RU2758758C1 - Method for making an elastic intermaxillary splint for immobilization of fragments in case of jaw fractures - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, in particular to orthopedic dentistry, and is intended for use in the treatment of fractures of the jaws. For immobilization of fragments in case of fractures of the jaws, kneading of the bulk with a catalyst of the impression silicone material is carried out. A roller is formed along the length of the ellipsoidal dentition. A dough-like roller is installed between the chewing and cutting surfaces of the teeth of the upper and lower jaws and the teeth are closed in the central occlusion for a period of 2-3 minutes until the mass solidifies, followed by drilling holes in the area of ​​the missing tooth for receiving liquid food. Then, milling is carried out, with the removal of excess. The final fit is carried out in the oral cavity with fixation with a head sling-like bandage.

EFFECT: method allows quickly making an intermaxillary splint and provide reliable immobilization of fragments for subsequent evacuation and treatment of patients with jaw fractures.

1 cl, 1 dwg, 1 ex

Description

The invention relates to medicine, in particular to orthopedic dentistry, and can be used in the treatment of fractures of the jaws.

The most common method of orthopedic treatment is known - dental wire splinting - proposed by S.S. Tigerstedt during the First World War (Guide to Prosthetic Dentistry, Kopeikin V.N., 1993). For the upper and lower jaw made of aluminum wire, the arc is bent with the fingers along the dentition with frequent correction in the oral cavity, avoiding repeated bending.

• If there is a defect in the dentition, a loop in the shape of the letter P is bent on the splint, the upper crossbar of which corresponds to the width of the defect and faces the oral cavity.

• The hinges are bent with crimp pliers. The distance between the loops is no more than 15 mm, 2-3 loops on each side. The toe loop should be no more than 3 mm long and curved at a 45 ° angle to the gum. The loops should not injure the oral mucosa.

• The splint is fixed with ligatures to as many teeth as possible. The ligatures are twisted clockwise, the excess is cut and folded towards the center so that they do not injure the mucous membrane. The lower jaw is fixed to the upper jaw with the help of rubber rings mounted on the hinges of an aluminum arc.

The disadvantages of this method is the impossibility of fixing the aluminum arc in the absence of 5 or more teeth on the jaw, with mobility of the teeth, in the presence of periodontal disease or periodontitis. Also, the disadvantage of this method is trauma to the gingival papillae with a ligature wire threaded between the teeth. In addition, food debris accumulates under the aluminum arc and ligature wire, impairing oral hygiene.

A known method of manufacturing a splint from plastic (Maxillofacial orthopedic dentistry, E.N. Zhulev, S.D. Arutyunov, I.Yu. Lebedenko, 2008). M.R. Marey recommends using nylon threads instead of ligature wire to fix the splint, and the splint for fractures of the lower jaw is made of fast-hardening plastic along a pre-made arc-shaped aluminum groove, which is filled with freshly prepared plastic, applying it to the vestibular surface of the dental arch. After hardening of the plastic, the aluminum groove is easily removed, and the plastic is firmly connected to the nylon threads and fixes the fragments of the jaw.

The disadvantage of this method is the need to make a splint by a dental technician in a dental laboratory, the laboriousness of manufacturing, the release of residual monomer of fast-hardening plastic in the oral cavity, which can cause allergy to the oral mucosa.

As the closest analogue for the treatment of single fractures of the lower jaw with complete mobility of fragments in the case of an insignificant number of teeth on the fragments or mobility of all teeth, a removable plastic Weber splint was chosen. (Guide to Prosthetic Dentistry, Kopeikin V.N., 1993). This splint covers the entire remaining dentition and gums on both fragments, leaving the chewing and cutting surfaces of the teeth exposed. It can be used to heal fractures of the lower jaw.

The disadvantages of the closest analogue include the need for a dental laboratory, which increases the labor intensity and time of manufacturing these tires, covering the gums, the tire causes bedsores. Also, the edges of the plastic, plunging into the undercut zones, make it difficult to remove the splint from the jaw, in addition, the plastic can cause allergic reactions.

The object of the present invention is to provide an immobilization splint that can completely eliminate the above disadvantages.

The task is achieved due to the fact that the method uses a silicone elastic material used in dentistry for taking impressions from the jaws, which does not cause side pathological, allergic effects on the oral mucosa, does not require special conditions and the presence of a dental laboratory and additional medical personnel. A dental splint is easily and quickly prepared by mixing the bulk with a catalyst in the hands, which is very important for the provision of emergency medical care in a dental clinic or even in a military field. For the manufacture of splints, a wide selection of silicone masses known in dentistry are used, such as: Spidexputty (Switzerland), Zetaplus (Italy), Silagum (Germany), Z-labor (Switzerland). The use of this splint is especially important in case of significant loss of teeth in the oral cavity or in the presence of loose teeth, when the possibilities for applying Tigerstedt wire splints are limited.

EFFECT: invention makes it possible to quickly and inexpensively manufacture an intermaxillary splint and provide emergency aid, which consists in reliable immobilization of fragments for subsequent evacuation and treatment of patients with jaw fractures. Due to its elastic properties, the splint freely plunges behind the equatorial line of the dentition and is fixed on it, preventing the displacement of the jaw fragments. At the stages of treatment, the intermaxillary splint, due to its elastic properties, can be removed and fixed again for additional medical and sanitary-hygienic procedures.

A method of making an elastic intermaxillary splint for immobilizing fragments in case of jaw fractures is as follows:

- if there is a displacement of the fragments, local anesthesia is performed in the area of the fracture, the fragments are corrected in the correct position, the border teeth on the fragments are fastened with a ligature wire to each other;

- according to the instructions, the silicone base part of the impression mass with a catalyst is thoroughly mixed in the hands;

- a roller is formed in the form of a "sausage" with a diameter of 1.5-2.0 cm along the length of the dentition;

- the roller is applied to the chewing surface and the cutting edge of the dentition of the lower jaw and ask the patient to close the jaws in the central occlusion position, holding the lower jaw with his hands, until the antagonist teeth completely close;

- on the vestibular side, in the area of the lips and cheeks, evenly form the mass, as when taking impressions from the jaws, and ask the patient from the inside of the mouth to evenly form the mass to the teeth with the help of the tongue;

- 2-3 minutes after the final polymerization, the splint is removed from the oral cavity, processed with a milling head, removing excess and smoothing out irregularities. The silicone mass is ground to the necks of the teeth, so as not to injure the gum with the edges of the splint. In the area of the missing tooth on the tire, a hole with a diameter of 5-10 mm is drilled to receive water and liquid food (Fig. 1);

- a silicone splint is fitted on the teeth of the upper and lower jaw and, with a fixed bite, a sling-like bandage is fixed on the head. Due to the elasticity of the splint, it easily sinks behind the equators of the teeth, penetrating into the under-inner zones and is well fixed on the jaws. For hygiene procedures, if necessary, the splint can be freely removed and re-fixed on the jaws.

FIG. 1 shows an elastic intermaxillary splint with an opening for food and water intake.

The implementation of the method is presented by clinical examples.

Clinical example: Patient M. was admitted with a diagnosis of "fracture of the upper jaw according to Le Fort 1, without displacement of fragments." After clinical and X-ray studies, the proposed elastic intermaxillary splint was splinted with a sling-like head bandage. Due to the fact that the splint can be easily removed and reattached on the jaws, during the immobilization period, regular sanitary and hygienic procedures of the oral cavity were carried out. The fracture of the jaw was treated without complications. On the radiograph after 5 weeks after the injury, the narrowing of the fracture gap is determined, a light shadow appeared, indicating the processes of enhanced reparative bone regeneration. Clinically there is no mobility of fragments and pain on palpation of the fracture area. After 5 weeks, the intermaxillary splint and sling-like dressing were removed, the patient is in a satisfactory condition. After 2 months, the fracture line is indistinct, a band of enlightenment is visible due to the formation of new bone tissue. No complications were noted with further follow-up.

Clinical example 2: Patient K. was admitted with a diagnosis of "Fracture of the mandible in the region of the 4th tooth on the right with displacement of fragments." When examining the oral cavity, partial secondary adentia is determined. Since it is not possible to immobilize the fragments with fixed wire splints like Tigerstedt splints due to the large number of missing teeth, it is recommended to make the proposed intermaxillary elastic splints with the imposition of a sling-like head bandage. After infiltration anesthesia in the area of the fracture of the lower jaw, finger reduction of the fragments was performed. The fragments are temporarily fastened together with a ligature wire along the teeth bordering with the fragments according to Ivy. Then, intermaxillary elastic splints were made according to the above technique with the imposition of a chin sling. The patient was prescribed a set of traditional therapeutic and prophylactic measures, consisting of anti-inflammatory, desensitizing and antibacterial therapy. On the 16th day of treatment, a slight narrowing of the fracture gap with fuzzy edges is determined. On the 30th day, on palpation, there is a thickening along the lower edge of the lower jaw bone from the side of the fracture due to the formation of periosteal callus. On the roentgenogram on day 30, a significant narrowing of the fracture gap with fuzzy edges is determined. On day 35, the splint was removed from the jaw. 2 months after the injury, a light shadow of the newly formed bone appears on the X-ray in the area of the fracture. With further follow-up, no complications were found.

Claims (1)

A method of making an elastic intermaxillary splint for immobilizing fragments in case of jaw fractures, which consists in kneading the bulk with a catalyst of an impression silicone material, forming a roller along the length of an ellipsoidal dentition, installing a dough-like roller between the chewing and cutting surfaces of the teeth of the upper and lower jaws, closing the teeth in the central occlusion for a period of 2-3 minutes until the mass hardens and subsequent drilling in the area of the missing tooth a hole for receiving liquid food and milling, with the removal of excess, and final fitting in the oral cavity with fixation with a sling-like head bandage.

Images