MOBILITY – RESTRAINT
I- Introduction:
Dental mobility is one of the main clinical signs of periodontitis, it is a frequent reason for consultation, it is often an alarm sign.
Retention, a symptomatic treatment of periodontal destruction, has long been the main stage of therapy.
Currently, since the bacterial etiology of periodontitis is no longer in question, is the retention of mobile teeth still justified? Does retention modify the progression of periodontal disease? Does retention help maintain periodontal health after treatment of inflammation? Does tooth 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 course of action to take in the face of increased mobility.
Chapter 1 : Dental mobility:
I- Definition:
Mobility is most often defined as an increase in the amplitude of displacement 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 the decrease in height of the supporting tissue and/or the increase in the width of the periodontal space.
II- The different types of dental mobility:
1- Physiological mobility:
In the absence of any stress, the teeth exhibit spontaneous physiological mobility. The amplitude of movements is a function of the periodontal pulse and is synchronous with the successive forces of systole and diastole. It was estimated at 0.4 mm +/- 0.05 mm by Korber (1971).
In the presence of occlusal stresses, we observe either axial or transverse mobility:
a- Transversal mobility:
It is due to the tooth’s 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.
b- 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.
Since collagen fibers are not elastic,
They become capable of transmitting axial occlusal forces to the supporting tissues (bone and cementum).
It is important to note that it is only in the case of axial forces that the majority of desmodontal fibers are stressed, whereas in the case of a transverse force, the number of fibers involved is considerably smaller. |
* Whether transverse or longitudinal, physiological mobility is related to several factors:
c- Factors of variability of mobility:
Normal dental mobility varies from one individual to another, it is due on the one hand to:
→ Shock-absorbing role of the alveolar-dental ligament
→ Compressible space between the root and the alveolar bone
→ The elasticity of the alveolar processes
And on the other hand to:
Number of dental roots time of day
– Monorooted – Upon waking
– Multi-rooted – During the day
Different general factors
– Pregnancy
– Menstruation
The response to the forces:
Tooth mobility depends on the tooth’s ability to respond to the forces exerted on it. These forces are differentiated according to their:
*direction *time
*intensity *duration *frequency
→ Direction:
The more the direction of the acting force deviates from the axial direction of the tooth, the more harmful its action on the alveolar-dental complex.
→ The moment:
A force directed closer to the point of rotation will produce a greater turning moment than a force directed further from that point.
→ Intensity:
The greater the intensity of the forces, the greater the tooth movement.
Beyond a certain threshold, a force will produce significant disorders at the periodontal level, which can even lead to fracture of the alveolar rim.
This threshold varies from one individual to another and depending on the state of the periodontal support.
→ Duration of action:
If an intermittent force is applied for a long enough time, the periodontium will react in the same way as to a continuous force, i.e. by bone destruction on the P side, and there will be no possibility of bone apposition on the T side.
This is the case of bruxism, in which forces are exerted on teeth
for a period of 1 to 2 seconds, which is considerable.
→ Frequency:
In normal function, rest intervals are much longer than work periods.
It is indeed necessary for the body to have sufficiently long rest intervals.
These rest intervals are not respected in bruxomanics.
2- Pathological dental mobility:
Mobility that occurs beyond the physiological range is called abnormal or pathological mobility.
Pathological mobility can be:
*reversible *irreversible
a- Reversible mobility:
→ Of inflammatory origin:
Mobility can result from the presence of:
- Any inflammation of the periodontal tissues, superficial or deep.
- Pulp inflammation, whether septic or not.
- Sometimes the onset of sinusitis can affect the teeth and lead to tooth mobility.
| Classical treatment of inflammation is sufficient to restore physiological conditions |
The alveolodental ligament the bony frameworks
Firms up decalcified recalcify
→ Of occlusal origin:
Tooth mobility can be observed in the following cases:
– Dental migrations – Overloads and trauma
Following occlusal extractions
Uncompensated. (prematurity – interference)
Bruxism)
| Orthodontic treatment helps restore stability to teeth. |
| Treatment of occlusal trauma allows for a rapid return to normality. |
Occlusal trauma only results in bone demineralization
and the disappearance of traumatic forces is sufficient to obtain a
re-mineralization 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 construction 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.
| This mobility is caused by a back and forth effect exerted on the tooth, resulting in an increase in the desmodontal space, which returns to normal after rehabilitation of the prosthesis. |
→ Of orthodontic origin:
Mobility can also be increased through orthodontic treatment.
An orthodontic force can be considered as a trauma causing lesions at the level of the periodontium, but unlike that which is called occlusal, the orthodontic trauma is directed and monitored.
*Note: Transient mobility may also be observed after endodontic treatment and periodontal surgery.
b- Irreversible mobility:
We speak of irreversible mobility when it comes to periodontitis.
Apical migration of the epithelial attachment + osteolysis
Increased mobility
→ Cause of mobility:
Widening the decrease of the
desmodontal attachment height
and bone height
the association of the 2
previous
– Periodontal shrinkage due to periodontitis is the most common cause of persistent tooth mobility.
– In the presence of periodontitis, tooth mobility is accentuated by the inflammatory reaction within the periodontium.
– Loss of bone support, by increasing the crown/root ratio, should be considered as the one and only situation where tooth mobility is not reversible.
→ Evolution of mobility:
● With treatment:
| Some teeth, which have become more mobile following periodontal disease, will stabilize after conventional treatment. |
Inflammation of the tooth’s supporting tissues
Being eliminated
The alveolodental ligament the decalcified bone frames
Firms up Recalcifies
● Without treatment:
– Either they remain but do not evolve
– Either they get worse
Note: If periodontal disease is such that it approaches the dental apex, increased tooth mobility may be observed. These ejected teeth will have a poor prognosis and are often doomed to extraction.
→ Mobility assessment:
Dental mobility can be qualified using automatic devices:
→ The Heinroth micro elastometer 1928.
→ The Mulhman periodontometer 1950.
Or manually by clues:
→ ARPA index:
Grade 1: Perceptible mobility in 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 light direction.
Grade 4: axial mobility.
→ Mobility and healing:
The influence of tooth mobility on periodontal healing remains controversial. While all authors agree on the need to eliminate the bacteriological causes of inflammation, the influence of retention on the repair capacity of the periodontium is debated.
| The question of the quality of healing of hypermobile teeth after treatment remains insufficiently documented. In clinical practice, examples of repair on mobile teeth add to the uncertainty about the need for retention. |
In light of these experiments, it is accepted to consider that in cases of periodontitis, pathological mobility is treated first by eliminating the inflammation.
In cases of extreme mobility, a support is indicated to improve the attachment gain obtained during healing.
2nd chapter: Containment :
I- 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 )
II- Objectives:
Retention consists of joining one or more loose teeth, together or with less loose teeth, so that:
Occlusal forces are distributed so that teeth whose
periodontal support is reduced, so they are less stressed.
The loads they transmit to the periodontium do not participate in
the worsening of pre-established lesions.
Mobile teeth normally perform their intended function.
Protect mobile teeth from trauma by stabilizing them in position
adequate occlusal.
Prevent pathological migrations.
Stabilize mobile teeth during therapy by promoting
tissue regeneration during healing.
Exp: so that any surgical treatments can be undertaken
without compromising the preservation of the most alveolyzed teeth.
Relieve the patient when the pain has the immediate cause of
tooth mobility.
For psychological purposes, when mobility represents worry
major of the patient.
However, restraint is controversial:
– Because it refers to the theme of overloads, itself very
controversial.
– Because the excessive and untimely application of restraints constitutes a
irreversible damage to dental tissue .
However, we believe that it is important to know how to properly determine the indications for restraint. |
III- Indications / contraindications:
1- Indications:
Retainers have lost many of their indications, however, they are recommended to avoid the inconveniences and risks caused by teeth with reduced periodontium:
a- 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.
b- Functional:
– Search for an individual occlusal function:
Functional deficiency of the mobile tooth responsible for a transfer of loads from one place to another onto other teeth less able to bear them.
– Stabilize function: functional discomfort during chewing, swallowing or speaking.
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.
– Risk of migration in the event of a breakdown of the balance forces, particularly at the level of the upper incisor-canine block in the event of failure of the posterior support, or in the event of excessive lingual pressure.
– Prevention of post-orthodontic migrations.
– After a hemisection or a 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.
2- Contraindications:
a- Absolute contraindications:
– Lack of hygiene.
– Predisposition to caries
– Quality of the enamel
– Altered psychological profile
– Dental malpositions.
– Presence of diastemas.
b- Relative contraindications:
– Aesthetic factor.
– Pulp volume (for intra-coronary contention)
– The cost of certain types of restraint.
V- Principles of restraint:
Whatever type of support chosen by the practitioner, it must meet common criteria guaranteeing its biological integration and effectiveness.
1- Mechanical principles:
a- 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 contiguous teeth belonging to 2 different mobility planes by a non-deformable means.
– The greater the number of teeth integrated into the retention system, the more effective the retention will be.
b- 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.
c- Principle of resistance of posterior anchors:
To ensure the stability of a retainer, the anchoring methods considered at the level of the posterior pillars must be the least traumatic and resistant. In descending order, the most used anchors are:
1- Tenon crowns. 2- Richmond crowns.
3- Simple crowns. 4- Tenon onlays.
5- Inlays.
d- Principle of mobilizing forces
– The mobilizing occlusal forces are centripetal and directed most
often in the axis of the teeth in the mandible.
– They are centrifugal in the maxilla, perpendicular to the axis of the teeth.
The risks of fracture of the containment system are therefore
superior to the maxilla.
The requirements for solidity are increased.
e- 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.
2- Biological principles:
a- Need for 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.
b- Respect for the periodontium:
– Respecting the vestibular and lingual embrasures in order to free the interdental papilla.
– Respecting cervical limits and avoiding creating undercut areas.
– Promote hygiene.
– The gum must be freed from any compression.
c- Patient comfort:
– If over-contours are necessary, they must not be irritating to the surrounding tissues, nor cause speech or mandibular posture disorders.
– Do not disturb or modify phonation.
– Be as unattractive as possible.
VI- Justification for restraint:
Most authors recognize the value of retention in the treatment of periodontal diseases.
Through its mechanical action, it immobilizes the teeth and slows down the progression of existing lesions.
Combined with other periodontal therapies, it promotes tissue repair, making it impossible to practice certain periodontal therapies without retention.
VII- Moments of restraint:
Before deciding on the time and type of restraint, a careful and complete clinical and paraclinical examination must be carried out to assess:
The quality of the support fabrics and their quantity.
Clinical and radiological C/R report. Degree of mobility.
Quality of contact points. Occlusal relationships.
Restraint can be undertaken:
Before periodontal treatment (emergency):
– To relieve the patient from the pain of dental mobility.
– Facilitate periodontal sanitation later.
During periodontal treatment:
– Facilitate scaling during initial therapy.
– Facilitate surgery.
– It facilitates occlusal equilibration.
At the end of treatment:
– Stabilize loose teeth after surgery so as not to compromise healing.
– To put the patient under observation.
After treatment:
– Helps to hold teeth together for a long time.
VIII- Equipment and techniques:
1-Classification:
2- The different restraint systems:
a- Temporary restraint:
– Temporary restraint allows for delay and elimination
for a time:
Pain Functional discomfort.
Avoid the inconvenience of scaling or surgery performed on teeth
mobiles.
→ 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 stay in place for a short time.
– The thread soaks up saliva and very quickly a
fermentation 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
– Notched pliers (pean type)
– Crown scissors.
– Flat snout pliers.
♦ 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 attitude.
- Inconvenience :
– Non-repairable, 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 acts 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 silk 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 modifiable.
– Allows you to obtain a precise position of the teeth.
- Disadvantages:
– Strands can be irritating and prevent proper interdental hygiene.
- Technique:
– A 0.2 to 0.3mm metal wire is used.
– First, we position the uprights, which we fix by tightening the ends of the wires very loosely.
– 5cm long sections 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 appearance of a metal ligature has led some authors to recommend covering it with self-polymerizing acrylic resin of the same shade as that of the ligated teeth: this resin is applied with a brush, then polished after hardening.
● Collage:
Bonding loose teeth with composite is a retention system reserved for very short periods.
- Indications:
– Improves 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 coronary 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 bonding:
Bonding is performed 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 applying too much excess.
The realization is quite quick and practically invisible.
C- Orthodontic attachments:
Bonding orthodontic brackets connected by a metal wire is a quick and easy procedure. Its lifespan depends on the strength of the bond between the brackets and 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.
● 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 braces:
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 bands, 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 for the delay of dental mutilation and the creation of an expensive 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 an appliance used in orthodontics to correct 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 a lingual band made of acrylic resin.
– It limits the vestibulolingual movement of the incisors which are sandwiched 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.
– It is a transparent acrylic gutter, which can be made using a thermoformable resin plate.
It should cover the free edges and slightly exceed the line of the largest lingual and vestibular contour.
– Posselt showed the interest of using these devices to ensure contention alongside their indications during malocclusion treatment.
- Advantages: holds teeth well and respects the marginal periodontium.
- Disadvantage: very bulky device.
| Note: They are frequently used in a protective role during nighttime parafunctions or during activities where the risk of trauma to mobile teeth is significant. |
● bite plane:
It is formed of a palatine plate, with a mucous covering, and rider hooks ensuring its retention.
At its anterior part, the plate presents a thickening which generally extends from canine to canine.
– It is indicated to correct malocclusions and can also provide temporary support for loose teeth.
● Sved plaque:
This is a raised plate with incisor-canine coverage.
- Advantage :
– It is not very visible.
- Inconvenience :
– Risk of attack on PM MOL blocks.
b- 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 carried out pending a final re-evaluation 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 splints, parallelizer, sealing composite, U-shaped splints (in 0.6mm rigid steel wire).
● Technique:
1: preparing a trench (strawberry).
2: 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 surface of the teeth.
3: choice of splint, measurement of the spacing of the wells (parallelizer)
4: sealing, placement of the sealing material at the lentulo, and control of the occlusion.
● Indications:
– It is particularly suitable for the upper incisor-canine area.
● Advantages:
– 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:
– It is difficult to perform on the mandibular incisors because of the pulp risk.
→ 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, reinforcement (most often a twisted metal wire) is embedded in the groove filled with composite.
Note: Industrial fiber reinforcement can be used.
After hardening, we proceed to finishing and polishing.
● Advantages:
– 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:
1: a curvilinear trench is made on the lingual surface, using an inverted cone burr.
2: presentation of the wire, twisted wire made with 2 strands of 0.25mm soft steel.
3: placement of the sealing composite and placement of the wire held with fine plugs or screws which are placed in the
loops of twisted metal wire.
4: 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, the 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 twisted soft ligature wires, because one can embed the twist in the groove with a plugger following the irregularities and malpositions.
● Advantages:
– Easy to make.
– Minimal dental 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.
c- Permanent restraint:
→ removable permanent restraints:
Various types of removable splints have been used to hold loose teeth, the most well-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 of removing 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 permanent retention is most often effective and most widely used thanks to current techniques.
● Cast and glued metal splints:
- Technique:
The teeth are prepared while preserving a layer of enamel as much as possible. The preparation is intended to:
- increase splint retention.
- Limit the possible axes of unsealing.
- Facilitate its positioning during fitting and gluing.
The preparation includes:
– Over the entire preparation: remove a layer of enamel.
– On the proximal surfaces: 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 posts.
– Taking fingerprints.
– Making the splint in the laboratory.
– Holes are made when manufacturing the splint.
– Collage.
- Benefits :
– Quick production.
– 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 a bridge intermediary 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 two by two, using a double inlay which secures the proximal faces; a dentin post 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 support to the neighboring teeth.
- Parallelism problems are reduced to a minimum.
- The preparation of a faulty element does not require a repair of the whole thing.
- Overall, the aesthetic appearance is satisfactory.
● Contention by permanent headgear:
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.
2- 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.
3- The morphology of the teeth:
Although 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.
4- Aesthetics:
For temporary systems, removable means are less aesthetic than external fixed devices but they can be removed temporarily when social conditions require it.
5- Traumatic effect:
Removable devices have their relative flexibility, but their traumatic effect during repeated insertion and removal of the device should not be underestimated.
6- Type of patient:
- Wearing removable appliances should be avoided in neglectful patients.
- Fixed metal appliances such as ligatures should be avoided in patients with parafunction.
- Aesthetic requirements and financial means vary from one patient to another.
- The creation of retention systems with or without dental preparation can be conditioned by the type of patient.
X- Conclusion:
The approach 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 clinical signs of 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:
- Research 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).
- Perform immediate restraint if necessary.
- Eliminate gum 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)
- Implementation 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.
MOBILITY – RESTRAINT
Wisdom teeth can cause infections if not removed in time.
Dental crowns protect teeth weakened by cavities or fractures.
Inflamed gums can be a sign of gingivitis or periodontitis.
Clear aligners discreetly and comfortably correct teeth.
Modern dental fillings use biocompatible and aesthetic materials.
Interdental brushes remove food debris between teeth.
Adequate hydration helps maintain healthy saliva, which is essential for dental health.