Digital workflow for periodontal splinting with a guided device.

OBJECTIVE: To detail a technique for bonding periodontal splint precisely in a digital workflow. CLINICAL CONSIDERATIONS: Periodontal splinting can be considered to stabilize the mobile teeth, especially for mandibular anterior teeth. Reliable bonding of periodontal splints is a prerequisite for successful clinical performance. However, when bonding the indirect splint to place or making direct splint intraorally, there is a significant risk of mobile teeth drifting away from the splint. To guide accurate insertion of periodontal splint with no risk of displacement of mobile teeth, a guide device fabricated by digital workflow is introduced in this article. CONCLUSIONS: Periodontal compromised teeth can be provisionally fixed during splinting, with the help of the guided device, and precise bonding of the splint is readily accomplished by using such digital workflow. This technique is not only applicable to the lingual splints, but also suitable for the labial ones. CLINICAL SIGNIFICANCE: The use of a guided device, after being digitally designed and fabricated, enables to stabilize the mobile teeth, in case of any displacement during splinting. It is straightforward, and beneficial to reduce the risk of complications, such as debonding of the splint, and secondary occlusal trauma.

A Digital Way for Fabricating a Resin-Bonded Fixed Partial Denture Combined with Periodontal Splint in the Mandibular Anterior Region.

Teeth loosening are caused by insufficient supporting tissue, inflammation of periodontal tissue, or occlusal trauma, which is one of the main clinical symptoms of periodontitis. A digital technique for fabricating resin-bonded splinting fixed partial dentures (S-FPDs) is presented. It restores the missing mandible anterior teeth and splints the adjacent periodontally mobile teeth of the patient at the same time. The S-FPDs is designed and fabricated by computer-aided design and computer-aided manufacturing (CAD/CAM) technology with flexible PMMA material. The workflow is straightforward, convenient, and accurate. Meanwhile, the restoration can meet the esthetic requirements and help with the stability of adjacent loosening natural teeth spontaneously. It could be considered a medium-term provisional restorative treatment option, but further controlled investigations still be needed.

Dental trauma splints for the mixed dentition - A finite element analysis of splint material, splint extension, missing teeth, and PDL representation.

BACKGROUND/AIMS: Dental traumatic injuries are common in children during the mixed dentition stage. These injuries usually require splinting for stabilization, which is complicated by the various stages of the permanent tooth development and primary tooth exfoliation. The aim of this study was to evaluate the effect on mobility of splint materials and extensions for an avulsed central incisor, stabilized with and without the adjacent incisor under intrusive and extrusive loading with different periodontal ligament (PDL) conditions. MATERIALS AND METHODS: Seventeen 3D model variations were created from a CBCT scan of a 7-year-old patient without erupted permanent upper lateral incisors. A 1000 N palatal load on the right central incisor simulated the avulsion injury and created an increased alveolus and bone deformation, resulting in an increased PDL thickness of 0.45 mm. Wire-resin composite splints with 0.9 mm cross-section (WCS) or 1.0 mm diameter nylon-resin composite splints (NCS) were created. The models simulated conditions with and without the adjacent upper central incisor. Two PDL conditions were investigated, simulating detached PDL or PDL with polyether impression material-like properties. Mobility was calculated under simulated biting loads in horizontal and vertical (intrusive and extrusive) directions. RESULTS: The NCS allowed greater tooth mobility of the avulsed incisor than the WCS, irrespective of splint extension, PDL condition, or load application. During horizontal loading, polyether-like properties for the PDL allowed around 0.2 mm mobility of the avulsed tooth with the WCS, similar to the intact tooth, whereas a simulated detached PDL allowed 25% more mobility with a WCS than with a NCS. CONCLUSIONS: Based on the FEA analysis, a 1.0 mm NCS may be suitable for splinting avulsion injuries during the mixed dentition stage compared to the considerably more rigid WCS. The NCS models provided flexibility for PDL healing while maintaining stability, even when missing adjacent teeth increased span widths. Extensions beyond directly adjacent teeth did not alter the mobility with the NCS but should still be considered an extra protection in case of bond failure or exfoliation.

Valoración del tratamiento del bruxismo mediante toxina botulínica / Assessment of the treatment of bruxism by botulinum toxin

El bruxismo se caracteriza por ser una actividad relacionada la activación de los músculos masticatorios de forma repetitiva y habitualmente durante el sueño. La relevancia de esta entidad reside en su asociación con erosiones y movilidad dentarias, fracturas dentales, mialgia e hipertrofia del músculo masetero y o artralgia característica. Si bien de etiología no clara se relaciona con multitud de factores fisiopatológicos. En la actualidad existen multitud de líneas de tratamiento para este problema de salud, tales como: terapia cognitivo-conductual, férulas de oclusión o de descarga, opciones farmacológicas como benzodiacepinas, y dopamina. Estas medidas habitualmente sirven como manejo de los signos y síntomas derivados del bruxismo, pero la eficacia de todas ella no es total. Actualmente, ante la necesidad de búsqueda de otras opciones terapéuticas al problema del bruxismo, múltiples ensayos han centrado su atención en la utilización de la toxina botulínica como alternativa, teniendo en cuenta su eficacia para una amplia variedad de patologías médicas y estéticas.El objetivo de esta puesta al día es actualizar el conocimiento a fecha actual de la evidencia existente acerca de la utilización de la toxina botulínica en el tratamiento del bruxismo. Para ello se seleccionan las revisiones sistemáticas existentes que incluyen los principales ensayos clínicos aleatorizados disponibles.Método: Revisión bibliográfica en las principales bases de datos utilizando las palabras “bruxismo” y/o “toxina botulínica” Resultados: Tras el análisis de las diferentes revisiones podemos decir que todos los resultados apuntan en la misma dirección: que las inyecciones de toxina botulínica en el masetero y / o los músculos temporales pueden ser una opción de tratamiento válida en pacientes con bruxismo, ya que pueden mejorar la calidad de vida.(AU)

Bruxism is characterized by being an activity related to the activation of the chewing muscles repeatedly and usually during sleep. The relevance of this entity resides in its association with tooth erosions and mobility, dental fractures, myalgia and hypertrophy of the masseter muscle and or characteristic arthralgia. Although its etiology is not clear, it is related to a multitude of pathophysiological factors. Currently there are many lines of treatment for this health problem, such as: cognitive-behavioral therapy, occlusion or discharge splints, pharmacological options such as benzodiazepines, and dopamine. These measures usually serve to manage the signs and symptoms derived from bruxism, but the effectiveness of all of them is not total. Currently, faced with the need to search for other therapeutic options for the problem of bruxism, multiple trials have focused their attention on the use of botulinum toxin as an alternative, taking into account its efficacy for a wide variety of medical and aesthetic pathologies. The objective of this update is to update the knowledge to date of the existing evidence about the use of botulinum toxin in the treatment of bruxism. For this, the existing systematic reviews that include the main available randomized clinical trials are selected. Method: Bibliographic review in the main databases using the words "bruxism" and / or "botulinum toxin" Results: After the analysis of the different reviews we can say that all the results point in the same direction: that botulinum toxin injections in the masseter and / or temporal muscles can be a valid treatment option in patients with bruxism, since they can improve the quality of life. With the exception of the systematic review by Ågren et al, 28 who do not see evidence through the tests that record electromyographic activity and bite force to recommend the use of botulinum toxin as a treatment for bruxism at the present time.(AU)

Influência da férula na resistência à fratura de restaurações com utilização ou não de retentores intrarradiculares em dentes tratados endodonticamente: uma revisão da literatura / Influence of the ferrule on the fracture resistance of restorations with or without the use of intraradicular posts in endodontically treated teeth: a literature review

Objetivo: realizar uma revisão de literatura narrativa sobre a importância e a influência do efeito férula na resistência à fratura de restaurações em dentes tratados endodonticamente com utilização ou não de retentores intrarradiculares. Metodologia: Foram utilizados os seguintes descritores indexados no DeCS (Descritores em Ciências da Saúde): "Férula", Prótese Dentária", "Falha da Restauração Dentária", "Técnica de Retentor Intrarradicular" e "Pinos de Retenção Dentária" para busca nas bases de dados PubMed, Embase, Lilacs, Web of Science, Scopus e Cochrane Library. Resultados: Os dados da maioria dos estudos in vitro ou in vivo incluídos nesta revisão sugerem o uso da férula para aumento da resistência à fratura e longevidade dos dentes tratados endodonticamente. Tem sido recomendada a confecção de uma férula com altura uniforme de 2 mm e espessura superior a 1,5 mm. Conclusão: O uso de retentores radiculares foi indicado pela maioria dos trabalhos, sendo geralmente recomendados os pinos de fibra de vidro ao invés de núcleos metálicos fundidos para minimizar os riscos de fratura radicular em razão do módulo de elasticidade semelhante à dentina, além de possibilidade de retratamentos em casos de falhas adesivas. Apesar disso, ainda são necessários estudos clínicos com acompanhamento a longo prazo para avaliar a longevidade das restaurações de dentes tratados endodonticamente utilizando pinos de fibra de vidro sem ou com a presença de férula em diferentes espessuras e alturas.

Objective: This study aimed to conduct a narrative literature review on the importance and influence of the ferrule effect on the fracture resistance of restorations in endodon-tically treated teeth with or without the use of intraradicular posts. Methodology: The following descriptors indexed in the DeCS (Health Sciences Descriptors) were used: "Ferrule", Dental Prosthesis", "Dental Restoration Failure", "Post and Core Technique", and "Dental Posts", to search on the databases of PubMed, Embase, Lilacs, Web of Science, Scopus, and Cochrane Library data. Results: Data from most of the in vitro or in vivo studies included in this review suggest the use of the ferrule to increase fracture resistance and longevity of endodontically treated teeth. It has been recommended to make a ferrule with a uniform height of 2 mm and a thickness greater than 1.5 mm. Conclusion: The use of intraradicular posts was indicated by most studies, and fiberglass posts are generally recommended instead of cast metal cores to minimize the risk of root fracture due to the modulus of elasticity similar to dentin, in addition to the possibility of retreatments in ad-hesive failure cases. Despite this, clinical studies with a long-term follow-up are essential to evaluating the longevity of restorations of endodontically treated teeth using fiberglass posts without or with the presence of ferrule in different thicknesses and heights.

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

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

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.

A digital technique for splinting periodontally compromised mobile teeth in the mandibular anterior region.

A digital technique for fabricating a periodontal splint is presented. The lingual surface of periodontally compromised mandibular anterior teeth is captured and registered to form the emergence profile of the periodontal splint. An accurate periodontal splint is fabricated for mandibular anterior teeth with increased mobility after scaling and root planing.

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.

Effects of Experimental Agents Containing Tannic Acid or Chitosan on the Bacterial Biofilm Formation in Situ.

Chitosan and tannic acid are known for their antibacterial properties. In the present in-situ study, their antibacterial and anti-adherent effects on biofilm formation on enamel were investigated. Six subjects carried upper jaw splints with bovine enamel specimens, allowing in-situ biofilm formation. During the two-day trial, subjects rinsed with experimental solutions that contained either chitosan, tannic acid (pH = 2.5), tannic acid (pH = 7) or hydrochloric acid. Water served as the negative and chlorhexidine as the positive control. Rinsing occurred four or five times following two different rinsing protocols to investigate both the immediate and long-lasting effects. After 48 h of intraoral exposure, the dental plaque was stained with LIVE/DEAD® BacLight, and fluorescence micrographs were evaluated by using the software ImageJ. The results were verified by scanning electron microscopy. Rinsing with chitosan resulted in little immediate antibacterial and anti-adherent effects but failed to show any long-lasting effect, while rinsing with tannic acid resulted in strong immediate and long-lasting effects. Except for a slightly lower antibacterial effect, the neutral solution of tannic acid was as good as the acidic solution. Hydrochloric acid showed neither an antibacterial nor an anti-adherent effect on dental biofilm formation. Experimental solutions containing tannic acid are promising anti-biofilm agents, irrespective of the pH values of the solutions. Chitosan, on the other hand, was not able to prevent biofilm formation.

Tratamiento con férula dental en bruxismo inducido por antoconvulsivo: Reporte de caso / Dental splint treatment in bruxism induced by anti-seizure drug. Case report

Los signos de desgaste y rechinamiento de los dientes están asociados con el bruxismo y se observan comúnmente en los consultorios dentales. En este reporte, las autoras describen un caso de bruxismo probablemente inducido por el medicamento anticonvulsivo Valpromed®, que fue tratado con éxito mediante una férula dental. El paciente llegó a la clínica declarando que deseaba mejorar su estética. En el examen clínico, se observó un desgaste moderado de las superficies oclusales de los molares asociado con antecedentes de rechinamiento nocturno, característico del bruxismo del sueño. Hace aproximadamente 5 meses, el paciente comenzó la terapia con Valpromed® por orden del neurólogo, debido a episodios de migraña. El medicamento se prescribió para evitar el riesgo de convulsiones ya que el paciente había sufrido de neurocisticercosis durante la infancia. Según los consejos del especialista en rehabilitación oral y la literatura revisada, las autoras concluyeron que el bruxismo podía atribuirse a la terapia con el medicamento anticonvulsivo. Para el tratamiento, se escogió una técnica mínimamente invasiva. Aunque el paciente todavía está en controles, la férula dental parece ser un enfoque prometedor para el tratamiento de esta afección. (AU)

Signs of tooth wear and grinding are associated with bruxism, which is commonly observed in dental offices. Here, the authors describe a case of bruxism probably induced by the anti-seizure drug Valpromed®, that was successfully treated with a dental splint. A man was attended in the dental clinic for improvement of dental aesthetics. On clinical examination moderate overwear of the occlusal surfaces of molars was observed associated with a history of nightly grinding, characteristic of sleep bruxism. Approximately 5 months previously, the patient had started therapy with Valpromed® due to episodes of migraine. The drug had been prescribed by a neurologist to prevent convulsions since the patient had had neurocysticercosis during childhood. Based on the advice of an oral rehabilitation specialist and the literature reviewed, it was concluded that the presence of bruxism in this patient may be attributed to the therapy with the anti-seizure medication. Although the patient is still under controls, the dental splint seems to be a promising approach for the treatment of this condition. The patient was treated with a minimally invasive dental splint and is monitored periodically, showing good results. (AU)

Evaluation of the efficacy of different treatment modalities for painful temporomandibular disorders.

The purpose of this study was to clinically evaluate the efficacies of three treatment methods and to compare their outcomes in patients with painful disc displacement. The study group comprised 45 patients with unilateral temporomandibular disorders who fell into Axis I group II (with limited mouth opening) of the Research Diagnostic Criteria for Temporomandibular Disorders. Magnetic resonance imaging was used for definitive diagnosis. The patients were divided randomly into three groups according to the treatment method: splint therapy, splint therapy with ultrasound-guided arthrocentesis, and splint therapy with low-level laser therapy. Patients were followed up after treatment for 6 months. The groups were compared in terms of pain and functional jaw movements (unassisted mouth opening without pain, maximum unassisted mouth opening, and contralateral movements). At the end of treatment, functional jaw movements were significantly increased while pain values were significantly decreased in all groups (P<0.05). Group 2 had a quicker improvement in terms of mouth opening scores at the end of the first month, and unassisted mouth opening without pain was found to be more than 35 millimetres in all groups at the end of 6 months. All treatment modalities showed effective results on pain and functional jaw movements in the treatment of temporomandibular disorders.

Mobility to Stability-Journey of a Hopeless Tooth.

The impact of implant dentistry is such that, today, very few dentists think about saving grade III mobile teeth with recurrent periodontal abscess. This case report presents the management of grade III mobile lower anterior teeth with recurrent periodontal abscess. Treatment included SRP, splinting of the lower anterior teeth using wire and composite, RCT of the lower anterior teeth, periodontal flap surgery, and placement of bone graft and PRF. A patient was evaluated at one week and then every three months up to one year. Clinical examination showed reduction in mobility, resolution of inflammation, and abscess; radiographic examination showed bone fill.

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

PURPOSE: To explore the aesthetic effect of orthodontics treatment combined with periodontal splint in the treatment of fan-shaped displacement of anterior teeth caused by periodontitis. METHODS: Fifty patients with fan-shaped displacement of anterior teeth caused by periodontitis in PLA air force hospital from January 2013 to October 2018 were selected and randomly divided into the control group (n=25) and the experimental group (n=25). Patients in the control group were treated with conventional periodontal splint, while patients in the experimental group were treated with combined orthodontic treatment on the basis of the control group. Florida periodontal probe exploration depth (PD), gingival index (GI), attachment loss (AL), sulcus bleeding index (SBI), plaque index (PLI) and mobility were observed and compared before and 1 month after treatment between both groups. The levels of serum inflammatory factors interleukin-4 (IL-4), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), C-reactive protein (CRP) and osteocalcin (OC) were measured and compared by ELISA before treatment and 1 month after treatment in both 2 groups. The data were analyzed with SPSS 21.0 software package. RESULTS: Compared with before treatment, PD and GI in both groups decreased significantly after treatment, and significantly lower in the experimental group than that in the control group (P<0.05); the levels of AL, SBI, PLI and tooth looseness in both 2 groups were significantly lower after treatment, and significantly lower in the experimental than in the control group (P<0.05); compared with before treatment, the levels of IL-4, IL-6, TNF-a and serum CRP in both 2 groups were significantly lower after treatment, and the experimental group was much lower than that in the control group (P<0.05). The level of osteocalcin in the experimental group was significantly higher than that in the control group at different time points after treatment (P<0.05). The level of osteocalcin in the experimental group reached its peak one day after treatment, and then gradually declined, the preoperative level was basically restored 7 days after treatment. CONCLUSIONS: Using orthodontics combined with periodontal splint in the treatment of fan-shaped displacement of anterior teeth caused by periodontitis has a remarkable effect. The symptoms of periodontitis can be effectively improved, the teeth can be effectively corrected and facial profiles of the patients can be improved.

Immunological and Morphological substantiation of the use of dental stick with biopharmaceuticals in the complex therapy of inflammatory periodontal diseases

Aim of the study: clinical, immunological and morphological substantiation of the use of a dental stick with biopharmaceuticals in the complex therapy of inflammatory periodontal diseases. Research methods: leukocyte migration test, cytograms, the study of quantitative and qualitative content of spontaneously released mixed saliva, measurement of the total content of protein, the content of secretory immunoglobulin A (sIgA) and lysozyme in it. Clinical improvement of the periodontal tissues condition after treatment by 77% was registered. OHI-S (hygienic index), PI (periodontal disease index), PMA (papillary-marginal-alveolar index) were 7.5, 3.4, and 8.7 times lower, respectively, compared to the pre-treatment group. The depth of periodontal pockets decreased 2.6-3.4 times, the number of sessions per treatment course was reduced to 3-8 visits to the doctor. The amount of mixed saliva (in comparison with the initial data) increased 2.7 times, normal levels were restored and were 1.2 ml higher than control indicators. Protein levels, lysozyme and sIgA concentrations increased and exceeded the pre-treatment level 1.8 times and by 44.5%, respectively. Cytograms data revealed that the number of red blood cells (in one field of view) in the gingiva specimens in inflammatory periodontal diseases (IPD) patients was 2.3 times lower, count of leukocytes with signs of destruction was 13.4 lower and intact leukocyte count was 3.8 times lower. Lymphocyte count was 2 times lower, indicating that the inflammatory process in periodontal tissues was reduced as a re sult of the reduction of the microbial burden: staphylococci and actinomycetes were detected 3 times less often, diplococci ­ 3.5 times less often, filamentous bacteria and streptococci ­ 4 times less often, protists ­ 5 times less often, respectively. The number of cocci microcolonies was 2.7 times higher. The number of fibroblasts (in one field of view) increased threefold, the content of collagen filaments of the normally oriented structure increased 1.4 times, compared to the original data, which indicated the formation of favorable conditions for healing and reparative regeneration processes. The results of the study showed that the use of a dental stick during local IPD therapy is an effective way of correcting changes in clinical and laboratory indicators of local immunity and that dental stick is a promising new dosage form in practical periodontology.

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

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

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.

Novedades técnicas en implantes subperiósticos: Ranc-implants. A propósito de un caso / Innovations in subperiosteal dental implants: Ranc-implants. A case report

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Long-term survival and maintenance efforts of splinted teeth in periodontitis patients.

OBJECTIVES: This study assessed the survival and maintenance needs of splinted teeth in periodontitis patients. METHODS: Patients receiving active and supportive periodontal treatment involving teeth splinting in a university setting were retrospectively assessed. Tooth and splint survival and number of splint-repairs were recorded. Multilevel Cox and generalized-mixed linear regression analyses were performed. RESULTS: Fifty-seven patients with 227 splinted teeth (maxilla/mandible: 148/79) were followed over mean ± SD 11.0 ± 7.2 [range: 2.0-32.4]) years. Twenty-six splinted teeth were extracted during this period, the mean (95% CI) time of splint retention was 7.3 ± 5.7 (0.1-22.7). Splinted teeth did not show significantly increased risk of tooth loss compared with non-splinted teeth (HR; 95% CI: 1.30; 0.87-1.93); while age (1.07; 1.05-1.09), PPD >6 mm (4.24; 1.26-14.31), bone loss (mean HR was 5.07-15.36 depending on severity), tooth location (posterior versus anterior teeth: HR 2.08; 1.24-3.49) and the number of occlusal contact areas (mean HR was 4.38-17.34 depending on the number of antagonistic contact areas) were associated with tooth loss. 75.3% splints required repair, with a mean of 2.6 ± 1.9 [1.0-8.0] repairs per splint during the mean observation time (0.4 ± 0.6 [0.0-3.5] repairs per splint/year). CONCLUSION: Splinting did not significantly increase the risk of tooth loss; splinted teeth showed long-term survival. To maintain splints, frequent repairs were needed. CLINICAL SIGNIFICANCE: Splinted teeth were not at significantly higher risk of tooth loss than non-splinted teeth. While splinting does not improve the prognosis of periodontally affected teeth, it can assist their retention by reducing their mobility.

Clinical Effectiveness of 6.5-mm-Long Implants to Support Two-Implant Fixed Prostheses in Premolar-Molar Region: The Influence of Immediate Loading and the Length of Splinting Implant.

PURPOSE: The purpose of this retrospective clinical study was to assess the influence of immediate loading and lengths of splinted implants on the clinical effectiveness of 6.5-mm-long implants supporting two-implant fixed prostheses in the premolar-molar regions. MATERIALS AND METHODS: A clinical database was reviewed in a private dental center to select those patients who had 6.5-mm-long implants placed to support two-implant fixed partial prostheses in the premolar-molar regions of the maxilla and the mandible. All implants were immediately loaded. The study groups were defined according to the lengths of the implants. Two groups were identified: the short-short splinted group, when both implants had 6.5 mm lengths, and the short-long splinted group, when one implant was longer than 6.5 mm. A total of 48 dental implants were placed in 16 patients to support 24 two-implant fixed prostheses. The mean follow-up time was 14 ± 5 months. The short-short splinted group included 8 patients with 16 implants; the short-long splinted group included 16 patients with 32 implants. The main variable was implant survival, and secondary outcomes were marginal bone stability and prosthesis survival. RESULTS: The statistical analyses indicated an absence of significant differences between the two groups in terms of implant and prosthesis survival (100% for both groups and both variables); however, distal bone loss around the splinted implants was significantly higher in the short-long splinted group. Bone loss was 0.37 ± 0.55 mm in the short-short splinted group and 0.94 ± 0.66 mm in the short-long splinted group. CONCLUSIONS: Immediate loading of short (6.5-mm-long) implants in the premolar-molar regions did not jeopardize their survival. Two-implant supported prostheses had the same clinical effectiveness, whether extra-short implants were splinted to another extra-short implant or to a longer one.