Intraoral Splints Research Articles

Treatment of incisive bone fracture in a horse using an acrylic splint

SummaryA ventrally displaced incisive bone fracture was diagnosed in a 3‐year‐old Andalusian stallion. Symptoms included swelling of the lips, dysphagia and ptyalism.External manipulation revealed pain and crepitus in the gingival region of the rostral maxilla. An intraoral examination revealed upper gingival haematomas, misalignment and malocclusion of the incisors (prognathism). A radiograph of the rostral maxilla confirmed ventrally displaced bilateral fractures of the incisive portion of the maxilla rostral to the canine teeth (Triadan 104/204).The fracture was reduced under general anaesthesia. A methylmethacrylate intraoral splint was used to stabilise the fracture. Post operative radiographs confirmed the fracture reduction. Post operative clinical control confirmed the correct position of the splint. No complications were encountered in the post operative period and good stabilisation was obtained. The splint was removed 60 days post operatively.The use of an acrylic intraoral splint successfully stabilised a bilateral, ventrally displaced incisive bone fracture. Normal occlusion was obtained.The use of an acrylic splint may represent a relatively simple, inexpensive and noninvasive technique for the repair of incisive bone fractures rostral to canine teeth in horses.

The use of intraoral splints: a case report

Intraoral splints are frequently used in dentistry and seem to be widely accepted as therapeutical strategies. This implies that the therapeutical mechanism and the treatment effects are well known and understood. Recently published reviews on oral splints determined that the quality of the evidence supporting the mechanisms of action of oral splints is still questionable. The initial therapy of a patient with craniomandibular disorder and reciprocal clicking in the right temporo-mandibular joint is described in detail in this paper. The treatment modalities and the measurements used to judge and to evaluate the treatment effect are provided. The therapeutical concept for this patient was not based on a particular splint design. An individual targeted therapeutical strategy was implemented instead. Splint strategies and splint prescription habits have to be reconsidered. In medicine, a strong trend towards individual therapeutical concepts can be observed. The term "target therapy concept" is used to describe the individual patient-orientated therapeutical demands. In splint concept, these individualized strategies are still not implemented. Using such individualized splint concept in clinical trials is, maybe, a key to improve the external, scientific evidence on this particular topic.

Eight Questions on Intraoral Splint Concepts: an Interview with Prof. Jeffrey P. Okeson

Eight Questions on Intraoral Splint Concepts: an Interview with Prof. Jeffrey P. Okeson

Eight Questions on Intraoral Splint Concepts: an Interview with Prof. Rudolf Slavicek

1. What do you think of a soft splint versus hard resin? RS: My viewpoint is based on the fact that teeth are hard structures. Therefore it makes sense to adhere as closely as possible to this fact when using a splint. A soft splint does not reduce muscle activity, but induces permanent movements. One explanation for the therapeutic mechanism of splints is the pacification of musculature. I personally believe that soft splints are contraindicated. 2. What are your recommendations about the anterior occlusal stop (like some pre-fabricated products)? RS: There is an old rule: hyperactive musculature and especially conditions associated with painful joints cannot be treated with anterior occlusal stops alone. Such devices are contraindicatedinthesecircumstances.TheShorePlate,asa typical example of an anterior occlusal stop device, is designed with an anterior stop and no lateral support. Another concept was the Schulte Interceptor. However, Schulte demands exact observation of the jaw joints – he always warns against the possibility of joint compression. Besides, he limited the use of this device to a maximum of one week. New devices equipped merely with a small anterior support are now available in the market. They may be indicated for short-term deprogramming but how does one prevent the patient from swallowing this little object? Of course an overloadoftheanteriorteethisfeasible.InanycaseIstrongly recommend adherence to Schulte’s rules: temporary therapeutic application and exact observation of the course of treatment. 3. What are your indications for a splint? RS: First, reduction of muscle activity. Such splints are known as Relaxation Splints or Myopathy Splints. Second, unloading joint structures. I do not use the term “decompression” in such situations. It’s not active distraction. Rather, it signifies a release of joint structures. The joint is moved forward and to a small extent downward. Third, a verticalisation splint in those cases in which verticalisation is indicated. The last indication is joint reduction using the so-called reduction splint. The use of such devices has declined in recent years. A discus in good shape and condition is a precondition for the use of such splints with the mandible in protruded position. A new approach to reduction splints is the Delta Y splint introduced by Alain Landry from Canada. Delta Y is defined as transverse displacement of the mandible to the left or the right. This shift must be taken into consideration and appears to be an important diagnostic finding. It exerts a significant impact on the success of a splint. I really do think this approach will increase the success rate in patients with lateral displacement of the mandible.

The Search for the Ideal Fixation of Palatal Fractures: Innovative Experience with a Mini-Locking Plate

Fractures of the palate have defied conventional management, such that malrotation and disinclination of the palatal shelves occur in a significant number of patients after repair. The fractured palatal shelves of eight patients were first prealigned. To do so, one or more 205-mm ratchet clamps and two intermaxillary fixation (IMF) posts were used. Rigid fixation was then achieved by applying a 2.0-mm mini-locking titanium plate (across the palatal vault) and by applying an adaptation miniplate across the fracture line as it exited the anterior surface of the maxilla. Screws were passed directly through the mucoperiosteum, to engage the palatal shelves and to lock the locking plate into position. Lacerations in the mucoperiosteum were neither used to aid fixation nor used as portals for dissection; incisions and mucoperiosteal flaps in the palatal vault were avoided. Adjuncts, such as intraoral splints, have not been used in cases to date, and early mobilization was allowed. Reconstitution of the craniomaxillofacial buttresses was added in patients with more extensive maxillary injury. The palatal appliance and screws remained rigidly in position in the roof of the mouth, much like an external fixator, until their removal 8 to 12 weeks after the repair. No patient suffered erosion of the mucoperiosteum or other major morbidity, other than a transient fistula of the soft palate. The palatoalveolar segments remained in proper realignment and inclination, and pretraumatic occlusal patterns and the width and depth of the lower face appear to have been restored with one exception. The latter suffered a subtle posterolateral open bite that was corrected orthodontically. Prealignment of fractured palatal shelves with one or more large ratchet clamps and two IMF posts provides several points of forced reduction of the palatal shelves, along the dental arch. In addition, stabilization with mini-locking plate(s) in the palatal vault and an adaptation plate across the fracture line, as it exits the maxilla, appear to have merit, based on this preliminary report (n = 8). Outcomes seen on computed tomography and clinical examination during this 3-year experience have been favorable.

Influence of different air‐abrasive powders on cell viability at biologically contaminated titanium dental implants surfaces

Studies have indicated that oral biofilm formation at structured titanium surfaces interferes with cell adhesion and proliferation, and its removal by means of conventional treatment procedures may not be sufficient to render these surfaces biologically acceptable. Therefore, the aim of the study was to evaluate the influence of different air-abrasive powders on cell viability at biologically contaminated titanium dental implant surfaces. Intraoral splints were used to collect an in vivo biofilm on sandblasted and acid-etched titanium discs for 48 h. A single (1x) and repeated (2x) use of four different powders (amino acid glycine or sodium bicarbonate particles; range of mean particle size (d(v50)):20-75 microm) was applied at two distances (1 and 2 mm) and angles (30 degrees and 90 degrees) to the surfaces. Specimens (2x) were incubated with SaOs-2 cells for 7 days. Residual biofilm (RB) areas (%), and surface alterations (SEM) (1x and 2x), as well as SaOs-2 cell viability, expressed as mitochondrial cell activity (MA) (counts/second) (2x specimens), were assessed. Comparable mean RB areas were observed within and between groups after both 1x (RB: 0.0% +/- 0.0% to 5.7% +/- 5.7%) and 2x (RB: 0.0% +/- 0.0%) treatments. All surface treatments did not lead to MA (2x) values comparable to the sterile control group. However, sodium bicarbonate particles resulted in significantly higher MA (2x) values than amino acid glycine powders of different sizes. This was associated with pronounced alterations of the surface morphology (2x). Within the limits of the present study, it was concluded that SaOs-2 cell viability at biologically contaminated titanium surfaces was mainly influenced by the particle type of the powder.

Influence of Nanocomposite Surface Coating on Biofilm Formation In Situ

Caries and periodontitis, the most wide-spread oral diseases around the world, are caused by bacterial adherence and biofilm formation onto the natural as well as restored tooth surface. One possible way to prevent the pathogenic consequences of intraoral biofilm formation might be the modification of the tooth surface by application of an anti-adhesive coating that interferes with the bacterial attachment and subsequent bacterial accumulation. The objective of this study was to investigate the effect of an experimental, low surface free energy nano-composite coating material on biofilm formation in situ. For this purpose, an organic/inorganic nano-composite coating (NANOMER, INM, Saarbrücken, Germany) with a surface free energy of 18-20 mJ/m2 was applied to enamel as well as titanium specimens. The nano-composite coated specimens and un-coated controls were attached to removable intraoral splints and carried by volunteers over 24 h in the oral cavity. After intraoral exposure, specimens were processed for transmission electron microscopic analysis. On non-coated enamel and titanium control samples a multi-layer of adherent bacteria was found. In contrast, on nano-composite coated specimens strongly reduced biofilm formation was observed. In most areas of the surface-coated specimens only a 10-20 nm thick electron dense layer of adsorbed salivary proteins with adherent protein agglomerates of 20-80 nm diameter could be detected. In addition, detachment of the adsorbed biofilm from the nano-composite coated surfaces was evident in electron microscopic micrographs. The present investigation provides ultrastructural evidence that it is possible to cover enamel as well as titanium with a nano-composite coating revealing easy-to-clean surface properties that cause reduced biofilm formation and accelerated removal of adherent biofilms under oral conditions.

Effects of Hydrophilicity and Microtopography of Titanium Implant Surfaces on Initial Supragingival Plaque Biofilm Formation. A Pilot Study

The aim of the present pilot study is to investigate the effects of hydrophilicity and microtopography of titanium implant surfaces on initial supragingival plaque biofilm formation. Test specimens were manufactured from commercially pure grade 2 titanium according to one of the following procedures: polished (P), acid-etched (A), chemically modified (mod) A (modA), sand-blasted large grit and A (SLA), and modSLA. Intraoral splints were used to collect an in vivo supragingival plaque biofilm in each group at 12, 24, and 48 h. Stained plaque biofilm (PB) areas (%) were morphometrically assessed. All groups exhibited significant increases of mean PB areas over time (p < 0.001; respectively). Morphometrical analysis revealed the following mean PB areas: 12h: SLA = modSLA > P > A =modA (p < 0.001; respectively); 24h: SLA > modSLA = P > A = modA (p < 0.001; respectively); 48h: SLA = modSLA = P > A = modA (p < 0.001; respectively). Within the limits of a pilot study, it could be concluded that hydrophilicity had no apparent effect, while microtopography had a highly uneven and unpredictable influence on supragingival plaque biofilm formation.

Removable splint with locking attachments for maxillary distraction osteogenesis with the RED system

The external traction hooks of the intraoral splint used to control traction forces applied to the maxilla with the rigid external distraction system represent a major barrier to surgical procedures. The purpose of this article is to introduce a removable intraoral splint with locking attachments that can be placed post-surgically immediately before distraction, facilitating surgery and consequently reducing the operative time. Fifteen cleft lip and palate patients underwent maxillary distraction osteogenesis using a rigid external distraction device in combination with the proposed removable splint that was fixed onto the maxillary teeth to provide anchorage. Initial records showed severe maxillary hypoplasia and negative overjet. The removable splint was fabricated using 1.5-mm diameter stainless-steel rigid orthodontic wires soldered to the locking attachments (Y&B Products LP, Chiang Mai, Thailand), making possible its placement post-surgically. Stable splint fixation was achieved prior to the distraction procedure and the desired treatment goals were reached. No complications inserting or removing the splint post-surgically, including pain or discomfort, were observed. The use of the removable splint with locking attachments has proved to be a highly effective fixation approach to manage the severely hypoplastic maxilla, eliminating lip constraints resulting from scarring, and allowing for easier, more deliberate and careful dissection.

Comparison of 4 registration strategies for computer-aided maxillofacial surgery

Surgeons have recently started to use computer-aided surgery (CAS) to assist with maxillofacial reconstructive surgery. This study evaluates four different CAS registration strategies in the maxillofacial skeleton. Fifteen fiducial markers were placed on each of four cadaveric heads. Four registration protocols were used: 1) group 1-invasive markers, 2) group 2-skin surface, 3) group 3-bony landmark, 4) group 4-intraoral splint. Two observers registered each head twice with each of the four protocols and measured the target registration error (TRE). The process was repeated on two different navigation systems for confirmation. The mean TRE values were: invasive, 1.13 +/- 0.05 mm (P < 0.05); skin, 2.03 +/- 0.07 mm (P < 0.05); bone, 3.17 +/- 0.10 mm (P < 0.05); and splint, 3.79 +/- 0.13 mm (P < 0.05). The TRE values were consistent across CAS systems. Of the techniques tested for CAS registration, invasive fiducial markers are the most accurate. Skin surface landmarks, bony landmarks, and an intraoral splint are incrementally less accurate.

Influence of an Erbium, Chromium‐Doped Yttrium, Scandium, Gallium, and Garnet (Er,Cr:YSGG) Laser on the Reestablishment of the Biocompatibility of Contaminated Titanium Implant Surfaces

The aim of the present study was to evaluate the influence of an erbium, chromium-doped yttrium, scandium, gallium, and garnet (Er,Cr:YSGG laser [ERCL]) on 1) the surface structure and biocompatibility of titanium implants and 2) the removal of plaque biofilms and reestablishment of the biocompatibility of contaminated titanium surfaces. Intraoral splints were used to collect an in vivo supragingival biofilm on sand-blasted and acid-etched titanium disks for 24 hours. ERCL was used at an energy output of 0.5, 1.0, 1.5, 2.0, and 2.5 W for the irradiation of 1) non-contaminated (20 and 25 Hz) and 2) plaque-contaminated (25 Hz) titanium disks. Unworn and untreated non-irradiated, sterile titanium disks served as untreated controls (UC). Specimens were incubated with SaOs-2 osteoblasts for 6 days. Treatment time, residual plaque biofilm (RPB) areas (%), mitochondrial cell activity (MA) (counts per second), and cell morphology/surface changes (scanning electron microscopy [SEM]) were assessed. 1) ERCL using either 0.5, 1.0, 1.5, 2.0, or 2.5 W at both 20 and 25 Hz resulted in comparable mean MA values as measured in the UC group. A monolayer of flattened SaOs-2 cells showing complete cytoplasmatic extensions and lamellopodia was observed in both ERCL and UC groups. 2) Mean RPB areas decreased significantly with increasing energy settings (53.8 +/- 2.2 at 0.5 W to 9.8 +/- 6.2 at 2.5 W). However, mean MA values were significantly higher in the UC group. Within the limits of the present study, it was concluded that even though ERCL exhibited a high efficiency to remove plaque biofilms in an energy-dependent manner, it failed to reestablish the biocompatibility of contaminated titanium surfaces.

New Fixation Method for Maxillary Distraction Osteogenesis Using Locking Attachments

The external traction hooks of the intraoral splint used in the rigid external distraction (RED) system for maxillary distraction osteogenesis interfere with the surgical procedures. The purpose of this study is to introduce an innovative splint fixation method for maxillary distraction osteogenesis with Locking Attachments and evaluate their advantages, such as reduction of operating time compared with the traditional intraoral splint method. Retrospective comparison of operative times of maxillary Le Fort I osteotomy procedures was carried out with the traditional protocol using the intraoral splint cemented to the maxillary dentition (n = 14), and a removable intraoral splint that is inserted postsurgically (n = 14). Operative procedure times were compared and analyzed statistically using the data extracted from the surgical records. There were no complications inserting the removable splint postsurgically, including pain, discomfort, or time-consuming procedure. Stable and secure splint fixation was obtained before the distraction procedure and the desired treatment goals were obtained in all patients. The total operative procedure times were significantly reduced in the Locking Attachments group by 24% to 41% (approximately 65 minutes) compared with earlier operations involving the conventional splints (P < .05). Maxillary distraction osteogenesis with the Locking Attachments is a highly effective fixation approach to manage severe hypoplastic maxilla, eliminating lip constraints resulting from scarring and allowing for easier, more deliberate and careful dissection. The use of the Locking Attachments is reliable in craniofacial surgery and has proved to be advantageous in the reduction of the operating time and surgical risks.

The efficacy of traditional, low-cost and nonsplint therapies for temporomandibular disorder: A randomized controlled trial

Treatment recommendations for patients with painful temporomandibular disorders (TMDs) range from conservative treatments such as physiotherapy to aggressive and irreversible treatments such as restorative reconstruction and joint surgery. The authors randomized 200 subjects diagnosed with TMD into three groups: usual conservative, dentist-prescribed self-care treatment without any intraoral splint appliance (UT); UT plus a conventional flat-plane hard acrylic splint (HS); and UT plus a soft vinyl (a low-cost athletic mouth guard) splint (SS). Subjects completed questionnaires and clinical examinations at three, six and 12 months. The authors observed no significant differences among the groups in TMD-related pain levels or other common signs and symptoms of TMD at baseline (BL) or at any follow-up. The changes from BL were comparable for all three groups. The authors did not note any significant differences at any follow-up for compliance with study protocols or for occurrences of adverse effects from either splint type. For HS versus SS, there were significant differences in rates of splint use, but these differences were not accompanied by differences in either self-reported symptoms or in clinical findings. All patients improved over time, and traditional splint therapy offered no benefit over the SS splint therapy. Neither splint therapy provided a greater benefit than did self-care treatment without splint therapy. These findings suggest that clinicians who treat patients with TMD should consider prescribing low-cost nonsplint self-care therapy for most patients.

Intra-articular and Muscle Symptoms and Subjective Relief During TMJ Internal Derangement Treatment with Maxillary Anterior Repositioning Splint or SVED and MORA Splints: A Comparison with Untreated Control Subjects

Discomfort associated with wearing an intraoral splint represents a problem in the management of temporomandibular joint (TMJ) internal derangement. This study evaluated whether the use of a mandibular splint during the day and a maxillary splint at night could be more comfortable and therefore as efficacious in internal derangement treatment as a maxillary splint (AR splint). Fifty (50) patients (average age 28.8; range 14-63) with confirmed internal derangement in at least one TMJ were divided into three groups: 20 patients treated with AR splint (Group I); 20 patients treated with a SVED (Sagittal Vertical Extrusion Device) and a MORA (Mandibular Anterior Repositioning Splint) (Group II); and 10 patients who underwent no treatment (Control Group). Joint noise, pain intensity and its character (as constant or chewing/biting pain), muscular pain, and subjective relief were evaluated monthly before treatment began (T0) and for six months thereafter. The following results were found: 1. Subjects in Group I and Group II displayed a significant decrease in joint pain (p<0.001), constant pain (p<0.001), chewing/biting pain (p<0.001), joint noise and muscle pain from the beginning through the sixth month follow-ups; 2. At T1 and T2, subjects in Group II reported significantly lower discomfort associated with the devices than subjects in Group I. The use of two splints seems to be as efficacious as the use of an AR maxillary splint; however an AR splint is considered more comfortable by patients, especially during the first months of therapy.

Current Evidence Providing Clarity in Management of Temporomandibular Disorders: Summary of a Systematic Review of Randomized Clinical Trials for Intra-oral Appliances and Occlusal Therapies

Pain and dysfunction from temporomandibular disorders (TMJD) is a significant clinical problem for which many diverse treatments have been used. Numerous articles evaluating success/failure of these TMJD treatments have been published with a wide range of success rates and methods to evaluate outcomes.1-6 Nearly all of these treatments have been evaluated for efficacy using the highest level of research evidence from randomized controlled trials (RCTs). With this available literature, clinicians are faced with the challenge of reviewing the methods and results of each study to make evidence-based clinical decisions. This process is further compounded by considerable variability with regard to their study designs, treatment techniques, and outcome measures. The Guidelines Committee for the American Academy of Orofacial Pain conducted an evidence-based literature review to systematically search and review the literature for all randomized clinical trials for TMJD treatment using methods derived from the Cochrane Collaboration (www.cochrane.org); the Oxford Centre for Evidence-based Medicine, (www.cebm.net); and the Centre for Reviews and Dissemination, University of York, United Kingdom (www.york.ac.uk/ inst/crd/index.htm). Trials in which placebo, no treatment, or other treatments were used in the control group were included as were trials in which postrandomization exclusions occurred since there was no evidence that these occurred preferentially in one or other arm of the trials. This presentation reviews the results of this review for intraoral splints and occlusal therapies for temporomandibular disorders. This paper only provides a summary of the methods and results. The full results can be found in the subsequent journal publication. METHODS OF THE REVIEW

Craniomandibular muscles, intraoral orthoses and migraine

Intraoral splints are effective in migraine prevention. In this review, changes in the quality of life of migraineurs treated with a palatal nonoccluding splint were measured. Using the Migraine Specific Quality of Life Instrument (Version 2.1), it was found that the palatal nonoccluding splint significantly improved the quality of life of migraineurs. The role of the craniomandibular muscles in the pathophysiology of migraine is also discussed.

Do different implant surfaces exposed in the oral cavity of humans show different biofilm compositions and activities?

Osseointegrated dental implants play an important role in restorative dentistry. However, plaque accumulation may cause inflammatory reactions around the implants, sometimes leading to implant failure. In this in vivo study the influence of two physical hard coatings on bacterial adhesion was examined in comparison with a pure titanium surface. Thin glass sheets coated with titanium nitride (TiN), zirconium nitride (ZrN) or pure titanium were mounted on removable intraoral splints in two adults. After 60 h of intraoral exposure, the biofilms were analyzed to determine the number of bacteria, the types of bacteria [by applying single-strand conformation polymorphism (SSCP analysis) of 16S rRNA genes], and whether or not the bacteria were active (by SSCP analysis of 16S rRNA). The results showed that bacterial cell counts were higher on the pure titanium-coated glass sheets than on the glass sheets coated with TiN or ZrN. The lowest number of bacterial cells was present on theZrN-coated glass. However, the metabolic activity (RNA fingerprints) of bacteria on TiN- and ZrN-coated glass sheets seemed to be lower than the activity of bacteria on the titanium-coated surfaces, whereas SSCP fingerprints based on 16S rDNA revealed that the major 16S bands are common to all of the fingerprints, independently of the surface coating.

Treatment of Joint Pain and Joint Noises Associated with a Recent TMJ Internal Derangement: A Comparison of an Anterior Repositioning Splint, a Full-Arch Maxillary Stabilization Splint, and an Untreated Control Group

Pain and joint noises associated with temporomandibular joint (TMJ) internal derangement are often treated by using an intra-oral splint. This study evaluated whether an anterior repositioning splint (AR splint) could be more effective in the treatment of these symptoms than a full-arch maxillary stabilization splint (FAMS splint), because of its capability to re-establish immediately the normal condyle/disk relationship. The authors treated 40 patients (average age 16.8; range 8.0-24.0) with confirmed internal derangement, joint pain, and joint noises in at least one TMJ for at least two months, with AR splint (20 subjects) or FAMS splint (20 subjects); 10 untreated patients comprised the control group. Joint noise, joint pain, and the intensity of pain were assessed using a visual analogic scale (VAS), and the pain was characterized (i.e., constant or chewing/biting pain) and evaluated monthly for eight months. Significantly fewer AR splint patients experienced pain after four months of treatment. A significantly lower intensity of pain was experienced by the AR splint patients after two months of treatment. Significantly fewer AR splint patients experienced chewing/biting pain after eight months of treatment. The frequency of joint noises decreased over time, with no significant differences between the groups. In conclusion, the AR splint seems to be more effective in decreasing pain, but it seems to make no difference in the treatment of joint noises.

The clayton intraaural device for temporomandibular disorders

Temporomandibular disorders (TMDs) are a group of conditions characterized by chronic pain and dysfunction in the temporomandibular joint (TMJ) and the muscles of mastication. The current clinically effective, reversible treatments for TMDs include physical therapy, behavioral therapy, pharmacological therapy, and intraoral splint therapy. The Clayton Intraaural Device (CID) is a hollow plastic patented device which rests in the outer third of the ear canal when the jaw is slightly opened. This device may add to the clinically effective, safe and reversible, conservative treatments for TMDs. The following pilot study was designed to test safety and efficacy of the CID and power a larger study.

Oral Burn Contractures in Children

Oral burn contractures in children present major reconstructive problem. Only few reports in literature discussed oral burns in children. Electrical, chemical, and thermal agents are the main causative agents for oral burns. Oral contractures can be classified into anterior, posterior, and total. Anterior contractures are usually caused by electrical burns and involve the oral commissure, lips, anterior buccal sulcus and surrounding mucosa, and anterior tongue. Posterior oral contractures are caused by caustic ingestion and involve the posterior buccal mucosa, posterior tongue, retro-molar area and oro-pharynx. Total oral contractures involve the lips, tongue, oral cavity, and oro-pharyngeal mucosa and are caused by lye caustic ingestion. This report reviews three children; one with posterior, two with total oral cavity contracture. All cases were managed by linear release of scar contracture and skin grafting followed by a prolonged intra-oral splinting with a fixed mouth-block and commissural splint. A successful outcome was observed in all cases.