Splinting of teeth following trauma: a review and a new splinting recommendation.

With advances in the understanding of healing processes of the periodontium, pulp and alveolar bone following various injuries, the role of splinting has become relatively well defined. This is generally reflected in the guidelines for trauma management published by the International Association of Dental Traumatology. While the widespread use of composite resin as an adhesive in various functional/flexible splinting systems has over many years allowed ease of application, removal of the material is not only time consuming but more seriously accompanied by minor or major iatrogenic damage to enamel. Dental materials science has continued to provide new materials and amongst them the development of resin activated glass-ionomer cement suitable for orthodontic bracket cementation has allowed the development of an alternative simplified splinting regimen for traumatized teeth which offers ease of application and removal with minimal or no iatrogenic damage to enamel.

The comparative study of thin and thick surgical splint during Le Fort I osteotomy in vertical maxillary excess.

In the maxillary superior reposition during Le Fort I surgery, 2 types of intermediate surgical splints (thick and thin splints) are used which help to place the maxilla in its new position. The aim of the study was to compare thin and thick surgical splint during Le Fort I osteotomy in vertical maxillary excess subjects. Splints were prepared using a model surgery on casts and were used during surgery. We determined changing in vertical reference lines on the maxilla when it was positioned. We evaluated 19 subjects (6 females and 13 males) that consisted of 10 skeletal class II-vertical maxillary excess (VME), 8 skeletal class III-VME, and 1 pure VME. Results showed that the changing the splint would lead to change in reference lines in 6 subjects (32%). In 4 subjects, reference line changes were positive and in 2 subjects were negative. In the remaining 13 (68%) subjects, no changes occurred. A significant relationship was seen among the maxillary superior reposition, incisal pin changes, and reference line changes. In conclusion, following the use of the thin and thick splints, the maxilla can take different positions. The possibility of variations in using thin and thick splints is related to the changes in the incisal pin and the amount of maxillary impaction. Furthermore, the use of thick splints will cause the maxilla to take a more correct position.

[Outcomes of four distinct fixation methods in the conservative treatment of fifth metacarpal neck fractures]. / Dört farkli tespit yöntemi ile konservatif olarak tedavi edilen besinci metakarp boyun kiriklarinin sonuçlari.

BACKGROUND: We evaluated four distinct fixation methods for the conservative treatment of neck fractures of the fifth metacarpal. METHODS: Patients in our clinics who were treated with non-surgical methods following closed reduction between 2008 and 2009 were evaluated prospectively. In this study consisting of 60 male patients, the following fixation methods were applied for four weeks: circular cast extending from the wrist to the distal interphalangeal (DIP) joint (Group A), circular cast covering semiflexed metacarpophalangeal (MCP) and DIP from the wrist to the DIP joint (Group B), circular self-adherent wrap covering metacarpal bones II-V, from the wrist to the DIP joint (Group C), and ulnar gutter splint covering semi-flexed IV-V MCP, proximal (PIP) and DIP joints (Group D). In patients who were followed up with anteroposterior (AP) and oblique radiography, angulations and metacarpal lengths were measured before and after reduction. RESULTS: Fifty-two patients with an average age of 30 (SD: 9) years completed the study. For fractures with radiographic angulation of 17 degrees (SD: 11) and 46 degrees (SD: 11.7) before treatment, union was achieved with an angulation of 5 degrees (SD: 5.9) and 27 degrees (SD: 10.5) after four weeks (p: 0.05). CONCLUSION: No statistically significant difference was found between the non-surgical methods applied for treatment of fifth metacarpal fractures.

Splinting--when and how?

UNLABELLED: The prognosis of a tooth following trauma is critical. This depends on various factors, including the type of splint used for immobilization and the immobilization period. This article discusses the above factors with an added note on splint removal. CLINICAL RELEVANCE: This article is relevant for clinicians who treat traumatic injuries as it should help them to decide on the type of splint to be used and the period of immobilization.

Trauma kits for the dental office.

The old Boy Scout's motto, "Be Prepared," can be beneficially applied to the management of dental trauma. A large number of dental injuries occur every year, primarily in the 7- to 15-year age group. Preserving the natural dentition during that time period is critically important, because tooth loss at an early age presents significant lifelong dental problems. Being prepared to manage an emergency can make the difference between tooth loss and a successful outcome. Two factors contribute to achieving the better outcome: knowledge of the essentials of dental traumatology, and being prepared with the dental materials needed for appropriate treatment. It is the hope of the authors that these factors are clearly elucidated in this article.

Intraradicular splinting of a horizontally fractured central incisor: a case report.

This case report presents the endodontic management of a horizontally fractured right incisor involving healing with granulation tissue using an intraradicular splinting technique. We also discuss the spontaneous healing of the fractured left central incisor with calcified tissue. A composite resin splint was made for all of the upper anterior teeth. The root canal of the right incisor was temporarily filled with calcium hydroxide slurry. The intraradicular splinting involved placing a file in the canal. Sealer was introduced into the canal and then a no. 110 K file was fixed in the canal with polycarboxylate cement. The tooth was asymptomatic and the composite splint was removed after 1 month. The right incisor appeared normal clinically and radiographically at the 30-month recall. This case demonstrates that intraradicular splinting can be used to manage horizontally fractured teeth with necrotic and mobile coronal segment.

An evidence-based appraisal of splinting luxated, avulsed and root-fractured teeth.

The evidence-based methodology involves framing a well defined PICO (problem, intervention, comparison and outcome) question related to a clinical problem and then comprehensively searching for the evidence, which is evaluated to appraise the value of the treatment intervention. For this systematic review of splinting of teeth that have been luxated, avulsed or root-fractured, the clinical PICO question is (P) what are splinting intervention decisions for luxated, avulsed and root-fractured teeth (I) considering that the splinting intervention choice may include (i) no splinting, (ii) rigid or functional splinting for the different types of trauma and (iii) different durations of the splinting period (C) when comparing these splinting choices for the different types of trauma and their effect on (O) healing outcomes for the teeth. A keyword search of PubMed was used. Reference lists from identified articles and dental traumatology texts were also appraised. The inclusion criterion for this review was either a multivariate analysis or controlled stratified analyses as many variables have the potential to confound the assessment and evaluation of healing outcomes for teeth that have been luxated, avulsed or root-fractured. A positive statistical test is not proof of a causal conclusion, as a positive statistical relationship can arise by chance, and so this review also appraises animal studies that reportedly explain biological mechanisms that relate to healing outcomes of splinted teeth. The clinical studies were ranked using the 'Centre of Evidence-based Medicine' categorization (levels 1-5). All 12 clinical studies selected were ranked as level 4. The studies generally indicate that the prognosis is determined by the type of injury rather than factors associated with splinting. The results indicate that the types of splint and the fixation period are generally not significant variables when related to healing outcomes. This appraisal identified difficulties in the design of animal experimentation to correctly simulate some dental injuries. Some of the studies employed rigid splinting techniques, which are not representative of current recommendations. Recommended splinting treatment protocols for teeth that have been luxated, avulsed or root-fractured teeth are formulated on the strength of research evidence. Despite the ranking of these studies in this appraisal as low levels of evidence, these recommendations should be considered 'best practice', a core philosophy of evidence-based dentistry.

[Progress study on fixation retainer of splint].

Splint fixation is an external fixation system,composed of retainer, splint, paper pad and traction. Pressure under retainer is the power source of splint fixation in treatment of fractures. Now we have a review literature about the progress of type and biomechanics of fixation retainer of splint, to offer the scientific parameters for modern reform of fixation retainer of splint.

Splinting flexor tendon injuries.

Frequently used zone 2 flexor tendon repair splints are reviewed and classified according to the American Society of Hand Therapists' Splint Classification System. These splints both restrict and mobilise digital motion and fall into two main groups: (1) splints that incorporate the wrist and digital joints as primary joints to allow predetermined increments of early passive or active motion at both the wrist and digital joints; and (2) splints that include the wrist as a secondary joint and the digital joints as primary joints, allowing early passive or active motion at digital joints but not at the wrist.

Classification of hand splinting.

The terminology in describing splint or orthosis has been reviewed but there is no one single system adopted universally. Joint efforts by doctors, therapists and orthotists had been set up to review the classification of splint. Four ways of classifying hand splints have been introduced: namely, eponym, acronym, descriptive classification system and the classification system proposed by the American Society of Hand Therapists. These systems include the use of rote memory or logical deduction in grouping of splints. This paper describes the advantages and disadvantages of each classification system. Neither one of the systems stands out to be the best. A combination of the advantages of different systems, such as precision and logical deduction, may be an option for developing a new system. Moreover, communication, documentation and other environmental factors should also be considered.

Management of simple finger injuries: the splinting regime.

Mallet finger injury, ligamentous sprain and dislocation of proximal interphalangeal (PIP) joint of fingers are very common types of simple hand injuries. Immediate correction of alignment and protection of the injured area will facilitate early joint movement while maximising functional recovery. This article is to introduce the fabrication of three simple finger splints to tackle these injuries for quick and effective conservative treatment. They are the mallet finger splint, buddy splint and dorsal finger block splint. The indications and functions of the three types of splints are discussed. The fabrication process will be illustrated; including materials needed, pattern drafting and steps of molding. Wearing regime and precautions will be highlighted to ensure effective patient compliance to splinting programme for the finger injuries.

Management of stiff hand: an occupational therapy perspective.

Joint stiffness, resulting from a variety of complications after hand injuries, remains a common problem. Prolonged swelling, scar formation and shortening of soft tissue after prolonged period of immobilisation are the major causes leading to the loss of joint range of motion. Treatment used to improve the joint stiffness should be integrative and problem-focused. Pressure therapy, active and passive mobilisation through remedial activities and corrective splinting should be started as soon as problems arise. Applying low-load stress through prolonged periods of time onto the shortened tissue at its maximum tolerable range is the main principle in restoration of passive joint range of motion. The greater the joint limitation becomes, the longer the time the splint should be applied. Therapists should understand the process of tissue healing and different functions of splints before a correct and effective splint can be prescribed properly.

Healing of 208 intra-alveolar root fractures in patients aged 7-17 years.

This retrospective study consisted of 208 root-fractured, 168 splinted and 40 not splinted incisors in young individuals (aged 7-17 years) treated in the period 1959-1973 at the Pedodontic Department, Eastman Institute, Stockholm. Clinical and radiographic analyses showed that 69 teeth (33%) had developed hard tissue (fusion) healing of fragments. Interposition of periodontal ligament (PDL) and bone between the fragments was found in 17 teeth (8%). Interposition of PDL alone was found in 74 teeth (36%). Finally, non-healing with pulp necrosis and inflammatory changes between fragments was seen in 48 teeth (23%). Various clinical factors were analyzed for their relationship to the healing outcome with respect to healing/no healing and type of healing (hard tissue versus interposition of bone and/or PDL). Immature root and positive pulp sensitivity at time of injury was found to be significantly related to both pulp healing and hard tissue repair of the fracture. The same applied to concussion or subluxation of the coronal fragment compared to luxation with displacement (extrusive or lateral luxation). This relation was also represented by the variable millimeter diastasis between fragments before and after repositioning. Repositioning appeared to enhance the likelihood of both pulp healing and hard tissue repair. A positive effect of splinting, splinting methods (cap splints or orthodontic bands with an arch wire) or splinting periods could not be demonstrated on either pulp healing or type of healing (hard tissue versus interposition of bone and/or PDL). In conclusion, the findings from this retrospective study have cast doubts on the efficacy of long-term splinting and the types of splint used for root fracture healing. It is suggested that the role of splinting and splinting methods be examined in further studies.

Ear, nose, and throat devices; classification of the nasal dilator, the intranasal splint, and the bone particle collector. Food and Drug Administration, HHS. Final rule.

The Food and Drug Administration (FDA) is classifying the nasal dilator, intranasal splint, and the bone particle collector into class I (general controls). FDA is also exempting the devices from the requirements of premarket notification. This action is taken under the Federal Food, Drug, and Cosmetic Act (the act), as amended by the Medical Device Amendments of 1976 (the amendments), the Safe Medical Devices Act of 1990 (SMDA), and the Food and Drug Administration Modernization Act of 1997 (FDAMA).

The dynamic elbow suspension splint.

Elevation of the upper extremity after elbow surgery has rarely been advocated and can be difficult to achieve. Usually the extremity is elevated with the elbow at 90 degrees of flexion, so that swelling from the hand drains to the elbow but the elbow remains dependent. Excessive swelling causes discomfort and compromised wound healing, makes early mobilization difficult, and predisposes to joint contracture. We report on a dynamic elbow suspension splint, which is analogous to the Thomas splint used for femoral shaft fractures. The arm is held in full extension with an above-elbow plaster slab and is secured to the Thomas splint with skin traction. The splint is suspended on a Balkan frame at an angle of 60 degrees. We prefer to use the new Zimmer Thomas splint, because it is radiolucent and has self-adhesive sheep-skin supports that can be simply applied. It allows the patient to mobilize in bed and is well tolerated by patients and nursing staff. The dynamic elbow suspension splint is a useful adjunct after complex elbow surgery or trauma, because it reduces swelling and maintains the elbow in extension.

Dynamic versus static splints: a prospective case for sustained stress.

Application of constant tension to elongate tissue has been shown to be beneficial. A dynamic splint was used to achieve tissue creep and full elbow extension. Use of a static splint on the contralateral elbow did not allow elbow extension. This case report demonstrates for this patient the superiority of a dynamic elbow extension splint over a static splint when used to correct progressive loss of elbow range of motion.