Dental Materials Journal 2017; 36(6): 731–739

Establishment of experimental models to evaluate the effectiveness of dental

trauma splints
Takahiro SHIRAKO1, Hiroshi CHUREI1, Takahiro WADA2, Motohiro UO2 and Toshiaki UENO1

1
Department of Sports Medicine/Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima,
Bunkyo-ku, Tokyo 113-8549, Japan
2
Department of Advanced Biomaterials, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima,
Bunkyo-ku, Tokyo 113-8549, Japan
Corresponding author, Toshiaki UENO; E-mail: [email protected]

The purpose was to describe a novel simple experimental model of injured teeth for developing dental trauma splints (DTS), and to test
various splints by combining use of this model and the Periotest® device. Rubber O-rings and spring washers were used to simulate
and modify injured tooth mobility. Splinting effects were assessed among three kinds of DTS, including a composite splint and two
wire-composite splints (1: rectangular orthodontic wire 0.533×0.635 mm, 2: cobalt-chromium alloy wire Φ0.9 mm). The Periotest
values were measured three times for each tooth before and after splint insertion. The splinting effect was defined as the change in
tooth mobility. Splinting effects significantly increased in the order wire-composite splint 1<wire-composite splint 2<composite splint
(p<0.05). This model system could evaluate the effects of DTS including the differences among various splint methods, which showed
reasonable reproducibility of dental trauma situations depending on severity in clinical usage.

Keywords: Dental trauma splint, Artificial model, Periotest®, Splint effect

human models1). Various methods have been used

INTRODUCTION
to evaluate DTS including the Periotest device
Dental trauma splints (DTS) are the cornerstone of (Medizitechnik Gulden, Modautal, Germany)4,22-29),
therapy for injured teeth. Patients with mobile front universal testing machines17-21,23,25,26) and
teeth may experience problems with food ingestion and periodontometry27).
aesthetics, and consequently refrain from tooth brushing As for the characteristics of each model, animal
and often adjust feeding or masticatory habits after and human models have advantages in terms of clinical
suffering dental injuries1). DTS is performed to stabilize relevance, mainly due to the presence of periodontal
injured teeth at their initial position and protect teeth ligament and tooth enamel, however, their disadvantages
from repeated trauma to support healing2-4). For injured include the individual specificity and difficulty to
teeth, optimal care consists of keeping the repositioned obtain1,3,27-29). On the other hand, commercial artificial
tooth in its initial position to ensure patient comfort and models as industrial products are easily obtained and
improve masticatory function5,6). The aim of DTS is to minimal variation exists between products. However,
improve the patient’s quality of life during the healing these models require complicated experimental designs
period. to simulate tooth mobility4,17-21).
Dentists should consider different types of DTS Among the evaluation systems for DTS effects, the
for injured teeth depending on the nature of trauma, Periotest is a well-established system for evaluating
because the DTS degree of rigidity is responsible for tooth mobility in periodontology30-32), orthodontics33)
the healing of injured teeth2,7-14). In the field of dental and dental traumatology1,3,29). The Periotest values
trauma, rigidity of DTS is classified into a) flexible: more (PTVs) correlate with Miller’s classification of tooth
mobility than a non-injured tooth, b) semi-rigid: same mobility30,31,33,34). Moreover, the Periotest is an easier
mobility as a non-injured tooth, and c) rigid: less mobility way to evaluate tooth mobility than universal testing
than a non-injured tooth15). In addition, the guidelines machines17-21,23,25,26) and periodontometry27) and is widely
for dental trauma management indicated that flexible used.
(non-rigid) splinting assists in healing and ideal splints A previous study evaluated the DTS effect on a
should allow physiologic tooth mobility and give injured commercial artificial model using Periotest4). In the
teeth room for slight motion5,6,16). study, apical parts of artificial teeth were removed
Previous research on DTS have used various and gaps between teeth and sockets were filled
experimental models including commercial4,17-21) or with impression materials to simulate a periodontal
custom-made22-26) artificial model, an animal model27), ligament. The study did not describe how the apical
a human cadaveric model28), and healthy3,29) or injured parts of artificial teeth were shortened and PTVs of
these teeth before splinting showed a wide range. In
other words, mobility or simulation of injured or
Color figures can be viewed in the online issue, which is avail-
able at J-STAGE.
Received Oct 11, 2016: Accepted Feb 9, 2017
doi:10.4012/dmj.2016-333 JOI JST.JSTAGE/dmj/2016-333
732 Dent Mater J 2017; 36(6): 731–739

uninjured teeth in the model was not clearly stipulated thinned by 0.5 mm using a dental hand piece with a
and, therefore, the method was not an entirely carborundum point to maintain the spaces and prevent
reproducible method. To improve the method, a custom- the influence of interproximal contacts (Fig. 2b).
made artificial model was developed by Berthold et al.22)
consisting of an aluminum base and stainless steel teeth Simulation of injured teeth (tooth 11)
attached with bovine tooth facets. In the model, tooth Two types of simulation differing in degree of tooth
mobility could be finely adjusted and acid-etching could mobility according to severity of trauma were produced
be performed, however, production of the model was in this study. One was Level M: moderate (simulated as
complicated and the model itself differed greatly from extrusive or lateral luxation) and the other was Level
human dentition. Therefore, the available experimental S: severe (simulated as avulsion or cervical area of root
models had diverse specifications and there were no fracture).
unified models.
In clinical situations, dentists encounter 1. Level M
opportunities to treat injured teeth with various levels A rubber O-ring was placed at the bottom of the socket.
of severity and mobility. Adequate DTS effects can differ An artificial tooth was inserted into the socket and
depending on the severity of injured teeth. However,
there are few simple models simulating dental trauma
of varying severity levels.
The purpose of this study was to describe a
novel simple experimental model of injured teeth for
developing DTS and related materials, and to test
various DTS by combining use of this model and the
Periotest. Moreover, this study produced two types
of simulations with different degrees of injured tooth
mobility experimentally to assess the DTS effect
according to degree of injured tooth mobility.

MATERIALS AND METHODS

Models
Three artificial models (D18FE-500A-QF, Nissin Dental
Products, Kyoto, Japan) with melamine resin teeth (A5A-
500, Nissin), rubber O-rings (1A S-2, SAKURA SEAL,
Tokyo, Japan) and spring washers (SLW2, MISUMI
Group, Tokyo, Japan) were used for this study (Figs.
1a, b). The right central incisor (tooth 11) simulated the
injured tooth. The right lateral incisor and left central
incisor (teeth 12 and 21) simulated uninjured teeth. To
create space between the tooth and socket for simulating Fig. 2 (a) Lateral incisors of artificial teeth were inserted
injured tooth mobility, lateral incisors of artificial teeth in central incisor sockets (indicated by arrows) and
were inserted in central incisor sockets of these models (b) mesial side of the right cuspid was thinned by
(Fig. 2a). Mesial side of the right cuspid (tooth 13) was 0.5 mm (indicated by an arrow).

Fig. 1 (a) Commercial artificial model with melamine resin teeth; (b) Lateral
incisor of artificial tooth, screw, rubber O-ring and spring washer.
 Dent Mater J 2017; 36(6): 731–739 733

locked with a spring washer and an apical fixation screw before splinting. This position was identical to that of
using an adjustable torque screwdriver (N1.5LTDK, the injured tooth in Level M. The tooth did not touch
NAKAMURA MFG., Tokyo, Japan) which can control anywhere in the socket when it was fixed by DTS. As
fastening torque. The fastening torque value was 11.0 the artificial lateral incisor tooth has a smaller root than
cN-m. that of the central incisor, there were gaps between the
tooth root and the socket.
2. Level S
Unlike Level M, the artificial tooth was not locked with Simulation of uninjured teeth (teeth 12 and 21)
an apical fixation screw. Therefore, there was a need for Rubber O-rings were placed at the bottom of these
determining the position of the tooth. The tooth position sockets like the injured tooth. These sockets were
was determined using silicone putty as a template filled with softened utility wax (composed mostly of
microcrystalline wax) (GC, Tokyo, Japan) which was
soaked in hot water (80°C). Immediately after this,
artificial teeth were inserted and locked with spring
washers and apical fixation screws using an adjustable
torque screwdriver. The fastening torque value was 11.0
cN-m. These models were kept for three hours at room
temperature (23°C) for the wax to solidify.
The above models are shown as schematic diagrams
(Fig. 3).

Tooth mobility assessment

Tooth mobility before and after splinting was assessed
using the Periotest Classic (Medizitechnik Gulden)
(Fig. 4a). This is an electronic system that measures
the damping characteristics of the periodontium for
evaluating tooth mobility, which can be used in vivo and
in vitro and is easy to handle1,3,4,22-34). This device consists
of an 8 g tapping rod inside the handpiece. During
measurement, the rod taps the tooth surface 16 times in
4 s at a velocity of 0.2 ms−1. The PTVs are calculated from
the contact time between the tapping head and the tooth
and vary from −8 to 50 in arbitrary units. The model was
Fig. 4 (a) Tooth mobility assessment using the Periotest fixed in a vise (WILTON, La Vergne, TN, USA), when
Classic (Medizitechnik Gulden). (b) The model was tooth mobility was measured (Fig. 4b). During the
fixed in a vise. (c) The handpiece of the Periotest measurement of tooth mobility, the handpiece of
was held at a right angle (handpiece horizontally, the Periotest was held at a right angle (handpiece
tooth axis vertically) and at a distance of about horizontally, tooth axis vertically) at a distance of about
1.5 mm between the tip of the handpiece and the 1.5 mm between the tip of the handpiece and the tooth
tooth. according to the manufacturer’s instructions (Fig. 4c).

Fig. 3 Schematic diagrams of Level M and Level S; lateral incisors of artificial

teeth were inserted in central incisor sockets.
Rubber O-rings (OR) were placed at the bottom of these sockets and
teeth were locked with spring washers (SW) and apical fixation screws.
Sockets of uninjured teeth were filled with the utility wax (UW).
734 Dent Mater J 2017; 36(6): 731–739

Fig. 5 DTS of front view; (a) CS1, (b) CS2, (c) WCS1, (d) WCS2 and top view; (e) CS, (f) WCS1, (g) WCS2
CS=Composite splint; WCS=wire-composite splint

The middle of the labial surface of artificial tooth was control) before measurements.
marked as the measuring point.
Evaluation of tooth mobility before and after splinting
Pretreatment of splinting As in the study by Berthold, the PTVs were measured
The area of tooth splint was determined using a three times and averaged for each tooth before (PTVpre)
thermoplastic sheet and silicone putty as a template. The and after (PTVpost) splint insertion. The splint effect
template was also used to determine tooth position and was defined as the change in tooth mobility, calculated
to avoid materials flowing into proximal areas. Artificial as the difference between PTVpre and PTVpost
teeth were sandblasted instead of acid-etched. A drop of (ΔPTV=PTVpre–PTVpost)4). The PTVpre of the injured
Clearfil Mega Bond primer (Kuraray, Tokyo, Japan) was tooth in Level S was conveniently determined as a
mixed with a drop of Clearfil Porcelain Bond activator score of 50 which was the max score of the Periotest,
(Kuraray) and applied in the area of tooth splint. After because the PTVs of an injured tooth with Level S were
30 s, the area was air-dried and Clearfil Mega Bond not available before splinting. All splints were adapted
(Kuraray) was applied in the area. The area was light- twice per three models (n=6).
cured (Elipar S10, 3M ESPE, St. Paul, MN, USA) for 20
s per tooth. Statistical analysis
Data were entered into Microsoft Excel (Microsoft,
Splinting Redmond, WA, USA). Ekuseru-Toukei 2015 (Social
Four kinds of DTS were prepared as follows (Fig. 5). Survey Research Information, Tokyo, Japan) was
a) CS1: Composite splint using light-cured resin- used for analysis. Nonparametric tests were applied,
based composite (MI Flow II, GC), width 1.5 mm, b) because the data of PTV were not normally distributed
CS2: Composite splint using light-cured resin-based (Kolmogorov-Smirnov test, p<0.05). The Wilcoxon test
composite (MI Flow II) width 2.5 mm. Resin-based was used to compare PTVpre and PTVpost of every
composite was directly injected from a syringe and tooth (p<0.05). The Mann-Whitney U-test was used
light cured for 30 s per tooth using an LED light unit. to compare PTVpost of injured teeth (11) and PTVpre
Thickness of CS was 1.5 mm. c) WCS1: Wires (a of uninjured teeth (21) (p<0.05). The Steel-Dwass test
rectangular orthodontic wire, Blue Elgiloy wire was used to verify the ΔPTV among all splints and
0.533×0.635 mm, Rocky Mountain Morita, Tokyo, the PTVpre of teeth 12, 11 and 21 among the three
Japan) were cut to the required length as necessary, commercial artificial models (p<0.05). The Steel-Dwass
d) WCS2: Wires (Dental cobalt-chromium alloy wire, test was applied as a multiple comparison procedure.
SUN-COBALT CLASP WIRE 0.9 mm, DENTSPLY- The ΔPTV among the three artificial models was
Sankin, Tokyo, Japan) were cut to the required length compared statistically using Kendall’s coefficient of
as necessary. They were prepared to fit the dental concordance (w) to evaluate consistency.
arch using pliers and attached to the tooth surface in
designated areas using resin-based composite (MI Flow RESULTS
II). The adhesive area was determined (2×2 mm) and
the resin-based composite thickness was 1.5 mm. The There were no significant differences among the three
width and thickness of the resin-based composite area commercial artificial models in PTVpre of teeth 12 and
of WCS and CS were adjusted using a dental hand piece 21 in each Level. The mean PTVpre for tooth 21 was
with a carborundum stone and checked using a dial 1.7±0.4 (mean±SD). There were also no significant
caliper (KORI SEIKI MFG., Tokyo, Japan). All splints differences among the three commercial artificial
were stored in a container for 24 h at 23°C (no humidity models in PTVpre of tooth 11 in Level M. Kendall’s w of
 Dent Mater J 2017; 36(6): 731–739 735

ΔPTV among three artificial models was 1.00 (p<0.05) in Level M

each Level. PTVpre and PTVpost of these teeth in each The mean PTVpre for injured tooth (11) was 31.5±0.9
Level are shown in Table 1. The ΔPTVs are shown in (mean±SD). The Coefficient of Variation (CoV) of
Table 2 and Fig. 6. PTVpre for the injured tooth (11) was 3.0%. There were

Table 1 Mean (±SD) PTVpre and PTVpost of each tooth for various DTS in Level M (a) and Level S (b)

(a) PTVpre (Level M)

tooth 12 tooth 11 tooth 21

CS1 1.4 (0.3) 31.2 (1.0) 1.6 (0.8)

WCS1 1.4 (0.5) 31.8 (1.0) 1.7 (0.4)
WCS2 1.7 (0.5) 31.6 (0.8) 1.8 (0.3)

PTVpost
tooth 12 tooth 11 tooth 21

CS1 0.6 (0.4) 0.9 (0.3) 0.7 (0.4)

WCS1 1.4 (0.5) 8.9 (1.8) 1.4 (0.4)
WCS2 1.6 (0.3) 3.8 (0.5) 1.6 (0.2)

(b) PTVpre (Level S)

tooth 12 tooth 11 tooth 21

CS1 1.3 (0.4) 50 (ND)* 1.7 (0.4)

CS2 1.5 (0.5) 50 (ND)* 1.1 (0.2)
WCS1 1.5 (0.3) 50 (ND)* 1.9 (0.5)
WCS2 1.4 (0.4) 50 (ND)* 1.5 (0.2)

PTVpost
tooth 12 tooth 11 tooth 21

CS1 1.2 (0.4) 19.8 (1.4) 1.8 (0.3)

CS2 1.4 (0.5) 12.7 (1.0) 1.6 (0.4)
WCS1 1.5 (0.5) 48.1 (0.8) 2.1 (0.4)
WCS2 1.4 (0.3) 29.6 (0.9) 1.7 (0.4)

CS=Composite splint; WCS=wire-composite splint

*: The PTVpre of the injured tooth in Level S was conveniently determined as 50 which was the max score of the Periotest,
because the PTVs of an injured tooth with Level S were not available before splinting.

Table 2 Mean (±SD) ΔPTV of various DTS for injured teeth in Level M (a) and Level S (b)

(a) ΔPTV (Level M)

CS1 WCS1 WCS2

ΔPTV 30.3 (1.0) 22.9 (1.5) 27.8 (0.7)

(b) ΔPTV (Level S)

CS1 CS2 WCS1 WCS2

ΔPTV 30.2 (1.4) 37.3 (1.0) 1.9 (0.8) 20.5 (0.9)

CS=Composite splint; WCS=wire-composite splint; PTV=Periotest value

736 Dent Mater J 2017; 36(6): 731–739

between PTVpre and PTVpost for uninjured teeth

(12, 21) in all cases. Comparing the DTS rigidity of
PTVpost of injured teeth (11) and PTVpre of uninjured
teeth (21), PTVpost of injured teeth using all DTS
was significantly higher than PTVpre of uninjured
teeth. The ΔPTV significantly increased in the order
WCS1<WCS2<CS1<CS2.

DISCUSSION
The purpose of this study was to develop a simple
experimental model and reproducible methods
for evaluating DTS effects. This study set out to
construct trauma models which were easy to handle
for researchers and dentists and had small variation
among measurement values or models. Commercial
artificial models which were standardized and industrial
products that could be obtained worldwide were used in
this study. It is possible that some discrepancies caused
by technical errors of enlarging the model’s sockets
or removing parts of artificial teeth might occur4,18-21)
during the production process because of variation
in researcher’s skills. Therefore, this study used only
artificial teeth supported by with rubber O-rings, utility
wax and spring washers and adapted these materials
directly to the experimental models. Rubber O-rings (JIS
B 2401) and spring washers (JIS B 1251) which were up
to the Japanese Industrial Standards (JIS) were used
to simulate and modify injured tooth mobility. Utility
wax was used for simulating peripheral ligament of
uninjured teeth. The utility wax was soft, pliable and
tacky at room temperature (congealing point was 64.0°C)
and commonly used in clinical procedures in dentistry,
for extending impression trays and developing a post-
Fig. 6 ΔPTV of various DTS for injured teeth in Level M palatal seal. Because temperature-dependent materials
(a) and Level S (b). were used, all working conditions were under controlled
For each figure, bars (mean±S.D. bar) with different temperature (23°C). All DTS were evaluated twice per
capital letters (A, B, C, D) indicate significant three models (n=6). There were no significant differences
differences (p<0.05) among the kind of DTS. among the three models, and the ΔPTV among three
CS=Composite splint; WCS=wire-composite splint; models showed good agreement. Therefore, these
PTV=Periotest value experimental models could reproduce the condition as
intended.
According to a previous study on normal PTV in
periodontally healthy teeth of individuals aged 20–
statistically significant differences between PTVpre 35 years in vivo3), the median PTV in the horizontal
and PTVpost for uninjured teeth (12, 21) in case of dimension was 3.2 (range −0.8–11.2) for the lateral
only CS1. On the other hand, there were statistically incisors, and 3.6 (range −0.5–13.7) for the central
significant differences between PTVpre and PTVpost incisors. In the current study, the PTVpre of simulated
for injured teeth (11) in all cases. Comparing the uninjured teeth (tooth 12 and 21) were 1.5 (±0.4) and
DTS rigidity of PTVpost of injured teeth and PTVpre 1.7 (±0.4), respectively which was within the range of
of uninjured teeth (21), there were no significant the in vivo study. Moreover, according to another study
differences between PTVpost of injured teeth using on normal PTV of healthy central incisors in males aged
CS1 and PTVpre of uninjured teeth. On the other 16–22 years in vivo32), the mean PTV was 1.8 (±1.1) for
hand, PTVpost of injured teeth using WCS1 and WCS2 tooth 21 which was near the PTV of this study. These
was significantly higher than PTVpre of uninjured findings showed that this experimental model method
teeth. The ΔPTV significantly increased in the order could successfully simulate uninjured teeth.
WCS1<WCS2<CS1. Two types of simulations differing in terms of
severity were produced. Level M simulated an injured
Level S tooth with degree of mobility III (PTVs 31.5±0.9). The
There were no statistically significant differences fastening torque value was 11.0 cN-m. In a pilot study,
 Dent Mater J 2017; 36(6): 731–739 737

adequate fastening torque value was evaluated to obtain guidelines for dental trauma management indicated
stable PTV of injured teeth at Level M. No one has ever that flexible (more mobility than a non-injured tooth)
assessed the PTV of teeth right after trauma, mainly splinting assists in healing5,6). It means that the PTVpost
because the Periotest should not be applied in the of injured teeth should be more than the PTVpre of
cases of acute trauma according to the manufacturer’s uninjured teeth (=1.7). Then, ΔPTV of Level M should
instructions. It is conceivable that some injured teeth are be less than 29.8 (=31.5−1.7) and that of Level S should
too mobile for the Periotest to obtain PTV procedures. be less than 48.3 (=50−1.7). There is no indication of the
Level S represented a severe injured tooth with mobility minimal required stability at the moment. However,
that was too large to evaluate using the Periotest. In degree of mobility III (PTV30~50) is easily noticeable
the actual clinical situation, there may be some cases in and the tooth moves more than 1 mm in any direction
which dentists apply DTS for injured teeth with severe or can be rotated in its socket, with mobility in response
mobility. But few studies have evaluated the effects of to lip or tongue pressure30,31,33,34). Splinted teeth with
DTS in severe injured teeth with mobility out of the mobility III may not have enough protection against
range of PTV. traumatic forces and sufficient function because of high
The Periotest Classic device was used in this study. mobility of injured teeth. PTVpost of injured teeth may
The PTVs vary from −8 to 50 and correlate with Miller’s be required to be less than a PTV score of 30, because
classification of tooth mobility: degree of mobility 0, no guidelines for the management of dental injures include
movement distinguishable, clinically firm teeth, PTV optimal care for injured teeth to keep the repositioned
−8 to 9: degree of mobility I, first distinguishable sign tooth in its initial position, provide patient comfort
of movement, palpable mobility, PTV 10 to 19: degree and improve function5,6). The ΔPTV of Level M may be
of mobility II, crown deviates within 1 mm, visible required to be more than 1.5 (=31.5−30) and that of
mobility, PTV 20 to 29: degree of mobility III, mobility is Level S may be required to be more than 20 (=50−30).
easily noticeable and the tooth moves more than 1 mm in Therefore, when using this model system, the cut-off
any direction or can be rotated in its socket, mobility in levels for minimal required ΔPTV of Level M was 1.5
response to lip or tongue pressure, PTV 30 to 5030,31,33,34). and maximal required ΔPTV was 29.8 and the cut-off
The variances in PTVs of injured and uninjured teeth levels for minimal required ΔPTV of Level S was 20 and
were small. This method was reproducible. maximal required ΔPTV was 48.3.
According to manufacturer’s instruction, the This study showed differences in DTS effects
tapping rod of the Periotest should hit the center of among novel experimental models and the Periotest. In
the labial surface of the test tooth. To avoid contact with injured teeth with Level M, PTVpost was in the range of
the tapping rod during measurement using Periotest, degree of mobility 0 in all DTS. The highest DTS effects
the DTS area was limited to within 2.5 mm from the were observed when using CS1 followed by WCS2 and
incisal edge, because the diameter of the tapping rod is WCS1. Under CS1, there were no significant differences
4.0 mm and the length of coronal area is 10.0 mm. between PTVpre of uninjured teeth and PTVpost of
A difference in adhesive strength between DTS and injured teeth. The results showed that CS1 can be
teeth could affect the effects of DTS. Some researchers categorized as semi-rigid splints for injured teeth (Level
tried to reduce the influence of difference in adhesive M) according to the requirements for an acceptable
strength. In the previous studies, there were some splint15). Since ΔPTV of CS1 was higher than the
experimental models for evaluating DTS effects using maximal required ΔPTV, CS1 might be not acceptable
human or bovine tooth facets to simulate the clinical as a splint for injured teeth with a mobility of Level M.
situation using the acid-etch technique18,22-26). One PTVpost of injured teeth splinted by WCS1 and WCS2
purpose of the current study was to construct a simple were significantly higher than the PTVpre of uninjured
experimental model, so only artificial teeth were used teeth. Therefore, WCS1 and WCS2 can be categorized as
instead of human or bovine facets. In this study, artificial flexible splints for injured teeth (Level M).
teeth were sandblasted instead of acid-etched. After On the other hand, in injured teeth with Level S,
that, primer and bond were applied to the surface of PTVpost of injured teeth using CS1 and CS2 were in the
artificial teeth as in clinical situations before tooth splint range of mobility I and WCS1 and WCS2 were in the
materials were applied. Sugashima35) has reported that range of mobility III and II, respectively. The highest
there were no statistically significant differences between DTS effects were observed using CS2 followed by CS1,
the adhesive strength of melamine resin teeth (9.2±1.9 WCS2 and WCS1. When injured teeth had a high degree
MPa) and those of human teeth (10.6±2.5 MPa) when of mobility out-of-range of PTV (as in Level S), these
using Mega Bond (same as in this study) in a study of DTS can be categorized as flexible splints, because
the adhesive strength and durability of melamine resin PTVpost of injured teeth were higher than PTVpre of
teeth (same as in this study) examined in comparison uninjured teeth with these four DTS15). Since the ΔPTV
with human teeth. Based on this report, the differences of WCS1 was lower than the minimal required ΔPTV,
between melamine resin teeth and human teeth had WCS1 might be not acceptable as a splint for injured
little effect on bonding with DTS in this study. teeth with a mobility of Level S.
Based on the results of this study, the cut-off levels Results of DTS rigidity in this study were almost
for minimal required stability and maximal required similar to those of previous studies in which WCS
stability in this model system could be defined. The was a flexible splint4,18,20,21,24,25,28). On the other hand,
738 Dent Mater J 2017; 36(6): 731–739

the results of this study were different from previous other models4,22).
studies4,20,21,28) that have shown composite splints This study had some limitations. The inter-observer
categorized as rigid splints. In these previous studies, variances were not evaluated, since only one person
researchers had not defined splint width, thickness evaluated this experiment. Therefore, in order to
or adhesive dimension. The current study aimed to make it easier for other researchers to reproduce the
evaluate the influence of the composite splint area on experimental system, the structure was simplified. All
the difference of splint effects. This research defined materials were commercially available goods and the
the width and thickness of composite splints showing method to set the model and measuring procedure were
that effects of composite splints differed depending closely defined. To evaluate reliability of this model
on the width of the splint and mobility of injured system and intra-observer variances, agreement of
teeth. Therefore, it may not be appropriate to suggest measurement values among three artificial models was
that composite splints are classified as rigid splints. evaluated, and was good. Another limitation was that
Composite splints can be useful in immobilizing injured the structure was simplified and clinical relevance was
teeth having a high degree of mobility. Adjusting the compromised in order to increase reproducibility. For
width or thickness of composite splints may also be example, the interproximal contact was not given in
necessary depending on the degree of injured tooth order to maintain the spaces and prevent the influence
mobility from the results of CS1 and CS2 in this study. of interproximal contacts.
In future studies, correlation between the width or This study evaluated only tooth mobility based on
thickness of composite splints and splint rigidity should DTS effects and gained limited results. Evaluation of
be evaluated. DTS effects require multifaceted approaches. Further
This model system had advantages over the various studies using this model system are needed in order to
available models which combined the Periotest with an evaluate DTS effects using other measurement methods
animal model27), human model28), commercial artificial including universal testing machines.
model4) and custom made artificial model22). This model system could evaluate the effects of
In an animal model study using sheep mandible27), DTS including the differences among various DTS
it was reported that “the values before splinting differed methods. These experimental models were reasonably
greatly between jaws tested” (the actual scores were not reproducible of tooth luxation and avulsion often seen in
shown in the publication). Since all front teeth exhibited clinical situations. Severity and mobility of injured teeth
highly increased mobility, uninjured teeth (adjacent vary depending on circumstances of accidents. DTS
teeth) could not be simulated and evaluated. Also, the effects should be evaluated in various degrees of severity
study using a human cadaveric model28) showed presplint and mobility. In this study, two levels of injuries were
mobility (Periotest value) ranging from about 2 to about devised. The evaluation methods designed in this study
45 according to the figure (the actual scores were not were very simple and easy to apply. This method may be
shown in the publication). On the other hand, the model considered useful in evaluating DTS effects.
in the current study successfully simulated uninjured
teeth and evaluated the effect of DTS on adjacent teeth, ACKNOWLEDGMENTS
as described earlier. The presplint mobility (PTVpre) of
level M ranged from 30.0 to 32.3. Many thanks to Dr. Michiyo MIYASHIN for her detailed
A previous study which evaluated the DTS effect information of the splinting procedures.
on a commercial artificial model using the Periotest4)
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