Splint:
The word splint when considered as a verb means
to immobilize, support or brace.
Types of fractures;
-simple; fracture without wound
- compound; fracture with wound.
- comminuted; fracture of bone into fragments.
- green stick; bone lean as in child.
Fructure manipulation;
-favorable; fractured segments opposite direction of muscle
attraction.
- unfavorable; fracture segments with the direction of muscle
attraction, widening the fracture space.
Uses of splints:
1- In jaw fractures to immobilize the fractured parts in
their original position until repair has taken place.
2- used to apply gradual force when fibrous union
occurred at old fracture and an immediate
reduction is impossible or painful.
3-To support resected mandible in its new position.
4-In orthographic surgery to correct discrepancy of
basal bones.
5-In holding another appliance e.g. training flange
6-As an aid in specific procedure or therapy e.g. in
bone grafting and in periodontal treatment as splint
for loose teeth.
Requirements:
1- provide rigid fixation to the jaw fracture.
2-Simple in construction with the least amount of
pain or discomfort to the patient.
3- Minimum injury to the standing teeth, bone or soft
tissues.
4- Minimum disturbance to normal function.
5- minimal interference to occlusion and obtain the
patient occlusion as much as possible.
Types of splints
A-For dentulous patients:
1- wiring;
- Direct wiring.
- Eyelet wiring.
- interdental wiring.
Arch bar.
- Hammond (double arch bar, buccal, lingual).
- Circumferential.
- Pinning (Roger Anderson pin)
2- Labiolingual splint.
3- Metal cap splint.
For completely edentulous patients:
1- Gunning splint.
2- Kingsley splint.
Direct wiring.
- Eyelet wiring.
interdental wiring.
Arch bar.
Metallic or acrylic;
-
- Circumferential.
- pinning.
- suspension
Design:
It is an acrylic band fits around the
buccolabial surfaces and lingual
aspects, leaving the occlusal
surfaces uncovered.
- consists of three sections; a lingual
section fits around the lingual
surface of the teeth and two labial
sections around the facial surface
of the teeth.
A stainless steel wire connects the
two acrylic portions posteriorly
around the last remaining tooth.
This wire acts as a hinge.
A button divided into two halves in the
midline is used to secure the two
labial sections by wiring.
- made of clear acrylic resin, cast
metal splint is used when a longterm immobilization is needed.
Construction:
1-An accurate alginate impression is made and
poured into dental stone.
2-If there is fracture displacement, the cast is sawed
at the fracture line and reassembled in the correct
position by a plaster base.
3-A half round wire 0.9 mm is well adapted to the
surface of the last standing tooth. The wire is then
bent at right angle to its length. This portion will
help to hold the wire in the flask.
Design:
- covers the buccal, lingual and occlusal surfaces of
the teeth on both sides of the fracture and
cemented to the teeth.
1-One piece (simple) metal splint:
used when there is little displacement and reduction
made by the help of the natural teeth occlusion.
Construction:
1- An alginate impression of both arches are made in
a shallow stock trays and poured into dental stone.
2- The cast is sawed at the fracture line and
reassembled in the correct position by a plaster
base
Gunning splint
Indication:
- fixation of mandibular or maxillary fractures in
completely edentulous patients.
- when little displacement and no infection.
Design:
- as a one piece for the two arches or two separate
pieces.
- The splint can be made in conjunction with elastic
chin bandage to reduce pain and discomfort
Construction:
A- Old denture modification:
1- The fitting surface of the old denture is
relieved to create space for soft lining
material.
2-The upper and lower anterior teeth are
removed to facilitate feeding and
cleaning.
3-Hooks or arch bars are fixed to the
facial surface for intermaxillary fixation.
4- Faulty occlusion and reduced vertical
dimension is corrected by adding
colored self-curing resin to the occlusal
surface of the denture.
5-Soft liner is used to correct the denture
fit and faulty denture extension.
6- Intermaxillary fixation is carried out to
fix the upper and lower dentures
Kingsley splint
Indications:
1- fracture of edentulous mandible as an alternate
to gunning splint.
2- As an emergency treatment for depressed
maxillary fracture where traction is required.
Design:
An intraoral tray is fitted to the teeth or edentulous
ridge by compound impression material. The tray
has stout wires attacked and projecting between
the lips around the sides of the face. The wires
provide attachment for bandage over the head in
case of maxillary fracture and below the chin in
mandibular fracture.
TRISMUS
Etiology
I- Acute Factors
1- Local trauma during an inferior alveolar nerve block
anesthesia.
2- Infection of the lateral pharyngeal space, as a sequel to
pericoronitis or oral surgery.
II- Chronic Factors
1-Temporomandibular joint dysfunction.
2-Poor joint architecture and malposition of the disk.
3- Rheumatoid arthritis.
4- Pathological processes as osteoma of condyle or zygoma,
cysts, and overgrowth condyle or coronoid process.
5. Intra-capsular or extra-capsular ankylosis.
III- Treatment Related Factors
1.Radiation therapy may limit mandibular movement if the
muscles of mastication or TMJ were in the treatment fields.
2. Surgical resection of the maxilla and mandible.
Treatment
1-Medical treatment
-When infection is the cause of trismus,
antibiotics are the treatment of choice.
-Arthritis, inflammation of the joint can be
treated with anti-inflammatory agents.
-Muscle relaxants may help in acute cases of
limited mandibular movement.
B. Mechanical devices
1- Simple devices
a-A tapered threaded acrylic screw can be used.
Placed and turned between the teeth to apply an
opening force to the mandible
C. An intraoral prosthesis with interarch spring:used for dentulous and edentulous patients. The
spring clips are attached to mandibular stent and
the free end of the clip locks into a latch on the
maxillary stent. The springs provide a constant
force bilaterally which is controlled by adjusting the
size of loop.