Use digital pressure as needed to reposition the displaced tooth into its correct anatomic position. Use adjacent and opposing teeth as guides. Gentle forceps traction in a forward direction is sometimes needed for palatally displaced teeth. Significantly displaced teeth are best referred directly to a dentist or oral surgeon. Check bite: Have the patient gently and slowly bite down to be sure opposing teeth do not move the repositioned tooth.
Prepare the flexible splint material as directed eg, for Coe-Pak TM periodontal paste, thoroughly blend a ratio of base and catalyst and roll into a cylindrical [sausage] shape using your moistened, gloved fingers.
Make 2 small strips of paste. Do not cover the occlusal surfaces of the teeth. If the temporary splint is not effective, send the patient directly to a dentist for more advanced splinting options. Give tetanus prophylaxis Tetanus Prophylaxis in Routine Wound Management Tetanus is acute poisoning from a neurotoxin produced by Clostridium tetani.
Symptoms are intermittent tonic spasms of voluntary muscles. Spasm of the masseters accounts for the name lockjaw Antibiotics are usually appropriate eg, amoxicillin mg 3 times a day for 7 days. The patient should not chew on the affected side, should eat only liquids and soft foods, and avoid hot and cold foods. Very gentle warm salt water rinses are done every 3 to 4 hours until follow-up. Gentle brushing is done down away from the gum line. Ice chips and NSAIDs nonsteroidal anti-inflammatory drugs, eg, ibuprofen mg every 6 hours are given for pain; narcotic analgesics eg, acetaminophen with codeine , hydrocodone, or oxycodone may be used if needed for a severe injury.
For relief of swelling, apply ice packs 30 minutes on, 30 minutes off to the side of the face for 24 hours, then switch to warm compresses. Arrange follow-up with a dentist as soon as possible, same day if possible, for hygienic splint placement eg, wire and bonded resin. Instruct the patient that reinserting and splinting an avulsed tooth does not guarantee its survival.
Even if reimplantation is successful, the tooth will require root canal therapy rarely, a quickly reimplanted immature tooth with an open apex will revascularize and not require root canal.
Do reimplantation within 30 minutes if possible. A tooth contaminated by dirt is a risk factor for tetanus Prevention Tetanus is acute poisoning from a neurotoxin produced by Clostridium tetani. Patients and parents are understandably worried and anxious. Calm reassurance is important in order to obtain the cooperation needed to reduce time to reimplantation.
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This site complies with the HONcode standard for trustworthy health information: verify here. Common Health Topics. Videos Figures Images Quizzes Symptoms. Additional Considerations. Relevant Anatomy. Step-by-Step Description of Procedure. Warnings and Common Errors. They believe that this stabilization helps the periodontal ligament to have better repair conditions, however those devices should be the least traumatic as possible 2 , 7 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 17 , 18 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , Several types of splints are available, depending on the mobility degree, they are classified as: flexible, semi-rigid and rigid.
The authors ideally recommend the use of semi-rigid splint in cases of dental avulsions when no bone fracture is detected 2 , 7 , 10 , 13 , 15 , 17 , 18 , 37 , 39 , 40 , 42 , 45 , Non-rigid immobilization is the ideal device due to its passive, atraumatic and flexible features, which allows a certain functional movement, and thus a functional arrangement of the periodontal ligament fibers, reducing the risk of external resorption and ankyloses 2 , 10 , 17 , 37 , 44 , 47 , 48 , Some authors also advocate the use of flexible splint in avulsions 4 , 36 , 38 , Even though Pereira et al.
However, the rigid splint is necessary in cases of fracture of the bone plate and late replantation 7 , 9 , 19 , Most authors believe that the ideal semi-rigid splint type is the one made with composite resin and orthodontic wire or nylon thread. The variation regards the type of thread and material used. Ruellas et al.
The nylon thread recommended by Andreasen et al. Authors like Prokopowitsch et al. Rigid immobilization can be made with composite and rigid wire 0. On the other hand, Oliveira et al. Prokopowitsch et al. There are other types of alternative splints, such as the ones made with orthodontic brackets associated with a passive wire, sutures or vestibular bars 18 , 40 , 45 , 47 , Regarding the time of immobilization, authors such as Isolan et al.
In cases of avulsion with no fracture in the bone plate, some authors advocate the use of splinting for just one week 2 , 5, 36 , 48 , Others, on the other hand, believe that 2 weeks are sufficient 14 , 40 , 41 , however, Trope et al.
McDonald and Avary 42 suggest for 7 to 14 days and Soares and Goldberg 45 , for 7 to 15 days. According to Souza Neto et al. In cases of avulsion associated with fracture of the bone plate Alvarez and Alvarez 12 suggest the use of splints for 6 to 8 weeks.
Trope et al. In late replantation, Prokopowitsch et al. Rigid Splint placed after tooth intrusion of an upper left central incisor. At the moment of the consult, the patient reported to be using this splint for 2 months. It was revived immediately. After CBCT, it was possible to confirm the substitutive resorption on the root of the tooth. Based on the literature, it can be concluded that after replantation the use of splint is compulsory for allowing immobilization of the teeth during the initial period, which is essential for the repair of periodontal ligament; the use of semi-rigid splint is more indicated than the rigid one, and that long periods of splinting showed that substitutive resorption or ankylosis is an expected complication.
Source of funding: None declared. Conflict of interest: None declared. National Center for Biotechnology Information , U. J Istanb Univ Fac Dent. Published online Dec 2. Author information Article notes Copyright and License information Disclaimer. Received Aug 15; Accepted Sep Users must give appropriate credit, provide a link to the license, and indicate if changes were made.
Users may do so in any reasonable manner, but not in any way that suggests the journal endorses its use. The material cannot be used for commercial purposes. No warranties are given. For example, other rights such as publicity, privacy, or moral rights may limit how the material can be used. This article has been cited by other articles in PMC. Abstract Avulsion is defined as the complete displacement of the tooth out of its socket with disruption of the fibers of periodontal ligament, remaining some of them adhered to the cementum and the rest to the alveolar bone.
Keywords: Tooth replantation, tooth avulsion, ankylosis, substitutive resorption, splinting. Introduction Traumatic dental injuries compromise the patient, in both functional and psychological aspects 1. Historic progress of dental splints The first experimental research regarding this content, according to Chelotti and Valentine 11 began with Wilkinson in , who used monkeys to perform teeth replantation and subsequent histological evaluation, which led him to conclude that it was necessary the presence of the periodontal membrane so that fixation could happen.
Usage of splinting Several factors might influence in the success of replantation, such as: extension of the trauma, extraalveolar permanence period, means of preservation, contamination, manipulation and conditions of the avulsed tooth Open in a separate window. Figure 1.
Semi-rigid splint, placed after tooth avulsion of the central incisors. Figure 2. Conclusion Based on the literature, it can be concluded that after replantation the use of splint is compulsory for allowing immobilization of the teeth during the initial period, which is essential for the repair of periodontal ligament; the use of semi-rigid splint is more indicated than the rigid one, and that long periods of splinting showed that substitutive resorption or ankylosis is an expected complication.
Footnotes Source of funding: None declared. References 1. A retrospective study of traumatic dental injuries in a Brazilian dental trauma clinic. Dent Traumatol. December; 17 6 —3. Texto e atlas colorido de traumatismo dental. Art Med. International Association of Dental Traumatology. Dental trauma guide [Internet]. August [revised Dec; cited Dec 2].
Predisposing factors for traumatic dental injuries in Brazilian preschool children. Eur J Paediatr Dent. June; 11 2 — Traumatic dental injuries in primary dentition: epidemiological study among preschool children in South Brazil. April; 26 2 — Prokopowitsh I. Alternative treatment for teeth with substitutive root resorption.
Ceschin JR. Apply the flowable composite material to the tooth and then the Ribbond tape, which is pressed into the composite applied and smoothed, and excess composite material is removed. Each tooth is then light cured for 30—40 s. Using a drill, we remove the excess composite material and polish the surface of the composite. Kevlar fiber, poly-paraphenylene terephthalamide, is a synthetic, organic fiber of exceptional strength five times stronger than metal.
As well as being used to make bulletproof vests and in the aero-industry, it is used in dental traumatology as a means of immobilizing teeth [ 6 ].
It has the identical features, therapeutic effect, and manner of application as Ribbond splints. A TTS is a more recent splint, made from pure titanium, only 0. It is available in 52 and mm lengths. It is designed in the form of a rhomboid mesh, which makes it easier to be fixed and makes it flexible in all dimensions Figure The size of the rhomboid opening, 1. It is fixed to the tooth in the same way as a wire-composite splint.
The weakness of this splint system is that it is very expensive in comparison with a wire-composite splint. Titanium trauma splint TTS.
In view of the diversity of splints which may be used for traumatized teeth, the following features of a good splint should be used as guidelines in selection [ 4 ]: It is simple to create and put in place.
In dentoalveolar traumatology, answers have not been found for all the questions that arise, especially regarding the duration of the use of splints. The effect of the duration of immobilization, that is, keeping a splint in place during the healing of the periodontal ligament, has still not been explained in clinical studies.
The long-term use of a splint leads to ankylosis and replacement resorption. On the other hand, it has not been confirmed that there is a better outcome of healing in the case of the short-term use of a splint [ 30 ]. The current trends in dentoalveolar traumatology recommend the use of a splint in cases of luxation and avulsion of a tooth and in fractures of the root and alveolar ridge [ 31 ]. Table 1 shows basic guidelines for the use of splints, in relation to the type of trauma, the duration of mobilization, and the type of splint.
Recommendations for the type and duration of immobilization depending on the type of trauma. There is a large selection of splints which are indicated for tooth trauma Table 2. Classification of splints with indications, contraindications, advantages, and disadvantages. Modern trends in dentoalveolar traumatology support the use of functional and flexible splints for luxation and avulsion.
The prognosis for traumatized teeth is more determined by the type of trauma than the type of splint selected. The type of splint and the duration of immobilization, therefore, may not be considered significant variables in terms of the outcome of healing. Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution 3. Help us write another book on this subject and reach those readers. Login to your personal dashboard for more detailed statistics on your publications.
Edited by Mazen Ahmad Almasri. We are IntechOpen, the world's leading publisher of Open Access books. Built by scientists, for scientists. Our readership spans scientists, professors, researchers, librarians, and students, as well as business professionals. Downloaded: Abstract Dentoalveolar trauma is considered an emergency condition and is challenging for every dentist. Keywords splinting traumatized teeth dentoalveolar trauma immobilization.
Introduction Since any dentoalveolar trauma is an emergency condition, it is a challenge for all dentists. However, first of all, let us look at what a splint is. In permanent dentition, the use of a splint is indicated for [ 10 ]: Injuries to the periodontal tissue subluxation, luxation, and avulsion Injuries to the hard dental tissue class IV root fractures.
This splint may be made in two ways: The direct method The indirect method 2. The following materials are needed for this method Figure 4 : Vaseline Self-adhesive acrylic powder and liquid A container for mixing the acrylic A piece of sterile gauze Glass for mixing A spatula for mixing Scissors Pliers Grinder.
Various models are created in the laboratory. The wax model is exchanged for acrylic. The splint is cemented in the same way as in the previous method. The technique is very simple because it consists of working with composite material in the classical way: Conditioning of the enamel of the injured and neighboring teeth Application of the adhesive and composite material with polymerization.
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