DENTAL MOBILITY

DENTAL MOBILITY

Introduction :

Tooth mobility is one of the main clinical signs of periodontitis, it is a frequent reason for consultation, it is often an alarm sign.

Retention, symptomatic treatment of periodontal destruction, has long been the main stage of therapy.

Currently, since the bacterial etiology of periodontitis is no longer questioned, is the retention of mobile teeth still justified? Does retention modify the progression of periodontal diseases? Does retention help maintain periodontal health after treatment of inflammation? Does dental mobility compromise healing after periodontal treatment?

The study of the literature of the last twenty years helps us to understand the effects of mobility on the future of the periodontium and guides us towards the conduct to adopt in the face of increased mobility.

 Tooth mobility: (etiologies classifications)

1. Definition :

Mobility is most often defined as an increase in the amplitude of movement of the dental crown under the effect of a defined force.

It is the ability of teeth to change position, causing functional changes.

This is the result of decreased height of the supporting tissue and/or increased width of the desmodontal space.

1. The different types of dental mobility:
   1. Physiological mobility:

In the absence of any stress, the teeth exhibit spontaneous physiological mobility. The amplitude of the movements is a function of the periodontal pulse and synchronous with the successive forces of systole and diastole. It was evaluated at 0.4 mm +/- 0.05 mm by Korber (1971).

In the presence of functional demands, mobility takes place in 2 phases: Initial mobility: is achieved by:

• A rapid movement of the tooth in its socket
  • Viscoelastic distortion and change in the volume of the desmodont
  • A new distribution of desmodontal fluids.

Secondary mobility: manifests itself by an elastic deformation of the alveolar bone. As soon as the force ceases: the teeth return to their initial position in 2 stages:

• The 1st ^: immediate elastic recoil
  • The 2nd ^: pulsatile recovery movement, synchronous with the heart rate.

We observe either axial or transverse mobility:

1. Transversal mobility:

It is due to the tooth version movements.

If a force F is applied to the incisal edge of a tooth, the alveolar and desmodontal resistance makes it possible to define a center of rotation: hypomochlion which makes it possible to understand that the force will create diametrically opposed pressure zones P and at the same time zones of T inverted in relation to the zones of P.

• Axial mobility:

Although difficult to demonstrate, longitudinal mobility exists even in healthy states.

In the resting position (separate arches) the teeth are slightly regressed by desmodontal blood pressure.

In inocclusion, the desmodontal fibers are distended (except those of the apical group).

In occlusion, these fibers are stretched by the movement of the tooth in the apical direction.

* Whether transverse or longitudinal, physiological mobility is related to several factors:

® Shock-absorbing role of the alveolo-dental ligament

® Compressible space between the root and the alveolar bone

® The elasticity of the alveolar processes

® Number of dental roots: single; multi-rooted

® Time of day: upon waking or during the day

® General factors: pregnancy, menstruation

• Pathological dental mobility:

Mobility that occurs beyond the physiological range is called abnormal or pathological mobility.

Pathological mobility can be:

*reversible

*irreversible

1. Reversible mobility:

→ Of inflammatory origin:

Mobility can result from the presence of:

• Any inflammation of the periodontal tissues, superficial or deep.
  • Pulp inflammation, septic or not.
  • Sometimes, the onset of sinusitis can affect the teeth and cause tooth mobility.

Classical treatment of inflammation is sufficient to restore physiological conditions

→ Of occlusal origin:

Tooth mobility can be observed in the following cases:

• Tooth migrations following extractions
• Overloads and occlusal trauma: (prematurity – interferences)

**Orthodontic treatment helps restore stability to teeth.

Occlusal trauma only causes bone demineralization and the disappearance of the traumatic forces is sufficient to obtain remineralization of this bone.

Therefore, these lesions are reversible, as long as the intensity and duration of the force do not exceed the adaptation capacity of the periodontium.

→ Of iatrogenic origin:

• Of prosthetic origin:

Poor prosthetic performance can cause tooth mobility, citing:

• The scholiodontic hook effect
• Elements fixed in extension, poorly distributed.
• Insufficient dento-mucosal support, with rotation effects around the residual teeth.

→ Of orthodontic origin:

Mobility can also be increased through orthodontic treatment.

Transient mobility may also be observed after endodontic treatment and periodontal surgery.

• Irreversible mobility:

We speak of irreversible mobility when it comes to periodontitis.

        Apical migration of the epithelial attachment + osteolysis

Increased mobility

→ Etiologies of mobility:

• Desmodontal enlargement
• Decrease in alveolar height

– Periodontal shrinkage due to periodontitis is the most common cause of persistent tooth mobility.

→ Mobility assessment: The teeth have a preferential direction of vestibulolingual mobility. From this observation, ROY determined 3 planes of dental mobility for an arch. → Mobility assessment:

Dental mobility can be qualified using automatic devices:

® The Heinroth micro elastometer 1928.

® The Mulhman periodontometer 1950. The teeth present a preferential direction of vestibulolingual mobility. From this observation, ROY determined 3 planes of dental mobility for an arch.

Or manually by indices:

® ARPA Index:

Grade 1: mobility perceptible to the fingers but not visible to the naked eye. Grade 2: mobility perceptible to the fingers and visible to the naked eye < 1mm in the VL direction.

Grade 3: mobility visible to the naked eye greater than 1 mm in the VL direction. Grade 4: axial mobility.

Tooth mobility: therapeutic strategies

1. Definition :

In periodontics, retention is “a symptomatic therapeutic procedure which allows dental organs to be immobilized temporarily while awaiting consolidation or permanently when mobility has become irreversible.” ( BARRELLE )

1. Goals :

Retention consists of joining one or more mobile teeth, together or with less mobile teeth, so that:

•       Occlusal forces are distributed so that teeth with reduced periodontal support are least stressed.
• The loads they transmit to the periodontium do not contribute to the aggravation of pre-established lesions.
• Mobile teeth normally perform their assigned function.
• Protect mobile teeth from trauma by stabilizing them in proper occlusal position.
• Prevent pathological migrations.
• Stabilize mobile teeth during therapy by promoting tissue regeneration during healing.
• To relieve the patient when the pain is caused immediately by dental mobility.
• For psychological purposes, when mobility is the patient’s major concern.

1. Indications / contraindications:
2. Indications:
   1. Clinics:

Depends on the type of periodontitis:

** Chronic periodontitis generalized horizontal alveolysis.

localized oblique irregular alveolysis.

** Early-onset periodontitis: PPR PJ PPP.

• High mobility of one or more teeth whose periodontium is particularly affected.
• If we observe that the mobility of the teeth increases despite the disappearance of the inflammatory signs.

• Functional:
• Search for individual occlusal function
• Stabilize the function: functional discomfort during chewing, swallowing or phonation. c- Radiological:

® Generalized horizontal regular alveolysis:

• Alveolysis reaching half of the root height.
• Root resistance coefficient is lower than the clinical crown work coefficient.

® Localized vertical alveolysis:

• When alveolysis reaches more than half of the root height.

d- Other indications:

• Ineffective plaque control due to fear of trauma.
  • Prevention of post-orthodontic migrations.
  • After a hemisection or root amputation, the immediate placement of a temporary crown prevents the migration of roots towards the intact septum.
  • If there is a real risk of accidental dental avulsion or dislocation, for example when chewing.
• Contraindications:
  • Absolute contraindications: Lack of hygiene. Predisposition to caries. Quality of enamel. Altered psychological profile. Dental malpositions.
  • Presence of diastemas.
• Relative contraindications:
  • Aesthetic factor. Pulp volume (for intra-coronary retention)
  • The cost of certain types of restraint.
• Principles of restraint:

Whatever type of support is chosen by the practitioner, it must meet common criteria guaranteeing its biological integration and effectiveness.

Mechanical principles:

1. ROY principle:

The teeth present a preferential direction of vestibulolingual mobility. From this observation, ROY determined 3 planes of dental mobility for an arch.

• a retention will be more effective if it unites by a non-deformable means contiguous teeth belonging to 2 different planes of mobility.
• The greater the number of teeth integrated into the retention system, the more effective the retention will be.

• Principle of resistance of the posterior pillars:
• Posterior abutments must be strong enough to be included in a retention system, i.e. have little or no periodontal damage at their level.
• In the case of a rigid retention system, the connection between the last 2 teeth must be reinforced to avoid a fracture at the embrasure, thus separating the mobile tooth from the system.

* Generally speaking, to avoid loosening, the retention of the appliance should be maximal on the most mobile teeth in the system.

• Principle of resistance of posterior anchors:

To ensure the stability of a retainer, the anchoring methods envisaged at the level of the posterior pillars must be the least traumatic and resistant.

• Integration into physiological occlusion:

The volume of the devices must be integrated into the physiological occlusion in order to avoid the appearance of craniomandibular dysfunction, worsening of mobility or simply fracture of the contention.

• The vertical location of the retention system: the latter must be located as close as possible to the free edge if not to the occlusal face.

Biological principles:

• Necessity of a healthy periodontium:

The creation of a definitive retention can only be undertaken after periodontal sanitation, although a temporary retention can be done in an emergency or per-operatively.

• Respect for the periodontium:
  • Respect for vestibular and lingual embrasures in order to free the interdental papilla. Respect for cervical limits and avoid creating undercut areas. Promote hygiene.
  • The gum must be freed from any compression.
• Patient comfort:
  • If over-contours are necessary, they must not be irritating to surrounding tissues, nor cause speech or mandibular posture disorders. They must not disturb or modify phonation.
  • To be as unsightly as possible.
• Justification for restraint:

Most authors recognize the value of retention in the treatment of periodontal diseases.

By its mechanical action, it immobilizes the teeth, slows the evolution of existing lesions. Associated with other periodontal therapies, it promotes tissue repair, it is therefore impossible to practice certain periodontal therapies without retention.

• Moments of restraint:

Before deciding on the time and type of restraint, a thorough and complete clinical and paraclinical examination must be carried out to assess:

• The quality of the supporting fabrics and their quantity.
• Clinical and radiological C/R report.
• Degree of mobility.
• Quality of contact points.
• Occlusal relationships.

Restraint can be undertaken:

1- Before periodontal treatment (emergency):

• To relieve the patient from the pain of dental mobility.
• Facilitate periodontal sanitation later.

2- In the periodontal treatment court:

• Facilitate scaling during initial therapy.
• Make surgery easier.
• It facilitates occlusal equilibration.

3- At the end of treatment:

• Stabilize loose teeth after surgery so as not to compromise healing.
• To put the patient under observation.

4- After treatment:

• Allows teeth to be held together for a long time. VIII- Equipment and techniques:
  • Classification:

The different restraint systems:

1. Temporary restraint:
   1. Temporary restraint allows you to delay and eliminate for a time:  Pain

 Functional discomfort.

 Avoid the inconvenience of scaling or surgery performed on loose teeth.

® Fixed systems:

• Ligatures :

A- ligature with silk thread:

• Indications :
• Used in the context of total emergency.
• Facilitate scaling on loose teeth.

• Benefits :
• Very quick to make.
• Almost invisible.
• Disadvantages :

• Fragile and can only remain in place for a short time.
• The thread becomes impregnated with saliva and very quickly a fermentation sets in which is unpleasant for the patient.

• Technique:
• We take a 30cm wire.
• We make a double turn at the neck of the 1st ^tooth and stabilize it with a double knot.

The following teeth are surrounded above the cingulum, each time making a double proximal knot.

• We finish on the last tooth as on the ^first .

B-metal ligatures:

We use:

• A flexible nickel-chromium wire, 0.3mm thick

• Sewing machine stitch binding
  • Indications:
• Teeth that are not very mobile    ( blocking the wire in the interdental space requires significant force, which may therefore be contraindicated in the case of very mobile teeth ).

• Benefits :
• Easy to make.
• She has a good outfit.

• Inconvenience :
• Unrepairable, the breakage of the wire requires the complete repair of the ligature

• Technique :
• We make a double turn around the premolar.
• We keep 2 free strands of unequal length.
• The shorter strand is pressed against the lingual surface while the longer strand serves as a shuttle and blocks the lingual wire in the interdental space between each tooth.
• This movement is continued until the opposite PM, where the 2 strands are then twisted.

• Figure eight ligature:

• Indication :
• Used for immobilization not to exceed one week.

• Benefits :
• Easy and quick to make.
• Disadvantages :

• Unsure
• Slides very easily
• Often loosens

• Technique :

It is similar to the floss ligature, but instead of making an interdental knot, we simply cross the strands, each one being successively vestibular and lingual.

• Ladder ligature:
  • Benefits :
• Solid, it can stay in place for a long time.
• Easily adjustable and changeable.
• Allows you to obtain a precise position of the teeth.

• Disadvantages:
• The strands can be irritating and prevent proper interdental hygiene.

• Technique :
• A 0.2 to 0.3mm wire is used.
• First, we position the uprights, which we fix by tightening the ends of the wires very loosely.
• 5cm long portions of wire are slipped and twisted into the interdental spaces (incomplete tightening), to bring the uprights together.

-the bars are tightened alternately and progressively.-the strands must be folded back towards the edge

Note: the questionable aesthetic aspect of a metal ligature has led some authors to recommend covering it using self-polymerizing acrylic resin of the same shade as that of the ligatured teeth: this resin is applied with a brush, then polished after hardening.

• The collage:

Bonding of loose teeth using composite is a retention system reserved for very short periods.

• Indications:
• Allows for improved patient comfort while waiting for a more reliable retention solution to be installed at a later stage.
• It can be useful: in an emergency, immediately before scaling or periodontal surgery.

A- Extra coronal bonding:

If it is necessary to stabilize mobile teeth for the duration of one session, simply bonding a composite resin bar to the vestibular surfaces may be sufficient.

B-dental-dental bonding:

Bonding is carried out around the contact point. The surfaces are first cleaned with ultrasound. Then the enamel is prepared with orthophosphoric acid. Finally, the composite in a more or less liquid phase is deposited with the tip of the probe around the contact point, without too much excess.

The realization is quite quick and practically invisible.

C- Orthodontic brackets:

Bonding orthodontic brackets connected by a metal wire is a quick and simple procedure to perform. Its lifespan depends on the adhesion strength of the bonding glue on the enamel.

The inexperienced practitioner will take care to use a round section wire to avoid unwanted parasitic movements.

The main disadvantage of this system is its unsightly appearance.

• The splints:

Dental, mucosal or mixed-supported devices, fixed or removable, external or internal, intended to immobilize and stabilize mobile teeth in favorable occlusal relationships.

A- Ligated cast arch:

A cast arch is held on the lingual surfaces by interdental ligatures.

B- Orthodontic rings:

Although ligatures give good results for anterior teeth, they are not recommended for posterior teeth, whose morphology is less suited to this technique.

At the molar and premolar level, it is recommended to use metal orthodontic rings, welded together and sealed.

• Disadvantages:
• Difficult to achieve.
• Prevent proper hygiene.

Removable systems:

• Benefits :

The production of this type of device is simple and allows the delay of dental mutilation and the creation of a costly retention system.

• Disadvantages:
• Its main disadvantage is intermittent wear, the patient will often have to separate from it before meals and to express himself orally.
• The trauma of insertion and then disinsertion risks worsening mobility.
• Less rigidity than fixed devices.
• Risk of patient neglect of wearing.
• Hawley Plate:

It is a device used in orthodontics to correct a vestibuloversion of the incisor-canine block.

An inactivated Hawlay plate can be used as a temporary retention system.

• This appliance consists of a vestibular arch made of steel wire, fixed to a palatal plate or to a lingual band made of acrylic resin.
• It limits the vestibulolingual movement of the incisors which are clamped between the wire and the plate.

• Occlusal splint:
• These are removable devices, placed between the dental arches, used temporarily to modify and reestablish the dento-dental relationships, and intended to correct occlusal dysfunctions or deficient mandibular functions.
• Posselt demonstrated the interest in using these devices to ensure

a retention in parallel with their indications during malocclusion treatment.

• Advantages: maintains teeth well and respects the marginal periodontium.
• Disadvantage: very bulky device.
• Bite plan:

It is formed of a palatine plate, presenting a mucous covering, riding hooks

• It is indicated to correct malocclusions and can also provide temporary retention of mobile teeth.

• Sved’s plaque:

This is a raised plate with incisor-canine coverage.

• Advantage :
• It is not very apparent.

• Inconvenience :
• Risk of aggression of PM blocks, M.
• Ambivalent contention:

Ambivalent restraints are carried out in cases where the indication for restraint has been definitively established:

• In the case of a complex treatment plan, an ambivalent retention may be performed pending a final reassessment at the end of all oral cavity care.
• Its lifespan can be from a few months to several years.

→ U-shaped splint:

The U-brace connects the teeth closely together using U-shaped steel wires, sealed in calibrated wells.

• Instrumentation:
• Drill, cylindrical-conical cutter on turbine, sealing lentulo, diamond tweezers for gripping the splints, parallelizer, sealing composite, U-shaped splints (in 0.6 mm rigid steel wire).

• Technique:
• : preparation of a trench (strawberry).
• : drilling of the wells: in the vertical plane the entrance of the wells is located in the line of the contact points. The axis of the wells is approximately parallel to the vestibular face of the teeth.
• : choice of the splint, measurement of the spacing of the wells (parallelizer)
• : sealing, placement of the sealing material in the lentulo, and control of the occlusion.

• Indications:
• It is particularly suitable in the upper incisor-canine area.

• Benefits :
• It offers great resistance by ensuring containment in 2 planes of space, horizontal and vertical.
• It has the particularity of bringing the teeth together one by one and therefore best meets our concern to limit the extent of the contention to the minimum number of teeth.
• Disadvantages:

Difficult to achieve at the ant-inf level due to the volume of the pulp

→ Ceria-Cerosi splint:

To correct tooth mobility, a lingual, palatal or occlusal groove (PM-MOL) is made at their levels to place a steel orthodontic wire or a polyethylene fiber mesh.

• Technique:
• A groove is made on the occlusal, lingual or palatal surface of the teeth to be included in the retention.
• Washing with hydrogen peroxide, drying, filling the trench with composite, a reinforcement (most often a twisted metal wire) is embedded in the groove filled with composite.

Note : Industrial fiber reinforcement can be used. After hardening, finishing and polishing are carried out.

• Benefits :
• Good stability
• Satisfactory aesthetic result.
• Inexpensive
• Disadvantages:

Coronal preparation, hence the risk of caries at the level of the trench if the anatomical precautions are not respected.

→ Berliner splint:

• Technique:
• : a curvilinear trench is made on the lingual surface, using an inverted cone bur.
• : presentation of the wire, twisted wire made with 2 strands of soft steel of 0.25mm.
• : placement of the sealing composite and placement of the wire held with fine plugs or screws which are placed in the loops of the twisted metal wire.
• : we complete the filling of the trench with composite.

5: after hardening the wire is cut with the cutter.

• Indications:
• This is a technique that is particularly suitable in the mandibular incisor-canine sector .
• For premolars and molars, retention can be made in pre-existing amalgam fillings, therefore without tissue damage.
• It can very well be done to join teeth in relative malposition if one uses the twisted soft ligature wires, because one can embed the twist in the groove with a plugger following the irregularities and malpositions.
• Benefits :

• Easy to make.
• Minimal tooth preparation.
• Ensures good stabilization of mobile teeth.
• Satisfactory aesthetic result.
• It is an economical process allowing the maintenance of teeth for a relatively long period.

• Disadvantages:
• Risk of unsealing.
• Risk of caries by infiltration: this is one of the reasons why the patient must remain under surveillance.
• Permanent restraint:

® removable permanent contention:

Various types of removable splints have been used to hold loose teeth, the best known being:

• Elbrecht splint:

The teeth are held by a metal frame with stabilizing fins that fit into corresponding proximo-occlusal cavities.

• Advantages of removable systems:
• No preparation of the teeth concerned.
• Fast execution.
• Possibility to remove the device for social reasons.

• This type of restraint has major drawbacks:
• Insufficient immobilization in the VL direction and zero in the axial direction.
• Unsightly.
• The risk of trauma when inserting and removing the splint is significant.

® Fixed permanent restraints:

This type of definitive contention is most often effective and most used thanks to current techniques.

• Cast and glued metal splints:
  • Technique:

The teeth are prepared while preserving a layer of enamel as often as possible. The preparation is intended to:

• increase splint retention.
• Limit the possible axes of unsealing.
• Facilitate its positioning during fitting and gluing. Preparation includes:
• On the whole preparation: remove a layer of enamel.
• On the proximal faces: 2 parallel vertical grooves limit the preparation in an area hidden from the vestibular view.
• At the level of the cingulum: a horizontal groove or a vertical well of relief with the proximal grooves.
• At the cervical level: the limits are clearly highlighted by a narrow supragingival shoulder.
• At the incisal level: to maintain the transparency of the tooth, the metal must not reach the enamel of the last two incisal millimeters, particularly in the maxilla.

Note: if the retention obtained by the preparation is deemed insufficient, it is possible to add screwed dentin tenons.

• Taking a fingerprint.
• Making the splint in the laboratory.
• Holes are made when manufacturing the splint.
• Collage.

• Benefits :
• Quick realization.
• Saving of dentin tissue.
• Possibility of including attachments for an auxiliary prosthesis.
• This type of splint can be made before the end of periodontal treatment.

• Disadvantages:
• The use of metal has aesthetic and biological disadvantages.
• The enamel-dentin adhesives used are hydrolyzable, their lifespan is theoretically limited.

• Bonded bridges:
  • Definition :

It is a fixed prosthesis composed of a metal structure glued to the palatal surface of the teeth, including an intermediate bridge and anchored with a composite resin to the etched enamel of the abutment teeth.

• Indications:
• Replace a single tooth, rarely two.
• Periodontal retention.
• Favorable occlusal relationship.
• Orthodontic indication: space maintainer.
• Pillars in good position.
  • Contraindications:
• Several missing teeth.
• Presence of diastemas.
• Overbite.
• Poor quality email.
• Short teeth.
• Pillars in bad position.
• For functions.

• Benefits :
• Respect for the periodontium and contact points.
• Good aesthetics.
• Tissue economy.

• Disadvantages:
• Very limited number of teeth to replace.
• Need for teeth in good position.
• Risk of detachment.
• Taking impressions of loose teeth can be problematic.

• Barelle Inlay:

In this process, the teeth are joined together in pairs, using a double inlay which secures the proximal faces; a dentine tenon ensures retention.

This catenary system offers many advantages:

• It is possible to initially support only one group of teeth and then, several years later, extend the retention to neighboring teeth.
  • Parallelism problems are reduced to a minimum. The preparation of a faulty element does not require a repair of the entire assembly.
  • Overall, the aesthetic appearance is satisfactory.
• Contention by permanent headdresses:

When dental organs are dilapidated or when a tooth loss needs to be compensated, a bridge made of metallic or metal-ceramic coronal restorations is sometimes the most reliable definitive solution.

These restorations are only carried out after periodontal treatment and are preceded for a few months by a temporary prosthesis.

IX- Selection criteria:

The choice between fixed or removable, external or internal processes is made according to: 1- Hygiene:

Hygiene must be taken into consideration, on the one hand, the device must not hinder brushing , and on the other hand, a restraint system must not be used on an unmotivated patient.

• Time of application:

In cases where mobility has increased following surgical treatment, an external fixed restraint, such as a ligature, is the procedure of choice.

• Tooth morphology:

If fixed retention by ligature is often possible at the level of the anterior block, the morphology of the crowns of the PM and MOL contraindicates this procedure, so for the posterior block, we resort either to removable systems or to other external fixed means.

• The aesthetics:

For temporary systems, removable means are less aesthetic than external fixed devices but they can be removed temporarily when social conditions require it.

• Traumatic effect:

Removable devices have their relative flexibility, but their traumatic effect during repeated insertion and removal of the device should not be underestimated.

• Patient type:
  • Wearing removable appliances should be avoided in neglectful patients. Fixed metal appliances such as ligatures should be avoided in patients with parafunctions. Aesthetic requirements and financial means vary from one patient to another.
  • The creation of retention systems with or without dental preparation may be conditioned by the type of patient.

X- Conclusion:

The course of action to take in the face of increased dental mobility is no longer to systematically apply retention, which could be dictated by the desire to quickly reduce one of the signs

clinical periodontitis, but would have no effect on the progression of attachment loss. On the other hand, the study of the literature guides us in the development of the diagnosis and the treatment plan:

• Investigate the causes of increased mobility:

-assess the health of the periodontium.

-assess the clinical crown/root ratio.

-study the forces applied to the mobile tooth (functional – parafunctional – iatrogenic, etc.).

• Assess the immediate risks incurred by mobile teeth (risk of dislocation).
• Provide immediate restraint if necessary.
• Eliminate gingival inflammation.
• Eliminate the causes of trauma if possible:

-Occlusal equilibration.

-adaptation or modification of a prosthesis.

-elimination of para functions and exogenous forces.

• Reassess the degree of mobility and the risks involved: (dislocation – functional discomfort – hindrance to hygiene – migration)
• Creation of an ambivalent or permanent restraint while respecting the indications of each, and we must choose the type of restraint most suited to the patient.

DENTAL MOBILITY