![]() ![]() Disadvantages of this technique are that this type of splint is rigid and arch bars may loosen and cause irritation. 19 A metal bar is bent into the shape of the arch and fixed with ligature wires. Arch bar splintsĪrch bar splints were initially adopted for maxillary and mandibular fractures in the 1870s and adapted for dentoalveolar trauma. Gross gingival irritation caused by the arch bar splint is evident (courtesy of Dr Rob Hazlewood). (b) The arch bar and ligature splint has been replaced with a titanium trauma splint. (a) Radiograph of an arch bar secured by wire ligatures. 15 While this type of splint was found to be irritating to the lips when compared to composite and wire splints and titanium trauma splints, 16 this is generally not considered to be a clinical problem as any lip irritation can be avoided with the application of wax. 13, 14 However, care must be taken that orthodontic forces do not develop stress that disturbs the healing phase of an injured tooth. Orthodontic bracket splints allow teeth that have been intruded or not repositioned correctly to have the occlusal relationships modified at a later date. 4 where the patient has sustained traumatic injuries to the maxillary right central and lateral incisors and the maxillary right central incisor. An example of this splint is shown in Fig. This splint, which is extensively employed by paedodontists in Australia, involves orthodontic brackets bonded to the teeth with a resin-based orthodontic cement and connected with a light 0.014 NiTi flexible wire. 2).Ī composite resin and whipper snipper nylon splint and purple coloured composite (courtesy of Dr Peter Foltyn). In this case the left central incisor was not replanted as the tooth was lost. 2 following an avulsion and subluxation injury to the central incisors. Another example of a composite and wire splint is shown in Fig. ![]() 12 An example of a wire and composite resin splint is shown in Fig. Types of splints in current use Composite and wire splintsĬomposite and wire splints are perhaps the most commonly used in clinical practice and are flexible splints when the wire has a diameter of no greater than 0.3–0.4 mm. Preferably fulfil aesthetic appearance.Allow pulp sensibility testing and endodontic access.Allow physiologic tooth mobility to aid in periodontal ligament healing. ![]() Stabilize the injured tooth/teeth in its correct position and maintain adequate stabilization throughout the splinting period.Be easily applied and removed without additional trauma or damage to the teeth and surrounding soft tissues.Allow periodontal ligament reattachment and prevent the risk of further trauma or swallowing of a loose tooth.10 The current recommendations of the IADT are summarized in Table 1. As a consequence of these and other studies, the International Association of Dental Traumatology (IADT) guidelines recommend splinting types that are flexible rather than rigid and employed for shorter duration. 8 Another study showed that teeth splinted for just 1 week were clinically firm, 9 which indicated shorter splinting times could be considered. A recent systematic review and meta-analysis on autotransplanted teeth reported that the ankylosis rate was three times higher with wire and composite resin splinting when compared with suture splinting, suggesting the importance of physiological movement on healing outcomes. A flexible splint allows functional movement in contrast to a rigid splint where the injured teeth are immobilized. 4- 6 The use of flexible splints arose when animal experimentation reported a lower incidence of ankylosis when teeth were subjected to masticatory forces, 7 which suggested that splints should provide some functional movement of the traumatized teeth. 3 The validity of this approach was questioned when studies showed rigid immobilization increased the incidence of pulp necrosis 4 and external root resorption. 2 Historically, splinting of teeth utilized the principles of jaw bone fracture with rigid, long-term immobilization for a few months. 1 A splint has been defined as ‘an apparatus used to support, protect or immobilize teeth that have been loosened, replanted, fractured or subjected to certain endodontic surgical procedures’. Splinting has been advocated after repositioning of a tooth/teeth to stabilize the tooth/teeth and to optimize healing outcomes for the pulp and/or the periodontal ligament. International Association of Dental Traumatology. ![]()
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