Christine Berthold

Rigidity of commonly used dental trauma splints

BACKGROUND/AIMS The stability of immobilization devices varies from flexible to rigid, depending on the trauma. We evaluated the rigidity of various commonly used splints in vitro MATERIAL AND METHODS An acrylic resin model was used. The central incisors simulated injured teeth, with increased vertical and horizontal mobility. The lateral incisors and canines stimulated uninjured teeth. Tooth mobility was measured with the Periotest device. Vertical and horizontal measurements were made before and after splinting, and the difference between values was defined as the splint effect. We evaluated 4 composite splints, 3 wire-composite splints, a titanium trauma splint, a titanium ring splint, a bracket splint, and 2 Schuchardt splints RESULTS For all injured teeth and all splints, there was a significant splint effect for the vertical and horizontal dimensions (P < 0.05). For injured teeth, the composite splints produced the largest changes in vertical tooth mobility; wire-composite splints 1 and 2, using orthodontic wires, produced the smallest vertical splint effects. For uninjured teeth, the Schuchardt 1 splint and the bracket splint produced the largest splint effects; wire-composite splints 1 and 2 produced only a slight change in tooth mobility. Composite splints 2 and 3 produced the largest horizontal splint effects for injured teeth, and the 4 composite splints produced the largest horizontal splint effects for uninjured teeth. The most horizontally flexible splints were the titanium trauma splint and wire-composite splints 1 and 2. CONCLUSIONS According to the current guidelines and within the limits of an in vitro study, it can be stated that flexible or semirigid splints such as the titanium trauma splint and wire-composite splints 1 and 2 are appropriate for splinting teeth with dislocation injuries and root fractures, whereas rigid splints such as wire-composite splint 3 and the titanium ring splint can be used to treat alveolar process fractures.

An evaluation of the Periotest® method as a tool for monitoring tooth mobility in dental traumatology

BACKGROUND/AIM The Periotest method is a technique for the objective assessment of tooth mobility. The aims of this study were to determine normal Periotest values in the vertical and horizontal dimensions of periodontally healthy teeth in individuals aged 20-35 years and investigate the reliability of Periotest in terms of intra-series and inter-series reproducibility before and after applying a dental trauma splint in vivo. MATERIALS AND METHODS Periotest values were measured in periodontally healthy dental students (n = 33; mean age 24.7 years) at reproducible measuring points in the vertical and horizontal dimensions, before and after splint insertion. Three readings were taken per series to observe the intra-series reproducibility; three series were measured to test inter-series reproducibility (Friedman-test; P <or= 0.001). Two different wire-composite splints, 0.45 mm Dentaflex and 0.8 x 1.8 Strengtheners, were inserted and the Periotest values were measured. RESULTS The median Periotest values before splinting were: canines -2.5, lateral incisors -0.9, and central incisors 0.0 for the vertical dimension, and canines 1.1, lateral incisors 3.2, and central incisors 3.6 for the horizontal dimension. The intra-series and inter-series Periotest values were highly reproducible. CONCLUSION The Periotest method provides highly reproducible results. Focused on dental trauma, the method can be applied diagnostically during the splint and follow-up period and for evaluating splint rigidity.

Noncontact intraoral measurement of force-related tooth mobility

The aim of this pilot study was to measure force-related tooth mobility. Vertical and horizontal anterior tooth mobility in 31 healthy periodontal subjects was measured by a noncontact optical measurement technique. The subjects continuously increased the force on each tooth by biting on a load cell. An automated software program recorded tooth displacement at 9-N intervals. Vertical and horizontal displacements were subsequently measured. The vector of tooth mobility in the buccal direction was calculated using the Pythagorean theorem. The average displacements over all subjects for each tooth were determined. Global differences were assessed with the Wilcoxon test. There were no significant differences between contralateral teeth overall load stages. There were no significant differences in tooth mobility between the central and lateral incisors except for in the horizontal direction. However, there were significant differences between central incisor and canine and lateral incisor and canine teeth.

Correlations between photogrammetric measurements of tooth mobility and the Periotest method.

Abstract Objective. The purpose of the present study was to investigate whether or not the quantitative Periotest values of anterior teeth correlate with quantitative metric values of tooth mobility under vertical (VL) and horizontal load (HL) in periodontally healthy subjects. Materials and methods. Thirty-one subjects with good periodontal conditions were included and subjected to two different tooth mobility measurement techniques. Periotest values were measured at reproducible measurement points in the vertical (vPT) and horizontal (hPT) dimensions of upper central and lateral incisors and canine teeth. Using the optical measurement technique (photogrammetry), tooth mobility was measured under load in the horizontal (HL) and vertical loading directions (VL) at different load forces. Pearsons correlation coefficients were used to determine exploratory associations. Results. The comparison between hPT and HL showed no correlations between the two measurements except for ‘weak’ and ‘moderate’ correlations for teeth 21 and 23. The analysis of correlations between vPT and VL data showed statistically significant correlations for both the left and right canine teeth that ranged from ‘weak’ to ‘high’. Comparisons between hPT values and VL and between vPT and HL showed significant correlations at a few loading forces only. Conclusion. Quantitative Periotest values cannot be used to draw conclusions about the metric assessment of tooth mobility. For this purpose, the photogrammetric technique could be an additional tool for scientific questions.

Influence of attachment and bone loss on the mobility of incisors and canine teeth

Abstract Objective. The purpose of this clinical study was to evaluate the correlation between tooth mobility (TM), crown-to-root ratio (CRR) and clinical attachment loss (CAL) in periodontally-compromised participants. Materials and methods. While slowly biting on a load cell, the mobility of the upper incisors and canine teeth of 20 volunteers was measured using a photogrammetric measurement technique. An automated software program recorded the force-related three-dimensional TM at 3-N intervals. CAL was assessed clinically and CRR values were assessed radiographically. For each contralateral pair of teeth (central, lateral incisor, canine) and for each main level of force, the Pearson product-moment correlation coefficient between TM and CRR and between TM and CAL was computed. Correlations were considered statistically significant at p < 0.05. Results. Statistically significant positive correlations were found between TM and CRR for incisors and canines for each main level of force, whereas canines had the lowest correlation. Statistically significant positive correlations were also found between TM and CAL for the central and lateral incisors at each main level of force. Canines showed no significant correlation between CAL and TM, regardless of force level. Conclusion. The loss of attachment and bone seem to have more influence on the mobility of incisors than canines.

Late reposition of a lateral luxated maxillary incisor with an immature apex

Here we describe an unusual trauma case. A recently erupted permanent upper-right incisor sustained a lateral luxation when a 5-year-old girl on a playground climbing net dropped off, catching the right upper incisor in the net. The tooth was laterally luxated in vestibular direction, and no other signs of injury occurred. A dental practitioner could not reposition the bony locked tooth. Four days later, the girl came to our clinic, and we performed an incomplete repositioning of the tooth and made a flexible splint. Controls were made at 1, 6, and 12 weeks and at 6, 12, 18, and 24 months later. The 24-month follow-up clinical examination revealed the patient to be asymptomatic and the tooth to be completely functional, and the recall radiograph showed further apical root growth. The implications of a late incomplete reposition of laterally luxated permanent teeth with immature apices are discussed.