| Objective: Displacement and loosening of the affected tooth would occur under stress since the periodontal supporting tissue in patients with periodontitis is impaired.The mobility of teeth would be alleviated after periodontal basic treatment and occlusal adjustment and periodontal surgeries.But if the mobility of the affected tooth is unacceptable for the patient,a periodontal splint fixation would be applied.The article chooses modified casting removable periodontal splints for loosened tooth fixation,and analyzes their fixing effects to provide foundation for clinical application of removable periodontal splints.Methods: 10 cases of patients with periodontitis treated in our hospital from March,2014 to January,2016 are chosen.The case inclusion criteria are as follows: firstly,the patients are definitely diagnosed with periodontitis,accompanying with/without dentition defects.Secondly,the patients refuse tooth extraction or grinding in a large amount,or tooth extraction is not allowed due to physical condition.Thirdly,thorough periodontal basic treatment as well as surgical treatment has been performed with inflammation being effectively controlled but the patients are unsatisfied with their masticatory function.Fourthly,comprehensive dental and endodontic therapies have been conducted in patients with endodontic symptoms or combined periodontal and endodontic lesions.Fifthly,the patients agree to conduct removable periodontal splint repairing,together with visible metal racks that are acceptable aesthetically.Sixthly,good oral hygiene can be kept postoperatively.Examine the intra-oral condition and conduct X ray examination to comprehensively evaluate the degree of periodontal and endodontic lesions.Extract the loosened teeth that are of no reservation value,but if the patients are unwilling or are not allowed to extract teeth due to physical condition,palliative treatments can be conducted.Make mesh-like corresponding tongue plate in the splint for tooth-adding in the future.Conduct dental filling in the decayed teeth,and thorough RCT therapy in patients with endodontitis or combined periodontal-endodontic lesions.Educate and instruct patients of methods for self-control of dental plaque,apply scaling and root planning to eliminate dental plaque and calculus above and below the gingiva,together with topical medicine applying.Examine the control of dental plaque and calculus in oral cavity,the probing depth of periodontal pocket,as well as tooth loosening in the return visit after6-8 weeks.Essential occlusion adjustment should be conducted after the inflammation being under control to construct balancing occlusal relationship.For patients with periodontal pocket ≥5mm,and hemorrhage and pyorrhea on probing,but with good oral hygiene after basic treatment;as well as those with grade II or III furcation involvement that requires surgical root furcation,surgical treatment should be applied.Casting of modified removable splints for affected tooth fixation should be performed when periodontal condition becomes stable.Choose teeth with no or grade I loosening as the abutment for retention,which should be dispersed to the greatest extent.The buccal retentive arm of retention abument should be placed below guide line.While the remaining clasp should be placed above guide line for supporting and stabilizing only,without any retention force.We design big occlusal rests,the areas of which are 1/2-2/3of the occlusion surface,for affected teeth with grade II to grade III loosening as well as those treated with endodontic therapy.The occlusal rests form tip-fossa contact with the paired jaw teeth,where the former functions as the fossa.The tips of the affected teeth does not contact with the paired jaw teeth,alleviating the occlusal stress on the affected teeth,and avoiding teeth separation.Should the affected teeth fall in the future,resin artificial teeth could be directly added,and the existing of big occlusal rests can effectively disperse the joint forces.Design modified combined clasps,with the clasp arm of the healthy abutment being below the guideline for retention,while that of the loosened teeth being above the guideline for locking.If there are two loosened teeth on the same side of the healthy abutment,a long-armed clasp could be designed,which is the coalition of the combined clasp and the long-armed clasp.Prepare occlusion fossa,gap groove(try to use natural gaps)as well as lingual guide plane for making path of insertion.The grade III loosened teeth can be fixed to the adjacent teeth through resin adhesive before mocking up so as to prevent displacement due to extrusion by impression materials.The removable splints could be made in the processing factory after mocking.Results: Evaluation criteria: Evaluate from three aspects,namely,the subjective sensation,clinical examination,as well as X ray examination of the patients.10 cases of patients receiving modified removable periodontal splint repairing show that pain disappears,masticatory function restores,and the loosened teeth are fixed after one to two-year of return visits.Clinical examination shows that the periodontal pockets become shallow,without pyorrhea,and the loosening of the affected teeth is alleviated or with no further development.While X ray examination shows generation of new alveolar bone or with no that alveolar bone has not further uptake.Conclusion: Casting modified removable periodontal splints has significant effects on loosened teeth due to periodontosis.The big occlusal rests we design,together with the modified combined clasps are especially suitable for affected teeth treated with endodontic therapy as well as those with severe loosening.They can effectively prevent dental separation and odontoptosis,better especially for elderly patients and those with moderate to severe periodontitis;effectively restore patients’ masticatory function,repair dentition defect,and eliminate food impaction.It is of extensive clinical application because of simple operation and low expense. |
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