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Medicine Nov 2023Intentional replantation and dental autotransplantation are 2 similar techniques both involving atraumatic tooth extraction, visualization of the root, and replantation....
BACKGROUND
Intentional replantation and dental autotransplantation are 2 similar techniques both involving atraumatic tooth extraction, visualization of the root, and replantation. They are considered as the last resort for unsalvageable teeth. The author aims to describe 2 mandibular posterior teeth with serious periapical lesions which are resolved by intentional replantation and dental autotransplantation, respectively.
CASE SUMMARY
In case 1, a 45-year-old male patient received root canal treatment because of a cracked mandible right first molar with periapical lesions. An endodontic file was separated in the apical third of the mesiolingual root canal. After conventional canal filling of the other root canals, the molar was atraumatically extracted. The separated instrument was removed, the mesiolingual root received a retrograde filling and the molar was replanted. At the 3-month follow up, the patient was asymptomatic and the X-ray picture showed no detectable root resorption and ankylosis. In case 2, a 29-year-old woman reported discomfort during occlusal loading after a root canal treatment and a coronal restoration of the mandibular right first molar. Radiographs showed a low-density shadow in the mesial apical and in the root furcation area of the mandibular first molar so the patient was diagnosed as chronic periapical periodontitis. After the removal of the affected tooth, the extraction socket was thoroughly debrided and irrigated. The intact mandibular right third molar with similar dimensions was extracted by minimally invasive procedure and transplanted. The donor tooth was fixed by a fiber-splint for 1 month and a root canal treatment was performed 2 weeks after surgery. After 1 year, clinical and radiographical examination revealed functional and periodontal healing.
CONCLUSIONS
These 2 reports present the successful management of intentional replantation and dental autotransplantation. Both procedures are recommended after nonsurgical endodontic treatment, especially when apical microsurgery is not an option, for example because of difficult accessibility or patient preference.
Topics: Male; Female; Humans; Adult; Middle Aged; Tooth Replantation; Transplantation, Autologous; Molar; Tooth Root; Root Canal Therapy; Mandible
PubMed: 37986277
DOI: 10.1097/MD.0000000000035822 -
The Bulletin of Tokyo Dental College Sep 2021The objective of this study was to verify whether loss of posterior occlusal support induced displacement of the mandibular condyles from a physiological point of view....
The objective of this study was to verify whether loss of posterior occlusal support induced displacement of the mandibular condyles from a physiological point of view. Stabilization-type splints were fabricated for 12 healthy dentulous individuals. Each splint was designed to cover the bilateral maxillary teeth up to the second molars. To reproduce loss of posterior occlusal support, the extent of the splint was reduced one tooth at a time, bilaterally, starting from the back and moving forward sequentially. Tapping movement and lateral excursions were performed with each splint and a jaw movement tracking device with 6-degrees of freedom used to observe condylar displacement. Evaluation of 3-dimensional (3-D) displacement of the kinematic axis of the condyle during experimental jaw movement was performed under each occlusal condition with occlusal contact on all teeth, including the maxillary second molars. The habitual closing position was used as the reference. An increase was observed in 3-D displacement of the kinematic axis at the terminal point of the tapping movement with loss of occlusal support, and significant differences were observed in both condyles. An increase was also observed in 3-D displacement of the kinematic axis on the working side during lateral excursion with loss of occlusal support, and a statistically significant difference was observed in the left condyle. A small increase was observed in 3-D displacement of the kinematic axis on the non-working side during lateral excursion with loss of occlusal support. The results of this study suggest that loss of posterior occlusal support induces displacement of the mandibular condyles, suggesting that occlusal support in the molar region is an important factor in stabilization of the condylar position.
Topics: Humans; Mandibular Condyle; Molar; Movement; Splints; Tooth
PubMed: 34393143
DOI: 10.2209/tdcpublication.2020-0052 -
Plastic and Reconstructive Surgery.... Feb 2022Management of comminuted facial fractures with maxillary-mandibular arch interruption is difficult, resulting in inadequate bone reduction and malocclusion....
BACKGROUND
Management of comminuted facial fractures with maxillary-mandibular arch interruption is difficult, resulting in inadequate bone reduction and malocclusion. Traditionally, a good quality dental splint is helpful, but difficult to obtain in acute trauma. We apply a computer-assisted design and three-dimensional printing technology to improve splint fabrication and utilization, thus facilitating restoration of dental occlusion and facial fracture.
METHODS
We retrospectively reviewed patients who suffered from facial fractures with interruption of the maxillary-mandibular arches. We developed the "computer-assisted reverse planning and three-dimensional printing model surgery" algorithm and applied it in selected patients. An occlusal splint was created as a surgical guide to enhance the maxilla-mandibular unit repair by taking care of the bone reduction and occlusion. All included patients were followed up to assess the functional outcome and patients suitable for this method.
RESULTS
From Jan 2015 to Aug 2020, 10 patients (eight men and two women) with comminuted facial fractures were included. The average time of surgery was 9.2 days. The average follow-up time was 8.6 months. There was no patient who needed major revision to correct malocclusion or facial asymmetry.
CONCLUSIONS
A computer-assisted design splint decreases intraoperative inaccuracies and difficulty in comminuted maxillo-mandibular fractures. It is a useful and reliable alternative. Collaboration with an experienced engineer and patient selection are indispensable in delivering successful outcomes. Patients who have more than three bone fragments in a single dental arch or more than four bone fragments in the entire maxillary-mandibular unit appear to be excellent candidates for this method.
PubMed: 35211367
DOI: 10.1097/GOX.0000000000004149 -
The Journal of Advanced Prosthodontics Oct 2023This study aimed to assess and compare the color stability, flexural strength (FS), and surface roughness of occlusal splints fabricated from heat-cured acrylic resin,...
PURPOSE
This study aimed to assess and compare the color stability, flexural strength (FS), and surface roughness of occlusal splints fabricated from heat-cured acrylic resin, milled polymethyl methacrylate (PMMA)-based resin, and 3D-printed (PMMA) based-resin.
MATERIALS AND METHODS
Samples of each type of resin were obtained, and baseline measurements of color and surface roughness were recorded. The specimens were divided into three groups (n = 10) and subjected to distinct aging protocols: thermomechanical cycling (TMC), simulated brushing (SB), and control (without aging). Final assessments of color and surface roughness and three-point bending test (ODM100; Odeme) were conducted, and data were statistically analyzed (2-way ANOVA, Tukey, <.05).
RESULTS
Across all resin types, the most significant increase in surface roughness (Ra) was observed after TMC ( < .05), with the 3D-printed resin exhibiting the lowest Ra ( < .05). After brushing, milled resin displayed the highest Ra ( < .05) and greater color alteration (ΔE) compared to 3D-printed resin. The most substantial ΔE was recorded after brushing for all resins, except for heat-cured resin subjected to TMC. Regardless of aging, milled resin exhibited the highest FS ( < .05), except when compared to 3D-printed resin subjected to TMC. Heat-cured resin exposed to TMC demonstrated the lowest FS, different ( < .05) from the control. Under control conditions, milled resin exhibited the highest FS, different ( < .05) from the brushed group. 3D-printed resin subjected to TMC displayed the highest FS ( < .05).
CONCLUSION
Among the tested resins, 3D-printed resin demonstrated superior longevity, characterized by minimal surface roughness and color alterations. Aging had a negligible impact on its mechanical properties.
PubMed: 37936836
DOI: 10.4047/jap.2023.15.5.227 -
The Journal of Clinical Pediatric... May 2022Bruxism is defined as a parafunctional activity. It could be in diurnal or nocturnal form, based on the time it occurs. The purpose of the study compares the...
OBJECTIVE
Bruxism is defined as a parafunctional activity. It could be in diurnal or nocturnal form, based on the time it occurs. The purpose of the study compares the effectiveness of occlusal splint treatments in children with nocturnal bruxism using the BiteStrip®.
STUDY DESIGN
The muscle activity of children was measured using the BiteStrip®. The groups used occlusal splints during nighttime sleep for three months, at the end of which their muscle activity were measured again through the use of the BiteStrip®.
RESULTS
Muscle pain in palpation and pain in the dynamic position of TMJ pain was significantly reduced in patients using soft occlusal splint (p=0.01). There was no significant change in the BiteStrip® score in both group I (p=0.11) and group II (p=0.61).
CONCLUSION
Soft occlusal splints could reduce pain caused by nocturnal bruxism on muscle and TMJ. The relationship between treatment results and BiteStrip® scores of patients using soft occlusal splint or hard occlusal splint are not significantly.
Topics: Child; Humans; Occlusal Splints; Pain; Sleep Bruxism; Splints; Treatment Outcome
PubMed: 35830638
DOI: 10.17796/1053-4625-46.3.8 -
Children (Basel, Switzerland) Mar 2023Non-surgical approaches have been proposed in the management of mandibular fractures, especially in children, but there is a lack of clear guidelines on the clinical... (Review)
Review
Non-surgical approaches have been proposed in the management of mandibular fractures, especially in children, but there is a lack of clear guidelines on the clinical indications of conservative approaches. The aim of this scoping review is to provide the available evidence of the role of the orthodontist in the management of mandibular fractures. The PRISMA-ScR guidelines were followed to select eligible articles from the PubMed, Scopus, and Web of Science databases according to precise inclusion criteria. The research questions were formulated as follows: "what is the scientific evidence concerning the rule of orthodontists in the management of mandibular fractures" and "the preferential use of the direct bonding technique with orthodontic brackets rather than rigid arch bars"? Seventeen articles were included. Five articles presented the use of removable acrylic splints or functional appliances, six articles concerned the employment of cemented acrylic or rigid splints, and six articles described the management of mandibular fractures in adults and children using orthodontic brackets or mini-screws. Most of these techniques have been employed in children and growing subjects, while fewer data were available regarding conservative treatments in adults. Preliminary evidence suggests that condylar and some minor parasymphyseal fractures in children may be managed with conservative approaches. In adults, minor condylar and stable body mandibular fractures with minimal displacement have been reduced similarly. However, there are no sufficient elements that could suggest the preferential use of orthodontic brackets over rigid arch bars in adults. Further randomized and non-randomized clinical trials with long follow-ups will be needed to better define the clinical indications of the orthodontic approaches in the management of mandibular fractures based on severity, location, and age.
PubMed: 36980163
DOI: 10.3390/children10030605 -
Journal of International Society of... 2022The effect of occlusal splint therapy on the muscle activity has been addressed in the literature. However, its effect on condylar movements in subjects with normal and...
AIMS AND OBJECTIVE
The effect of occlusal splint therapy on the muscle activity has been addressed in the literature. However, its effect on condylar movements in subjects with normal and abnormal occlusions has not yet been investigated. This prospective clinical study addressed the effect of occlusal splint therapy on condylar movements in subjects with normal and abnormal occlusions using an electronic pantograph.
MATERIALS AND METHODS
Two groups of subjects were included in this study. The first group included subjects with normal occlusion, whereas the subjects in the other group were diagnosed with abnormal occlusion. The occlusal splint was fabricated, adjusted clinically, and delivered for each subject. Condylar movements were recorded using a Cadiax Compact II electronic pantograph at baseline, 2-, 4-, and 6-month follow-up periods to assess sagittal condylar inclination (SCI), immediate mandibular lateral translation (IMLT), and progressive mandibular lateral translation (PMLT). The t-test, one-way analysis of variance (ANOVA), and two-way ANOVA were used to compare the parameters between the groups and to assess the time effect on these parameters (α = 0.05).
RESULTS
Twenty subjects were recruited for this study ( = 10). Among them, 12 were women and eight were men, with a mean age of 34 years. In each group, insignificant differences were reported for each tested parameter at baseline and during the follow-up periods ( > 0.05). However, when comparing the two groups, the only significant difference was found in the SCI during the 6-month follow-up period ( = 0.014).
CONCLUSIONS
Occlusal splints had an insignificant effect on the parameters SCI, IMLT, and PMLT up to 6 months of follow-up for subjects with normal or abnormal occlusion. SCI increased substantially in normal occlusion subjects compared with abnormal occlusion subjects during the 6-month follow-up period.
PubMed: 36532322
DOI: 10.4103/jispcd.JISPCD_96_22 -
Journal of Clinical Medicine Nov 2022Background. Acute anterior disc displacement without reduction (ADDWoR) is characterized by permanent TMJ disc displacement, pain and functional limitations. Occlusal...
Background. Acute anterior disc displacement without reduction (ADDWoR) is characterized by permanent TMJ disc displacement, pain and functional limitations. Occlusal appliances (OA) are among the therapies of choice. Methods. A single-blind randomized study was carried out to compare the therapeutic success of two different types of splints in patients with ADDWoR. A total of 30 subjects were eligible for the study out of the 330 screened. Group I (n = 15) received RA.DI.CA splint therapy and Group II (n = 15) received stabilization splint therapy. Temporomandibular pain, headache, neck pain and functional excursions were evaluated at baseline (T0), after 4 weeks (T1) and after 6 months (T2). Descriptive and inferential statistics were performed. Results. There was a significant increase in maximum jaw opening and a reduction in pain in both groups (p < 0.05), except for neck pain in Group II. Significant differences in between- and within-subject factors emerged in all of the parameters evaluated, especially between T1 and T2 scores, with a greater trend of improvement in Group I than Group II. Conclusion. RA.DI.CA splints were found to be more effective for the considered sample, especially in the treatment of comorbidities and functional movements, probably due to the greater orthopedic action and joint mobilization.
PubMed: 36498611
DOI: 10.3390/jcm11237037 -
Journal of Cranio-maxillo-facial... Aug 2020To evaluate the feasibility of safely managing subcondylar fractures using an original surgical procedure combining an intraoral approach, the use of a custom-made...
INTRODUCTION
To evaluate the feasibility of safely managing subcondylar fractures using an original surgical procedure combining an intraoral approach, the use of a custom-made occlusal overlay splint, and intraoperative imaging.
MATERIALS AND METHODS
Condylar fragment was freed from surrounding soft tissues, was laterally exposed to the ramus, and a miniplate was fixed in place for osteosynthesis. An overlay splint maintaining the dental occlusion was used to facilitate reduction and stabilization during fixation. Intraoperative monitoring by cone-beam computed tomography (CBCT) was performed before completing the fixation.
RESULTS
Between November 2018 and June 2019, 10 patients were treated using this procedure. The median length of the proximal condylar fragment was 29 mm (range 24-39 min). Five patients had an associated mandibular fracture. The median duration of the condylar fracture surgery was 54.5 min (range 38-79 min). All patients had satisfactory reduction and osteosynthesis with no complications.
CONCLUSION
It is feasible to safely manage subcondylar fractures with this surgical procedure that could facilitate open reduction using intraoral approaches. Occlusal splints maintain downward pressure on the rami bilaterally and symmetrically, helping to anatomically reposition condylar process fractures. Intraoperative imaging is used to monitor this step.
Topics: Fracture Fixation, Internal; Humans; Mandibular Condyle; Mandibular Fractures; Occlusal Splints; Open Fracture Reduction
PubMed: 32680670
DOI: 10.1016/j.jcms.2020.05.005 -
BMC Oral Health Jan 2024Sleep bruxism is a prevalent condition in dentistry practice, characterized by involuntary grinding or clenching of the teeth during sleep. Several therapies, including...
BACKGROUND
Sleep bruxism is a prevalent condition in dentistry practice, characterized by involuntary grinding or clenching of the teeth during sleep. Several therapies, including occlusal splints, have been used to manage sleep bruxism and temporomandibular disorders, including occlusal splints. This study aimed to compare the effectiveness of different occlusal splints in managing sleep bruxism.
METHODS
The PICO framework encompasses the characterization of the population, intervention, comparison, and pertinent outcomes. A comprehensive and systematic literature review was conducted on PubMed, Scopus, and Google Scholar to identify grey literature. The search specifically targeted scientific studies published before September 20, 2023. The Cochrane Collaboration Risk of Bias Tool assessed the accuracy of the included Randomized Control Trials (RCTs). The modified Newcastle-Ottawa Scale assessed non-randomized studies. Data were systematically extracted, synthesized, and reported thematically.
RESULTS
Out of the total of 808 articles that were evaluated, only 15 articles were found to meet the specified inclusion criteria. Adjustable splints, such as full-occlusion biofeedback splints, were more effective in reducing sleep bruxism episodes, improving patient-reported symptoms, and enhancing overall well-being. The impact of different occlusal sprints on electromyographic activity varies, and potential adverse effects should be considered individually.
CONCLUSIONS
This review provides valuable insights into the effectiveness of occlusal splints in managing sleep bruxism. The results of this study indicate that occlusal splint therapy is a viable treatment approach for sleep bruxism.
Topics: Humans; Occlusal Splints; Sleep Bruxism; Sleep
PubMed: 38182999
DOI: 10.1186/s12903-023-03782-6