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.

Splinting in the management of dental trauma in the primary dentition: a systematic review.

PURPOSE: The purpose of this study was to gather existing data on the efficacy of tooth splinting (TS) in patients with traumatized primary teeth, evaluating their overall prognosis and reported complications. METHODS: Electronic searches were performed in seven databases up to Februray/2023. Clinical studies published in the last two decades and presenting the following characteristics were included: (a) reporting on children with traumatized primary teeth; (b) describing the efficacy of splinting those teeth. Studies describing imobilization of dental avulsion were excluded. RESULTS: A total of 163 potentially relevant studies were initially found. After title/abstract screening, and full-text evaluation, three retrospective studies with moderate to high risk of bias were included. The studies described the outcomes of TS in primary teeth with luxation (intrusion, extrusion, lateral displacement), intra-alveolar root fracture, and/or alveolar fracture. High clinical success rate was observed for teeth with root fracture. Benefits of spliting teeth with lateral luxation were not identified, although it may be a reccomended approach. No study was found evaluating TS for alveolar fracture. CONCLUSION: Based on a low level of evidence, the findings highlight a better clinical success rate of the use of TS in the management of deciduous teeth with root fractures.

An Alternative Approach Using Circummandibular Wiring for Treatment of Dentoalveolar Fractures in Children: A Case Report.

The prevalence of dentoalveolar injuries in children is approximately 25%, with falls from own height being one of the main etiologies. Diagnosis is based on the clinical evaluation associated with complementary imaging tests. The treatment of choice depends on the type of damage and structure affected. For alveolar process fractures, closed reduction and semi-rigid dental splinting for 4 to 6 weeks is generally satisfactory. However, some cases, such as severe segmental fractures, require open treatment to ensure adequate reduction and stabilization of the displaced alveolar segment, which is usually achieved by titanium miniplates and screws. Nevertheless, there are situations where this type of fixation is not possible, requiring alternative methods. Therefore, this article describes a surgical technique performed by open reduction, associating semi-rigid dental splint and circummandibular wiring in pediatric patient diagnosed with dentoalveolar fracture through clinical examination (with bone fracture displacement) and tomography. The technique promoted a good prognostic to the patient, proving to be a viable alternative for treating dentoalveolar fractures.

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.

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.

Lateral luxation of incisor - a case report of using a new cone-beam computed tomography software and reposition guideline

Abstract Lateral luxation injuries are one of the most severe periodontal injuries in dental trauma. The correct diagnosis followed by repositioning of the tooth on the right position is fundamental for the periodontal ligament healing. This study reported a clinical case of lateral luxation of maxillary central incisor involving a new cone beam computed tomography (CBCT) software for reconstruction (e-Vol DX) to confirm the lateral luxation after no conclusive dental trauma injury definition by using conventional exam. The lateral luxation injury was digitally reduced by insertion of tooth back to its alveolus, and at the same session, the tooth was stabilized with a rigid splint and further changed to a semi-rigid nylon splint. During the pulpal status monitoring, the pulp was diagnosed necrotic, then the root canal was treated to prevent root resorption. External office-bleaching and restorative procedure was performed. The 4-years follow up and new imaging exam and digital reconstruction confirmed bone healing and no complication. CBCT images analyzed by eVol DX can be used to determine and to guide lateral luxation treatment.

Resumo Lesões de luxação lateral são uma das lesões periodontais mais graves no traumatismo dental. O diagnóstico seguido do reposicionamento do dente na posição correta é fundamental para o reparo do ligamento periodontal. Este estudo relata um caso clínico de luxação lateral do incisivo central superior envolvendo um novo software de reconstrução (e-Vol DX) por tomografia computadorizada de feixe cônico (TCFC) para confirmar a luxação lateral após nenhuma definição de lesão por trauma dental conclusivo pelo exame convencional. A lesão de luxação lateral foi reduzida digitalmente pela inserção do dente de volta ao seu alvéolo e, na mesma sessão, o dente foi estabilizado com uma contenção rígida e posteriormente trocada para uma contenção de nylon semirrígida. Durante o monitoramento da condição pulpar, foi diagnosticada necrose da polpa e, em seguida, o canal radicular foi tratado para evitar a reabsorção radicular. Procedimento externo de clareamento e restauração foi realizado. O acompanhamento de 4 anos e o novo exame de imagem e reconstrução digital não confirmaram reparo ósseo e nenhuma complicação. Imagens de TCFC analisadas pelo e-Vol DX podem ser utilizadas para determinar e orientar lesão de luxação lateral.

Manejo de complicación postraumática dental. Informe de caso / Management of the postraumatic dental complication. A case report

Resumen Se presenta el caso clínico de una paciente femenina de 7 años de edad, la cual sufrió traumatismo dental en el central superior derecho permanente, al impactarse de manera directa en el pavimento al caer de una bicicleta. Se presenta necrosis pulpar como complicación postraumática a un mes de ocurrido el evento. El objetivo de este caso es mostrar que el diagnóstico adecuado y el conocimiento sobre un protocolo para el manejo del paciente con trauma dental son indispensables para el éxito del tratamiento y pronóstico del diente.

Abstract The clinical case of a 7-year-old female patient who suffered dental trauma in the permanent upper right central incisor presented by directly impacting the pavement after falling from a bicycle. Pulpar necrosis is presented as a postraumatic complication one month after the event. The objective of this case is to show that the adequate diagnosis and knowledge about the protocol for the management of the patient with dental trauma is essential for the success of the treatment and prognosis of the tooth.

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.

Autotrasplante de un tercer molar inmaduro: reporte de un caso / Autotransplantation of an immature third molar: a case report

El autotrasplante se refiere a la transferencia quirúrgica de un dientede una posición a otra en el mismo individuo dentro de los alveolosde dientes extraídos o sitios preparados quirúrgicamente. El autotrasplante de un diente inmaduro puede ser una opción para reemplazarmolares con caries extensas en pacientes jóvenes como una alternativaal reemplazo de dientes con prótesis fi ja o implanto-soportada. Es unprocedimiento clínico con un índice de éxito de 98 por ciento cuando los dientes son trasplantados traumáticamente y el tiempo extraoral se mantiene al mínimo. El estado de desarrollo del diente determina ampliamente el potencial de reparación pulpar después del autotrasplante. Para obtener una pulpa vital en un diente autotrasplantado el foramen apical no debe medir menos de1 mm de diámetro. El área receptora debe ser 1-2 mm más grande y profunda que las medidas de las raíces donadoras parapreservar las células del ligamento periodontal, un óptimo contacto entreambas estructuras puede mejorar el suministro sanguíneo y los nivelesde nutrición de las células del ligamento periodontal, el cual puedeincrementar el éxito del autotrasplante. En este artículo se presenta un caso exitoso de autotrasplante de tercer molar inmaduro.

Autotransplantation refers to the surgical transfer of a tooth fromone position to another in the same individual onto extracted toothsockets or surgical prepared recipient sites. Autotransplantation of animmature teeth can be an option to replace extensive decayed molarsin young patients as an alternative to immediately replacing teeth withfi xed or implant-supported prosthesis. Autotransplantation is a clinicalprocedure with a success rate of 98% when teeth are transplantedatraumatically and when the extraoral time is keep to a minimum.The developmental stage of the tooth highly determines the potentialof pulpal repair after transplantation. To obtain a vital pulp in anautotransplanted tooth, the apical foramen should not be smaller than1 mm in diameter. The recipient area must be 1-2 mm larger and deeperthan the measurements of the donor roots to preserve the periodontalligament cells, an optimal contact between both structures can improvethe blood supply and the level of nutrition to the periodontal ligamentcells, which can increase the success of autotransplantation. In thispaper, we report one case of successful autotransplantation of animmature third molar.

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.

Contenção Interdentária Empregando Fibra de Vidro e Resina Composta: Relato de Caso e Acompanhamento de 13 Anos / Dental Splinting Using Glass Fiber and Composite Resin: A Case Report and 13-Year Follow-Up

A perda óssea, em resposta à doença periodontal, compromete a estabilidade dentária, e gera desconforto ao paciente. A contenção interdentária pode ser uma opção de tratamento definitivo, destinado principalmente à população carente. Além de possuir baixo custo, é um procedimento conservador e estético que proporciona melhor distribuição de tensão ao tecido de suporte. A paciente O. P. C., 49 anos, gênero feminino, compareceu ao Hospital Odontológico da Universidade Federal de Uberlândia, apresentando sinais clínicos de periodontite, tal como mobilidade dos incisivos centrais e laterais inferiores, inflamação e sangramento a sondagem. O reestabelecimento da saúde periodontal foi obtido através da adequação do meio bucal e o protocolo para estabilização dentária e da perda óssea foi determinado. Optou-se pela técnica de contenção intracoronária com associação de fibras de reforço impregnadas por sistema adesivo e resina composta, do dente 13 ao 23. Nessa mesma sessão, também foi proposto à reconstrução estética e fechamento de diastema empregando resina composta nos dentes anteriores inferiores. Após 13 anos de acompanhamento clínico e radiográfico verificou-se paralização e estabilização da perda óssea, reestruturação da crista óssea e redução da mobilidade dentária. Sendo assim, este relato de caso de contenção interdentária com fibra de vidro e resina composta é mais uma informação segura de que este protocolo pode ser indicado em casos de perda óssea, desde que este seja seguido rotineiramente o protocolo de boa higiene bucal e acompanhamento periódico pelo cirurgião-dentista.

Bone loss in response to periodontal disease compromises the dental stability, and causes discomfort to the patient. After basic periodontal therapy, dental splinting might be a definitive option of treatment, mainly intended for the lower class population. Besides of the low cost, it is a conservative and aesthetic procedure that also improves the stress distribution in the support tissues. The patient O. P. C., 49 years, female gender, attended the Dental Hospital of the Universidade Federal de Uberlândia, presenting clinical signs of periodontitis, such as mobility in the lower incisors, inflammation and bleeding on probing. After reestablishment of periodontal health through the adequacy of the oral cavity, the protocol to stabilize the teeth and bone loss was established. We selected the splinting technique using glass fiber-reinforced associated with composite resin extending from canine to canine. In the same session, it was proposed the esthetic reconstruction and closing diastema with composite resin in the mandibular anterior teeth. After 13-years of clinical and radiographic follow-up, it was verified the stagnation and stabilization of bone loss, restructuring of the bone crest, and reduction of mobility of teeth. Thus, this case report of interdental splint with fiberglass and composite resin is more one safety information that this protocol can be indicated in cases of bone loss, since it is routinely followed by a protocol of good oral hygiene and regular monitoring by the dentist

Effect of splinting in accuracy of two implant impression techniques.

Because there is no consensus in the literature about the need for a splint between copings, the aim of this study was to evaluate, in vitro, the accuracy of 2 impression techniques for implant-supported prostheses. A master cast was fabricated with four parallel implant abutment analogs and a passive framework. Two groups with 5 casts each were formed: Group 1 (squared impression copings with no splint: S) and Group 2 (splinted squared impression copings, using metal drill burs and Pattern resin: SS). The impression material used was polyvinyl siloxane with open trays for standard preparation of the casts. For each cast, the framework was positioned, and a titanium screw was tightened with 10 N·cm torque in analog A, after which measurements of the abutment-framework interface gaps were performed at analogs C and D. This process was repeated for analog D. These measurements were analyzed using software. A one-way analysis of variance (ANOVA) with a confidence interval of 95% was used to analyze the data. Significant differences were detected between S and SS in relation to the master cast (P ≤ 0.05). The median values of the abutment-framework interface gaps were as follows: master cast: 39.64 µm; squared impression copings with no splint: 205.86 µm; splinted squared impression copings: 99.19 µm. Under the limitations of this study, the technique presented for Group 2 produces better results compared with the technique used for Group 1.

Effect of moisture on flexural strength of fiber-reinforcedcomposites used as splinting materials / Efeito da umidade na resistência flexural de resinas compostas reforçadas por fibras usadas como material de esplintagem

Objectives: Different fiber types are available for reinforcing composite restorations. Little information exists regarding flexural strength of various fiber used to reinforce direct composites. This in vitro study examined the flexural strength of polyethylene and glass fibers when used to reinforce composite and influence of moisture exposure on the same materials. Materials and methods: The two types of fiber were used to reinforce blocks of composite (RX Flow, Dental Life Sciences) prepared to test flexural properties and compared with the unreinforced controls. Mean flexural strengths values were determined in a 3-point bend test at a crosshead speed of 8 mm/min by use of a universal testing machine. Results: Significant increases in mean flexural strength were found for all fiber-reinforced groups in comparison to the unreinforced controls at both before and after moisture exposure. The polyethylene fiber gave the greatest reinforcing effect. After 1 month of storage in an artificial saliva substitute, a significant decline occurred in the mean flexural strength of all the groups tested. Conclusion: Within the limitations of this study, the choice of fiber type was shown to have a significant increase on the flexural properties of the fiber-reinforced composite. Polyethylene fibers increased the flexural strength of the composite the most.

Objetivo: Diferentes tipos de fibras estão disponíveis para reforçar restaurações em resinas compostas. Há pouca informação sobre a resistência flexural de fibras usadas para reforçar compósitos diretos. Este estudo in vitro avaliou a resistência à flexão de fibras de polietileno e de vidro, quando usadas para reforçar resina composta e a influência da exposição à umidade sobre os mesmos materiais. Materiais e métodos: Os dois tipos de fibras foram usados para reforçar blocos de resina composta (RX Flow, Dental Life Sciences), preparados para testar as propriedades mecânicas e comparados com os controles não reforçados. Os valores médiosde flexão foram determinados em um ensaio de flexão de três pontos a uma velocidade de 8 mm/min em uma máquina de ensaio universal. Resultados: Um aumento significativo na resistência à flexão média foi encontrado para todos os grupos reforçados com fibras, em comparação com os controles não reforçadas, tanto antes quanto depois da exposição à umidade. A fibra de polietileno forneceu o maior efeito de reforço. Após 1 mês de armazenamento em saliva artificial, houve uma diminuição significativa na força média de flexão de todos os grupos testados. Conclusão: Dentro das limitações do presente estudo, o tipo de fibra demonstrou exercer um aumento significativo sobre as propriedades de flexão do compósito reforçado com fibras. Fibras de polietileno aumentaram mais a resistência à flexão do compósito.

Regeneración periodontal: ¿sí o no? / Periodontal regeneration: yes or no?

Se describe el caso clínico de un paciente de 45 años de edad con antecedentes de periodontitis aguda (localizada en el diente 21), bolsas periodontales de 3-8 mm, movilidad dentaria de grado IV y encía alterada con índice gingival de 2,5, que fue remitido a la Clínica Estomatológica Provincial Docente "Mártires del Moncada" en Santiago de Cuba. Se realizó tratamiento pulporradicular y ferulización de la pieza afectada, la técnica de colgajo periodontal. Transcurridos 6 meses se obtuvo una considerable disminución del índice gingival a 0,1, profundidad de 3 mm al sondeo y movilidad dentaria de grado I, con osteointegración positiva y regeneración periodontal demostrada radiográficamente.

The case report of a 45-year-old patient with a history of acute periodontitis (located in tooth 21), 3-8 mm periodontal pockets, IV grade dental mobility and gingival swelling with a gingival rate of 2,5 was described, who was referred to "Mártires del Moncada" Provincial Teaching School of Dentistry in Santiago de Cuba. Pulpar radicular treatment and splinting of the affected tooth, technique of periodontal flap were performed. After 6 months a significant reduction of gingival rate to 0,1, deep to 3 mm at probing and dental mobility of grade I were obtained, with positive osteointegration and periodontal regeneration radiographically viewed.