Article

In vitro comparison of the flexibility of different splint systems used in dental traumatology

School of Dentistry, University of Padova, Padova, Italy.
Dental Traumatology (Impact Factor: 1.6). 02/2010; 26(1):30-6. DOI: 10.1111/j.1600-9657.2009.00843.x
Source: PubMed

ABSTRACT

The aim of the study was to evaluate the flexibility of five different splint systems [polyethylene fibre-reinforced splint (Ribbond THM, Ribbond Inc., Seattle, WA, USA), resin splint (RS), wire-composite splint (WCS), button-bracket splint (BS) and titanium trauma splint (TTS)] commonly used in clinical practice for the treatment of dental traumatic injuries involving the periodontal supporting tissues.
For the experimental study, a resin cast of the upper arch was manufactured, where teeth 11, 12 and 21 (used for the stress analysis) were inserted in a non-rigid fashion so as to allow for replacement, whereas the other teeth were permanently fixed to the corresponding sockets. Two different test sessions were performed for each splint: (i) stress analysis with increasing intensity ranging between 0 and 50 N directed along the tooth's longitudinal axis; (ii) stress analysis with 45 degrees of oblique force of increasing intensity ranging between 0 and 30 N. For each loading direction, five recordings were conducted without a splint, followed by five with the splint applied. The energy required to modify the position of the teeth was calculated for both the splinted and un-splinted teeth and the difference between the two values was determined. Energy variation was assessed for the testing of both axial (DeltaE(a)) and oblique force (DeltaE(o)). DeltaE represents the rigidity index of the analysed contention devices: high DeltaE values correspond to high rigidity materials.
The RS showed the highest DeltaE value for the axial stress analysis, whereas the highest DeltaE value at a 45 degrees was recorded for the WCS and RS. For both tests, the lowest DeltaE values were recorded for the TTS and Ribbond THM splints.
The data show that the contention devices with the highest flexibility are the TTS and the Ribbond THM as they exhibit a lower energy variation needed for splint deformation compared with the other materials that were examined.

Full-text

Available from: Eriberto Bressan
In vitro comparison of the flexibility of different
splint systems used in dental traumatology
Epidemiological studies report that by the age of
16 years, 35% of the subjects have sustained dental
trauma and that the percentage rises to 50% by the age of
18 (1, 2).
These traumas can involve both the primary and
permanent dentition. Nevertheless, the former are
mainly lesions of the supporting periodontal tissues
(luxations and avulsion), whereas traumas involving the
hard dental tissues (crown, crown-root and root frac-
tures) are more frequently observed in the permanent
dentition (1).
The frequent periodontal involvement observed in
traumas of the primary teeth is due to the higher
elasticity of the alveolar bone of the children, as at this
age, there is more spongy than cortical bone (2, 3).
In any case, in daily practice clinicians often find
themselves treating traumatic lesions involving the sup-
porting tissues.
From a prognostic standpoint, traumas involving
these structures have more unpredictable outcomes
and restitutio ad integrum of the periodontal ligament
is the crucial prerequisite for complete healing of the
lesion.
To achieve this, a contention device or splint is
employed, i.e. a ‘rigid or flexible appliance for the
fixation of mobile or dislocated parts’ (4).
In dentistry, splinting consists of the connection of two
or more teeth to each other to limit increased mobility
because of acute periodontal lesions following trauma.
The splint reduces the load exerted on each tooth by
distributing the masticatory and perioral muscle forces
on multiple teeth and a broader surface.
Furthermore, the direction of the forces applied to the
teeth is favourably modified, converting the lateral loads
into vertical ones that are less harmful for the tooth-
supporting apparatus (5), which can thus heal more
easily by restoring bone integrity and rearranging the
periodontal ligament fibres (6).
There are essentially two biomechanical factors
regarded as the conditio sine qua non for successful
treatment: mild loads applied to the healing tissues and
controlled tooth movement (about 50 lm) within the
traumatized socket (7).
Several splints are used in clinical practice but,
independently of the type, passivity and flexibility are
essential qualities for the physiological movement of the
Dental Traumatology 2010; 26: 30–36; doi: 10.1111/j.1600-9657.2009.00843.x
30 2010 The Authors. Journal compilation 2010 John Wiley & Sons A/S
Sergio Mazzoleni, Guglielmo
Meschia, Raffaello Cortesi,
Eriberto Bressan, Cristiano
Tomasi, Roberto Ferro, Edoardo
Stellini
School of Dentistry, University of Padova,
Padova, Italy
Correspondence to: Dott. Guglielmo
Meschia, via Paolotti 4 35128 Padova, Italy
Tel.: +39 42 3732836
Fax: +39 42 3491715
e-mail: gmeschia@libero.it
Accepted 12 September, 2009
Abstract Aim: The aim of the study was to evaluate the flexibility of five
different splint systems [polyethylene fibre-reinforced splint (Ribbond
THM,
Ribbond Inc., Seattle, WA, USA), resin splint (RS), wire-composite splint
(WCS), button-bracket splint (BS) and titanium trauma splint (TTS)] commonly
used in clinical practice for the treatment of dental traumatic injuries involving
the periodontal supporting tissues. Materials and methods: For the
experimental study, a resin cast of the upper arch was manufactured, where teeth
11, 12 and 21 (used for the stress analysis) were inserted in a non-rigid fashion so
as to allow for replacement, whereas the other teeth were permanently fixed to
the corresponding sockets. Two different test sessions were performed for each
splint: (i) stress analysis with increasing intensity ranging between 0 and 50 N
directed along the tooth’s longitudinal axis; (ii) stress analysis with 45 of
oblique force of increasing intensity ranging between 0 and 30 N.
For each loading direction, five recordings were conducted without a splint,
followed by five with the splint applied. The energy required to modify the
position of the teeth was calculated for both the splinted and un-splinted teeth
and the difference between the two values was determined. Energy variation was
assessed for the testing of both axial (DE
a
) and oblique force (DE
o
). DE
represents the rigidity index of the analysed contention devices: high DE values
correspond to high rigidity materials. Results: The RS showed the highest DE
value for the axial stress analysis, whereas the highest DE value at a 45 was
recorded for the WCS and RS. For both tests, the lowest DE values were
recorded for the TTS and Ribbond THM splints. Conclusions: The data show
that the contention devices with the highest flexibility are the TTS and the
Ribbond THM as they exhibit a lower energy variation needed for splint
deformation compared with the other materials that were examined.
Page 1
traumatized tooth to promote healing of the periodontal
fibres (8).
It has been observed that teeth stabilized with high-
flexibility splints are less likely to undergo root resorp-
tion and show a better reorganization of the periodontal
fibres compared with teeth splinted by means of rigid
contention devices (7, 9, 10).
Many studies have attributed the negative effect of the
rigid contention to the periodontal neoangiogenesis
deficit produced by excessive compression on the peri-
odontal ligament, whereas the mechanical stimulus
exerted by mild tooth movement would favour the
revascularization process (11–14), prevent ankylosis and
maintain the Hertwig’s epithelial root sheath (15), which
is vital in the event of the developing roots.
Complete immobilization, on the contrary, thwarts
healing by interfering with fibroblast metabolism because
of the lack of mechanical stimuli (7).
These considerations led several authors to conclude
that a splint allowing mild tooth movement (1, 8, 15–
20) for a limited period of time is actually more
effective.
Materials technology is very prolific in proposing new
contention systems that can satisfy the ideal requisites:
appearance, user-friendliness and easy hygiene proce-
dures, together with the ability to stabilize the trauma-
tized tooth (8, 21–24) without employing an excessively
rigid system.
This study compared the flexibility of five different
splints commonly used in clinical practice through in vitro
assessment of their degree of rigidity, expressed by the
movement allowed to the splinted teeth.
Materials and methods
The examined splints were as follows:
Polyethylene fibre-reinforced splint (Ribbond
THM)
Wire-composite splint (WCS)
Button-bracket splint (BS)
Resin splint (RS)
Titanium trauma splint (TTS)
Following the protocol proposed by Oikarinen (21), a
resin cast of the upper arch was made and the stress
analyses were performed on preformed resin teeth
(Frasaco).
All teeth were fixed on the cast with the exception of
the three front ones (11, 12, 20), which could be removed
and replaced.
To simulate the form and characteristics of the
periodontal ligament, polyvinyl siloxane (Gingifast Elas-
tic-Zhermack, Ravigo, Italy) was placed at the apical
level (thickness 3 mm to allow a small vertical movement
(21, 25)) and around the root (thickness 0.3 mm) of 11,
12, and 21.
Therefore, after splinting, these three teeth had mild
axial and bucco-lingual mobility and, being removable,
they were replaced after each test.
The load was applied to 11, previously splinted to 12
and 21, as there are no benefits in extending the splinting
(22, 23).
Before splint placement, the buccal aspect of the
teeth was roughened with pumice powder and primer
agent (PermaQuick Primer and Bonding Resin/
Ultradent) (24, 25).
We then proceeded with splint placement as follows.
Splint 1: Ribbond
A fibre segment (Ribbond
THM) length of which
corresponded to the teeth to be splinted was cut and then
a thin layer of unloaded resin was placed on them
(PermaQuick Bonding Resin, Ultradent Products Inc.,
South Jordan, UT, USA).
The buccal aspect of the teeth was covered with a
thin layer of fluid composite (PermaFlow, Ultradent
Products Inc., USA), avoiding the interproximal con-
tact points.
The Ribbond
fibre, previously wetted with adhesive
resin, was then applied at the middle third of the buccal
surfaces of the teeth and light-cured for 40 s.
Splint 2: wire-composite splint
At the middle third of the teeth to be splinted, a wire
made of two interwoven orthodontic steel wires (Aescu-
lap Inc., Center Valley, PA, USA, Ø = 0.016) was
passively adapted and fixed by means of a fluid
composite (PermaFlow) and light-cured for 40 s.
Splint 3: button-bracket splint
Orthodontic brackets (Edgwise standard, slot = 0.022)
were applied to the teeth to be splinted and a steel wire
was passively adapted (Aesculap Inc., Ø = 0.016).
Splint 4: resin splint
The composite material (Enamel Plus) was applied at the
middle third of the dental surfaces and light-cured for 40 s.
Splint 5: titanium trauma splint
The titanium wire (TTS, Medartis
Basel, Switzerland)
was placed at the middle third of the dental surfaces. The
TTS’s rhomboidal holes were filled with fluid composite
(PermaFlow) and light-cured for 40 s.
To assess the rigidity of the five splints, stress analyses
were performed using a universal machine (Erichsen
model 476, Fig. 1).
The machine, by means of a cylindrical punch, applies
an increasing linear force measured in Newtons (N) at
the incisal margin of tooth 11 (Fig. 2).
Using programmable logic controller (PLC) software,
for each test, the machine is able to elaborate a force-
movement graphic that makes it possible to evaluate the
movement of the teeth when the applied load is
increased.
Four analyses were performed to evaluate each splint:
1 Test 1: test without splint, with axial load (the applica-
tion point was the incisal margin of 11), and linear
increasing intensity ranging from 0 to 50 N (Fig. 3);
2 Test 2: test with splint, with axial load (the application
point was the incisal margin of 11), and linear
increasing intensity ranging from 0 to 50 N;
Evaluation of the flexibility of different splint systems
31
2010 The Authors. Journal compilation 2010 John Wiley & Sons A/S
Page 2
3 Test 3: test without splint, with oblique 45 force (the
application point was the incisal margin of 11), and
linear increasing intensity ranging from 0 to 30 N
(Fig. 4);
4 Test 4: test with splint, with oblique 45 force (the
application point was the incisal margin of 11), and
linear increasing intensity ranging from 0 to 30 N.
The four tests were repeated five times for each splint
for a total of 20 experiments.
The increasing load of 0–50 N was chosen because
these values fall into the physiological range of the
masticatory forces, which amount to 10–20 N for soft
foods and reach 100 N for harder ones (26).
For the 45 tests, the maximum applied load was
lower to compensate for the broader movement caused
by the oblique force.
The values obtained for the tests 1 and 3 represent the
reference parameter for tests 2 and 4.
After each set of tests, with and without splints, the
teeth (and their supporting polyvinyl siloxane) were
always exchanged with identical new elements, and their
position was replicated by means of a polyether template
(Impregum F; Espe Dental AG, Seefeld, Germany)
prepared when the cast was made. Therefore, for each
test, the initial position was replicated so as to minimize
any bias due to wear of the materials.
Results
Each splint underwent testing under both axial and 45
loads, with respect to the longitudinal tooth axis
(respectively, tests 1 and 2; tests 3 and 4), recording the
movements of the teeth at the increasing applied forces,
with and without the splint.
For each splint, at the end of the two sets of 5 tests,
the mean of the movements recorded at 50 N was
calculated. (Table 1)
For the RS splint, it was impossible to calculate the
relative movement at 50 N because it constantly fractured
with smaller loads, with a maximum allowed movement of
0.25 mm in the 5 tests, corresponding to 42 N.
Similarly, the mean of the movements at 30 N of the
different splints during the 45 tests was recorded
(Table 2).
Fig. 1. Universal machine (Erichsen 476).
Fig. 2. Linear force applied at the incisal margin of the 11.
Fig. 3. Axial load and linear increasing intensity ranging from
0to50N.
Fig. 4. Oblique 45 force and linear increasing intensity ranging
from 0 to 30 N.
32 Mazzoleni et al.
2010 The Authors. Journal compilation 2010 John Wiley & Sons A/S
Page 3
During this test as well, the RS always fractured,
allowing for a maximum movement of 0.85 mm at
17.6 N.
To assess the rigidity of the examined splints, the
deformation energy (E) was calculated both for the stress
and movement analyses.
This energy (in mJ) can be defined as the work needed
by the machine to move the teeth by a predefined dS
value, and it is expressed by the formula (1)
E ¼ L ¼
Z
S
max
0
FðSÞds ð1Þ
As the applied load increases linearly over time during
this type of experiment, the deformation energy can be
simplified by the formula (2), where L represents work,
S
max
is the maximum movement and F
max
is the load
linked to maximum movement
E ¼ L ¼
1
2
F
max
S
max
ð2Þ
The S
max
value the allowed tooth movement before
irreversible deformation of the splint occurs was
adopted as a reference parameter to compare the
flexibility of the tested materials. This corresponds to
the movement allowed by the RS, which unlike all the
other splints fractured before 50 and 30 N were
reached.
With this procedure, the deformation energy was
calculated for each splint as follows:
1 E
1
= deformation energy of test 1;
2 E
2
= deformation energy of test 2;
3 E
3
= deformation energy of test 3;
4 E
4
= deformation energy of test 4.
The difference between the deformation energies of
each type of splint was calculated every time as:
DE
a
¼ E
2
E
1
D E
o
¼ E
4
E
3
where DE
a
corresponds to the variation of deformation
energy for each test performed along the longitudinal
axis and DE
o
indicates the change in deformation energy
for each oblique force test. The mean values of the
deformation energy obtained in the five sessions of the
tests 1 and 2 were then assessed (Table 3).
DE
a
indicates the difference between the mean defor-
mation energy obtained from the five tests performed
with and without splint (Table 3).
The mean values of the deformation energy tests were
also calculated for tests 3 and 4 (Table 4).
In this case, DE
o
represents the difference between the
mean deformation energy obtained from the five tests
performed with and without the splint (Table 4).
Statistics
To compare the mean values of E
1
and E
2
and E
3
and E
4
,
a series of Student’s t-tests for independent variables
were performed, one for each type of splint (Tables 5 and
6).
The reliability of the Student’s t-test was confirmed by
the F-test for equal variances, employed to verify if the
standard deviations of the compared groups differed
significantly.
The F-test was not statistically significant in any of the
cases, as the P-value was always >0.05.
Discussion
This study provides experimental data on the flexibility
of different splint systems commonly used in clinical
practice to allow a certain degree of mobility to
traumatized teeth to promote optimal healing of the
periodontal tissues.
One of the study limitations is represented by the
consideration that the structural and physical
properties of the resin cast used for the experiments is
Table 1. Movements recorded at 50 N
Splint at 50 N
Mean movement (mm)
Without splint With splint
Ribbond 0.43 0.41
TTS 0.6 0.56
WCS 0.38 0.36
RS 0.61 N/A
BS 0.59 0.47
TTS, titanium trauma splint; WCS, wire-composite splint; RS, resin splint; BS,
button-bracket splint.
Table 2. Movements recorded at 30 N
Splint at 30 N
Mean movement (mm)
Without splint With splint
Ribbond 1.5 1.1
TTS 1.33 1
WCS 1.64 1.3
RS 1.43 N/A
BS 1.47 1.23
TTS, titanium trauma splint; WCS, wire-composite splint; RS, resin splint; BS,
button-bracket splint.
Table 3. E
1
, E
2
mean values and difference between the means of energy deformation for tests 1 and 2 (n =5)
E
1
means ± SD E
2
means ± SD DE
a
±SD
Ribbond 1.802000 ± 0.158177 2.000000 ± 0.164469 0.198000 ± 0.289948
TTS 1.598000 ± 0.170939 1.702000 ± 0.158177 0.104000 ± 0.016733
WCS 2.770000 ± 0.138564 2.992000 ± 0.120499 0.222000 ± 0.258302
BS 1.535000 ± 0.537192 2.394000 ± 0.555050 0.859000 ± 1.091.664
RS 1.600000 ± 0.636396 5.250000 ± 0.777817 3.650000 ± 1.414.214
TTS, titanium trauma splint; WCS, wire-composite splint; RS, resin splint; BS, button-bracket splint.
Evaluation of the flexibility of different splint systems
33
2010 The Authors. Journal compilation 2010 John Wiley & Sons A/S
Page 4
not representative of the more complex structure of the
biological dental tissues, alveolar bone and periodontium.
The reported data nevertheless describe the physical
characteristics of the examined splints and thus represent
an indication of their respective behaviour in the oral
cavity.
In general, the change observed in the deformation
energy represents the energy absorbed by the splint.
A different force is needed to arrive at the same degree
of deformation of two different materials, a rigid one and
a flexible one; in particular, DE will be higher for the
rigid one.
The parameter that allows the comparison of different
splints is therefore the value of the deformation energy of
the tested materials.
The differences in mean movements of teeth without
splinting (Tables 1 and 2) may be explained from the
substitution of the teeth and their supporting polyvinyl
siloxane with new materials at the end of each series of
tests. The extent of shift of the tooth without splint was,
in fact, carried out each time just to evaluate the
flexibility of the different splinting techniques taking
into account the inevitable small differences in thickness
in the supporting material from one test to another. The
analyses were performed with two different force appli-
cation angles to replicate the forces applied on the teeth
in physiological conditions as precisely as possible.
In both tests, the RS splint unlike the other devices
fractured after minimal deformation and with stresses of
<50 and 30 N.
The RS was the most rigid splint, exhibiting a very
high DE
a
(Table 3) and showing a statistically significant
difference (P = 0.00004) between the means of defor-
mation energy with and without the splint (Table 5).
In tests 1 and 2, the BS and WCS splints also showed
statistically significant differences between the means of
deformation energy with and without the splint (respec-
tively, P = 0.0377 and P = 0.0269; Table 5), with DE
a
values (Table 3) much lower than those recorded for RS.
These results suggest that while the BS and WCS
splints showed flexibility, they may not give the trauma-
tized tooth the mobility (7) it needs for optimal healing.
Even if tooth mobility is a prerequisite, Cengiz et al.
observed that the WCS seems to protect the traumatized
teeth from stresses in the apical and cervical regions
more than the other splint types because of the higher
intrinsic rigidity of the orthodontic wire fixed on the
tooth surface (7).
As a result, one could draw the wrongful conclusion
that the higher the splint rigidity, the better the chances
of healing because of the lower stress exerted on the
injured periodontal tissues.
Nevertheless, there is evidence that tooth immobiliza-
tion is unnecessary for healing of the traumatized
periodontium. In contrast, the tooth requires a certain
degree of controlled mobility (7), which would favour the
production and maturation of collagen and protocolla-
gen, given that the load is not excessive and the
movement limited to a maximum range of 150 lm (7).
According to Weisman (26), the characteristics of the
ideal splint include passivity and flexibility to guarantee
both contention and physiological dental mobility,
without exerting any displacing force on the traumatized
tooth (16).
Passivity varies according to the different properties
of the materials and the technique employed for their
placement. When using brackets and orthodontic wires,
as required by the BS, it is difficult to prevent undesired
forces from affecting the healing process (26, 27).
Splint flexibility is considered one of the main factors
in post-traumatic healing which, according to clinical
data, is related to the degree of allowed movement and
Table 4. E
3
, E
4
mean values and difference between the means of energy deformation for tests 3 and 4 (n =5)
E
3
means ± SD E
4
means ± SD DE
o
±SD
Ribbond 0.742000 ± 0.078230 0.852000 ± 0.078867 0.110000 ± 0.157003
TTS 0.749000 ± 0.066370 0.840400 ± 0.075702 0.091400 ± 0.141774
WCS 0.513200 ± 0.114853 0.739380 ± 0.103023 0.226180 ± 0.217427
BS 0.477800 ± 0.095547 0.624600 ± 0.098238 0.146800 ± 0.193771
RS 0.434600 ± 0.052923 0.657600 ± 0.045703 0.223000 ± 0.090526
TTS, titanium trauma splint; WCS, wire-composite splint; RS, resin splint; BS, button-bracket splint.
Table 5. Student’s t-test for the mean values of E
1
and E
2
(P = 0.05)
Treatment E
1
E
2
Significance
Ribbond 1.802 ± 0.158 2.000 ± 0.164 NS
TTS 1.598 ± 0.171 1.702 ± 0.158 NS
WCS 2.770 ± 0.139 2.992 ± 0.120 P = 0.0269*
BS 1.535 ± 0.537 2.394 ± 0.555 P = 0.0377*
RS 1.600 ± 0.636 5.250 ± 0.778 P = 0.00004****
TTS, titanium trauma splint; WCS, wire-composite splint; RS, resin splint; BS,
button-bracket splint.
The increasing number of * states the major relevance of the statistical
significance.
Table 6. Student’s t-test for the mean values of E
3
and E
4
(P = 0.05)
Treatment E
3
E
4
Significance
Ribbond 0.742 ± 0.078 0.852 ± 0.079 NS
TTS 0.749 ± 0.066 0.840 ± 0.075 NS
WCS 0.513 ± 0.115 0.739 ± 0.103 P = 0.0112**
BS 0.478 ± 0.096 0.625 ± 0.098 P = 0.0435*
RS 0.435 ± 0.053 0.658 ± 0.046 P = 0.00001****
TTS, titanium trauma splint; WCS, wire-composite splint; RS, resin splint; BS,
button-bracket splint.
The increasing number of * states the major relevance of the statistical
significance.
34 Mazzoleni et al.
2010 The Authors. Journal compilation 2010 John Wiley & Sons A/S
Page 5
should resemble physiological conditions as closely as
possible (7, 8).
The best semi-physiological mobility can be obtained
by means of flexible splints. In this study, the Ribbond
THM and the TTS showed the highest flexibility, with a
significant difference between the mean values of the
deformation energy with and without splinting
(P > 0.05) (Table 5), and DE
a
showed significantly
lower values compared with the other examined samples
(Table 3).
The higher flexibility of the Ribbond THM and the
TTS was also confirmed by the results of the analysis
performed at a 45 (Tables 4 and 6).
In the same oblique test, however, the WCS and
RS showed greater rigidity, with similar DE
o
values
(Table 4).
Despite the fact that the RS was the most rigid splint,
during tests 3 and 4, it showed far more flexibility
compared with tests 1 and 2, as was the case with the BS.
For the RS, this difference is because of the wider
composite surface of force distribution at 45, whereas
for the BS, it is because of the mechanical nature of the
system, which is composed of brackets and wire that
better withstand excursions on the horizontal and
vertical planes (7, 27).
Overall, we can conclude that the TTS and the
Ribbond THM have the highest elasticity, demonstrated
by their low deformation energy.
In fact, independently from the loading direction, the
deformation energy recorded with and without splint
was not significant, contrary to what was observed for
the other tested materials (Tables 5 and 6).
The highly overlapping results of the two systems are
ascribable to their similar elasticity module and their
strong resemblance in shape and size.
On the other hand, the RS was the most rigid splint
and was thus subjected to fracture with even minimal
deformations that were instead endured by more pliable
materials, which were initially deformed and did not
break until later. Consequently, for clinical application,
the RS does not appear to be able to allow in all
situations the necessary tooth mobility for the healing of
the periodontal ligament (7, 10) and, in addition, the
fracture of the splint may occur when it is subjected to
forces of low extent (25). This implies excessive rigidity
of the splint, which also demonstrates low stress toler-
ance to progressive weakening, continuing to serve its
purpose for a given period of time. Moreover, RS
provides less comfort to the patients compared with
other splinting techniques (10, 16).
Consequently, the post-traumatic rigid splints used
in the past, which once reflected the principles of
immobilizing bone fractures (16), are no longer
employed to treat periodontal traumatic injuries, as
prolonged immobilization increases the risk of root
resorption (6).
Mandel and Viidik have shown that the post-trau-
matic healing obtained by means of passive and flexible
semi-rigid splints is similar to what a traumatized tooth
would undergo without a splint (28–31), whereas An-
dreasen et al. (8) reported that the splinting does not
modify the healing process of non-displaced teeth.
Even if the use of semi-rigid splint systems does not
seem to affect the healing processes significantly pro-
vided that any mechanical stress exceeding the physio-
logical tolerance range is avoided (7), based on the data
obtained from this study and in accordance with the
literature (25), we can state that among the examined
splint systems, the TTS and the Ribbond THM are the
materials with the passivity and flexibility features that
are best suited for the treatment of traumatic lesions
involving the supporting tissue of the tooth.
References
1. Borsse
`
n E, Holm AK. Treatment of traumatic dental injuries in
a cohort of 16-years-old in northern Sweden. Endod Dent
Traumatol 2000;16:276–81.
2. Ga
`
bris K, Tarja
`
nI,Ro
`
zsa N. Dental trauma in children
presenting for treatment at the Department of Dentistry for
children and Orthodontics. Budapest 1985–1999. Dent Trau-
matol 2001;17:103–8.
3. Gaubert SA, Hector MP. Periodontal mechano-sensory
responses following trauma to permanent incisor teeth in
children. Dent Traumatol 2003;19:145–53.
4. Andreasen JO. Traumatic dental injuries in children. Int J
Paediatr Dent 2000;10:181.
5. Ferencz JL. Splinting. Dent Clin North Am 1987; 31: 395–416.
6. Oikarinen K. Functional fixation for traumatically luxated
teeth. Endod Dent Traumatol 1987;3:224–8.
7. Cengiz SB, Atac As, Cehreli ZC. Biomechanical effects of splint
types on traumatized tooth: a photoelastic stress analysis. Dent
Traumatol 2006;22:133–8.
8. Andreasen JO, Andreasen FM, Meja
`
re I, Cvek M. Healing of
400 intra-alveolar root fractures. 2. Effect of treatment factors
such as treatment delay, repositioning, splinting type and period
and antibiotics. Dent Traumatol 2004;20:203–11.
9. Andreasen JO, Andreasen FM. Avulsions. In: Andreasen JO,
Andreasen FM, Andersson L, editors. Textbook and Color
Atlas of Traumatic Injuries to the Teeth, 4th edn. Oxford, UK:
Wiley-Blackwell; 2007. p. 444–88.
10. Von Arx T. Splinting of traumatized teeth with focus on
adhesive techniques. J Calif Dent Assoc 2005;33:409–14.
11. Lagana
`
G, Marino A, Cozza P. Linee guida al paziente in eta
`
pediatrica. Dental Cadmos 2004;7:1–24.
12. Flores MT. Traumatic injuries in the primary dentition. Dent
Traumatol 2002; 18:287–98. Review.
13. Humphrey JM, Kenny DJ, Barrett EJ. Clinical outcomes for
permanent incisor luxations in a pediatric population. I.
Intrusion. Dent Traumatol 2003;19:266–73.
14. Kelly JR. Perspectives on strength. Dent Mater 1995;11:103–10.
15. Bauss O, Schwestka-Polly R, Schilke R, Kiliaridis S. Effect of
different splinting methods and fixation periods on root
development of autotransplantated immature third molars.
J Oral Maxillofac Surg 2005;63:304–10.
16. Filippi A, von Arx T, Lussi A. Comfort and discomfort of
dental trauma splints a comparison of a new device (TTS)
with three commonly used splinting techniques. Dent Trauma-
tol 2002;18:275–80.
17. Andreasen JO, Andreasen FM, Skeje A, Hjørting-Hansen E,
Schwartz O. Effect of treatment delay upon pulp and peri-
odontal healing of traumatic dental injuries a review article.
Dent Traumatol 2002;18:116–28.
18. Wong GB. Non rigid splinting for avulsions and luxations.
Ontario Dent 1982; 59: 12, 14, 16-7 passim.
19. Neaverth EJ, Georig AC. Technique and rationale for splinting.
J Am Dent Assoc 1980;100:56–63.
20. Oikarinen K, Andreasen JO, Andreasen FM. Rigidity of
various fixation methods used as dental splints. Endod Dent
Traumatol 1992;8:113–9.
Evaluation of the flexibility of different splint systems
35
2010 The Authors. Journal compilation 2010 John Wiley & Sons A/S
Page 6
21. Oikarinen K. Comparison of the flexibility of various splinting
methods for tooth fixation. Int J Oral Maxillofac Surg
1988;17:125–7.
22. Finucane D, Kinirons MJ. External inflammatory and replace-
ment resorption of luxated, and avulsed replanted permanent
incisors: a review and case presentation. Dent Traumatol 2003;
19:170–4. Review.
23. von Arx T, Filippi A, Buser D. Splinting of traumatized teeth
with a new device: TTS (Titanium Trauma Splint). Dent
Traumatol 2001;17:180–4.
24. Yildirim Oz G, Ataog
˘
lu H, Kir N, Karaman AI. An alternative
method for splinting of traumatized teeth: case reports. Dent
Traumatol 2006;22:345–9.
25. Stellini E, Avesani S, Mazzoleni S, Favero L. Laboratory
comparison of a titanium trauma splint with three conventional
ones for the treatment of dental trauma. Eur J Paediatr Dent
2005;6:191–6.
26. Weisman MI. Tooth out! Tooth in! simplified splinting. CDS
Rev 1984;77:30–7.
27. Pre
´
vost J, Granjon Y. An in vitro study of the passivity of
splints in dental trauma. J Dent 1998;26:39–45.
28. Mandel U, Viidik A. Effect of splinting on the mechanical and
histological properties of the healing periodontal ligament in
the vervet monkey (Cercopithecus aethiops). Arch Oral Biol
1989;34:209–17.
29. Strobl H, Haas M, Norer B, Gerhard S, Emshoff R. Evaluation
of pulpal blood flow after tooth splinting of luxated permanent
maxillary incisors. Dent Traumatol 2004;20:36–41.
30. Barbakow F, Imfeld T. Principles in the replantation of
permanent teeth (1). Quintessenz 1980;31:29–34.
31. Pre
´
vost J, Louis JP, Vadot J, Granjon Y. A study of forces
originating from orthodontic appliances for splinting of teeth.
Endod Dent Traumatol 1994;10:179–84.
36 Mazzoleni et al.
2010 The Authors. Journal compilation 2010 John Wiley & Sons A/S
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  • [Show abstract] [Hide abstract] ABSTRACT: Objectives The aim of this paper is to demonstrate, by means of a review of the literature and presentation of an illustrative case, the successful management of traumatic dental avulsion with replantation and stabilizing orthodontic therapy.
    No preview · Article · Jan 2011 · Dental Cadmos
  • [Show abstract] [Hide abstract] ABSTRACT: We developed two versions of an artificial model and assessed their suitability for splint rigidity evaluation. These models allowed the simulation of traumatically loosened teeth and the use of the acid-etch technique for splint application. A straight and half-round arch bar model with bovine tooth facets were manufactured. Using the Periotest method, tooth mobility was evaluated before (PTVpre) and after (PTVpost) splinting. Two types of previously investigated wire-composite splints, WCS1 (Dentaflex 0.45 mm; Dentaurum) and WCS2 (Strengthens 0.8 × 1.8 mm; Dentaurum), were applied (n = 10) to each model. The relative splint effect (SpErel = ΔPTV/PTVpre) was calculated, and the working times for the models and splints were evaluated. Student's t-test and the Mann-Whitney U-test were employed with Bonferroni correction for multiple hypotheses. When comparing the relative splint effect of the 'injured' central incisors between the models within one splint type, differences were only found for tooth 21 (WCS2; P < 0.008); for comparisons of splints within one model type, differences were detected for both incisors and model types (P < 0.008). With the straight model, significantly less working time was necessary (P < 0.05). Using these models for in vitro splint rigidity evaluation, the splints can be applied with the acid-etch technique and tooth mobility can be individually adjusted. WCS1 is considered flexible compared to the more rigid WCS2. The results from the straight and the round model were predominantly closely related to each other. In terms of working time, the straight model is superior to the round model.
    No preview · Article · May 2011 · Dental Traumatology
  • [Show abstract] [Hide abstract] ABSTRACT: To evaluate the influence of reinforcement material on in vitro dental splint rigidity.  A custom-made artificial model was used. The central incisors simulated 'injured' teeth with increased mobility, and the lateral incisors served as 'uninjured' teeth with physiologic mobility. The Periotest and Zwick methods were used to assess horizontal and vertical tooth mobility before and after splinting, and relative splint effect (SpErel) was calculated. Teeth 12-22 were splinted using two wire-composite splints (WCS), WCS1 (Dentaflex 0.45mm), and WCS2 (Strengtheners 0.8×1.8mm) as well as four quartz-fiber splints, QS1 (Quartz Splint UD 1.5mm), QS2 (Quartz Splint Rope 1.5mm), QS3 (Quartz Splint Woven 2.5mm), and QS4 (dry fibers 667 tex). The influence of the splint type was evaluated using anova, Tukey range, and the Dunnett-T3 test (α=0.05). To test the influence of initial tooth mobility, the t-test was applied (α=0.05).  Reinforcement materials significantly influenced splint rigidity (P<0.05). The horizontal and vertical SpErel of WCS1 compared with WCS2 and QFSs1-4 was statistically significant (P<0.05). Significant differences were found when comparing the horizontal SpErel of WCS2 with WCS1 and QSs1-4 (P<0.05). SpErels of the 'injured' and 'uninjured' teeth showed significant differences (P<0.05).  WCS1 is flexible compared with the more rigid WCS2 and QSs1-4. Initial tooth mobility influences SpErel. The flexible WCS1 can be recommended for splinting dislocation injuries whereas the semi-rigid/rigid WCS2 and QS1-4 can be used for horizontal root fractures and alveolar process fractures. The QS1-4 provide good esthetic outcome.
    No preview · Article · Jul 2011 · Dental Traumatology
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