The lower jaw is subject to traumatic damage much more often than other bones of the facial part of the skull. Although it is one of the strongest bones, its mobility and protruding position make it susceptible to fractures. Up to 85% of all injuries to facial bones occur due to fractures of the lower jaw. These figures include both isolated fractures of the lower jaw and fractures with simultaneous damage to other bones of the facial skeleton.
Experts predict that the number of injuries to the lower jaw will only increase, as well as the nature of such injuries. This is facilitated by an increase in the number of vehicles, an increase in their speed limits, as well as complex technical equipment in production.
Features of the splinting procedure
In dentistry, there are many types of diseases that can potentially increase tooth mobility. This causes severe discomfort and negatively affects the condition of the jaw apparatus. It becomes difficult for a person to chew and he has to adhere to a special diet.
To solve this problem, you need to use a splinting technique. At its core, this is a procedure for strengthening teeth, which allows you to connect several units in a row and protect them from falling out.
The application of a splint is necessary so that there is not such a strong load on the gums, and other treatment methods can be freely applied. At the same time, it will be much more comfortable for the patient to chew different types of food.
Unloading tissue with splinting helps reduce the intensity of the inflammatory process. This is especially useful for periodontitis, when it is necessary to keep the gums in a calm state while doctors carry out general sanitation and restore damaged teeth.
In this material we will tell you in more detail how teeth splinting is done, what products are used in the process, and also touch on many other important issues regarding the procedure.
USING ARAMID FIBER
Also very popular is cable splinting of teeth with aramid thread, which has enormous strength. Experts have conducted several studies, during which it turned out that aramid fiber has eight times greater strength than piano steel with similar parameters.
- This technique allows you to achieve excellent aesthetics and correction of the dentition in case of displacements caused by periodontal diseases, injuries and other reasons.
- Aramid fiber is superior in durability to any other thread.
- The material does not enter into chemical reactions with saliva and food, and has excellent biocompatibility.
- Bone tissue stops rapidly atrophying.
- Large gaps between teeth are eliminated. Consequently, the space between them is not clogged and the overall aesthetics are improved.
- The natural load on the dentition is restored.
- You can simultaneously install dentures to replace lost teeth.
For what reasons does the dentition become mobile?
Doctors identify many reasons why patients need to be splinted. And these include such types of diseases as:
Periodontitis. The main reason for its appearance is poor oral hygiene, as well as the characteristics of the microflora. A strong build-up of tartar can often stimulate the inflammatory process and loosen teeth. In this case, there is a gradual destruction of the fixing ligament, which connects the tooth to other tissues.
- Periodontal disease. It can be quite easily determined by external examination. The gums become whitish, although any negative sensations and pain are practically not observed. Gradually, the volume of the gums decreases, and bare roots become very noticeable. Due to insufficient supporting tissues, the tooth begins to loosen over time. Periodontal disease is often observed in patients with a weakened body due to systemic diseases or long-term treatment.
- Injury. Problems can begin if a jaw fracture has been recorded.
Other categories of patients are also at risk. If you smoke a lot, neglect advice on regular oral hygiene, or suffer from metabolic disorders, you can develop severe tooth mobility. It also manifests itself due to age or poor nutrition.
Metal Kirschner spokes
This type of wire was first used to treat fractures of the lower jaw in 1933. Intraosseous insertion of these wires can be carried out both percutaneously (without incisions) and with soft tissue incisions.
In 1975 V.V. Donskoy used an original technique, with which he inserted a wire into the branch of the lower jaw through the mucosa without an incision, then carried out a reposition, and fixed it like a splint to the teeth or to a splint. Later, in 1988, Deryabin E.I. and Osipov V.Yu., and Yu.G. Kononenko and G.P. Ruzin proposed modifications of this method in 1991. Today there are many techniques where the wire suture is combined with knitting needles, staples, surrounding wire ligatures, etc.
Indications and contraindications for splinting
The decision about whether splinting can be performed in a particular case is made by the doctor. It is important that the technique has no contraindications and is effective.
There are several main common indications:
- Severe changes in the position of teeth or loosening due to periodontitis.
- Trauma – fractures of the upper or lower jaw.
- Reducing the volume of gum tissue.
- The gum pockets reach a size of 5 mm.
- Exposed roots.
There are also a number of contraindications for the procedure. Splinting cannot be performed when the patient has caries on the supporting teeth or severely inflamed gums. Also, restrictions are imposed if a person has too sensitive enamel or has a reaction to various materials of the system’s components.
It is also worth preparing for the fact that after splinting you will need to follow the rules of oral hygiene. Here the situation is similar to wearing braces - you will need to carefully monitor how well you brush your teeth.
First aid for fractures of the lower jaw
It can be carried out either at the scene of the incident or in an ambulance. It can be provided by both medical and non-medical workers in the form of mutual assistance.
The victim’s damaged jaw is temporarily (for several hours) fixed (the upper jaw is pressed to the lower) using bandages or other devices in order to be able to deliver him to a medical facility.
For fixation, the following can be used: a circular bandage parietal-mental bandage, a soft chin sling (Pomerantseva - Urbanskaya), an Entin splint (standard transport rigid bandage), as well as various types of intermaxillary ligature binding. If the patient has a traumatic brain injury, ligature binding is used with extreme caution - fixed jaws do not allow opening the mouth, and can lead to aspiration of vomit or blood.
What materials are used when splinting a tooth?
The cost and other parameters of tire installation will greatly depend on what materials the system was made from. Let's look at the most common ones:
- Fiberglass thread. Fiberglass splinting of teeth is completed in just one and a half to two hours. You can expect at least three years of active use.
- Aramid fiber. Also in demand when performing splinting. It is valued for its careful attitude towards the enamel - after removal there is no damage left on it.
- Polyethylene. It is valuable because it is well tolerated by the mucous membrane and causes virtually no discomfort when worn even by sensitive people.
- Metal. Classic material for making retainers. Perfectly holds teeth in the desired position.
- Silk. This fiber can also be used; it is gentle on both mucous membranes and enamel, but is characterized by low strength.
- Ceramics. Typically used when permanent prosthetics are planned. Problems may arise due to the fact that the method is quite labor-intensive and expensive.
It is also possible to use metal-ceramics in the process. It is durable and quite affordable.
How to eat?
Since during intensive therapy and during the recovery period the jaws are rigidly fixed and habitual chewing of food is out of the question, correction of the diet is necessary during this period.
Food should have the consistency of low-fat sour cream. These are broths, pureed soups, carefully chopped vegetables and fruits, milk drinks, liquid cereals. Spices are excluded, salt consumption is limited. The temperature of the dish should not be higher than 45-50 °C. The most convenient way to eat food is through a straw.
You need to gradually switch to your usual diet after removing the splint. This is important not only for restoring chewing functions, but also for preventing disorders in the gastrointestinal tract.
Benefits of the procedure
This procedure really helps to significantly reduce mobility and reduce stress on the gums. Periodontitis slows down, and restoration of normal chewing ability has a positive effect on the digestive process.
The procedure also has a positive effect on the patient’s personal comfort. The space between his teeth becomes smaller - this removes the psychological pressures that prevent many people from smiling normally.
Modern systems are designed so that you can talk in them calmly. Food restrictions are minimal.
Traumatic deformities of the jaw area. 3D planning
Patients often come to NKclinic with post-traumatic deformations of the jaw area, resulting in malocclusion and/or tooth loss. Treatment of such pathology usually requires an interdisciplinary approach and the involvement of orthodontists in the therapeutic process.
Drawing up a program of orthodontic preparation for reconstructive surgery, prosthetics and surgical correction of post-traumatic deformities in the jaw area, as well as the intervention itself, require a thorough comprehensive diagnosis, including computed tomography, production of plaster and STL models. Computer processing of the obtained data helps to visualize all stages of treatment, as well as immediately demonstrate to the patient his future face. The experience and exquisite work of our maxillofacial surgeons allow us to achieve a 99% coincidence of the ideal result with the real one.
Digital planning of orthodontic and surgical procedures using interactive programs Nemotec and Dolphin 3D allows all specialists involved in the treatment process to work harmoniously, according to a strictly defined model, and achieve maximum results.
Disadvantages of the method
The main disadvantage is that when installing the tire, you will need to carry out special mechanical processing of the enamel.
It is also worth considering that the product cannot be used by all patients. Much depends on the patient himself. He needs to be attentive to oral hygiene and brush his teeth on time. Otherwise, the risk of caries occurring and developing is very high. Hygiene itself will also become more difficult.
When installing a tire, you need to remember the adaptation process. During the first few days, there may be severe tooth sensitivity to sour, hot and cold foods.
Recovery period
The period of restoration of jaw functionality depends on the following factors:
- severity, type of fracture;
- duration of treatment;
- absence or presence of complications;
- patient's age;
- the presence of concomitant internal diseases.
Returning the joint to full function is not always possible. Here the responsibility and diligence of the patient himself comes to the fore. To restore healthy jaw function, you must strictly follow all prescribed recommendations. Long-term, scrupulous rehabilitation is the key to normal functioning of the jaw joints.
Rehabilitation measures:
- Exercise therapy for developing joints. All exercises are performed with full amplitude, even with pain;
- regular courses of therapeutic massage;
- physiotherapeutic procedures - paraffin applications, mud therapy, ultrasound, electrophoresis with calcium, UV irradiation in winter;
- gentle food.
Types of teeth splinting
There are many parameters to classify such a procedure. One of the main ones is location. The tire can be installed in two options:
- Frontal. Usually placed in the gap next to the incisors and canines.
- Lateral. Placed on a group of chewing teeth.
It is also possible to install a special clasp design - it is more expensive, but allows you to use both jaws.
Another difference parameter is the division into permanent and temporary splinting. Typically, a temporary option is indicated when the disease is just beginning to develop and the gums have not become too thin. This type of splinting is also allowed when there are injuries and deformations of the dentition.
An option with permanent splinting is also possible, when long-term stabilization is ensured. When choosing between a clasp prosthesis and permanent splinting, many patients prefer the first option because it is more aesthetically pleasing.
As the name implies, temporary and permanent structures differ in terms of wearing time:
- Temporary. Typically used between a few days and several months. This option allows you to correctly distribute the load and prevents serious damage to the mucous membrane. The design itself is quite simple, so it can be easily put on and taken off. Depending on the patient's current condition, the number of units to be splinted is selected. Common materials used in manufacturing are plastic and metal.
- Permanent. Suitable if you need to fix a tooth for many years. The advantage is that a truly reliable fixation is created, and the time spent adapting to such a design is greatly reduced.
You need to understand that the process of oral hygiene when using permanent prosthetics will become more difficult. You also need to pay attention that all tasks within the framework of dental treatment must be completed before the splint is installed - then it will be much more difficult.
Osteosynthesis
Indispensable for complex, comminuted and multiple fractures with displacement, loose teeth and complete absence of teeth, for periodontal disease and other inflammatory diseases of the gums in the area of injury. Osteosynthesis is also effective in cases of fracture of the condylar process complicated by dislocation of the articular head of the lower jaw.
Fastening materials can be steel knitting needles and rods, pins, nitride-tinan wire with shape memory, quick-hardening plastics, polyamide thread, special glue.
However, osteosynthesis with metal miniplates is considered the most convenient and safe method today. They allow you to cut through the skin and muscles on only one side, which simplifies the operation itself and shortens the recovery period. Another undeniable advantage is the ability to reliably fix fragments in areas with significant dynamic loads.
Teeth splinting methods
At the first appointment, the dentist assesses the current condition of the oral cavity and takes an x-ray. The task before him is to understand how much the bone tissue has thinned. You also need to determine the degree of tooth mobility, see what condition the bite is in, and whether there are any irregularities or other problems.
The condition of the gums is also of great importance, because it allows you to understand what methods can be used for splinting, what are the risks of irritation or other problems arising.
Installation of a splint is allowed only if there are no contraindications for this and no inflammation is observed. Sanitation of the oral cavity and treatment of caries may also be required. This becomes especially important when the installation of permanent permanent structures is planned.
Splinting using fiberglass
Fiberglass splinting is one of the most common methods. It is usually used when you need to connect several teeth and save as much as possible. The duration of use of one tire does not exceed two years - after this period it will be necessary to install a new one.
The entire installation process does not take more than two hours. First you need to clean the enamel, then create a small groove on it. After this, the fiberglass tape is fixed to the composite materials. After the structure is polished, the doctor is convinced that nothing is bothering the patient, the work is considered completed.
This technique is needed in order to splint teeth in case of periodontal disease. The choice of this method is supported by a high level of strength, good compatibility with dental tissues and affordability.
Screw method
The main material for this splinting is armid thread. This method can be used when a person is injured.
Splinting teeth for jaw fractures and increased mobility allows you to get noticeable results.
The installation process is similar to what has already been described above. First, the enamel is cleaned, then a groove is created. A cord of armid thread is stretched in the recess.
Clasp remedy
This technique refers to methods of permanent prosthetics and is suitable if you need to stabilize the dentition with severe loosening.
The use of modern means makes it possible to prepare abutments and crowns so that large gaps between teeth can be prevented.
Securing crowns
The product is suitable for you if you need to fix four teeth in a row at once. In this case, you will need to install crowns that connect. The installation is the same as in the cases described above. The main difference is the laboratory installation of crowns, as well as their fitting before placing them on permanent cement.
Splinting for periodontitis
This splinting option will be used if there is severe destruction of bone tissue. In this case, you need to apply a splint as quickly as possible in order to qualitatively reduce mobility and prevent further progression of tissue atrophy.
Splinting for injuries
Splinting teeth for fractures is a common practice. In this case, the doctor is tasked with preventing the manifestation of asymmetry. Temporary restorations are often prescribed to restore the correct position of the teeth throughout the recovery period.
Splinting after braces
Sometimes splinting must be used after the patient removes braces. In this case, the tire acts as a retainer. It allows you to prevent tooth displacement, which could lead to spoiling the result of many months of treatment.
International standards
A real revolution in maxillofacial surgery occurred in 1958, when M. Muller, M. Allgower, R. Schneider, H. Willenegger organized the International Association for the Study of Internal Fixation (AO/ASIF - Ardeitsgemeinschaft fur Osteosynthesefragen/Association for the Study of Internal Fixation – working association for the study of osteosynthesis/association for the study of internal fixation).
According to the postulates of AO/ASIF, the osteosynthesis technique implies that:
1. the structures used must be made of bioinert metal alloys;
2. bone fragments must be anatomically accurately compared and fixed;
3. the use of gentle surgical techniques ensures the preservation of blood supply to bone fragments and surrounding soft tissues;
4. stable fixation of fragments is ensured by interfragmentary compression;
5. early application of functional load is indicated;
6. restoration of contractile activity of muscles and movement in the joint.
AO/ASIF staff also developed and implemented metal plate systems for mandibular osteosynthesis:
· dynamic compression plates;
· reconstructive (blocking) plates (Locking reconstruction plates);
· blocking (locking) plates (Locking plates 2.0 mm);
· universal plates (Universal fracture plates);
· mandibular plates (Mandible (Mandible plates 2.0 mm).
They developed dynamic compression plates (DCP), through which it was possible to create compression between fragments for their primary fusion. The design of these plates includes oval holes with beveled walls, which allows the fragments to be brought closer together when the screws are tightened. The use of dynamic compression plates made it possible to achieve stable internal immobilization, reduced the number of cases of delayed fusion of fragments, and eliminated the need for additional fixation. But their use still does not eliminate the risk of microcracks in the area of the fracture line and the development of osteoporosis in the bone at the site of contact with the plate.
The locking plate/screw system, with threaded plate holes and locking screw heads, was developed to prevent bone necrosis under the plate. The system provides rigid fixation of bone fragments using a plate and a plate and screws to each other - this helps prevent the screws from unscrewing and avoid possible displacement of the fragments while tightening the screws in the hole of the plate. The plate itself is located at a certain distance from the surface of the bone, which prevents the development of lysis.
Foreign studies have not revealed significant differences in the effectiveness and possible development of postoperative complications during osteosynthesis with locking plates with screws and non-locking plates.
Another system developed by AO/ASIF experts is the LCP (locking compression plate system with angular stability) is a design of multi-cell plates with numerous holes and consists of two parts: a threaded one for fixing the head of a locking screw and a hole for creating dynamic compression by eccentric insertion of standard cortical or cancellous screws.
Installation of the plate requires special tools and is carried out according to clearly established technology.
If the adjustment of the LCP to the shape and relief of the outer surface of the lower jaw bone is carried out in accordance with the established requirements, then this creates ideal conditions for the fusion of fragments during osteosynthesis of multiple comminuted fractures of the lower jaw of various locations, in case of suppuration of a bone wound, traumatic osteomyelitis, in case of a fracture with the occurrence of a bone defect tissue, fracture of toothless jaws. Limited contact of LCP with bone helps prevent the development of bone necrosis under the plate.
Make an appointment to install a splint on your teeth
If you have an indication for teeth splinting, make an appointment with our clinic. Clients come to us from different cities - Khimki, Kurkino, Novogorsk and many others.
We guarantee a professional approach from dentists with extensive experience, fast treatment and the use of high-quality materials.
To make an appointment for your first consultation and examination with a dentist, simply leave a request on the website or call us. We will answer your questions and tell you which treatment option is right for your situation. We also provide many other services in the field of medical or aesthetic dentistry.
Before hospitalization
First aid to the victim includes:
- stopping bleeding (pressing or packing the wound, applying cold);
- if necessary, cardiopulmonary resuscitation;
- pain relief (analgin, revalgin intramuscularly);
- immobilization of the jaw with the help of fixing bandages (contraindicated if the victim is unconscious, since this increases the risk of suffocation from the retraction of the tongue or vomit entering the respiratory tract).
