jcda
J Can Dent Assoc 2013;79:dXX
2013;79:d131
ca
ESSENTIAL DENTAL KNOWLEDGE
Published by
The Canadian Dental Association
jadc
DES CONNAISSANCES
DENTAIRES INDISPENSABLES
Publié par
l’Association dentaire canadienne
At 7 months 19 days post-trauma, clinical examination shows preservation
of all traumatized teeth and significant
reestablishment of the arch form.
At 8 months 23 days post-trauma,
a pontic was inserted to replace the
avulsed tooth 21.
A maxillary Hawley-type retainer
incorporating the pontic was placed
19 months following initial injury.
Clinically, all of the traumatized teeth were vital, asymptomatic and responded to thermal stimuli. Radiographic examination revealed that the traumatized teeth were in an early stage of root development; roots were less than half their final length
and apices were open. No signs of intraosseous or pulpal pathology were found.
Considering the severe consequences of premature tooth loss, it was decided that every effort should be made to maintain the
traumatized teeth. A fixed orthodontic appliance was used as a trauma splint. This allowed for simultaneous management of
the various luxation injuries and facilitated future rehabilitation.
Flexible, passive splints, such as wire-composite splints, are recommended in the guidelines for treatment of traumatic injuries to the dentition because of their proven track record. However, the management of dental trauma is not conducive to onesize-fits-all solutions. As demonstrated in this case, orthodontic splinting may provide distinct advantages over conventional
techniques. a
Treatment Considerations
There are 4 main situations in which an orthodontic splint may be advantageous:
1. When it is not possible to construct an adequate wire-composite splint, e.g., in the case of severely malpositioned teeth
2. When multiple dental injuries must be addressed complicating the splint design
3. When repositioning of the traumatized teeth is required, e.g., intrusive luxation
4. When the least traumatic method of repositioning is desirable to safeguard pulpal vitality, e.g., in the case of teeth with open apices,
which have greater potential for pulpal revascularization
Orthodontic splinting is a simple and versatile procedure. The following general principles should guide the construction of an orthodontic splint:
• Forces should be as light as possible to establish a splinting effect
• Adequate anchorage should be established using non-traumatized posterior teeth
• Optimal oral hygiene is critical for quick healing without complications
• The patient should be monitored consistently to manage potential complications and monitor the movement of teeth
Cite this as: J Can Dent Assoc 2013;79:d131
• 38 •
| 2014 | Vol. 80, No. 1 |
jcda
ca
ESSENTIAL DENTAL KNOWLEDGE
Published by
The Canadian Dental Association
jcdaf
ca
DES CONNAISSANCES
DENTAIRES INDISPENSABLES
Publié par
l’Association dentarie canadienne
2014_issue_1_January english.indd 38
2/4/2014 8:56:37 AM