|Year : 2016 | Volume
| Issue : 2 | Page : 69-72
Retrospective evaluation of splinting performed in a Nigerian periodontology clinic
Clement Chinedu Azodo, PI Ojehanon
Department of Periodontics, University of Benin, Benin City, Edo State, Nigeria
|Date of Web Publication||19-May-2016|
Clement Chinedu Azodo
Department of Periodontics, Prof. Ejide Dental Complex, Room 21, 2nd Floor, University of Benin Teaching Hospital, P. M. B. 1111, Ugbowo, Benin City, Edo State
Objective: To determine the characteristics, reasons, and patterns of splinting done in the Periodontology clinic of University of Benin Teaching Hospital, Benin City, Nigeria. Materials and Methods: This retrospective review of patients treated with splints in the Periodontology clinic of University of Benin Teaching Hospital, Benin City, Nigeria, over a 3-year period (January 2013–December 2015) was done using a self-developed pro forma as the data collection tool. Results: A total of ten patients aged between 24 and 68 years with a mean age of 45.40 ± 14.19 years had composite and wire splinting. The majority of the patients were middle--aged adults and elderly (60.0%), females (60.0%), indigenous people (70.0%), and reside near the specialist clinic (60.0%). The patients were mostly the first-time dental clinic attendee (80.0%), fully dentate (80.0%), and had fair oral hygiene status (70.0%). The reasons for dental attendance among the patients were mainly due to pain (50.0%) and tooth mobility (50.0%). The main reason for the splinting was tooth mobility caused by chronic periodontitis (50.0%). The patients had 1–11 mobile teeth with a mean of 3.5 teeth. Central incisor (90.0%) was almost always the involved mobile tooth in the treated patients. The periodontal treatments involved were scaling and root planing, medications, incision, and drainage for the abscess. The most prescribed antibiotic was doxycycline. The splinting was equally divided into maxillary and mandibular arches. The majority of the splinting were done on buccal/labial surfaces of the teeth (80.0%). On recall, three cases (30.0%) had complications in form of debonding; one case was changed from lingual/palatal surfaces to buccal/labial surfaces while the other two cases were redone. Conclusion: Periodontal splinting were done mainly for older, nonprofessional, female, indigenous patients for varied reasons in the studied periodontology clinic.
Keywords: Splinting, tooth mobility, treatment
|How to cite this article:|
Azodo CC, Ojehanon P I. Retrospective evaluation of splinting performed in a Nigerian periodontology clinic. SRM J Res Dent Sci 2016;7:69-72
|How to cite this URL:|
Azodo CC, Ojehanon P I. Retrospective evaluation of splinting performed in a Nigerian periodontology clinic. SRM J Res Dent Sci [serial online] 2016 [cited 2021 Sep 27];7:69-72. Available from: https://www.srmjrds.in/text.asp?2016/7/2/69/182664
| Introduction|| |
Periodontitis is an advanced form of periodontal disease. It is categorized as chronic periodontitis, aggressive periodontitis, periodontitis as a manifestation of systemic disease, necrotizing periodontitis, and periodontitis associated with endodontic lesions in the 1999 International Workshop for classification of periodontal diseases and conditions. Periodontitis is common in Nigeria as it has constantly remained one of the major causes of tooth loss in the country.,,,
Periodontitis, which usually manifests with periodontal pockets, connective tissue attachment loss, and tooth mobility, may be treated nonsurgically only or using both nonsurgical and surgical approaches. When periodontitis is associated with tooth mobility, the treatment involves splinting in addition to the periodontal treatment. Splinting is also used to stabilize teeth following acute trauma and after some orthodontic treatments. The splint serves to redistribute masticatory force, improve comfort, and facilitate healing of the affected tooth/teeth after treatment. Extracoronal temporary splint in form wire and composite splint is commonly employed in periodontal practice because of the ease of use.
The objective of this study was to determine the characteristics, reasons, and patterns of splinting done in the Periodontology clinic of University of Benin Teaching Hospital, Benin City, Nigeria.
| Materials and Methods|| |
Study design and settings
This was a retrospective review of all patients treated with periodontal splints at University of Benin Teaching Hospital, Benin City, Nigeria, over a 3-year period (January 2013–December 2015).
Protocol of the periodontal splinting in the specialist clinic
After diagnosis, treatment plan is formulated and informed consent would be obtained from the patient. The periodontal treatment is performed followed by occlusal grinding before splinting. The sequence of activity for wire and composite splinting includes measuring the extent of the splinting with dental floss. This will determine the length of 0.5 mm hard stainless steel wire to be used. After that, the teeth included will be etched with 37% phosphoric acid for 60 s. After 60 s, copious irrigation of etched site will be done followed by air drying to reveal ice frost appearance. Bonding agent will be applied and cured. The 0.5 mm hard stainless steel wire will be placed on the teeth surfaces. On the top of the stainless steel wire and surfaces of teeth, composite will be applied and cured. The surface of the teeth can either be buccal/labial or lingual/palatal surface based primarily on esthetics. Lingual/palatal surfaces are preferred for patients, which are highly involved in public interaction. Instruction in relation to periodontal treatment, medication, and oral hygiene instruction with special emphasis on cleaning of the splinted area will be given. Patient will be discharged after recall visit appointment has been given.
Data collection tool/procedure
Ten patients treated with composite and wire splint were retrospectively retrieved from the clinic log book. The case notes were retrieved from the Medical Record's Library. The self-developed pro forma was used to obtain information which includes demographic characteristics, presenting complaint, diagnosis, number of mobile teeth, dental history, dentate status, and oral hygiene status assessed using Simplified Oral Index by Greene and Vermillion (1964). Other clinical examination findings, medications, periodontal treatments rendered, and arch and surface of teeth that on which the splint was done were also recorded.
The data obtained were subjected to univariate analysis using SPSS Version 20.0 (Chicago, IL) and reported as frequencies and percentages. The age of patients was used to categorize the patients as young adults (18–40 years), middle-aged adult (41–64 years), and elderly (≥65 years); ethnicity was categorized into indigenous (ethnic groups in the state in which the periodontology clinic is located) and nonindigenous population (ethnic groups outside the state in which the periodontology clinic is located). Residency was categorized into near (if the transport fare from the location to the hospital is <500 naira) and far (if the transport fare from the location to the hospital is ≥500 naira).
| Results|| |
A total of ten patients aged between 24 and 68 years with a mean age of 45.40 ± 14.19 years had composite and wire splinting. Middle-aged adults and elderly constituted 60.0% of the patients. The majority of the patients were females (60.0%), nonprofessionals (60.0%), indigenous population (70.0%), and reside near the specialist clinic (60.0%) [Table 1].
The reasons for dental attendance among the patients were (50.0%), tooth mobility (50.0%), bleeding from gum (10.0%), tooth replacement (10.0), and teeth cleaning (10.0). The patients were mostly the first-time dental clinic attendee (80.0%), fully dentate (80.0%), and had fair oral hygiene (70.0%) [Table 2].
The reasons for splinting were tooth mobility due to chronic periodontitis (50.0%), periodontal abscess (30.0%), aggressive periodontitis (10.0%), and trauma (10.0%). The patients had 1–11 mobile teeth with a mean of 3.5 teeth. The majority had one mobile tooth. Central incisor (90.0%), lateral incisor (60.0%), and molar (20.0%) were almost always involved in the treated patients. The other clinical findings were recession (40.0%), dental caries (10.0%), attrition (10.0%), fractured teeth (10.0%), and supraeruption (10.0%) [Table 2]. The periodontal treatments were scaling and root planing, medications, incision, and drainage for periodontal abscess. Medications were antibiotics, analgesics, and vitamins. The antibiotics were mainly doxycycline followed by amoxicillin and metronidazole combination and a combination of clindamycin and metronidazole. Occlusal grinding was done before all the splinting procedure. The splinting was equally divided into maxillary and mandibular arches. The majority of the splinting were done on buccal/labial surfaces of teeth (80.0%). On recall, three cases (30.0%) had complications in form of debonding; one case was changed from lingual/palatal surfaces to buccal/labial surfaces while the other two cases were redone.
| Discussion|| |
This study was set to determine the characteristics, reasons, and patterns of periodontal splinting done in a Nigerian periodontology clinic found that the treated patients were of wide age range because of the age range of different dental conditions that resulted in tooth mobility in this study. The higher proportion of middle-aged adults and elderly among the patients and the mean age of patients falling into the middle-aged adulthood can be explained by high prevalence of chronic periodontitis and periodontal abscess which is a common complication of chronic periodontitis as the diagnosis of the patients. Chronic periodontitis has consistently been reported to be more prevalent with aging. The other clinical findings such as recession, dental caries, attrition, fracture, and supraeruption which are plaque retentive factors and features of periodontitis explain why the majority of the patients do not have good oral hygiene status. Poorer oral hygiene has been linked with different forms of periodontal disease, especially periodontitis.
In this study, more females than males were treated which agrees with several reports that documented more female than male dental clinic attendance for treatment.,,, Although males may suffer more from chronic periodontitis as it is linked to poorer oral hygiene than females, more females are likely to opt for periodontal treatment option rather than tooth extraction. This is usually due to their consideration of esthetics in their care as the majority of patients treated had mobile central and lateral incisors.
The nonprofessionals received the treatment more than professionals in this study, and it may be linked with the fact that the prevalence of periodontitis decreases as income level increased.,, The attendance at periodontology clinic was mainly for symptomatic reasons including pain and mobility as the majority of reasons for dental attendance in this study. This is because of the preference of curative dental visit to preventive dental visit among Nigerians. This attitude was obviously confirmed by the fact that more than the three-quarters of the patients were the first-time dental clinic attendees despite being mainly of the indigenous population and residing near the specialist clinic.
The array of periodontal treatment rendered which included scaling and root planing, medications, incision, and drainage for the abscess could be explained by the wide range of conditions (chronic periodontitis, periodontal abscess, aggressive periodontitis, and trauma) that led to tooth mobility among the treated patients. Antibiotics prescription is consistent part of treatment of advanced periodontal disease. In this study, the antibiotics prescription was mainly doxycycline followed by combination (amoxicillin and metronidazole, clindamycin and metronidazole). The antibiotics prescription in dental healthcare is mainly empirical, and the implicated flora in periodontal disease is susceptible to these prescribed antibiotics, and in addition, clindamycin has peculiar bone penetration ability.
The splinting was equally divided into maxillary and mandibular arch [Figure 1] and [Figure 2] with the majority done buccal/labial surfaces while a few done lingual/palatal surfaces. The lingual/palatal splinting was done because of esthetics, but it is challenging to the patient due the discomfort in relation to tongue activities and to the dentist in application due to limited visibility of the area and moisture control. Three cases (30.0%) debonded, and one case was changed from lingual/palatal to buccal/labial while the other two cases were redone further buttressing the difficulty of this treatment and why it is not commonly offered to patients outside the specialist clinic.
| Conclusion|| |
Periodontal splinting were done mainly for older, nonprofessional, female, indigenous patients for varied reasons in the studied periodontology clinic.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
1999 International Workshop for a Classification of Periodontal Diseases and Conditions. Papers. Oak Brook, Illinois, October 30-November 2, 1999. Ann Periodontol 1999;4:i, 1-112.
Oginni FO. Tooth loss in a sub-urban Nigerian population: Causes and pattern of mortality revisited. Int Dent J 2005;55:17-23.
Adeyemo WL, Oderinu HO, Oluseye SB, Taiwo OA, Akinwande JA. Indications for extraction of permanent teeth in a Nigerian teaching hospital: A 16-year follow-up study. Nig Q J Hosp Med 2008;18:128-32.
Saheeb BD, Sede MA. Reasons and pattern of tooth mortality in a Nigerian Urban teaching hospital. Ann Afr Med 2013;12:110-4.
Akaji EA, Folaranmi N, Okoye LO, Chukwuneke FN. Oral health problems and causes of tooth loss at the University Of Nigeria Teaching Hospital, Enugu-Nigeria. Ebonyi Med J 2011;10:27-32.
Abdellatif HM, Burt BA. An epidemiological investigation into the relative importance of age and oral hygiene status as determinants of periodontitis. J Dent Res 1987;66:13-8.
Okoye L, Ekwueme O. Prevalence of dental caries in a Nigerian rural community: A preliminary local survey. Ann Med Health Sci Res 2011;1:187-95.
Ajayi EO, Ajayi YO. Utilization of dental services in a population of Nigerian University students. Niger Dent J 2007;15:83-6.
Azodo CC, Unamatokpa B. Gender difference in oral health perception and practices among medical house officers. Russ Open Med J 2012;1:0208.
Aikins EA, Braimoh OB. Utilization of dental services among civil servants in Port Harcourt, Nigeria. J Dent Res Rev 2015;2:62-6.
Farsi JM. Common causes of extraction of teeth in Saudi Arabia. Saudi Dent J 1992;4:101-5.
Olanrewaju I, Arowojolu OM, Gbadebo SO, Ibiyemi TS. An audit of pattern of patients' presentation at the periodontics clinic of the university college hospital, Ibadan. Ann Ib Postgrad Med 2009;7:16-20.
Gundala R, Chava VK. Effect of lifestyle, education and socioeconomic status on periodontal health. Contemp Clin Dent 2010;1:23-6.
Gautam DK, Vikas J, Amrinder T, Rambhika T, Bhanu K. Evaluating dental awareness and periodontal health status in different socioeconomic groups in the population of Sundernagar, Himachal Pradesh, India. J Int Soc Prev Community Dent 2012;2:53-7.
[Figure 1], [Figure 2]
[Table 1], [Table 2]