Temporary Splinting Research Articles

MEDICAL LESSON FROM THE OPERATION IRAQI FREEDOM

Summary A critical prospective analysis was conducted for the missile injuries of the extremities in Basrah University Department of Orthopaedic Surgery at the time of operation Iraqi Freedom (20 th of March – 20 th of April 2003). The wounds were classified into four grades according to the severity of the injuries. Wound closure was performed primarily in 20 (16%), secondarily in 44 (35.2%) while skin graft was necessary for 36 (28.8%) patients. Although the transportation time was less than two hours, the injuries were severe because of the close proximity of shortening. Collapses of the old houses in Basrah were responsible for the associated closed or open injuries. Primary wound excision was insufficient in 37(27%) patient, this was related to the lack of experience by the junior staff, and was the reason behind the high incidence of wound infection which was recorded in 78 (56.93%) patients. Compound fractures were recorded in 66 (48.17%) patients, soft tissue injuries were noticed in 43 (31.38%), while amputation was the final outcome in 24 (17.5%) patients. The injurious agents were fragments of shell in 74 (54.01%), bullets in 34 (24.81%) while closed injuries were noticed in 12 (8.65%) patients. The fractures were immbolished by external fixation in 24 (9.48%), temporary internal splint in 13 (9.48%), gypsona in 29 (21.16%). The mortality rate was 4.83%. The infection rate and other complications could have been lower if war surgical principles were accepted and performed precisely in the management.

A technique to create appropriate abutment tooth contours for removable partial dentures.

A technique is presented for using light-cured composite resin to create desirable contours on abutment teeth for the retention and support of removable partial dentures. The desired tooth shape is created on a diagnostic cast, captured in a clear temporary splint material, and formed in resin on the abutment teeth with the splint acting as a matrix.

Stenting versus Splinting of Uretero-Intestinal Anastomoses: Our Experience

The role and type of temporary ureteral splints to be used for uretero-intestinal anastomoses is not yet clear, especially regarding whether they help prevent stenoses or fistulas, which are complications that can affect the successful outcome of the actual operation. The aim of this study is to assess the results using the double J ureteral stent and the splint in patients subjected to radical cystectomy and urinary diversion using the intestine. Material and methods From November ‘94 to December ‘97, 109 patients underwent radical cystectomy: 60 orthotopic neobladders were created (53 VIP, 4 Reddy 2, 2 Studer, 1 Carney 2), 42 ileal conduits, 4 heterotopic diversions (2 Indiana, 1 Mainz1, 1 Mainz2), 3 USS and 216 u-i anastomoses (93 Le Duc, 6 Leadbetter, 4 Goodwin, 2 Split-cuff, 2 Main, 2 Ghoneim, 41 Nesbit, 35 Wallace1, 13 Bricker, 12 Polsino, 6 Wallace2). 115 splints were used (in orthotopic and heterotopic diversions the counter-opening was through the abdominal wall) and 101 double J stents. A check by neocystography/Brikergraph and transplintgraph (with possible removal of the splint) was carried out on the 15th day, while the double J stent was removed on the 30th day by flexible cystoscopy. Results 18 stenoses occurred, of which 7/115 patients subjected to splinting and 11/101 patients subjected to stenting. Fistulas occurred in 6 patients: 5/6 with stent, 1/6 with splint (5 VIP with 5 Le Duc, 1 Bricker with Nesbit): these resolved spontaneously keeping the ureteral splint in situ for a longer period (average 20 days, range 15–32). These is consequently no statistically significant difference between the two groups of patients (p = 0,09 for stenoses and p = 0,11 for fistulas). Conclusions The importance of the temporary ureteral splint in u-i anastomoses in order to prevent stenoses or fistulas seems to be recognised in literature, but the type of splint is not clarified. Our study does not seem to indicate a substantial preference. The choice of splint depends on the personal preference of the surgeon, also taking into account that although the splint allows radiological (also serial) control of the upper urinary tracts (important with urinary fistulas), the stent is perhaps easier to handle and better tolerated by the patient.

Facial approach to stabilization of mobile maxillary anterior teeth with steep vertical overlap and occlusal trauma

The necessity for splinting and the advantages of some types of permanent, semipermanent, and temporary splinting are given. Specific step-by-step instructions are given for a special purpose splint that can be used for stabilizing mobile maxillary teeth when the patient has thin teeth faciolingually and a steep vertical overlap. This can be the treatment of choice for such patients. (J Prosthet Dent 1997;77:550-2.)

Acute carpal tunnel syndrome as a complication of oral anticoagulant therapy

Acute carpal tunnel syndrome is well recognized in patients with haemophilia and conservative management with factor replacement and temporary splinting is recommended. There have, however, been very few reported cases of acute carpal tunnel syndrome as a complication of oral anticoagulant therapy. We describe such a case in a patient on long-term warfarin anticoagulation, drawing attention to particular features of the history and clinical findings. In contrast to previous reports, we recommend prompt decompression under local anaesthesia and continuation of the anticoagulant therapy.

上顎欠損症例に対するエチレンビニールアセテートを用いた暫間床副子

Patients with maxillary tumors, suffer considerable dysfunction until they wear the final prosthesis.We report the use of a temporary splint made of vinyl acetate ethylene in a patient with a maxillary defect.

Die konservative Korrektur angeborener Formanomalien der Ohrmuschel*

Congenital deformities of the shape of the auricle may be corrected with a nonsurgical procedure by means of temporary splinting with dental material and surgical tapes (steri-strips) as reported elsewhere. If the dressing was performed during the first three days of life the aesthetic results achieved were persistent and made a posterior surgical correction unnecessary. The elasticity of the ear cartilage seems to be related to the levels of estrone and estradiol.

Collagen/hydroxylapatite implant for augmenting deficient alveolar ridges: Twelve-month clinical data

In a multicenter study, 77 edentulous patients had mandibular augmentation with implants of purified fibrillar collagen combined with dense hydroxylapatite (Alveoform™ Biograft); 22 of these patients also had maxillary augmentation. Most patients had Class III or IV mandibular atrophy, and had outpatient surgery with the subperiosteal tunneling technique. Temporary splints were worn for 24 hours post-surgery. Mean ridge height was 15.3 mm before surgery and 19.5 mm after 12 months, an augmentation of 4.2 mm. Predictable compaction occurred largely in the first few months after denture loading. Most patients, surgeons, and prosthodontists assessed the results of the procedure as good to excellent at 1 year following implantation. Adverse experiences, largely dehiscence and paresthesia, tended to resolve over time. Sera from ten patients demonstrated antibodies to bovine collagen that were not clinically significant. Alveolar augmentation with collagen/hydroxylapatite achieved clinically significant results that compared favorably with those achieved with other types of ceramic implants.

Bilateral traumatic dislocations of Volz total wrist arthroplasties: A case report

Bilateral traumatic dislocations of Volz total wrist arthroplasties in a patient with rheumatoid arthritis occurred 7 years after the initial surgical procedures. Treatment consisted of closed manipulation and reduction of both wrists followed by temporary splinting. Good function was restored in both wrists without operative intervention. No fractures or loosening at the bone cement interface was encountered.

Significance of occlusion in the etiology and treatment of early, moderate, and advanced periodontitis.

Elimination of lesions diagnostic of trauma from occlusion is an essential part of complete periodontal therapy and restoration of health in the masticatory system for such patients. This can be achieved by orthodontic treatment, temporary splinting, bite-planes, occlusal adjustment and permanent splinting of teeth. Occlusal therapy may be required during periodontal treatment for trauma from occlusion and to enhance occlusal stability at any stage of periodontitis, but is most often needed in advanced periodontitis. Splinting of hypermobility of self-limiting trauma from occlusion is not indicated. Splinting may be required in addition to occlusal adjustment in moderate to severe periodontitis when trauma from occlusion is progressive.

Impact of a periodontal course on oral hygiene and gingival health among senior dental students.

This survey attempted to determine the impact of the periodontal course on oral hygiene and gingival health among 50 senior dental students. The course included the following: patient motivation, instruction in oral hygiene procedures and plaque control, scaling and curettage, temporary splinting and occlusal adjustment. Without advance notice, plaque deposits were scored using the Plaque Index and gingival health was determined using the Gingival Index. The results were collected at the beginning and at the end of the periodontal course (about 2 months). The results were analyzed using the paired t-test. No improvement of either oral hygiene or gingival health was noted at the end of the periodontal course. It seems that even some dental students, who should know the direct relationship between bacterial plaque and periodontal diseases and should be better motivated than the average patient, failed to demonstrate effective oral hygiene. It is difficult to expert an improvement of patient oral hygiene, when the patients have been motivated by students who are unable to perform satisfactory personal oral hygiene themselves. It is suggested that a greater emphasis be placed on patient motivation and instruction in oral hygiene throughout the dental curriculum.

A new method for stabilization of periodontally involved teeth.

An approach is presented for the construction of an extracoronal temporary splint that meets the demands of stabilization in the presence of a compromised attachment apparatus. It is completely reversible and esthetically acceptable. It also combines the versatility of two often used materials--orthodontic grid material (for bracket placement) and self-polymerizing resins and composites, giving the combined effect of strength, stability and esthetics.

Animal experiments on reanastomosis of the vas deferens using fibrin glue.

In 31 rabbits the stumps of the previously severed vasa deferentes were joined with a fibrin glue and splinted in various ways: silicone T-tube, silk thread and chromium catgut thread. In a fourth group the vasovasostomy was carried out with a suture. The patency of the vasa deferentes was examined by evaluation of of the ejaculate, vasogrphy and histological examination. In almost 50% of the cases, patency of the was deferens was achieved with fibrin glueing. According to our investigations, temporary splinting with silk thread during the glueing or suture process appears to be the best method. Patency of anastomosed vasa deferentes should be evaluated by examination of the ejaculate. The radiological findings only permit a definitue statement when there is bilateral occlusion.

人工歯肉を兼ねた暫間固定の1症例

The patient was 36-years-old female whose chief complaint was marked gingivitis of maxillary anterior teeth include root exposure or lossing of teeth.The treatment consisted of plaque control, curattage, occlusal adjustment and flap operation in order the mentioned above. But after flap operation, marginal area of 3-3 showed more root exposure.On the esthetic view point or strongly complaint of patient, this case carried out in the removable type of temporary splint which is composed of proshetic gingiva on swing lock attachment.

Fiber Glass Splints

Temporary splints to immobilize periodontally diseased teeth were made by fiber glass bonded and attached to the teeth with acid-etch technique with BIS-GMA resin. Twenty-one splints were made. Observation time ranged from 4 to 14 months. During the observation only one splint fractured and was repaired while the others functioned without failure.

Pin-retained composites for splinting lower anterior teeth

Splinting of teeth follows a pattern of either a temporary type of splint or a permanent type of splint. The classic temporary splint is composed of wires which circumferentially engage the six lower incisors and impart a degree of rigidity and support to them, especially when the wires are stabilized with one of the unfilled resins.' These techniques often rely upon surface anchorage to enamel via the acid-etch method. The major disadvantage of this method is danger of fracture at the composite-enamel junction. Effective permanent splinting of lower anterior teeth may be accomplished by crowning the teeth or by anchoring them to a lingual plate of gold with pins. These pins may be an integral part of a gold casting,2. 3 or they may be screwed to the lingual gold plate.4. 5 To ensure permanence they are cemented to the teeth to convert them into a single rigid unit. The major disadvantages of the pin-retained casting are its expense and difficulty in fabrication. The method described in this article might b e classified as semipermanent. It involves the use of the acid-etch concept, composite resin, and interlocking TMS Minim pinst in the lingual embrasure (Fig. 1).

Surgical Treatment of the Massively Dilated Ureter in Children. Part I. Management by Cutaneous Ureterostomy

One of the major therapeutic challenges facing the pediatric urologist is the massively dilated ureter. When conservative measures, such as relief of obstruction or treatment of infection, have failed or are likely to fail, surgical treatment must be directed at the massive dilatation itself. These circumstances were encountered in 366 massively dilated ureters in 244 children during a 10-year period. Loop and/or terminal cutaneous ureterostomy was used to manage 125 of these ureters in 74 children. Indications for temporary non-intubated proximal urinary diversion included uncontrolled infection, sepsis, azotemia, significant ureteral redundancy and tortuosity, and questionable over-all renal function. Advantages of loop ureterostomy included more proximal drainage and less stomal problems but terminal ureterostomy required a significantly lesser number of surgical procedures in reconstructing the urinary tract. Temporary splinting of the ureter in dry ureteral reimplantations has diminished markedly the incidence of ureterovesical complications. No instances of permanent vesical contracture were noted after long periods of defunctionalization. After initial reconstruction of 47 cutaneous ureterostomies good results by all parameters were obtained in 68 per cent. Additional surgical procedures in selected initial failures have resulted in a final success rate of 85 per cent.

Rationale for stabilization.

1. The subjective separation of the normal and the diseased periodontium for splinting purposes is artificial. With the exception of cases of secondary trauma from occlusion, the diseased periodontium should be treated in the same manner as the normal periodontium with regards to splinting. 2. Retionales for stabilization found to be valid are: I. Prevention of mobility A. Post acute trauma. B. In occlusal therapy. II. Prevention of drifting A. Replacement of missing teeth. B. Postorthodontics. III. In treatment of secondary trauma for occlusion. A. For functional stability. B. With unknown effects on the progression of periodontitis. 3. The relationship of trauma from occlusion and periodontitis is unclear at this time. 4. A need exists for a clinical test correlating histologic signs of trauma from occlusion and clinical findings. 5. Temporary splinting generally is not indicated during the initial or surgical phase of treatment of the periodontal patient, because mobility short of secondary trauma from occlusion does not impair healing.

The use of a self-polymerizing resin with enamel etchant for temporary stabilization.

The indications and characteristics of ideal temporary splints have been discussed. A technique has been presented using a self-polymerizing resin with an enamel etchant for extracoronal splinting of anterior teeth. When properly fabricated, the restoration has most of the properties of an ideal temporary splint: economy, simplicity of fabrication, lack of irritation, compactness, durability and esthetics.

Application of Temporary Splints

Emergency splintage is a variety of first aid. The procedures which one might expect to find performed before the patient enters the hospital for definitive diagnostic treatment are too often ignored in a busy and otherwise excellent veterinary practice. Simple entrance in the hospital and cage confinement do not appreciably lessen the likelihood of increased self-trauma. The manipulation inherent in physical and radiographic examination of the injured and painful animal is an even greater indication for immobilization to prevent additional trauma. The clinician is dutybound to place a proper splint on the affected animal to lessen subsequent trauma and to prevent edema. The techniques presented allow this application with minimal time and expense and maximal support and protection to the patient.