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PubMed1982

A parallel tube provisional splint technique.

Splinting does not replace occlusal and periodontal therapy, but it is frequently a useful adjunct to such treatment. A parallel tube splint technique that is effective for provisional splinting and simple to place has been presented. It does not require extensive tooth reduction or restorative dentistry, nor does it result in overcontouring or problems for the periodontal tissues (Figs. 16 to 19). The splint is easy to clean and maintain; it is also inexpensive when compared to other types of splints. Clinical evaluation of this technique is continuing and will be reported at a later date.

Dental Instruments↗

PubMed1983

Compound splint for comminuted mandibular fracture.

Maintenance of an adequate airway, control of bleeding, and neurologic evaluation should take precedence over treatment of facial injuries. Comminuted mandibular fractures are rare and require the use of complex splints. Severe lacerations and bone displacement accompany comminuted mandibular fractures. Extraoral facial splints constructed from donor facial moulages can be used along with intraoral splints for these patients. Preaccident photographs and radiographs are excellent aids to help realign the fractured segments. The use of an extraoral "donor" splint in conjunction with an intraoral splint to stabilize comminuted mandibular fracture helps to eliminate unnecessary gross removal of mandibular bone.

Equipment Design↗

PubMed1992

Temporomandibular joint disk displacement without reduction. Treatment with flat occlusal splint versus no treatment.

A flat occlusal splint has been extensively used in the treatment of patients with temporomandibular joint disk displacement without reduction, but no studies with untreated controls have assessed its effect. We randomly assigned 51 patients with temporomandibular joint pain and arthrographically verified disk displacement without reduction to be treated with a flat occlusal splint or to serve as untreated control subjects in a 12-month clinical trial. Pain symptoms disappeared in about one third of the patients in each group. Another third of the patients in the control group improved. Sixteen percent of the patients in the control group and 40% of the patients treated with a flat occlusal splint were worse at the end than at the beginning of the study. Joint pain and muscle tenderness decreased more frequently in the nontreatment controls than in the treatment group. A statistically significant benefit of a flat occlusal splint over nontreatment control subjects could not be identified in this study of patients with painful disk displacement without reduction. The use of a flat occlusal splint in this patient group should therefore be reconsidered.

Adolescent↗

PubMed1990

Soft occlusal splint therapy in the treatment of migraine and other headaches.

Fifty-seven patients suffering from migraine, tension headache or tension vascular headache were prescribed a soft occlusal splint for night-time wear. Dental, psychosocial/psychiatric and neurological data were recorded prior to commencement of therapy and at the conclusion of a 3 month treatment period. A statistically significant number of patients presenting with migraine or tension vascular headache experienced marked improvement or complete relief of headache symptoms, but most patients suffering from tension headache failed to benefit from splint therapy. A majority of patients displaying intercurrent features of craniomandibular dysfunction experienced reduction in these symptoms also. There was a statistically significant association between TMJ improvement and headache type. Prior to treatment, patients who subsequently benefited from splint therapy in terms of headache improvement had experienced significantly fewer headaches than patients who failed to respond, although headache intensity and duration were similar in both groups. It is suggested that headache type and frequency may be prognostic indicators of the likely success of dental splint therapy in treatment of headache. Nevertheless, the use of occlusal splints in the treatment of patients complaining of headache in the absence of evidence of craniomandibular dysfunction should not be embarked upon until medical examination has excluded the possibility of organic neurological disorder.

Adolescent↗

PubMed1994

The efficacy of oral splints in the treatment of myofascial pain of the jaw muscles: a controlled clinical trial.

Oral splints are widely used in the treatment of myofascial pain of masticatory muscles, even though their mechanism of action is unknown. The present study evaluated the therapeutic efficacy of splints using a parallel, randomized, controlled and blind design. Following a sample size estimation, 63 subjects were recruited and assigned to 3 groups: (1) passive control: full occlusal splint worn only 30 min at each appointment; (2) active control: palatal splint worn 24 h/day; and (3) treatment: full occlusal splint worn 24 h/day. On each of 7 visits over 10 weeks, subjects rated on 100 mm visual analogue scales their pain intensity and unpleasantness at rest and after experimental mastication. The effect of pain on the quality of life was also rated on category scales. All pain ratings decreased significantly with time, and quality of life improved for all 3 groups. However, there were no significant differences between groups in any of the variables. These data suggest that the gradual reduction in the intensity and unpleasantness of myofascial pain, as well as the improvement of quality of life during the trial, was non-specific and not related to the type of treatment.

Adolescent↗

PubMed1987

Long-term functional results of prosthetic airway splinting in tracheomalacia and bronchomalacia.

The long-term functional results of splinting a collapsing major airway with a silastic Marlex mesh prosthesis were assessed. Six patients in whom follow-up has been longer than 4 years (mean 5.3 years) were studied. The prosthetic semirigid splints had been implanted in five children with tracheomalacia and one with bronchomalacia. Mean age at the time of airway splinting was 4 years (range 6 months to 8 years). At their last clinical evaluation, all six children were leading normal active lives. Three had mild respiratory symptoms not related to the splinting. The only long-term complication was a serous effusion that developed around the splint and compressed the trachea in one child 2 years postoperatively. Tracheal fluoroscopy, barium swallow, and computed tomography scans of the trachea in five patients demonstrated satisfactory tracheal caliber without airway collapse during expiration and coughing. Pulmonary function testing showed a mild increase in airway resistance in one child who had had a tracheostomy. These results demonstrate that the application of composite synthetic graft to a segment of a malacic airway in young patients can provide long-term relief from airway collapse without compromising airway growth.

Airway Obstruction↗

PubMed1986

The reaction of the periodontium to different types of splints. (I). Clinical aspects.

To study the influence of splints on the periodontia over a period of time, Obwegeser and Merkx splints were applied on beagles. Clinical evaluation using different periodontal parameters was carried out before, and 48 h, 3 weeks and 6 weeks after splinting. It was shown that both splints act as plaque-retentive devices and provoke gingival inflammation. A statistically significant difference between both splints could, however, only be demonstrated for the plaque index.

Animals↗

PubMed1996

Activity of the extrinsic finger flexors during mobilization in the Kleinert splint.

This study investigated the activity of the extrinsic finger flexor muscles during active extension in the Kleinert splint. Electromyographic data on the activity of the profundus and superficialis flexor muscles in 10 healthy subjects were recorded with use of fine needle electrodes. The subjects exercised in the original Kleinert splint as well as in several modifications of the splint, which varied with respect to (1) wrist position, (2) position in which extension of the metacarpophalangeal joint was blocked, (3) number of fingers dynamically splinted, (4) nature of the spring mechanism, (5) amount of resistance, and (6) use of a palmar pulley. Persistent flexor muscle activity during active extension was observed in the majority of subjects. This coactivity was more often observed for the superficialis muscle than for the profundus muscle. The least amount of coactivity was found when extension was least resisted. This study does not support the concept that the flexor muscles relax during resisted extension in the Kleinert splint.

Electromyography↗

PubMed1997

Simplified functional splinting after extensor tenorrhaphy.

The medical records of 22 patients who had a total of 61 simple or complex lacerations of finger, thumb, and wrist extensor tendons repaired in zones V-VIII (thumb zones TIII-TV) were reviewed. By 7 days after surgery, custom-molded splints were applied to hold the patients' wrists extended (approximately 30 degrees) and the metacarpophalangeal (MP) joints flexed slightly (20 degrees-30 degrees), leaving the interphalangeal (IP) joints free. If thumb tenorrhaphies were done, the thumb carpometacarpal and MP joints were included and splinted in neutral (0 degree extension) position. Patients performed active JP joint range of motion (ROM) exercises as instructed. At a mean follow-up period of 4.5 months (range, 1.5-12 months), there were no residual impairments that interfered with patients' activities of daily living or prevented their return to preinjury employment status; 19 of 22 patients (86%) had good or excellent results, based on objective criteria of active motion. There were no tenorrhaphy failures. The results support the concept of functional splinting techniques, which allow early active IP joint ROM while protecting the repaired tendons, thus resulting in less joint stiffness than older methods of static splinting without being as complicated and labor-intensive as dynamic splinting.

Activities of Daily Living↗

PubMed1993

The Kleinert dynamic splint: where it fails and how it can be modified.

After primary tenoraphy of flexor tendons one often finds a hampered function of the DIP-joint. Analysis of the pattern of early mobilization exercised by our patients in the Kleinert splint and analysis of the excursions of the flexor tendons of fresh unembalmed specimens brought us to the conclusion that the Kleinert dynamic splint fails in maintaining a sliding movement of the deep and the superficial flexor tendons along each other because the splint excludes motion at the distal interphalangeal joint. Based on our observations we modified the Kleinert dynamic splint. Our experience with 37 patients shows that this modified splint gives a better function in the DIP-joint.

Biomechanical Phenomena↗

PubMed1987

[Influence of a splint in maintaining the opening of the first web in arthritis of the base of the thumb].

Trapezometacarpal osteoarthritis of the thumb includes an progressive aspect in the form of contracture of the first web. The wearing of a C-shaped bar splint is designed to prevent this contracture. The heat-molded plastic splint used by the authors is characterised by the following 3 points: reduction, stabilisation and comfort. The authors have systematically evaluated the action of the splint by measuring the variations in the M1M2 and TM1 angles on X-rays with and without the splint. Analysis of the quantitative data and of the X-rays shows an improvement in the opening of the first web and a reduction in the subluxation of the trapezometacarpal joint. Although they did not analyse the intrinsic process, the authors also noted a very marked reduction in pain (90% of cases) by wearing the splint.

Aged↗

PubMedDate not supplied

The biomechanics of a thumb carpometacarpal immobilization splint: design and fitting.

Splinting for the common osteoarthritis of the carpometacarpal (CMC) joint of the thumb is infrequently described in the literature, but the few splints that are described include one or both adjacent joints. This paper describes the design and biomechanics of a custom-molded thumb CMC immobilization splint that excludes the thumb metacarpophalangeal and wrist joints. The problem of the imbalance of extrinsic extensor/abductor forces against the intrinsic flexor/adductor forces is described. The accompanying weakening of the thumb CMC capsule allows dorsal shifting of the proximal end of the metacarpal, producing pain. The splint described in this paper 1) prevents motion of the first metacarpal in relation to the other metacarpals, 2) prevents tilting (flexion) of the first metacarpal during pinch, and 3) allows unrestricted thumb metacarpal and wrist joint motion. Attention to detail during construction is required for an accurate pattern, precise positioning of the CMC joint during molding, accurate molding around the first metacarpal, and well-distributed pressure. This design may also be used for protection following thumb CMC arthroplasty or thumb CMC sprain or strain and as a base for thumb metacarpophalangeal and/or interphalangeal mobilization splinting.

Activities of Daily Living↗

PubMedDate not supplied

Splinting for symptoms of carpal tunnel syndrome during pregnancy.

OBJECTIVE: To determine whether splints are effective in decreasing symptoms of carpal tunnel syndrome during pregnancy. METHODS: Case series at a military hospital of 82 pregnant women who had symptoms of carpal tunnel syndrome (135 hands). The author compared the ratings of eight subjective symptoms (tingling, numbness, pain, weakness, wakes you up, drops things, swelling, and stiffness) and grip (Jamar) and pinch (two-point, three-jaw, and key) strengths at the time of referral and 1 week after splinting (polyform volar splint with the wrist in 10 to 15 degrees of extension). Forty-eight women (82 hands) returned 1 month postpartum for reassessment. Grip and pinch strengths of an additional 26 women who had not had problems with their hands during pregnancy were measured 1 month postpartum. RESULTS: One week after splinting, there was an average increase of 5.4 pounds in grip strength and over 1 pound in each type of pinch strength (p < 0.0001). There was a decrease in each of the eight symptoms (range, -0.9 to -1.6; scale of 5). At 1 month postpartum, symptoms had resolved completely for 76% of the subjects (weakness had resolved for 76% and wakes you up for 93%). Strength was improved, but was not normal. However, the women who had not had hand problems during pregnancy did have normal strengths. CONCLUSIONS: Splinting is a noninvasive method for helping to decrease the uncomfortable symptoms of carpal tunnel syndrome during pregnancy.

Adult↗

PubMedDate not supplied

Splinting in the management of proximal interphalangeal joint flexion contracture.

Proximal interphalangeal (PIP) flexion contracture is a common complication following hand injuries and conditions. This study investigated the treatment outcome of 20 subjects with PIP flexion contracture who followed a dynamic splinting program using either a Capener or low-profile outrigger. The splint applied a 250-g force to the distal end of the middle phalanx. Each patient was instructed to wear the splint for 8 to 12 hours per 24 hours for 8 weeks followed by a 2- to 3-week weaning period. Passive extension was evaluated objectively using torque range-of-motion measurement. The average pretreatment flexion contracture was 39 degrees. Final extension deficit averaged 21 degrees, an improvement of 18 degrees. There was no statistically significant effect on final results based on joint stiffness (as expressed by the slopes of the torque angle curves). Total end-range time (TERT) averaged 10 hours per 24 hours, for an average period of 4.3 months. Statistical analysis showed that splinting time was the only statistically significant factor affecting outcome. The correlation coefficients showed that the longer the contracture was present, the stiffer the joint and the less the contracture resolved. Dynamic splinting was an effective form of treatment for PIP flexion contracture.

Adult↗

PubMedDate not supplied

An alternative splint design for trigger finger.

Conventional resting splints used to treat digital stenosing tenosynovitis (trigger finger) are often discontinued or not worn consistently by patients. Informal reports by patients indicate that the splints are too bulky, interfere with activities of daily living, and are visibly too noticeable. Since resolution of the condition may take as long as 9 weeks, this is a significant issue. A new splint design has been developed to avoid these shortcomings in hopes that physicians and therapists will have successful compliance when utilizing splinting in the treatment of this condition. It is both cost-effective and noninvasive. This article describes the condition and treatment options for digital stenosing tenosynovitis and fabrication techniques for the proposed alternative splint.

Constriction, Pathologic↗

PubMed2002

The use of knee splints after total knee replacements.

The aim of this randomised prospective study was to establish whether the use of knee splints following total knee replacement is necessary. The study included 81 patients undergoing total knee replacement who were randomised into a 'splint' and a 'no splint' group post-operatively. The following parameters were recorded: The range of movement pre-operatively, 5 days post-operatively and 6 weeks post-operatively; the length of time to straight leg raise; the blood drained from the wound; and the amount of post-operative analgesia required. We found that patients in the 'no splint' group achieved significantly greater flexion at 5 days and 6 weeks post-operatively but drained significantly more blood from the wound. Transfusion requirements were similar in the two groups. There was no other significant difference in the parameters measured between the two groups. In conclusion we found no evidence to advocate the use of knee splints following total knee arthroplasty.

Aged↗

PubMedDate not supplied

A retrospective study of standing gastrocnemius-soleus stretching versus night splinting in the treatment of plantar fasciitis.

Plantar fasciitis is the most common cause of heel pain, yet the conservative treatment of plantar fasciitis is not standardized. This open retrospective study compared the effects of standing gastrocnemius-soleus stretching to a prefabricated night splint. One hundred and sixty patients with unilateral or bilateral plantar fasciitis were evaluated and treated according to the standard regimen in addition to either night splints or stretching. Seventy-one patients performed standing stretching of the gastrocnemius-soleus complex. Eighty-nine patients utilized the prefabricated night splint without standing stretching. The night splint treatment group had a significantly shorter recovery time (p < .001), fewer follow-up visits to recovery (p < .001), and fewer total additional interventions (p = .034) compared to the stretching group. Absolute body weight, body mass index, and age did not have a statistically significant effect on the time to recovery or additional interventions needed. The duration of pain prior to this treatment was a predictive factor and was associated with increased time to recovery and increased number of treatment interventions. Its was concluded that early treatment in a standardized four-tiered treatment approach, including the night splint without standing stretching of the gastrocnemius-soleus complex, speeds time to recovery.

Fasciitis↗

PubMed2000

Evaluation of the Herbst Mandibular Advancement Splint in the management of patients with sleep-related breathing disorders.

Sleep-related breathing disorders such as snoring and obstructive sleep apnoea syndrome are the cause of significant social disruption and hypersomnolence. Several intraoral appliances for the treatment of these disorders have been described, especially where nasal continuous positive airway pressure is poorly tolerated. Mandibular Advancement Splints, such as the Herbst splint used in this study can also be offered to patients with mild to moderate sleep apnoea and simple snorers. The success and compliance rate noted in the literature are quite diverse. Few side-effects have been reported. We therefore undertook this study to assess: (1) the compliance; (2) the effectiveness; and (3) the side-effects in the long- and short-term. All patients for whom a Herbst splint had been prescribed in the last 18 months were sent a postal questionnaire regarding the above mentioned issues. In all, 179 questionnaires were posted and on analysis of the 132 returned it was noted that 82% of splints were worn and 88% of patients found the device to be effective. The long-term side-effects were minimal. In addition objective assessment on 10 patients with and without a jaw-retaining device was also obtained. We conclude that the Herbst Mandibular Advancement Splint is a justifiable option in selected subjects with sleep-related breathing disorders.

Female↗