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(TTS) with Three Commonly Used Splinting Techniques

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(TTS) with Three Commonly Used Splinting Techniques Dental Traumatology 2002; 18: 275–280 Copyright # Blackwell Munksgaard 2002 Printed in Denmark. All rights reserved DENTAL TRAUMATOLOGY ISSN 1600–4469 Comfort and discomfort of dental trauma splints ^ a comparison of a new device (TTS) with three commonly used splinting techniques Filippi A, von ArxT, Lussi A. Comfort and discomfort of dental Andreas Filippi1, Thomas von Arx2, trauma splints ^ a comparison of a new device (TTS) with three Adrian Lussi3 commonly used splinting techniques. DentTraumatol 2002;18: 1Department of Oral Surgery, Oral Radiology and Oral 275^280. # Blackwell Munksgaard, 2002. Medicine, University of Basel, Basel, Switzerland, 2Department of Oral Surgery and Stomatology, Abstract ^ The present experimental study compared four dental 3Department of Operative Dentistry, University of trauma splints in10 volunteers.The evaluated splints included a Berne, Berne, Switzerland wire-composite splint (WCS), a button-bracket splint (BS), a resin splint (RS), and the newly developed titanium trauma splint (TTS). All splints were bonded to the labial surfaces of the maxillary lateral and central incisors and left in place for 1week. After splint removal, the next splint was placed after a 1-week rest period.The sequence of splint application was randomized for each individual.The following subjective parameters were assessed using a visual analogue scale: sensitiveness of splinted teeth, irritation of the gingival margin, irritation of the lips, impairment of speech, eating and oral hygiene.The results show that the Key words: dental trauma splint; splinting method; application of BS leads to a signi¢cantly higher irritation of the lips discomfort; subjective assessment and greater impairment of speech compared to other splints Dr Andreas Filippi, Department of Oral Surgery, Oral (P < 0.05).The RS leads to an increased and signi¢cantly higher Radiology and Oral Medicine, University of Basle, Hebelstrasse 3, CH-4056 Basle, Switzerland irritation of the gingiva (P < 0.05) owing to a signi¢cant increase in Tel.: þ4161267 2609 cleaning di⁄culties (P < 0.05). In conclusion,WCS andTTS Fax: þ4161267 2607 appear to be more accepted splints according to a subjective e-mail: [email protected] assessment by 10 volunteers. Accepted 21 March, 2002 Traumatically loosened, displaced or avulsed perma- Commonly used splinting techniques have been nent teeth are normally splinted. The splinting investigated in vitro and in vivo (9^13).In a recent study, method used for stabilization should support period- parameters such as tooth mobility (Periotest values), ontal healing. Many di¡erent types of splinting tech- probing depths, plaque accumulation, bleeding on niques have been described in the literature (1^4). probing and the chair time needed for splint applica- Today, an ideal splint should be passive and £exible tion and removal were evaluated. The investigated to allow physiologic tooth mobility.The duration of splinting methods included the wire-composite splint splinting should be as short as possible. Usually, the (WCS),thebutton-bracket splint (BS),the resin splint periodontal ligament reaches most of its normal (RS) and the new titanium trauma splint (TTS) strength 7^14days following trauma. Both prolonged (14).Itcouldbe shownthat all fourtested splintsmain- and rigid splinting may lead to adverse e¡ects, such tained normal tooth mobility: TTS and WCS allow- as ankylosis and replacement resorption (5^8). In ed a more physiologic and RS a critically reduced addition, trauma splints should have optimal proper- tooth mobility (horizontal Periotest values). Period- ties for handling, application and removal. ontal parameters remained unchanged, re£ecting 275 Filippi et al. the excellent oral hygiene by the study subjects. The chair time used for ¢xation and removal was signi¢- cantly lower forTTS. From the patient’s perspective, it is important that these splints are comfortable anddo not interferewith oral hygiene, speaking and eating. In addition, the splints should not irritate adjacent tissues (gingiva, lips).The objective of this experimental study was to compare and evaluate TTS, WCS, RS and BS with respect to the subjective assessment by the patient. Materials and methods The study was conducted in 10 volunteers recruited from the sta¡ of the Department of Oral Surgery Fig. 1. TTS: titanium trauma splint (occlusal view). and Stomatology, University of Berne. All subjects were female with a mean age of 21years and 6 months (range 17years and 6 months to 34years and 9 months).ThestudydesignwasapprovedbytheEthi- cal Commission of the Canton Berne (study-number: ZMK-OC1/2000) and the clinical study was carried out according to the Helsinki declaration. The same studydesign hasbeenused in aprevious paperanalys- ing di¡erent clinical parameters, such as tooth mobi- lity, periodontal status, working time (9). All four maxillary incisors in all volunteers were free of caries and periodontal diseases. All subjects were healthy and presented no medical contraindications for the planned procedures. Four di¡erent splinting methods were evaluated in each individual, resulting in a total of 40 splints. The sequence of splint application was determined at ran- dom. Each splint was left in situ for 7 days. After Fig. 2. WCS: wire-composite splint (occlusal view). removal, the next splint was placed after waiting for at least 1week. using a plier and secured with identical composite All splints were bonded to the labial aspect of all (Fig.2). maxillary incisors. By placing the splints coronally, they were kept away from the gingival margin and Button-bracket splint (BS) the papillae. After drying the teeth, etching of the enamel surface was performed with 35% phosphoric Button brackets for direct bonding (Dentaurum, acid gel for 30 s. Subsequently, the gel was rinsed o¡ Ispringen, Germany) were bonded with the same with water and the etched surfaces were dried again. composite. Thereafter, a 0.3-mm soft wire (Rema- 1 Athin layer of bonding agent was applied. After poly- nium , Dentaurum, Ispringen, Germany) wasbraid- merization, the splints were placed with the techni- ed from button to button to connect the four incisors. ques described below. Finally, the wire was secured to each button with composite (Fig.3). Titanium trauma splint (TTS) After cutting to the desired length, theTTS was bent Resin splint (RS) to the labial aspects of the incisors. Per tooth, one 1 The resin (Protemp II, ESPE Dental, Seefeld, rhombus of theTTS was ¢lled with light-curing com- 1 Germany) was mixed according to the manufac- posite (Tetric Flow Chroma, Vivadent, Schaan, turer’sinstructions. Usinga syringe, resinwascontinu- Liechtenstein) (Fig.1)with 30 s of polymerization. ously applied to the labial crown aspects connecting Wire-composite splint (WCS) all incisors (Fig.4). Thesubjectivestudyparameterswerethefollowing: An 0.16in. Â0.22 in. orthodontic wire was cut to the sensitiveness of splinted teeth, irritation of gingival desiredlength, adaptedtothecurvature oftheincisors margin, irritation of the lips, impairment of speech, 276 Comfort and discomfort of dental trauma splints eating and oral hygiene. All study parameters were recordeddailybyeachvolunteerforeachsplintfollow- ing splint application.They were given a special form with a visual analogue scale (v.a.s.) (length 10cm) for each parameter per day. After completion of the study,thelengthofthemarkingsonthev.a.s. wasmea- sured in millimetres. The statistical evaluationwas performedat days1,4 and 7 to register not only the immediate e¡ects of the splints, but also a possible subsequent adaptation by the volunteers. All data were analysed by descrip- tive methods using box plots. As they were not nor- mally distributed, the Wilcoxon test for paired data was performed. When employing multiple compari- sons, the P-values were correctedusing theBonferroni Fig. 3. BS: bracket splint (occlusal view). adjustment procedure (Systat 5.2, Systat Inc., Evan- ston, IL, USA). The signi¢cant level chosen in all statistical tests was 0.05. Results Noneofthesubjectswithdrew fromthestudy;atotalof 40 splints could, therefore, be evaluated. The parameters ‘impairment of eating’and ‘irrita- tion of gingival margin’ showed no statistical di¡er- ences between the four splints. However, RS showed an increasing irritation of the gingiva over time com- pared to the other splints (day 1 vs. days 4and 7, P < 0.05) (Fig.5). Sensitiveness of teeth and lips was more severe for most splints on day 1, with a continu- ous recovery on the following days (Figs.6 and 7). Statistically signi¢cant di¡erences of sensitive teeth on day 1 were found for BS compared to WCS (P < 0.05) and of sensitive lips for BS compared to Fig. 4. RS: resin splint (occlusal view). WCS and RS (P < 0.05). At days 4and 7, no statisti- Fig. 5. Irritation of the gingival margin (mean values and standard errors). Sig- nificant differences (P < 0.05) are marked. 277 Filippi et al. Fig. 6. Sensitiveness of teeth (mean values and standard errors). Significant differ- ences (P < 0.05) are marked. Fig. 7. Irritation of the lips (mean values and standard errors). Significant differ- ences (P < 0.05) are marked. cally signi¢cant di¡erences were found. Regarding the healing soft tissues must be avoided.Maintenance impairment of speech, signi¢cant di¡erences were of oral hygiene is essential forhealing following dental found on day 1 for BS compared to all other splints trauma (15). Plaque accumulation is detrimental to (P < 0.05) (Fig.8). The oral hygiene
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