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Luxated teeth: A new way of splinting
Surgical Technique
Int, J. Oral Surg. 1978: 7:221-223 (KeY words: spti~1ting system; trauma; luxatett teeth; surgery, oral)
Luxated teeth: A new way of splinting O. M. E, W I K K E L I N G
Department of Maxilla-Facial Surgery, Utrecht State University, Utrecht, The Netherlands
ABSTRACT -- A new and simple method to splint forcefully removed teeth is described. The traditional eircumdental wiring is replaced by bar fixation with an adhesive bonding material.
(Received/or publication 11 April, accepted 7 July 1977)
I n all sorts of accidents, sport contests and other events, teeth are often dislodged traumatically. Generally speaking the luxated elements can be r e i m p l a n t e d with or without root canal t r e a t m e n t being done previously3, ~. T h e patients call on either their family physician o r dentist for medical attention or go to a hospital. R e f e r r e d by these officials, they end up in an oral surgery department. By then a great a m o u n t of time has elapsed and, as has been pointed out1-3, ~, the less t i m e the luxated tooth is outside its socket, the better the results of reimplantation. Dentists in general p r a c t i c e claim they are n o t equipped to r e i m p l a n t and splint luxated elements and, m o r e o v e r , lack the help of office personnel trained in m i n o r oral surgery. This p a p e r is an attempt to provide b o t h oral surgeons and general practitioners in dentistry with an easy, reliable and simple "on the spot" splinting method.
Method 1. The tooth to be reimplanted is prepared as usual (root canal treatment, apicectomy or
root incision technique, for instance). Careful handling will prevent further damage to the periodontium. 2. The tooth surfaces selected to carry the splint (labial and buccal in most instances) are pumiced and thoroughly washed with water. 3. The empty socket is inspected and foreign material is removed using pliers, suction and/or a saline rinse. 4. Reimplantatiou is now effected and an arch bar (Remanit/dentaurum O 1.3 ram, halfround and soft) is bent to fit the labial/buccal surfaces of the selected teeth. For extra retention the bar may be prepared with a mounted disk or stone (Fig. 3) but we do not regard this as compulsory. 5. Cotton rolls are applied and the teeth are dried with air. 6. Phosphoric acid (3M Concise| Acid Etch and Custom Mix system catalog :~ 1924/1925) on a small cotton pellet is applied to the selected surfaces and left there for 60-90 sec. Again the teeth are washed thoroughly with water and dried. 7. Now the resin components are mixed well and applied to the etched enamel. Small portions of the composite-catalyst mixture, prepared in the meantime, are added and the previously bent arch bar is now laid in its selected position. The composite material is adapted and modelled and can be finished after setting, in the usual manner.
222
WIKKELING
8. After 6-8 weeks, the appliance can be easily removed by snapping off the acrylic bonds with a large needle holder, an orthodontic ligature cutter 5, or any other suitable instrument. Any pieces of acrylic that remain may be removed with an ultrasonic scaler. The etched spots should be properly finished off and polished. While manipulating one should take care not to overstrain the implant. It is wise in some instances to cut the bar into segments before starting the maneuver of removing.
Case History Roy O., a 10-year-old boy, stumbled and fell, while playing one afternoon. T o o t h 11 (Ilsd) was totally luxated. A l a r m e d by his cries, his mother came, comforted him and recovered the tooth in a short while. The time was 4 p.m. A telephone call to her dentist informed the patient's mother that the doctor was not in. She called back at 5 p.m. Shortly before 6 p.m. Mrs. O. succeeded in locating the dentist. By that time the tooth had been out of its socket 2 hours and kept dry, wrapped in a piece of cotton. The dentist advised Mrs. O. to put the tooth in a salty solution (one teaspoon of salt in a glass of water) and take her son and his luxated tooth to our clinic in the University Hospital in Utrecht. Family O. lives in a rural district and they had to travel by bus. A t 10 p.m. we were able to start treatment. Figs. 1 and 2 show the patient before and after replantation and fixation while Fig. 3 is an X-ray view. In order to demonstrate the adhesive bonding splinting system in a concise, visual manner, we did not, in this case, cfix the arch bar after the replantation but m a d e an extra step (Fig. 1). Although conditions were not favorable (6 hours' delay, a history of 2 hours' dry storage and 4 hours in a hypertonic solution) we reimplanted this tooth after root canal treatment and apicectomy. Reimplantation a n d fixation were fast and painless. Time will show how long the tooth will last but meanwhiie another prosthetic treatment can be postponed. We have also advised the family dentist about our splinting system and how to make a physiological saline solution. Naturally the child received tetanus prophylaxis.
Fig. 1. Patient with arch b a r in position, fixed to neighboring teeth. Empty socket I1 (Iisd).
Discussion This e a s y - t o - h a n d l e m e t h o d is especially suited f o r t h e g e n e r a l p r a c t i t i o n e r . All m a terials r e q u i r e d a r e usually a v a i l a b l e in his office so r e i m p l a n t a f i o n c a n b e e f f e c t e d w i t h o u t delay, t h u s saving v a l u a b l e t i m e and, b y d o i n g so, i m p r o v i n g t h e r a t e o~ success. I n o u r clinic w e u s e the special 3 M C o n c i s e | kit b u t a n y c o m m e r c i a l b r a n d of p h o s p h o r i c acid, e.g. as o x y p h o s p h a t e c e m e n t liquid, will d o as a n etching liquid ~ a n d a n y b r a n d of c o l d - c u r e m e t h y l m e t h acrylate acrylic will suffice f o r fixation of the bar.
Fig. 2. Patient with reimplanted 11 (Itsd) fixed to arch bar.
SPLINTING OF LUXATED TEETH
223
Bridging a gap is fairly laborious in this scheme 4 while a diastema is easily dealt with by using the splinting system previously described (Fig. 1). Compared to our splint McEvoY & MINKS' is bulkier but nevertheless requires repair in some cases of premature splint fracture. 4 In the test cases preceding this paper in which 3M Concise/ Remanit splints were used, breakage never occurred. The one thing that seems to. make our adhesive bonding splinting system especially suited for everyone in the profession is the fact that it does not require skills other than those of the average dentist. Fig. 3. X-ray view of reimplanted 11 (Ilsd) and splinting system in situ. Note notches for extra
retention.
References The method is applicable even in small children with partially erupted permanent teeth or still with their primary dentition. In most instances local anesthetic is not required, which is especially an advantage in children. With this technique no damage is done to the parodontium as may be the case when using bars with circumdental wires for fixation or some sort of acrylic splints, with the disadvantage of food impaction and subsequent parodontologic problems. McEvoY & MINrO published a method for temporary stabilization of loosened anterior teeth. These authors use an acidetched resin splint. Although this is a handy method, it has some disadvantages as well.
1. ANDREASEN, L O. & HSbRTrNG-HANsEN,E.: Replantation of teeth. I. Acta Odontol. Scand. 1966: 24: 263-286. 2. ANDREASt~N, 1. O. & HS6RTn~CG-HANSEN,E.: Replantation of teeth. II. Acta Odontol. Scan& 1966: 24: 287--306. 3. HOVrNGA, J.: Replantatie en transplantatie van tanden. Academic Thesis, Amsterdam University 1968, p. 44. 4. McEvoy, S.A. & MINK, J. R.: Acid-etched resin splint for temporarily stabilizing anterior teeth. J. Dent. Child. 1974: 4: 439441. 5. ROSENBERG, F. A., DISTEFANO, J. F. & BYegs, S. S.: Adhesive bonding of arch bars for maxillomandibular fixation. J. Oral Surg. 1976: 34: 651-653. 6. WEPt,rzR, F.: Die Replantation der Frontziihne nach traumatischem Zahnverlust. Osterr. Z. Stomatol. 1976: 73: 275-282. Address: O. M . E . Wikkeling Department o] Maxillo-Facial Surgery Utrecht State University Utrecht The Netherlands
Int, J. Oral Surg. 1978: 7:221-223 (KeY words: spti~1ting system; trauma; luxatett teeth; surgery, oral)
Luxated teeth: A new way of splinting O. M. E, W I K K E L I N G
Department of Maxilla-Facial Surgery, Utrecht State University, Utrecht, The Netherlands
ABSTRACT -- A new and simple method to splint forcefully removed teeth is described. The traditional eircumdental wiring is replaced by bar fixation with an adhesive bonding material.
(Received/or publication 11 April, accepted 7 July 1977)
I n all sorts of accidents, sport contests and other events, teeth are often dislodged traumatically. Generally speaking the luxated elements can be r e i m p l a n t e d with or without root canal t r e a t m e n t being done previously3, ~. T h e patients call on either their family physician o r dentist for medical attention or go to a hospital. R e f e r r e d by these officials, they end up in an oral surgery department. By then a great a m o u n t of time has elapsed and, as has been pointed out1-3, ~, the less t i m e the luxated tooth is outside its socket, the better the results of reimplantation. Dentists in general p r a c t i c e claim they are n o t equipped to r e i m p l a n t and splint luxated elements and, m o r e o v e r , lack the help of office personnel trained in m i n o r oral surgery. This p a p e r is an attempt to provide b o t h oral surgeons and general practitioners in dentistry with an easy, reliable and simple "on the spot" splinting method.
Method 1. The tooth to be reimplanted is prepared as usual (root canal treatment, apicectomy or
root incision technique, for instance). Careful handling will prevent further damage to the periodontium. 2. The tooth surfaces selected to carry the splint (labial and buccal in most instances) are pumiced and thoroughly washed with water. 3. The empty socket is inspected and foreign material is removed using pliers, suction and/or a saline rinse. 4. Reimplantatiou is now effected and an arch bar (Remanit/dentaurum O 1.3 ram, halfround and soft) is bent to fit the labial/buccal surfaces of the selected teeth. For extra retention the bar may be prepared with a mounted disk or stone (Fig. 3) but we do not regard this as compulsory. 5. Cotton rolls are applied and the teeth are dried with air. 6. Phosphoric acid (3M Concise| Acid Etch and Custom Mix system catalog :~ 1924/1925) on a small cotton pellet is applied to the selected surfaces and left there for 60-90 sec. Again the teeth are washed thoroughly with water and dried. 7. Now the resin components are mixed well and applied to the etched enamel. Small portions of the composite-catalyst mixture, prepared in the meantime, are added and the previously bent arch bar is now laid in its selected position. The composite material is adapted and modelled and can be finished after setting, in the usual manner.
222
WIKKELING
8. After 6-8 weeks, the appliance can be easily removed by snapping off the acrylic bonds with a large needle holder, an orthodontic ligature cutter 5, or any other suitable instrument. Any pieces of acrylic that remain may be removed with an ultrasonic scaler. The etched spots should be properly finished off and polished. While manipulating one should take care not to overstrain the implant. It is wise in some instances to cut the bar into segments before starting the maneuver of removing.
Case History Roy O., a 10-year-old boy, stumbled and fell, while playing one afternoon. T o o t h 11 (Ilsd) was totally luxated. A l a r m e d by his cries, his mother came, comforted him and recovered the tooth in a short while. The time was 4 p.m. A telephone call to her dentist informed the patient's mother that the doctor was not in. She called back at 5 p.m. Shortly before 6 p.m. Mrs. O. succeeded in locating the dentist. By that time the tooth had been out of its socket 2 hours and kept dry, wrapped in a piece of cotton. The dentist advised Mrs. O. to put the tooth in a salty solution (one teaspoon of salt in a glass of water) and take her son and his luxated tooth to our clinic in the University Hospital in Utrecht. Family O. lives in a rural district and they had to travel by bus. A t 10 p.m. we were able to start treatment. Figs. 1 and 2 show the patient before and after replantation and fixation while Fig. 3 is an X-ray view. In order to demonstrate the adhesive bonding splinting system in a concise, visual manner, we did not, in this case, cfix the arch bar after the replantation but m a d e an extra step (Fig. 1). Although conditions were not favorable (6 hours' delay, a history of 2 hours' dry storage and 4 hours in a hypertonic solution) we reimplanted this tooth after root canal treatment and apicectomy. Reimplantation a n d fixation were fast and painless. Time will show how long the tooth will last but meanwhiie another prosthetic treatment can be postponed. We have also advised the family dentist about our splinting system and how to make a physiological saline solution. Naturally the child received tetanus prophylaxis.
Fig. 1. Patient with arch b a r in position, fixed to neighboring teeth. Empty socket I1 (Iisd).
Discussion This e a s y - t o - h a n d l e m e t h o d is especially suited f o r t h e g e n e r a l p r a c t i t i o n e r . All m a terials r e q u i r e d a r e usually a v a i l a b l e in his office so r e i m p l a n t a f i o n c a n b e e f f e c t e d w i t h o u t delay, t h u s saving v a l u a b l e t i m e and, b y d o i n g so, i m p r o v i n g t h e r a t e o~ success. I n o u r clinic w e u s e the special 3 M C o n c i s e | kit b u t a n y c o m m e r c i a l b r a n d of p h o s p h o r i c acid, e.g. as o x y p h o s p h a t e c e m e n t liquid, will d o as a n etching liquid ~ a n d a n y b r a n d of c o l d - c u r e m e t h y l m e t h acrylate acrylic will suffice f o r fixation of the bar.
Fig. 2. Patient with reimplanted 11 (Itsd) fixed to arch bar.
SPLINTING OF LUXATED TEETH
223
Bridging a gap is fairly laborious in this scheme 4 while a diastema is easily dealt with by using the splinting system previously described (Fig. 1). Compared to our splint McEvoY & MINKS' is bulkier but nevertheless requires repair in some cases of premature splint fracture. 4 In the test cases preceding this paper in which 3M Concise/ Remanit splints were used, breakage never occurred. The one thing that seems to. make our adhesive bonding splinting system especially suited for everyone in the profession is the fact that it does not require skills other than those of the average dentist. Fig. 3. X-ray view of reimplanted 11 (Ilsd) and splinting system in situ. Note notches for extra
retention.
References The method is applicable even in small children with partially erupted permanent teeth or still with their primary dentition. In most instances local anesthetic is not required, which is especially an advantage in children. With this technique no damage is done to the parodontium as may be the case when using bars with circumdental wires for fixation or some sort of acrylic splints, with the disadvantage of food impaction and subsequent parodontologic problems. McEvoY & MINrO published a method for temporary stabilization of loosened anterior teeth. These authors use an acidetched resin splint. Although this is a handy method, it has some disadvantages as well.
1. ANDREASEN, L O. & HSbRTrNG-HANsEN,E.: Replantation of teeth. I. Acta Odontol. Scand. 1966: 24: 263-286. 2. ANDREASt~N, 1. O. & HS6RTn~CG-HANSEN,E.: Replantation of teeth. II. Acta Odontol. Scan& 1966: 24: 287--306. 3. HOVrNGA, J.: Replantatie en transplantatie van tanden. Academic Thesis, Amsterdam University 1968, p. 44. 4. McEvoy, S.A. & MINK, J. R.: Acid-etched resin splint for temporarily stabilizing anterior teeth. J. Dent. Child. 1974: 4: 439441. 5. ROSENBERG, F. A., DISTEFANO, J. F. & BYegs, S. S.: Adhesive bonding of arch bars for maxillomandibular fixation. J. Oral Surg. 1976: 34: 651-653. 6. WEPt,rzR, F.: Die Replantation der Frontziihne nach traumatischem Zahnverlust. Osterr. Z. Stomatol. 1976: 73: 275-282. Address: O. M . E . Wikkeling Department o] Maxillo-Facial Surgery Utrecht State University Utrecht The Netherlands