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Skeletal Fixation Splint in Mandibular Fractures as an Aid to Early Denture Construction
SKELETAL FIXATION SPLINT IN MANDIBULAR FRACTURES AS AN AID TO EARLY DENTURE CONSTRUCTION F. A.
R i c h Is o n , *
D.D.S., and J. T.
K enn ed y,!
D.D.S., Philadelphia, Pa.
U R IN G this period of war and de fense activities, the mission of the Naval Medical Corps, of which the Dental Corps is an integral unit, is applicable to all— “ To keep as many men at as many guns as many days as possible.”
arising from the closure of the teeth by wire or other appliances placed within the mouth. It allows the patient to carry on his work without pain or discomfort while the fracture is healing. Also, dur ing this period, dental restorations or re placements may be completed, and
F ig . i . — S p lin t in place. (M a rc h 2 7 , 19 4 3 .)
F ig . 2.— S p lin t in p lace and u p p er and low er dentures constructed. (A p ril 16 , 19 4 3 .)
D
Any procedure, method or appliance that will reduce the time away from any position, whether defense or military, is a direct contribution to the effort now being made. The use of the skeletal fixation splint in fractures of the mandi ble has been and is indeed a direct con tribution to the reduction of time lost by the patient as a casualty. The appliance permits normal masticatory function and also eliminates any chance of mishaps *C o m m an d er ( D C ) U S N ; C h ie f o f D en tal S e rv ic e , U . S. N a v a l H ospital. ■¡"Lieutenant C o m m an d er ( D C ) U S N R .
Jour. A.D .A., Vol. 3 1 , M ay 1, 1944
the total sick days of the afflicted person be shortened. The splint is especially adaptable aboard ship where mal de mer is preva lent. The patient is not prohibited, as by other appliances, from opening the mouth in case of vomiting, this eliminat ing the possibility of aspiration in cases of seasickness. In the following case, full upper and lower dentures were inserted seventeen days after the skeletal fixation splint was placed on the fractured mandible 646
R ic h is o n a n d K e n n e d y — S k e l e t a l F ix a t io n S p l in t and nineteen days after the fracture oc curred. R E P O R T O F CASE
March 25, 1943, M. J. T., white, aged 56, weight 180 pounds, was admitted to the U. S.
647
March 26, an x-ray picture showed frac ture of the edentulous mandible (left), for ward of the angle, with displacement. March 27, a skeletal fixation splint was applied. April 1, an x-ray picture showed the frac tured fragments held in place by the skeletal splint. The position and alinement were excellent. April 16, full upper and lower dentures were completed and inserted, seventeen days after appliance of the skeletal splint
F ig . 3.— A p p e aran ce a fte r rem o val o f splint, th irty-fo u r days a fte r ap p lication . T h e frac tu re lin e an d resorption a re a aro u n d the pins are evident. ( M a y 3 , 19 4 3 .)
F ig . 5.— Sp lin t in place an d dentures in serted. (A p ril 16 , 19 4 3 .)
F ig . 4.— A p p e aran ce fo u r and one h a lf m onths a fte r rem o val o f splint. T h e re is fill in g in o f new bone in the fra c tu re lin e an d in areas w h ere pins w ere inserted. (Septem ber 28, 19 4 3 -)
Naval Hospital, Philadelphia, Pa., with a diagnosis of fracture of the mandible (left).
and nineteen days after the fracture oc curred. April 29, an x-ray picture of the fracture of the edentulous mandible showed no change in the excellent position and aline ment of the fragments. The splint'was in situ and the patient was wearing the den tures. May 3, the skeletal splint was removed. The splint had been in place thirty-four days.
648
T
he
J ournal
of the
A
m e r ic a n
D
ental
A
s s o c ia t io n
M ay 7 , an x-ray p icture of th e frac ture of the edentulous m an d ib le m ade after rem oval of th e splint show ed no change in alinem ent an d position of the fragm ents. T h e fractu re line an d re sorption of bone aro u n d th e splint pins w ere evident. S eptem ber 28, an x-ray p ictu re taken four and one h alf m onths after rem oval of the splint show ed a very fain t fractu re line and filling in of the resorbed bone aro u n d the pin positions.
weeks before the appliance was removed. A saving of at least three weeks in time as required by any other method of re duction was gained in construction of the dentures. At no time was mastica tory function denied the patient, and three weeks’ use of the dentures was gained while healing was in progress. There was virtually no pain or discom fort, and mouth hygiene was easily main tained.
The use of the skeletal fixation splint allowed full upper and lower dentures to be completed and used by the patient two and one-half weeks after the frac ture and approximately two and one-half
U. S. N aval Hospital. Note: All assertions and opinions expressed in this article are those of the writers and are not to be construed as official or as reflecting the views of the Navy D epartm ent or the Naval Services a t large.
CIVILIAN DENTISTRY IN WAR-TIME H
enry
K
l e in
,*
D.D.S., Sc.D., Bethesda, Md.
in t r o d u c t io n
L A R G E number of dentists formerly in civilian practice have joined the armed services in order to make it possible for officers and enlisted person nel to receive the dental care they need. There are now indications that there will not be enough dentists or dentist workcapacity left to give civilians all the den tal service to which they have heretofore been accustomed; for the dentists re maining to serve civilians are now, in the main, older practitioners, who are already spending longer hours in their offices, more of their working time at the chair, treating more patients and being forced by the pressure of circumstances and their own physical limitations to give each patient less chair-time than they
A
*Senior D ental Officer, U n ited States Pub lic H ealth Service. From the Division of Public H ealth M ethods, Office of the Surgeon General, U nited States Public H ealth Service. Jour. A.D .A., Vol. 3 1 , M ay 1, 1944
formerly did. That situation will be in tensified by the further withdrawal of young dentists from civilian practice. What will be the effects ? Just how much has war affected the practice of dentis try among civilians in this country ? What remedies are there, and which of them can be developed best? This paper will attempt to answer some of these questions. In order to obtain the information needed for that purpose, it was neces sary to canvass civilian dentists. It was obviously impossible to ask every one of them to report on his work in detail, but it was entirely practical by a question naire-sampling procedure to get good returns from a representative group scattered over the country, in cities, towns and villages. This report is based on 1,442 replies from dentists considered as representative of white civilian practitioners in the United States in 1943.
R i c h Is o n , *
D.D.S., and J. T.
K enn ed y,!
D.D.S., Philadelphia, Pa.
U R IN G this period of war and de fense activities, the mission of the Naval Medical Corps, of which the Dental Corps is an integral unit, is applicable to all— “ To keep as many men at as many guns as many days as possible.”
arising from the closure of the teeth by wire or other appliances placed within the mouth. It allows the patient to carry on his work without pain or discomfort while the fracture is healing. Also, dur ing this period, dental restorations or re placements may be completed, and
F ig . i . — S p lin t in place. (M a rc h 2 7 , 19 4 3 .)
F ig . 2.— S p lin t in p lace and u p p er and low er dentures constructed. (A p ril 16 , 19 4 3 .)
D
Any procedure, method or appliance that will reduce the time away from any position, whether defense or military, is a direct contribution to the effort now being made. The use of the skeletal fixation splint in fractures of the mandi ble has been and is indeed a direct con tribution to the reduction of time lost by the patient as a casualty. The appliance permits normal masticatory function and also eliminates any chance of mishaps *C o m m an d er ( D C ) U S N ; C h ie f o f D en tal S e rv ic e , U . S. N a v a l H ospital. ■¡"Lieutenant C o m m an d er ( D C ) U S N R .
Jour. A.D .A., Vol. 3 1 , M ay 1, 1944
the total sick days of the afflicted person be shortened. The splint is especially adaptable aboard ship where mal de mer is preva lent. The patient is not prohibited, as by other appliances, from opening the mouth in case of vomiting, this eliminat ing the possibility of aspiration in cases of seasickness. In the following case, full upper and lower dentures were inserted seventeen days after the skeletal fixation splint was placed on the fractured mandible 646
R ic h is o n a n d K e n n e d y — S k e l e t a l F ix a t io n S p l in t and nineteen days after the fracture oc curred. R E P O R T O F CASE
March 25, 1943, M. J. T., white, aged 56, weight 180 pounds, was admitted to the U. S.
647
March 26, an x-ray picture showed frac ture of the edentulous mandible (left), for ward of the angle, with displacement. March 27, a skeletal fixation splint was applied. April 1, an x-ray picture showed the frac tured fragments held in place by the skeletal splint. The position and alinement were excellent. April 16, full upper and lower dentures were completed and inserted, seventeen days after appliance of the skeletal splint
F ig . 3.— A p p e aran ce a fte r rem o val o f splint, th irty-fo u r days a fte r ap p lication . T h e frac tu re lin e an d resorption a re a aro u n d the pins are evident. ( M a y 3 , 19 4 3 .)
F ig . 5.— Sp lin t in place an d dentures in serted. (A p ril 16 , 19 4 3 .)
F ig . 4.— A p p e aran ce fo u r and one h a lf m onths a fte r rem o val o f splint. T h e re is fill in g in o f new bone in the fra c tu re lin e an d in areas w h ere pins w ere inserted. (Septem ber 28, 19 4 3 -)
Naval Hospital, Philadelphia, Pa., with a diagnosis of fracture of the mandible (left).
and nineteen days after the fracture oc curred. April 29, an x-ray picture of the fracture of the edentulous mandible showed no change in the excellent position and aline ment of the fragments. The splint'was in situ and the patient was wearing the den tures. May 3, the skeletal splint was removed. The splint had been in place thirty-four days.
648
T
he
J ournal
of the
A
m e r ic a n
D
ental
A
s s o c ia t io n
M ay 7 , an x-ray p icture of th e frac ture of the edentulous m an d ib le m ade after rem oval of th e splint show ed no change in alinem ent an d position of the fragm ents. T h e fractu re line an d re sorption of bone aro u n d th e splint pins w ere evident. S eptem ber 28, an x-ray p ictu re taken four and one h alf m onths after rem oval of the splint show ed a very fain t fractu re line and filling in of the resorbed bone aro u n d the pin positions.
weeks before the appliance was removed. A saving of at least three weeks in time as required by any other method of re duction was gained in construction of the dentures. At no time was mastica tory function denied the patient, and three weeks’ use of the dentures was gained while healing was in progress. There was virtually no pain or discom fort, and mouth hygiene was easily main tained.
The use of the skeletal fixation splint allowed full upper and lower dentures to be completed and used by the patient two and one-half weeks after the frac ture and approximately two and one-half
U. S. N aval Hospital. Note: All assertions and opinions expressed in this article are those of the writers and are not to be construed as official or as reflecting the views of the Navy D epartm ent or the Naval Services a t large.
CIVILIAN DENTISTRY IN WAR-TIME H
enry
K
l e in
,*
D.D.S., Sc.D., Bethesda, Md.
in t r o d u c t io n
L A R G E number of dentists formerly in civilian practice have joined the armed services in order to make it possible for officers and enlisted person nel to receive the dental care they need. There are now indications that there will not be enough dentists or dentist workcapacity left to give civilians all the den tal service to which they have heretofore been accustomed; for the dentists re maining to serve civilians are now, in the main, older practitioners, who are already spending longer hours in their offices, more of their working time at the chair, treating more patients and being forced by the pressure of circumstances and their own physical limitations to give each patient less chair-time than they
A
*Senior D ental Officer, U n ited States Pub lic H ealth Service. From the Division of Public H ealth M ethods, Office of the Surgeon General, U nited States Public H ealth Service. Jour. A.D .A., Vol. 3 1 , M ay 1, 1944
formerly did. That situation will be in tensified by the further withdrawal of young dentists from civilian practice. What will be the effects ? Just how much has war affected the practice of dentis try among civilians in this country ? What remedies are there, and which of them can be developed best? This paper will attempt to answer some of these questions. In order to obtain the information needed for that purpose, it was neces sary to canvass civilian dentists. It was obviously impossible to ask every one of them to report on his work in detail, but it was entirely practical by a question naire-sampling procedure to get good returns from a representative group scattered over the country, in cities, towns and villages. This report is based on 1,442 replies from dentists considered as representative of white civilian practitioners in the United States in 1943.