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11MEDICAL SCIENCES
METHOD FOR SPLINTING TEETH USING REINFORCING TAPE
Aliyev M.,
Doctor of Philosophy in Medicine Department of Therapeutic Dentistry Assistant Azerbaijan Medical University Baku, Azerbaijan Yagubova F.,
Department of Pediatric Dentistry Assistant Azerbaijan Medical University Baku, Azerbaijan Jalilova G.
Department of Pediatric Dentistry Assistant Azerbaijan Medical University Baku, Azerbaijan DOI: 10.5281/zenodo.7618260
ABSTRACT
Positive qualities of Adhesive Splints: maintaining the vitality of splinted teeth; aesthetics; there is no need for significant preparation of hard tissues of the teeth; relative technological ease of manufacture and independence from the dental laboratory; simultaneity of the procedure; the possibility of repairing ASh and the possibility of treating abutment teeth without removing the structure; the marginal periodontium remains open, its injury is excluded, hygiene and local therapy are facilitated.
Materials based on an inorganic matrix (fiberglass) and based on an organic matrix (polyethylene) are used as non-metallic reinforcing composite materials. So far, there are no special studies that would unequivocally reveal the priority of any one group of materials.
In the traditional design of AS, the fiber itself does not fix the teeth between themselves, but only strengthens the composite material from the inside, so the durability of these splints depends mainly on the composite used.
The purpose of the work is to provide the necessary strength of the block of splinted teeth, increase aesthetics, improve adhesion to the teeth and the elements of the splinting composition to each other. Adhesive splinting structures are increasingly used in the clinic of therapeutic dentistry. One example is the stabilization of teeth in the early stages of periodontitis.
Keywords: aesthetic dentistry, tooth splinting, restoration planning.
The availability of a wide range of composite materials, reinforcing tapes, and original methods for manufacturing structures ensured the development of therapeutic methods for immobilizing mobile teeth. Indications for the use of a band construction are significant destruction of the crown, palatal position or the absence of one tooth, as well as pathological mobility[1.2]. Designs can be made in the form of veneers, adhesive bridges, splinting and combined restorations in the clinic or in the laboratory. Sufficiently stable teeth must be included in the splint design so that they can support the functionally and morphologically weakened perio-dontium of mobile teeth[3]. Modeling of adhesive structures in a direct way is carried out directly in the oral cavity. The indirect tire manufacturing method is produced on models in the laboratory. Extra-coronal splinting does not require preparation of hard tissues of the tooth (abrasive instruments remove the non-prism layer of enamel, the surface is etched with acid) [5]. In-tracoronal involves the preparation of hard tissues of the tooth (recesses are formed into which the reinforcement is placed). Splinting of teeth of the I degree of mobility, as a rule, does not dictate the need to create a groove on the surface of the teeth, with II—III degrees of mobility, a groove 1-1.5 mm deep is formed. When splinting the lateral teeth, the preparation of the groove
on the chewing surface is supposed. Splinting of the upper incisors involves the use of the intracoronal method. The splinting design involves mobile teeth in need of stabilization, with the obligatory inclusion of stable teeth on which the adhesive restoration is fixed. Splinting of premolars and molars eliminates their mobility in the mesio-distal and partially in the buccal-lingual direction. Immobilization of the incisors reduces their mobility in the oral-vestibular direction. Adhesive splinting has a number of positive aspects. The procedure for direct fabrication of the structure most often fits into one visit. There is no need to excise a significant amount of hard tissue or depulp the tooth. Provides reliable stabilization of the teeth for a long period of time. The color of the design meets the aesthetic needs of patients, the small volume does not create discomfort. From splinting to esthetic veneers, interdental spaces can remain open, which is important for good hygiene and access to periodontal pockets. If there is a defect in the dentition, adhesive splints are able to carry an artificial tooth. The splinting procedure is preceded by professional oral hygiene, selective grinding of su-pracontacts, patient training in individual hygiene. Indications for the use of splinting are the following cases: the presence of mobile teeth in periodontal diseases; the need to stabilize the teeth after injury; all
types of retainers (preservation of interdental space)[4.6].
Direct way to make a tire
If possible, dental deposits are removed from the accessible surfaces of the splinted teeth, which are mechanically cleaned with a fluoride-free paste. The colors of the composite material are selected. With the help of carbon paper, occlusal contacts are assessed and the contours of the future restoration are planned: the tooth-splint border should not fall on the occlusion points. With the mobility of the teeth in the upper jaw, a groove is formed on the palatine or chewing surface with a diamond spherical bur with a diameter of at least 2 mm. (If necessary, anesthesia is performed.) The furrow is prepared, stepping back from the cutting edge of the tooth 1.5-2 mm. On the lower teeth, in the absence of significant mobility, it can be limited to removing a thin layer of enamel. In the presence of wedge-shaped defects, they can serve as a "bed" of an adhesive splint. In all cases, fixed teeth should close the splinting structure. To measure a piece of tape of the required length, while maintaining the teeth in the desired position, apply a narrow strip of foil to the area of \u200b\u200bthe future tire. Using a tool, the foil tape is pressed into the interdental spaces so that it fits snugly against the crowns, following their contours, and maximally covers the perimeter of the closing teeth. Cut a strip of foil to the required size, and then prepare a strip of the same length as the strip of foil turned out to be. Prepared surfaces are etched with gel, washed, dried and covered with a thin layer of unfilled adhesive bond. Cure it with the light of a halogen lamp. A thin layer of flowable composite is then applied to the treated surface. With fingers in latex gloves, the tape is pressed through the composite layer so that it touches the teeth, the tool is pressed into the interdental spaces, repeating the contours of the crowns. After adapting the tape, the excess of the composite is removed, the material is smoothed in the direction of the gum and the incisal edge of the splint. Light cure splint on both sides (lingual and vestibular), each tooth 30-40 seconds. A thin layer of hybrid composite is applied to the tire and smoothed with a gloved finger moistened with an adhesive, cured under the light of a halogen lamp. Polishing should be in accordance with the requirements for the surface finish of the composite.
Indirect technique (laboratory)
The advantages of laboratory technology are the ease of manipulation of materials, since time and access to the teeth are not limited; there is no contact of the structure with the oral environment (the working field is dry and clean); the composite cures better. To facilitate work and improve the accuracy of splinting, it is desirable to drill recesses on the lingual surface of each tooth with a spherical bur of medium size. Take algi-nate impressions and cast a model from supergypsum in the laboratory. Prepare a piece of tape of the desired length. On the model, expand the interdental spaces from the lingual surface, cover the teeth with a colorless varnish, and then apply a thin layer of the lightest hybrid material on the lingual surfaces of the teeth included in the splint. Pressing the tape with your fingers,
push it with the tool into the interdental spaces sequentially and carefully from one tooth to another, avoiding displacement. Apply a small amount of composite to the edges, gingival and incisal side of the splint, illuminate for 30-40 s each area. Apply a thin layer of composite to the tire and smooth with a finger moistened with adhesive bond.
Carry out curing in a light oven or box. Polish without damaging the threads. Sandblast the surface of the tire facing the teeth. Etch this area with an acid gel. In the clinic, etch the prepared enamel of mobile teeth and apply a thin layer of adhesive bond. The splint is reinforced with a hybrid transparent material (light-cured or dual-cured). While the composite is curing, direct the force of pressure perpendicular to the tooth surface so that the splint does not move towards the incisal edge. Fill the spaces between the structure and the teeth with composite by pressing it into these gaps with the instrument. Illuminate each tooth vestibularly and lin-gually for 40-60 s. Polish the tire. Treat teeth with a fluorine preparation. An example of aesthetic adhesive splinting in periodontitis is the following clinical case using modern dental tools and treatment methods. Patient N., 48 years old, complained of a change in the position of the central incisors, mobility and sensitivity from cold. In the anamnesis - a few years ago, the roots began to become exposed and the teeth loosened. On examination, a pronounced displacement of the central incisors in relation to the dental arch, the formation of a diastema, exposure of the necks of the teeth and % of the root of the 21st tooth is determined. Dental ther-mometry is painful. Since, in accordance with the clinical picture (mild pain from thermal stimuli, slightly painful preparation, electrical excitability within 10 ^A), the teeth cannot be depulped, it was decided to make an adhesive splint in the frontal region of the upper jaw. Modeling of the vestibular surface of the anterior teeth is also required. A feature of the proposed design is the conduction of the tape through the vestibular surface of the front teeth. The chosen tactics is due to a deep bite, which complicates manipulations on the palatal surfaces and prevents the manufacture of a splint without malocclusion. According to indications, GrandTEC (VOCO) adhesive fibers are used, as well as Admira (VOCO) photocurable composite. The choice is explained by the properties of these materials. GrandTEC (GrandTEK) is a light-cured glass fiber, factory-impregnated with resin, intended for use in dental adhesive technology. Indications for use are the need to stabilize the teeth after orthodontic or periodontal treatment, to fix and splint displaced or mobile teeth. Admira (Admira) is a highly aesthetic light-curing composite, which is indicated for use in the restoration of anterior and chewing teeth, including when performing adhesive prosthetics and splinting. The advantages of the photopolymer are the natural principle of color reproduction, a simple method of work, a quick aesthetic result, a plastic consistency that is convenient for modeling. The material is highly resistant to external "flare" in the office, high color stability. It has the property of "chameleon effect" for creating discreet restorations. The teeth were mechanically processed with special brushes using Klint (VOCO) paste. The shades of
the composite were selected by comparing the standards with the color of intact teeth. It is planned to use a flowing material (Admira flow), as well as light opaque and transparent enamel (Admira). Planning the size, shape, and microrelief of the restoration included an assessment of the morphological features of the anterior group of teeth: a triangular shape with mild signs of angle and curvature of the crown is assumed. Individual features include an oval gingival edge of the crown, a smooth cutting edge, and the absence of a pronounced relief of the vestibular surface. At the planning stage, a preliminary determination of the length of the adhesive structure is also made using a strip of foil, which is laid along the dentition, pressed into the interdental spaces for 23 to 13 teeth, and then cut off at the mark made. The resulting segment serves as a matrix in the preparation of the fiberglass tape. Next, the preparation of the anterior teeth is carried out for the application of an adhesive tape and modeling of restorations. The vestibular surface is excised to the thickness of the veneer coatings (0.5-0.8 mm). In order to create a place for the tape (taking into account the deep bite), a groove is created through the vestibular surface of each incisor and canine, 2 mm wide, in the direction from the distal to mesial edge of the tooth (in the central section). Its depth corresponds to the thickness of the adhesive fibers (about 1 mm). Diamond burs are used at first medium and then fine grit. The prepared surfaces are thoroughly washed with water. Then the adhesive tape is prepared. The size of the segment corresponds to the length of the section of the dental arch, on which the splinting structure will be installed. (The parameters were previously determined using a piece of foil at the planning stage). Adhesive preparation begins with acid etching with Vococid gel (VOCO) of the prepared surfaces. After washing off the gel and exposure to an air jet, an adhesive bond is applied and photopolymerized. The next layer that is applied to the tape bed area is the flowable composite. The latter is not cured by the light of a halogen lamp. Directly through this layer, a piece of adhesive fibers prepared in advance is pressed against the bottom of the groove formed on the vestibular surface of the teeth. This manipulation starts from the 23rd tooth. The tape is wrapped around the canine, and then pressed into the interdental space and transferred to the lateral incisor. Next, the adhesive structure is successively adapted to the central incisors, and then to the lateral incisor and canine on the opposite side. A strip of fibers is pressed into the interdental space each time. After completion of the manipulations, light curing of each section of the structure is carried out. This area is covered with a thin layer of opaque composite to prevent translucence of the tape. The same material masks the dentin of bare roots in accordance with the planned
anatomical features, a small mesial bulge is modeled. The cutting edge and corners of the crown of each incisor are formed. The gaps between the teeth are closed with a composite material by shifting it from the vestibular surface to the distal side on the central incisor and to the mesial side on the lateral incisor. The oval shape of the gingival region, the straight cutting edge, the linear contact between the lateral surfaces of the teeth are controlled. Enamel layers are applied to all modeled surfaces. The next step is the processing and polishing of the restoration. Using fine-grained diamond burs, the surface layer of the composite is removed over the entire area of the restoration. Polishing is carried out with Diamanto (VOCO) heads of different hardness. The filling-enamel border and the free surfaces of the restored teeth are covered with a varnish containing fluorine Bifluorid 12 (VOCO).
Findings
Adhesive splinting structures are widely used in aesthetic dentistry to stabilize teeth at various stages of periodontitis in order to prevent their further displacement and loosening. The strong fibers hold the teeth in optimal position, and the photo-curable composite provides an esthetic design.
References
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