Dental trauma splints for the mixed dentition - A finite element analysis of splint material, splint extension, missing teeth, and PDL representation. 2022

Andomar Bruno Fernandes Vilela, and Priscilla Barbosa Ferreira Soares, and Antheunis Versluis, and Carlos José Soares
Department of Operative Dentistry and Dental Materials, Dental School, Federal University of Uberlândia, Uberlândia, Brazil.

OBJECTIVE 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. 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.

UI MeSH Term Description Entries
D010513 Periodontal Ligament The fibrous CONNECTIVE TISSUE surrounding the TOOTH ROOT, separating it from and attaching it to the alveolar bone (ALVEOLAR PROCESS). Alveolodental Ligament,Alveolodental Membrane,Gomphosis,Alveolodental Ligaments,Alveolodental Membranes,Gomphoses,Ligament, Alveolodental,Ligament, Periodontal,Membrane, Alveolodental,Periodontal Ligaments
D010516 Periodontal Splints Fixed or removable devices that join teeth together. They are used to repair teeth that are mobile as a result of PERIODONTITIS. Splints, Periodontal,Periodontal Splint,Splint, Periodontal
D002648 Child A person 6 to 12 years of age. An individual 2 to 5 years old is CHILD, PRESCHOOL. Children
D003188 Composite Resins Synthetic resins, containing an inert filler, that are widely used in dentistry. Composite Resin,Resin, Composite,Resins, Composite
D003764 Dental Materials Materials used in the production of dental bases, restorations, impressions, prostheses, etc. Dental Material,Material, Dental,Materials, Dental
D003818 Dentition, Mixed The complement of teeth in the jaws after the eruption of some of the permanent teeth but before all the deciduous teeth are absent. (Boucher's Clinical Dental Terminology, 4th ed) Dentition, Transitional,Dentitions, Mixed,Dentitions, Transitional,Mixed Dentition,Mixed Dentitions,Transitional Dentition,Transitional Dentitions
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D013165 Splints Rigid or flexible appliances that are used to maintain a displaced or movable part in position, or to maintain the position of and protect an injured part. Dynamic Orthoses,Dynamic Splint,Dynamic Splinting,Dynamic Splints,Static Orthoses,Static Splint,Static Splinting,Static Splints,Dynamic Splintings,Splint,Splint, Dynamic,Splint, Static,Splinting, Dynamic,Splinting, Static,Splints, Dynamic,Splints, Static,Static Orthose
D014084 Tooth Avulsion Partial or complete displacement of a tooth from its alveolar support. It is commonly the result of trauma. (From Boucher's Clinical Dental Terminology, 4th ed, p312) Avulsed Tooth,Dislocation, Tooth,Tooth Luxation,Avulsion, Tooth,Avulsions, Tooth,Dislocations, Tooth,Luxation, Tooth,Luxations, Tooth,Tooth Avulsions,Tooth Dislocation,Tooth Dislocations,Tooth Luxations,Tooth, Avulsed
D020342 Finite Element Analysis A computer based method of simulating or analyzing the behavior of structures or components. Analysis, Finite Element,Analyses, Finite Element,Element Analyses, Finite,Element Analysis, Finite,Finite Element Analyses

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