Use Of Splint Research Articles

123 Flexion Glove Modification to Isolate Proximal and Distal Interphalangeal Joint Range of Motion

Abstract Introduction Flexion gloves are a quick and easy way to provide a dynamic stretch to the digits for patients with limited composite flexion range of motion (ROM) or who are at risk for digit extension burn scar contractures. However, the flexion glove has been observed clinically to bias metacarpal phalangeal (MCP) joint flexion ROM when compared to the proximal and distal phalangeal (PIP and DIP) joints. The purpose of this case study is to demonstrate the use of a custom thermoplastic hand-based splint to block MCP joint motion in order to better isolate PIP and DIP joint ROM for a patient with primary PIP and DIP flexion ROM limitations. Methods A custom, thermoplastic, palmer hand-based splint was fabricated with an opening for the thumb and the splint extending to the proximal phalanxes stopping below the PIP joints in order to block MCP joint flexion ROM as seen in Figure 1b. Composite flexion passive ROM (PROM) measurements were taken for all MCP, PIP, and DIP joints of digits 2-4 with only the flexion glove donned and with the hand-based splint applied over the flexion glove as seen in Figure 1a and 1c. Results An increase in combined PIP and DIP joint PROM was found for all digits when the hand-based splint was donned over the flexion glove compared to the flexion glove only (see Table 1). These increases in combined PIP and DIP PROM included 35° for the index finger, 10° for the middle finger, 20° for the ring finger and 30° for the small finger, with an overall mean increase of 23.75° Conclusions This easy splinting technique combined with a flexion glove was effectively used to bias stretch of the PIP and DIP joints into flexion for a patient with adequate MCP flexion ROM and impaired PIP and DIP flexion ROM caused by burn scar contracture. Applicability of Research to Practice Using an off the shelf flexion glove and a basic hand-based splint, therapists can use this technique to easily adjust the angle of pull to maximize the benefit from a flexion glove to address specific joint limitations of the finger caused by burn scar contracture.

755 3D Printed Mouth Stretcher

Abstract Introduction Microstomia can impede eating, speech, dental care, and surgical procedures (intubation). MPAs (microstomia preventative appliance/apparatus) are often used to manage burns around the mouth where there can be tightness in the oral commissures (microstomia). MPAs, however, are becoming more difficult to attain. Burn center therapy departments have been trying to find, or develop, a comparable replacement. Having been able to procure a 3D printer, our department is now able to print this new design. It has been trialed with a patient who reports the device is comfortable to wear and easy to use. Methods In developing a device to incrementally spread the oral commissures, different “garage tools” (C-clamp, caliper, wrench, etc) were trialed. From these ideas, this ratcheting slide version was determined to be the most durable and simple to use. The “clamp” ends were replaced with interchangeable “spools”. It is printed with a plastic filament called PLA (polylactic acid) and took between 100 minutes to 200 minutes to print all pieces of the mouth stretcher depended on the size of the device. The total cost to print ranges from $1.00 to $2.00 per device depending on the size. The main support, the slider, and the spools each need their own STL file, but were designed synchronously so that the parts all fit together properly. This mouth stretcher can be resized via different sized spools or made on a smaller scale for a pediatric version. It can also be used as a horizontal mouth stretcher (instead of using layers of tongue depressors). Results Our adult patient was able to improve his oral commissure measurements and he reports the device was comfortable and he was even able to sleep with it. The patient was able to increase the horizontal opening of his mouth 1 cm and vertical opening of his mouth 1.25 cm with inconsistent use over 9 months as he needed to take breaks due to another eye surgery during this time. Conclusions Stretching the oral commissures can be done cost-effectively (once a 3D printer is available) and easily used with minimal instruction for the patient. It could be trialed with varying sizes and shapes of “spools” for improving patient comfort and to minimize any areas of tissue breakdown (pressure sores) in the mouth. Past use of microsomia splints have been very beneficial, increasing mouth ROM which can diminish likelihood of surgical reconstruction and decrease the possibility of eversion of lower lip. Applicability of Research to Practice It may be difficult to provide for patients due to the expense of procuring a 3D printer and requires knowledge of 3D printing. However, as 3D printing becomes more commonplace in schools, hospitals, and homes, there will be increasing opportunity for further creativity, innovation, and use in the burn world.

Novel Custom Maxillary Disimpaction Splint.

LeFort I, II, and III osteotomies are commonly used in complex craniofacial reconstruction. Patients requiring these procedures typically have a craniofacial cleft, other congenital craniofacial deformities, or severe facial trauma. Both the cleft and traumatized palate have poor bony support, which leads to possible complications when the disimpaction forceps are used during the downfracture of the maxilla. Such potential complications include trauma or formation of a fistula of the palatal, oral, or nasal mucosa; trauma to adjacent teeth; and fracture of the palate and alveolar bone. To help prevent these complications, we developed a custom disimpaction splint. The splint is designed to cover the palate and occlusal surfaces to increase retention and minimize splint movement during the maxillary downfracture portion of the surgical procedure. The base of the splint is fabricated from a two-layered biocryl material, and the palatal area is built with soft-cushion rebase material. This allows for a stable grip of the disimpaction forceps blades and provides protective coverage of the cleft, traumatized palate, or alveolar bone graft site during the downfracture. The custom maxillary disimpaction splint has been routinely used in our clinic from September 2019 to the present for LeFort osteotomies in patients with a compromised primary palate. No surgical complications related to the maxillary downfracture have been noted during this period of time. We conclude that the routine use of a custom maxillary disimpaction splint can result in improved outcomes and decreased complications of LeFort osteotomy procedures in patients with cleft and traumatized palate.

Prediction of Early Postoperative Pain in Infants Undergoing Primary Cleft Palate Repair.

Identification of at risk patients before surgery could facilitate improved clinical communication, care pathways and postoperative pain management. A retrospective cohort study was performed in all infants who had undergone cleft palate repair. Tertiary Institutional. Infants < 36 months of age who underwent primary repair of cleft palate between March 2016 and July 2022. Requirement for analgesic intervention in the post operative care unit. Adverse perioperative event defined as pain or distress. Secondary outcomes were the incidence of airway obstruction, hypoxemia or unplanned intensive care admission. Two hundred and ninety one patients (14.6 months,10.1 kg weight) were included. Cleft distribution included submucous (5.2%), Veau I (23.4%), Veau 2 (38.1%), Veau 3 (24.4%), and Veau 4 (8.9%). Overall 35% of 291 infants undergoing cleft palate repair experienced pain or distress requiring opiate intervention in the first hour after surgery. Infants with a Veau 4 cleft palate had 1.8 times and Veau 2 cleft palate had 1.5 times the risk of postoperative pain compared to infants with Veau 1 cleft palate (relative risk 1.82, 95%CI 1.04-3.18 and 1.49, 95%CI 0.96-2.32 respectively). The use of bilateral above elbow arm splints was significantly associated with postoperative pain or distress (odds ratio 2.23, 95%CI 1.01-5.16). Post operative pain requiring intervention in PACU is common despite adequate intraoperative multimodal analgesia, local anaesthesia infiltration and postoperative opiate infusions. Infants undergoing soft palate alone or submucous palate repair may require less perioperative opiates.

P104 The role of occupational therapy for the self-management of rheumatoid arthritis: a mixed methods systematic review

Abstract Background/Aims Occupational therapy (OT) can support people with rheumatoid arthritis (RA) to self-manage their symptoms and engage in meaningful daily activities. Previous evidence reviews are dated, limited to quantitative research designs, and lack a focus on self-management. The effectiveness of OT in supporting RA self-management is unclear when accounting for both measurable outcomes (e.g., function) and lived experience. This review aimed to assess the impact of OT on the self-management of RA by reviewing quantitative (pain, function and fatigue) outcomes and qualitative (narrative experience) evidence. Methods PROSPERO registration CRD42022302205. We systematically searched for studies involving adults with RA participating in self-management programmes incorporating OT. Searches were conducted via MEDLINE, CINAHL, AMED, PsycINFO, Web of Science (Core Collection) databases, and grey literature sources up to 1 April 2022, with a refresher search conducted on 30 June 2022. Three reviewers screened titles and abstracts. Two reviewers independently extracted and assessed full texts of eligible studies, using the Cochrane risk of bias (quantitative and mixed methods) and Critical Appraisal Skills Programme (CASP) (qualitative) tools to assess study quality. Studies were categorised as: educational-behavioural, comprehensive OT, community (home-based) OT, splints and assistive devices, and other programmes, including workplace interventions. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) (quantitative) and GRADE-CERQual (qualitative) were used to assess the quality of evidence for each intervention category. Patients and occupational therapists (OTs) were consulted via online workshops to inform the search strategy (n = 4 patients) and interpret review findings (n = 6 patients; n = 4 OTs). Results Of the 36 papers meeting eligibility criteria, 27 were quantitative studies (n = 1802 participants), three qualitative (n = 31), and six mixed methods (n = 844). Strong evidence supports the use of educational-behavioural programmes for pain and function, particularly group sessions on joint protection education. Qualitative evidence was limited to three papers exploring personal transformations experienced during community-based (home) OT. Weak evidence supports the use of splints and assistive devices, whereas comprehensive OT intervention had mixed effectiveness. Across all intervention types, there was little evidence to support OT for self-managing fatigue. Conclusion Educational-behavioural programmes offer improvements in pain and function, but behaviour changes in self-management do not translate to improved long-term health benefits. For fatigue, the evidence to support OT self-management programmes is inconclusive, with the few qualitative insights on lived experience relating to illness, independence, (occupational) activity and altruism specific to home-based OT. Our findings extend current research that OT programmes targeting RA self-management behaviours are effective for short-term behaviour change and improving pain and function, but cannot demonstrate prevention of further physical deterioration for progressive RA. Timing programmes to match the individual’s disease stage (i.e. early or established RA) appeared to impact therapy outcomes and patient experience. Evidence on the patient experience and long-term effectiveness are lacking. Disclosure J.P. Gavin: None. L. Rossiter: None. J. Adams: None. V. Fenerty: None. J. Leese: None. A. Hammond: None. E. Davidson: None. C. Backman: None.

Maxillofacial Fracture Types and Their Management in 3-to 18-year-old Individuals Referred to Shariati Hospital, Tehran, Iran.

Objectives: This study was performed to find the most common types of maxillofacial fractures and their management in 3 to 18-year-old individuals referred to the Department of Oral and Maxillofacial Surgery at Shariati Hospital in Tehran, during a 9-year period. Materials and Methods: This retrospective study evaluated the records of 319 patients with maxillofacial fractures between 2012-2020, ranging in age from 3 to 18 years. Data regarding the etiology and location of the fracture, age, gender, and treatment approach were retrieved from the archival records and analyzed. Results: A total of 319 patients were included in the study, out of which, 255 (79.9%) were males and 64 (20.1%) were females. Motor-vehicle accidents were the most common cause of trauma (N=124, 38.9%). We recorded 605 fractures and among them, the parasymphysis (N=131, 21.6%) was the most common site of isolated fractures. Type of treatment varied depending on the fracture type and degree of displacement of the broken segments. It consisted of open reduction and internal fixation, and closed reduction procedures, which included the use of arch bars, ivy loops, lingual splints, and circummandibular wirings. Conclusion: Analysis of the results revealed that the severity of injury increased with age. Older individuals had higher a number of fracture sites and experienced greater displacement of the broken segments.

Silicone septal splint for recurrent epistaxis in HHT patients: experience of a national referral centre.

To report our experience in the use of silicone septal splint for recurrent severe epistaxis in hereditary haemorrhagic telangiectasia patients (HHT). This is a descriptive analysis carried out at the Otorhinolaryngology Department of Fondazione IRCCS Policlinico San Matteo in Pavia, a reference centre for the treatment and diagnosis of HHT. We retrospectively evaluated HHT patients who underwent silicone septal splint positioning after the endoscopic surgical treatment of epistaxis from 2000 to 2022. Of the 506 patients surgically treated in the period of analysis, 74 patients underwent silicone septal splint positioning and 37 were post-operatively interviewed. With a mean of 2.4 previous surgical treatments and a mean epistaxis severity of 7.38, the majority of patients presented with septal perforation (71.6%). On average, patients maintained the splint in place for 54.5 months, with a good tolerability and a significant reduction in epistaxis severity, need for blood transfusion and improvement of haemoglobin levels. In HHT patients with recurrent severe epistaxis and with septal perforation, the placement of septal splints offers a useful additional strategy in the management of nosebleeds.

Orthodontic Approaches in the Management of Mandibular Fractures: A Scoping Review.

Non-surgical approaches have been proposed in the management of mandibular fractures, especially in children, but there is a lack of clear guidelines on the clinical indications of conservative approaches. The aim of this scoping review is to provide the available evidence of the role of the orthodontist in the management of mandibular fractures. The PRISMA-ScR guidelines were followed to select eligible articles from the PubMed, Scopus, and Web of Science databases according to precise inclusion criteria. The research questions were formulated as follows: "what is the scientific evidence concerning the rule of orthodontists in the management of mandibular fractures" and "the preferential use of the direct bonding technique with orthodontic brackets rather than rigid arch bars"? Seventeen articles were included. Five articles presented the use of removable acrylic splints or functional appliances, six articles concerned the employment of cemented acrylic or rigid splints, and six articles described the management of mandibular fractures in adults and children using orthodontic brackets or mini-screws. Most of these techniques have been employed in children and growing subjects, while fewer data were available regarding conservative treatments in adults. Preliminary evidence suggests that condylar and some minor parasymphyseal fractures in children may be managed with conservative approaches. In adults, minor condylar and stable body mandibular fractures with minimal displacement have been reduced similarly. However, there are no sufficient elements that could suggest the preferential use of orthodontic brackets over rigid arch bars in adults. Further randomized and non-randomized clinical trials with long follow-ups will be needed to better define the clinical indications of the orthodontic approaches in the management of mandibular fractures based on severity, location, and age.

Treatment of temporomandibular joint trauma following odontectomy

Temporomandibular Joint Disorder (TMD) is a non-dental musculoskeletal disorder that has a complex and multifactorial etiology. The most frequent symptoms are pain in the masticatory muscles, in front of the ears, and in the temporomandibular joint (TMJ); this disorder can also be accompanied by clicking sounds and locking. This study aimed to present a case report of temporomandibular joint trauma following odontectomy. A 22-year-old patient came with some complaints, namely pain in the TMJ, a clicking sound when opening and closing the mouth, and limited mouth opening. The symptoms started when the patient underwent odontectomy on all the four third molars, causing tightness around the jaw, pain, and clicking. However, she did not seek any treatment for these conditions until the pain became worse and disturbed her activities. The patient had to deal with limited mouth opening and severe migraines up to twice a day. During an examination, the patient was able to open her mouth without pain only 25 mm in width, with a maximum mouth opening of 35 mm. The therapy was done by constructing a 4-mm stabilization splint and educating the patient on how to reduce the pain. In fact, 2 months after the treatment and the use of stabilization splints, her complaints of TMJ pain and clicking sounds decreased, her mouth opening increased, and the migraines never came back. In this case, non-invasive treatment as the first-line therapy in patients with disc displacement with reduction and arthralgia can reduce the joint pain symptoms, and some of the symptoms have even disappeared.

The use of platelet-rich plasma, hyaluronic acid, and botulinum toxin for the treatment of TMJ disorders

The temporomandibular joint (TMJ) is a synovial joint that connects the mandibular to the skull. Its main function is to facilitate the movement of the jaw and when it suffers any type of damage or injury, it leads to a decrease in mobility and pain in the area. This localized pain is called temporomandibular joint disorders (TMJD), and it can be caused by intraarticular or extraarticular disorders. The most common symptoms include acute pain, decreased mouth opening, tightening of the muscle, headache, and loss of joint function. Nowadays, there are treatments for temporomandibular joint dysfunction from surgical procedures up to less invasive methods, such as the use of splints. Platelet rich plasma (PRP), hyaluronic acid (HA) and botulinum toxin (BTX) injections have been categorized as a complement of primary treatment in TMJD, as well as decrease drug excess in patients. Due to their natural origin, PRP and HA can regenerate tissue in cases of cartilage degeneration, inhibit inflammation, slow down the progression of osteoarthritis and increase the production of natural lubricating fluid in the joint. Its intra-articular application reduces pain due to lubrication and nutrition to the avascular areas of the disc and condylar cartilage. Botulinum toxin (BTX) has been used for years in the medical and cosmetic field, but its use in TMJD refers to injections specifically within masseter muscle, with the objective to reduce the muscular tension TMJ overload, therefore, pain decreases, and movement increases. Over the years these less invasive methods have been increasing in the medical area due to the great pain management in the neuro-muscular and articular complex.

Tendon Sheath Incision for Surgical Treatment of Trigger Finger.

Open trigger finger release is an elective surgical procedure that serves as the gold standard treatment for trigger digits. The aim of this procedure is to release the A1 pulley in a setting in which the pulley is completely visible, ultimately allowing the flexor tendons that were previously impinged on to glide more easily through the tendon sheath. Although A1-or the first annular pulley-is the site of triggering in nearly all cases, alternative sites include A2, A3, and the palmar aponeurosis1. Typically, the surgical procedure can be conducted in an outpatient setting and can vary in duration from a few minutes to half an hour. The surgical procedure involves the patient lying in the supine position with the operative hand positioned to the side. A small incision, ranging from 1 to 1.5 cm, is made on the volar side of the hand, just proximal to the A1 pulley in the skin crease in order to minimize scarring. Once the underlying neurovascular structures are exposed, the A1 pulley is released longitudinally at least to the level of the A2 pulley, followed by decompression of the flexor tendons that were previously impinged on. In order to confirm the release, the patient is asked to flex and extend the affected finger. The wound is irrigated and closed once the release is confirmed by both the patient and surgeon. Aside from an open release, trigger finger can be treated nonoperatively with use of splinting and corticosteroid injection. Alternative operative treatments include a percutaneous release, which involves the use of a needle to release the A1 pulley2. Trigger finger can initially be treated nonoperatively. If unsuccessful, surgical intervention is considered the ultimate remedy2. Because of their efficacious nature, corticosteroid injections are indicated preoperatively, particularly in non-diabetic patients3. Splinting is often an appropriate treatment option in patients who wish to avoid a corticosteroid injection1. However, if nonoperative treatment modalities fail to resolve pain and symptoms, surgical intervention is indicated2. In comparison with a percutaneous trigger finger release, an open release provides enhanced exposure and may be safer with respect to avoiding iatrogenic neurovascular injury2. However, in a randomized controlled trial, Gilberts et al. found no difference in the rates of recurrence when comparing open versus percutaneous trigger finger release4. With reported success rates ranging from 90% to 100%, the open release of the A1 pulley is considered a common procedure associated with minimal complications2. Complications of the procedure were assessed in a retrospective analysis of 43 patients who underwent 78 open trigger releases performed by 1 surgeon. In that study, the authors reported a minor complication rate of 28% and a major complication rate of 3%5. Specifically, the 2 major complications noted by the authors were a synovial fistula and a proximal interphalangeal joint arthrofibrosis. In a larger study that included 543 patients who underwent 795 open trigger releases, the authors reported a minor complication rate of 9.6% and major complication rate of 2.4%6. Furthermore, the most common complications involved persistent stiffness, swelling, or pain. In that analysis, the authors suggested that sedation, male gender, and general anesthesia may be associated with greater risk6. At the discretion of the surgeon, a longitudinal, transverse, or oblique incision is made directly on top of the tendon at the level of the metacarpophalangeal joint, which is the preferred incision site because it provides maximal accessibility to the A1 pulley.Local anesthesia is preferred because it allows the patient and surgeon to confirm the release immediately.If conducting an open trigger release on the thumb, the surgeon should identify and protect the radial digital nerve, which courses directly over the A1 pulley. MCP = metacarpophalangeal.

Finite analysis of temporomandibular joint loading with occlusal splint use

Finite analysis of temporomandibular joint loading with occlusal splint use

ECRB avulsion fracture therapy management: Case report

Avulsion fractures at the base of the second and third metacarpals are very rare, and there is no evidence in the literature for post-surgical therapy management. The purpose of this study was to identify a treatment protocol for post-surgical management of an extensor carpi radialis brevis (ECRB) avulsion fracture. The patient had a fabricated volar wrist splint with 30 degrees of wrist extension and 60 to 70 degrees of MCP flexion. At 4 weeks, the patient progressed to ROM outside of the splint. At 6 weeks, PROM was completed, and splint use was discontinued. At 8 weeks, the patient began progressive strengthening. Following therapy management, the patient achieved near normal range of motion, was pain-free, and had a functional wrist based on the Quick Disabilities of the Arm, Shoulder, and Hand score. Patients with an ECRB avulsion fracture managed with surgery should be splinted post-operatively and progressed through a therapy protocol to monitor both bone healing and the response of the tendon.

Assessment of condylar position in asymptomatic individuals before and after neuromuscular deprogramming with a stabilization splint

Introduction/Objective. Deprogramming of the neuromuscular system with the use of stabilization splint might provide more precise evaluation of the centric relation (CR) ? maximum intercuspation (MI) discrepancy. The study aimed to evaluate the differences between the bite registrations obtained in the CR before and after the application of the stabilization splint therapy. Methods. The sample included 48 non-deprogrammed individuals without any apparent signs and symptoms of temporomandibular disorders (TMDs). The neuromuscular system was deprogrammed by employing stabilization splint therapy. A condylar displacement evaluation was performed on vertical, horizontal, and transverse planes of space, with the assistance of a condylar position indicator. Results. The mean values of condylar displacements, which were obtained after the deprogramming of the neuromuscular system, were significantly greater than those obtained before neuromuscular deprogramming for vertical condylar displacement (p &lt; 0.0001). A greater degree of condylar distraction was observed on the left side of the vertical plane before (p &lt; 0.01) and after neuromuscular deprogramming (p &lt; 0.05). The highest level of condylar displacement occurred in the postero-inferior direction subsequent to the muscle deprogramming. Conclusion. It was observed that the level of average condylar displacements was significantly higher following the deprogramming of the neuromuscular system compared to that recorded before neuromuscular deprogramming using stabilization splint therapy. A more precise orthodontic diagnosis could have been obtained if the condyles were placed in a more exact CR position by muscle deprogramming.

Quality of life assessment in patients with temporomandibular disorder with stabilization splints and home therapeutic exercises: a randomized clinical trial

Objective: The present study aimed to evaluate the quality of life in TMD patients with the use of Stabilization Splints (SSs) and Home Therapeutic Exercises (HTEs) guidance. Material and Methods: The study was a clinical, randomized, controlled, prospective, and interventional trial. The screening included dentate patients of both genders, diagnosed with TMD through the RDC/TMD questionnaire with no TMJ osteoarthritis and/or osteoarthrosis. To assess the quality of life, the Short-Form Health Survey (SF-36) questionnaire was applied to all patients (n=70), randomized into a test group with SS and a control group with HTE. The evaluations of both questionnaires were performed before and after the intervention of 12 weeks. Results: The comparisons between pre- and post-intervention intragroups were performed by the non-parametric Wilcoxon test with a 5% significance level. There was a frequency distribution of the responses to the 36 items of the SF-36 questionnaire and comparisons between times. In the test group, 49 patients received a SS and did HTEs. In the control group, 21 patients performed HTEs. In the statistical analysis, among the eight domains, three were identified with significant scores: pain, mental health, and vitality. Conclusion: It was found that there was an improvement in pain and quality of life after the treatment of TMD with a SS and HTE. KEYWORDS Clinical trial; Quality of life; Stabilization splint; Temporomandibular disorder; Therapeutic exercises.

Use of Suture as an Alternative to Stainless Steel Wire for Stabilisation of Open Cap Splint in Paediatric Mandibular Fractures

Abstract The presence of ongoing mandibular growth and tooth buds make it challenging for the treatment of mandibular fracture in paediatric. Most common and widely used method is the use of occlusion splint which are secured with the help of circumandibular wiring. The aim of this technical note was to describe a new method for the treatment of paediatric mandibular fracture in which the occlusion splint was used and stabilized with the help of suture so as to prevent minimal trauma to the soft tissue. Management of paediatric mandibular fracture is challenging and is different then that of adult. Usually this fracture in children are manage with conventional close reduction technique because of the presence of tooth buds and developing stage of mandible. Open reduction and internal fixation is rarely used so as to prevent harm to the developing teeth it is used only if the fracture is severely displaced.

Henri Léger-Dorez: The First Expandable Implant (1912).

In the early 1900s, various authors worked on "artificial roots" to replace missing teeth. E. J. Greenfield's pioneering works (1910-1913) are among the best-known today and are often cited in publications reviewing the history of oral implantology. Shortly after Greenfield's first communications in the scientific literature, a French dental surgeon, Henri Léger-Dorez, designed the first expanding dental implant, which he indicated was used successfully in cases of single tooth edentulism. Its aim was to obtain the best primary stability and thus avoid the use of dental splint during osseous healing process. Léger-Dorez's works give us a new angle on the research in oral implantology by the pioneers of the early 20th century.

Mean Pain Score Before and After Wrist Splinting for Carpal Tunnel Syndrome Presenting to Orthopedic Department Hayatabad Medical Complex, Peshawar

Median nerve neuropathy, often known as carpal tunnel syndrome (CTS), is a pathological condition that develops when the median nerve becomes entrapped within the carpal tunnel, resulting in pain, numbness, and tingling sensations. The most popular non-surgical procedure right now is splinting the wrist with a rigid splint, mainly at night and occasionally in conjunction with other therapies. Objective: To determine mean change in pain score before and after wrist splinting for carpal tunnel syndrome presenting to orthopedic department Hayatabad Medical Complex, Peshawar. Methods: This Quasi Experimental Study (Uncontrolled Trial) was held in the Orthopedic Department Hayatabad Medical Complex Peshawar for six months duration from 5th September 2020 to 6th March 2021 after approval of synopsis. A total of 60 patients with CTS were included in the study in a consecutive manner and subjected to wrist splinting. Baseline and follow up pain scores were measured at 6th post splinting week. Results: The mean age of the sample was 42.3 + 12.8 years. While distributing the patients with regards to gender, we observed that in our study 65% of the sample was male and 35% were female gender. The mean BMI was 25.2 + 3.4kg/m2 and 13.3% of sample was diabetic. Mean use of splint / day was 5.3 + 2.2 hours and 43.3% used ibuprofen as analgesic. Mean baseline pain score of the sample was 8.9 + 0.9 and mean follow up pain score at 6th week of splint use was 4.2 + 1.5 (p &lt; 0.001). Conclusion: Wrist splinting is an effective conservative treatment for CTS in terms of significant pain relief after 6 weeks and is not dependent upon BMI, gender, diabetes or type of NSAIDs used. However, our study sample size was too small to draw conclusions there is no evidence of functional improvement after splinting. We recommend more studies (interventional) on large sample size and taking into account pain as well as functional assessment to develop future guidelines for the treatment of CTS using wrist splinting Keywords: Carpal tunnel syndrome, Splinting, diabetes, Body mass index, Pain, Visual analogue scale

Lateral Epikondilitli Hastalarda Farklı Tedavi Yöntemlerinin Klinik Sonuçlarının Karşılaştırılması

Aim: In our study, the effectiveness of steroid injection therapy, extracorporeal shock wave therapy (ESWT) and splint use in the treatment of lateral epicondylitis, were compared.Methods: A total of 97 patients (28 males, 57 females, mean age: 47 years) with a clinical diagnosis of lateral epicondylitis were included in the study. The patients were divided into three treatment groups. Steroid injection was applied to 30 patients, ESWT treatment to 28 patients, and bandage treatment to 29 patients. Patients were evaluated with Visual analog scale (VAS) and Disabilities of the Arm, Shoulder and Hand (DASH) scores before and after treatment.Results: A decrease in VAS and DASH scores and clinical improvement compared to pre-treatment were observed in all three groups. Although positive results were obtained with all three treatment methods, we found that the most statistically significant treatment method was steroid injection. Better results were obtained in the group that received steroid injection with the peppering technique. (p&amp;lt;0.05).Conclusion: The results of this study showed that local steroid injection, ESWT application and bandage treatment may be beneficial in the short term in the treatment of patients with lateral epicondylitis. However, it was evaluated that the best improvement in scores was obtained with local steroid injection with the peppering technique, whereas the least improvement was obtained with bandage treatment.

PENGGUNAAN SPLINT EKSTRAKORONAL PADA PERAWATAN PERIODONTITIS KRONIS (LAPORAN KASUS)

Introduction: The use of splints is one of the stages of treatment in periodontitis accompanied by tooth mobility. Based on the location of the splint, there are two types of splinting, namely extra-coronal and intra-coronal splinting. Treatment using splints is based on the condition of the periodontal tissue, occlusion, articulation, and the severity of periodontitis. This article discusses two case reports regarding the management of chronic periodontitis with tooth mobility. Case report and Management: The first case was a 45-year-old female patient with a diagnosis of localized chronic periodontitis in teeth 32, 31, and 41 with tooth mobility. Initial treatments were scaling-root planning (SRP), plaque control, occlusion adjustment, endodontic treatment, and extra-coronal splinting using fiber-reinforced and composite resins. The second case was a 47-year-old woman with controlled diabetes, and a diagnosis of localized chronic periodontitis on teeth 12, 11, 21, 33, 32, 31, 41, and 42. Initial treatment was SRP, plaque control, occlusion adjustment, and extra-coronal splinting using 0.03 diameter wire and composite resin. The patient stated that she was satisfied with the results of the initial treatment carried out because the teeth that experienced mobility were maintained and remained in the oral cavity. The next therapy is periodontal flap surgery accompanied by the addition of bone grafts. Conclusion: The use of extra-coronal splints in the initial therapy phase of chronic periodontitis cases aims to stabilize loose teeth. Extra-coronal splinting treatment is carried out to support the success of periodontitis treatment.