed after 22 years of service due to pain and increasing mobility.

Management of a rare combination of avulsion and intrusive luxation: A case report

In traumatic dental injury, concomitant occurrence of avulsion and intrusive luxation is exceptional. This is because the vectors of forces responsible for both avulsive and intrusive injuries are in different directions. The present case report reviews the management of a rare combination of avulsion in right maxillary lateral incisor (tooth #12) and intrusive luxation in right maxillary central incisor (tooth #11) in a 22-year-old Asian male. Clinical and radiographic evaluation was done at 12-month follow-up. Various treatment modalities and complications associated with both avulsion and intrusion are also discussed in the paper.

A sectional-splinting technique for impressing multiple implant units by eliminating the use of an open tray

Since the inception of root form implant dentistry by P-I Branemark in the early 1980's, so many technical advances have been put forward by several authors. However, the open tray impression technique is still performed for impressing multiple implant fixtures as it was first described in the original Branemark procedure manual. The most critical aspect for a successful implant-supported restoration is the passive and an accurate fit of superstructures to avoid preload and loading stresses. Splinting impression technique in multiple implants has gained popularity. Auto-polymerizing acrylic resin is among the most routinely practiced splinting material for multiple implant units. However, unfortunately, it exhibits shrinkage, which makes an impression quite inaccurate. This case report presents the solution to minimize the shrinkage of resin by utilizing sectional-splinting technique as advocated in the previous implant literature.

Physical therapy and splinting after flexor tendon repair in zone II

INTRODUCTION

Early physical therapy and splinting after flexor tendon repair in zone II is very important to improve tendon healing, increase tensile strength, decrease adhesion formation, early return of function and less stiffness and deformity. We conducted a study to observe and record the results of early active mobilization of repaired flexor tendons in zone II.

MATERIALS AND METHOD

This study reports the results of physical therapy and splinting which was applied to 75 patients with 76 digits after flexor tendon repair in zone II, treated at the Department of Plastic Surgery and Physical and Rehabilitation Medicine Clinic, Pristine-Kosovo. Physical therapy and splinting started the first day after surgery and have lasts until week 12. Patients were evaluated with regarding to the range of motion and grip strength. The assessments were done at the 8, 10, 12 weeks and the finale assessments were done after 6 months.

RESULTS

Range of motion after 6 months according to the Strickland Classification were excellent in 21.1%, good in 44.7, fair in 11.8% and poor in 22.4%. Grip strength was good in 63.8% of cases.

CONCLUSION

Results of this study shows that using a physical therapy and splinting achieve good results in range of motion, muscle force and early return of function of the hand.