Dental trauma splints for the mixed dentition – A finite element analysis of splint material, splint extension, missing teeth, and PDL representation

Abstract

Background/Aims Dental traumatic injuries are common in children during the mixed dentition stage. These injuries usually require splinting for stabilization, which is complicated by the various stages of the permanent tooth development and primary tooth exfoliation. The aim of this study was to evaluate the effect on mobility of splint materials and extensions for an avulsed central incisor, stabilized with and without the adjacent incisor under intrusive and extrusive loading with different periodontal ligament (PDL) conditions. Materials and Methods Seventeen 3D model variations were created from a CBCT scan of a 7‐year‐old patient without erupted permanent upper lateral incisors. A 1000 N palatal load on the right central incisor simulated the avulsion injury and created an increased alveolus and bone deformation, resulting in an increased PDL thickness of 0.45 mm. Wire‐resin composite splints with 0.9 mm cross‐section (WCS) or 1.0 mm diameter nylon‐resin composite splints (NCS) were created. The models simulated conditions with and without the adjacent upper central incisor. Two PDL conditions were investigated, simulating detached PDL or PDL with polyether impression material‐like properties. Mobility was calculated under simulated biting loads in horizontal and vertical (intrusive and extrusive) directions. Results The NCS allowed greater tooth mobility of the avulsed incisor than the WCS, irrespective of splint extension, PDL condition, or load application. During horizontal loading, polyether‐like properties for the PDL allowed around 0.2 mm mobility of the avulsed tooth with the WCS, similar to the intact tooth, whereas a simulated detached PDL allowed 25% more mobility with a WCS than with a NCS. Conclusions Based on the FEA analysis, a 1.0 mm NCS may be suitable for splinting avulsion injuries during the mixed dentition stage compared to the considerably more rigid WCS. The NCS models provided flexibility for PDL healing while maintaining stability, even when missing adjacent teeth increased span widths. Extensions beyond directly adjacent teeth did not alter the mobility with the NCS but should still be considered an extra protection in case of bond failure or exfoliation.

Critical analysis of the article titled, “Dental trauma splints for the mixed dentition‐ A finite element analysis of splint material, splint extension, missing teeth and PDL representation”

“…We have gone through a recently published article in Dental Traumatology titled: "Dental trauma splints for the mixed dentition-A finite element analysis of splint material, splint extension, missing teeth and PDL representation" authored by Vilela et al 1 It was indeed an innovative effort in inciting a deep contemplation on the various aspects of the most commonly used treatment modality for the management of traumatic dental injuries, that is, dental splinting. The work undeniably is a thoughtful step in analysing the same in the mixed dentition which is an enigma to most clinicians.…”

Comparison of two composite resin materials for splinting of dental luxation injuries: A double blind randomized controlled trial

“…A recent double blind randomized controlled trial observed the effect of splinting time on the treatment of teeth with extrusion and crown root fractures 39 . Similarly, a recent paper reported finite element analysis of splints 40 . Therefore, the purpose of this double blind randomized controlled trial was to compare conventional packable composite‐wire splints to bulk‐fill composite‐wire splints in adult luxation injuries.…”

“…39 Similarly, a recent paper reported finite element analysis of splints. 40 Therefore, the purpose of this double blind randomized controlled trial was to compare conventional packable composite-wire splints to bulk-fill composite-wire splints in adult luxation injuries. The parameters evaluated for comparative analysis were composite resin retention, adhesive point dimension, splint application and removal time, and tooth mobility reduction.…”

Prevention of maxillofacial injuries through analysis of mechanisms, patterns, and long‐term sequalae

“…The mixed dentition, however, mandates the consideration of tooth eruption and root resorption stages of the adjacent teeth prior to splinting. By using a CBCT scan of a 7‐year‐old patient with 14 permanent teeth, Vilela et al were able to simulate avulsion and repositioning scenarios with different types of splint materials 39 . Nylon and resin splints were compared, along with different splint lengths and PDL conditions.…”

“…By using a CBCT scan of a 7-year-old patient with 14 permanent teeth, Vilela et al were able to simulate avulsion and repositioning scenarios with different types of splint materials. 39 Nylon and resin splints were compared, along with different splint lengths and PDL conditions. In this Issue, the authors provide some more information in response to queries that were asked by another group of researchers in the February issue.…”