hygiene procedures. lhere IS no ,nd,callon to prescllbe antibiOtics unless l\le lip wound was contaminated.
• How IOllg sllQlIld till' sp/iut «'lIInilr ill pIau? IV!" sirollirl be dOlle ill litis perio"?
Fill;, 33,3 Wire and composite SlllKlt WI poslhOM
addition the pulps must also be removed from the fractured inCisors. These also have closed apices, lhe pulps have bl'l:!n exposed to ,nfecllon for 24 hours and the exposures are large. In addition, Inlecllon In the fracture line must be aVOided. Again, the root canals can be dressed WIth calcium hydroxide pasle and the teeth restored temporarily WIth composite, carefully checking the occlusion so as not to precipltale lurther trauma. A chlorhexld,ne mouthwash should be prescnbed for use untill\le tissues have healed sufficiently to allow oral
The composite sphnt should remam In place for about 4 weeks. This sphnting perOO should be adequate for both healing 01 the alveolar fracture and stabilization of the luxation inJUry. Some author~ies suggest that laleral luxatlO!1 injUries should be splinted for slightly longer. ThiS can be achieved by selectIVely separahng IndlVldual teeth lrom the sphnt With a bur. The canine should not be left unsplinted il there is mobility or pain. It IS deSirable to remove the teeth Irom spllnllng as soon as is prachcable because it is difficult to isolate them With a rubber dam 10 rOOI filling. Permanent endodontICS musl walt until the spli IS removed. II stili in place, the upper left laleraltnClsor 10 may now be surgically extracted Wlthoot disturbing the fracture and replaced WIth a prostheSIS for 6 months to allow alveolar bone remodelling Throogllout this period. oral hygiene InStrUCtion and dietary advice should be given, Success 01 treatment during this period will determine lhe long·term ophon$ for reslora\lon.
Table 33.1 Types of temporary replacement to tle CClllSide,ed ==:WI 1
U
TyPll"of prosthesis
Ad¥anta&u
Di$.3dvanla&CS
ParMI acrylic denture of
M1romal gmgN<lI coverage, easy to make and
Palleflts dlshke retllO\/abIe prostheses and they may be difficult for some patlems to toleo-ate. WI! reqwre relnlng folloWIng af;<eolar rcrnodelhnl/.
[""
"'"
cheap, Does 001 interfere WIth orthograde loot filIlIliS 01 adjacent teeth. Acrylic flange masks tlone defect following alveolar remodelling.
COITIllOMe or dent",e tooth bonded to adlacent teeth WIth composite
fIXed replacement WIlh no gllgNal coverage No laboratory stage, slfT"4)le cha.SIde techmque Allows orthograde root filling of adjOCeflt teeth.
Bond may fail because enamel had already been bonded for the etCMetall1ed sp.\nt Difficult to mask space formed beneath POfIOC lollOWlnl/ resorptl()ll.
Rochen~type
Fixed replacement WIlh no gmgNal cO'Vt'fage. SlmpIe cantilever design poSSIble, eaSIly removed by dentist for permaoent restoratIOn.
ThIckness of WIf1g tcquue<t may confllcl Wlttl deep O'Vt'fb<te C<llJSInI/ occlusal trauma in already CompfOffllsl'd leeth. Bond may fail bec3llsC eflamCl has already been bonded for tile etch·retained splint. Dlfficu~ to mask space formed beoeath POntIC foloww1& resorptl()ll, Ofthograde root filhng of abulmenltooth not POSSIble,
fixed reDlacCffil)llt WIth no glngr;<lI cover aI/e. Simple canbleveo' deSll/n poss.t:lle. Metal Wlnl/ ltooner ttloo Rochette
Bond may filii because eflamel has already been borxle<I for the etcMetaoned splint. Dlfficult 10 mask Sllace lormed beneath pontIC followtnR resorption More difficult to
""go
adheSIVe
AdheSlVt bridge cemented WIth an /llJlesrve cement (e.g Pal'l3Vla 21)
remove, may reqoJue ultrasClllICs. Ofthograde rool filling of abutment looth not possible. Heat-.:..-ed acryk conventIOnal type tlrtdge
FIXed replacement av()Mjmg gllgr;al margllS of
teeth other than the abulmeflts, Grealer range of deSigns possible ,nclt.chng SImple can\lleVCf or lU.ed - lU.ed deSign. Besl awear aoce and restores the coronal fract..-es 01 abutment tootlVleeth
o.fficutt to mask SPace formed beneath POntIC folowing resorptl()ll bUt bndge IS eaSler to remove and modIly WIlh wmpoSllc and leplace, ReQljlres tooth preparatton and comrmts paltellt to a permanent coovenbonal brl(lge. More destructlVC than ll<JleSIVC delll/ns though teeth are akeady badly I,ac:t..-ed. Slightly more dliflCult to Isolate Wllh rut.ber dam for orthograde root filllnl/ of abutment leeth: tlrldge might need to be rCfflOlled for heatment.