2010

3rd year students Dr. Ibrahim Eltorky

[INTRAORAL STENTS]
[Type the abstract of the document here. The abstract is typically a short summary of the contents of the document. Type the abstract of the document here. The abstract is typically a short summary of the contents of the document.]

Stents
What is a dental stent? Stent: is a device used in conjunction with a surgical procedure to keep a skin graft in place; often modified with acrylic resin or dental modeling impression compound that was previously termed stent`s mass; also refers to any device or mold used to hold a skin .graft in place or provide support for anastomosed structures Dental stents are manufactured by a dental technician from plastics or acrylic resins, which cover all or parts of the dental arches. Different stents may have different purposes, thus depending on the objective that one seeks to use different types of dental stents. i. Anti hemorrhagic stent:

It is an appliance constructed so as to control post extraction bleeding .especially in haemophilic patients What Is Haemophilia? Human blood contains special proteins, known as clotting factors. Identified by Roman numerals, clotting factors help stop bleeding and allow a blood vessel to heal after an injury. he last step in the clotting process !also called coagulation" is the creation of a #net# that closes the torn blood vessel and stops the bleeding. his part of the process involves clotting factors $III and I%. &eople with hemophilia are deficient in one of those factors due to their abnormal genes and, as a result, their blood can't clot properly. :Construction a!illary and mandibular impressions are made and the casts are .poured in stone The casts are mounted on articulator. The teeth to be e!tracted .are removed and the socket is prepared on the casts

" base plate is prepared wi#th a bite rim over the socket containing the occlusal imprint of the corresponding teeth of the .opposite arch .The stent is constructed with acrylic resin "fter e!traction$ the stent is lined with tissue conditioning material and gently inserted in the mouth and allowed to remain for %&' .days. The stent may be lined with a haemostatic agent ii. rainage stent:

The fistula is a channel created in the oral cavity on its own$ to fish out bacteria or pla(ue. " tooth which has an inflammation e!udes pressure to the teeth close to it. The mouth therefore forms a fistula to chart out the accumulated pus and release the tension at the inflamed site. Therefore$ it is seen that a fistula is beneficial to the body. "ccordingly$ using a stent to release of fluid pressure within the cyst causes shrinkage of the cyst. )urgical removal of large cystic defects is often preceded by a period of decompression through a drainage stent *decompression stent+ to allow the escape of blood or other fluids. Construction: "n impression is made and a fistula and the fistula is reproduced in the stone cast. " ,% gauge polyethylene tube is inserted in the hole and the labial aspect of the cast is covered with two layers of base plate wa!. The stent is processed with acrylic resin. This type of drainage stents can be constructed by modifying a partial or complete denture. iii. Stent !or use in gra!t "rotection:

-hen a skin or mucous membrane graft is placed in a vestibule or palate$ a stent is re(uired to hold the graft *split thickness graft+ in close appro!imation to the periosteum during initial healing.

-ithout intimate contact$ a hematoma may form between the graft and periosteum. The graft will not adhere to the underlying periosteum and bone. Construction: .re& surgical preparation: "n over e!tended impression is made in a modified stock tray. odeling compound is used to force or distend tissue and it can also be reheated to obtain ma!imum e!tension. )tudy cast is poured. The site and e!tent of the preparation are discussed with the surgeon. The area to be operated on is then outlined on the cast. /f any modifications of the shape of the cast are necessary$ grinding stone and large burs are used. The stent can be made from heat or cold curing acrylic resin. Surgica# "rocedure: "t the time of the operation and after the surgical site has been prepared$ the stent is fitted. /f the estimation of the flange was e!cessive$ it can be reduced. /f the stent is made short$ it can be e!tended by modeling compound. This acrylic resin stent with the modeling compound will be used as the final appliance. Tissue conditioning material is used as a thin liner to fill in the discrepancies between the stent and bone contours. The skin graft is applied to the stent$ then placed in position and held with circum mandibular sutures from ,0&,% days. i$. Occ#usa# s"#int:

1cclusal splints *also called bite splints$ bite planes+ are removable dental appliances carefully molded to fit the upper or lower arches of teeth. They are used to: .rotect tooth and restoration surfaces.
4

anage mandibular *jaw+ dysfunction.

)tabili2e occlusion or create space prior to restoration procedures. The primary function of the occlusal splint is to disengage occlusion temporarily and to interrupt e!isting patterns of muscle function which contribute to painful myospasm in cases of tempromandibular joint pain dysfunction syndrome and to reposition the condylar head in the glenoid fossa.

1cclusal splints are typically made of a heat&cured acrylic resin. )oft acrylic or light cured acrylic resin$ or vinyl splints may be made more (uickly and cheaply$ but are not as durable$ and are more commonly made for short&term use. )oft splints are also used for children$ because normal growth changes the fit of hard splints. They generally cover all the teeth of the upper or lower arch$ but partial coverage is sometimes used. 1cclusal splints are usually used on either the upper or the lower teeth$ termed ma!illary splints or mandibular splints respectively$ but sometimes both types are used at the same time. a!illary splints are more common$ although various situations favor mandibular splints. )tabili2ing or ichigan&type occlusal splints are generally flat against the opposing teeth$ and help jaw muscle rela!ation$ while repositioning occlusal splints are used to reposition the jaw to improve occlusion. Construction: /mpression of the ma!illa and mandible are made and poured in stone. /nterocclusal records are made for proper mounting of the casts on an articulator. The articulator is opened slightly for a new vertical
5

dimension. The upper or lower model is used for wa!ing a base plate type of appliance which e!tends to the occlusal surface and caries imprints of the antagonist arch and processed in clear acrylic resin. $. %outh "rotector or mouth guard:

" mouth protector is an appliance constructed for protection of the teeth in cases of: 3ontact sports. -hen ma!illary anterior fi!ed bridge or crowns are present and the patient is to enter surgery under general anaesthesia. 4ru!ism during night. outh breather.

5ental mouth guards and splints can relieve pain$ discomfort$ and wear caused by teeth grinding and jaw clenching. )pecialty mouth guards can also be corrective$ conditioning the body to stop grinding the teeth or clenching the jaw. These mouth guards are to be worn at night$ during sleep to prevent the pain and discomfort associated with nocturnal bru!ism.
Definition of Bruxism:

4ru!ism is clenching *tightly holding top and bottom teeth together+ or grinding *sliding teeth back and forth over each other+ teeth. 4ru!ism is not a dangerous disorder. 6owever$ it can cause permanent damage to the teeth and uncomfortable jaw pain$ headaches$ or ear pain.
Treatment:

The goals of treatment are to reduce pain$ prevent permanent damage to the teeth$ and to prevent damage to the teeth$ intra oral appliances *splints+ have been used since the ,#70s to treat teeth grinding$ clenching$ and T 8 disorders. " splint may help protect
6

the teeth from the pressure of clenching or reduce clenching as much as possible. Construction: a!illary cast will be used only$ with few e!ceptions such as a severely prognathic individual. The outline of the appliance is penciled on cast. /t is not necessary to carry this outline across the palate or to the deepest part of mucobuccal fold. 9inyl resin sheet is uniformly warmed and adapted on the cast using vacuum molding machine. The e!cess is trimmed. $i. La&ia# "eriodonta# stent:

3osmetic results are often a disappointment after e!tensive periodontal surgery in the anterior part of the mouth. " thin labial stent of gingival tissue toned and characteri2ed acrylic resin can be made to cover the e!posed roots seen in a wide smile. :enerally only a ma!illary stent is needed. /t depends for retention upon tooth undercuts and lips. $ii. Surgica# stent:

" surgical stent can e!press the prosthetic plan to surgeons during operation directly in the mouths of patients. /t is very helpful to the surgeons to take account of both the condition of jaw bone and the future denture making. 6oles$ tunnels and windows on surgical stents can be used as the guidance of drilling positions and directions. The surgical stents may also be a useful reference to surgeons to make bone graft$ do some changes in surgical plan and even cancel the implant denture therapy when the situation of jaw bone significantly differ from what the e!pectancy.

Radiothera"y "rostheses I. Radiation stents

7

.rosthetic devices used during radiation therapy include stents$ splints$ shields$ carriers and positioners. They are used to optimi2e the delivery of radiation. ;ses: '( )ositioning stent: /t is prosthesis for directing a radiation beam. .osition the anatomical structures to be irradiated in a predictable and repeatable position. /t permits the radiation oncologist to correctly position the radiation beam. This type of prostheses holds an intra oral cone in the e!act position the radiotherapist desires and will deviate the tongue from the source of radiation. /t positions the cone accurately during all treatment sessions. )uch stents are usable in both dentulous and edentulous patients. /t is of two types namely$ oral positioning stent and per& oral cone positioning devices. The former serves to position the tissues whereas the later serves to position the radiation appliance. Construction: <or an edentulous patient&mandibular and ma!illary record bases are fabricated. The actual per oral cone or a cylinder of the same diameter is used to form an acrylic resin ring. Tinfoil is wrapped around the cone to ensure its separation from cold& curing acrylic resin that is used to form the ring. The ring is attached to the ma!illary record base while holding the cone in the selected position with the radiotherapist present. <or dentulous patients ma!illary and mandibular occlusal indices are fabricated and the acrylic resin cone is attached in a similar fashion.

*( Shie#ds:

5isplace and=or shield to protect other normal structures. They are metallic screens provided to prevent unwanted e!posure of normal tissues. /t is helpful when the patient is to receive a unilateral dose of radiation as buccal mucosa$ skin or alveolar ridge. 3. Radiation carrier: /t can be defined as a device used to administer radiation to confined areas by means of capsules$ beads or needles of radiation emitting materials such as radium or cesium. +unction: /ts function is to hold radiation source securely in the same position during the entire period of treatment. .osition the radioactive source into or adjacent to the tumour site. ,( Tissue &o#us de$ice ;sed when tissues to be irradiated are irregularly contoured

II
+unctions:

is"#acement stents

,+ 5isplacing the tongue$ lips or cheeks away from the path of radiation. >+ /n some instances the lesion is displaced and held in the same place during every treatment period. 7+ /nserting lead *or lead alloy+ shields in the stent serves to protect normal tissues.
9

10

?+ 3ontrol tongue and mandibular positions during treatment. Construction: Techni-ue !or dentu#ous "atients: " double thickness of hard base plate wa! is softened and cut to the general shape of the mandibular arch. The wa! is highly pressed on the occlusal surface of the teeth and shaped to cover the tongue while it is in the re(uired position. -a! rims are built on the superior surface of the pattern on either side. The occluding surface of the rims is softened and the pattern is placed in the mouth. The patient is instructed to open his mouth as wide as he can the pattern is inserted in its previous place on the mandibular teeth and the patient is instructed to close lightly. The pattern is cooled and removed from the mouth. The indentations of the ma!illary teeth are reduced with a sharp knife to the level that includes only the occlusal surfaces. 3ertain modifications of the wa! pattern may be necessary to achieve additional re(uirements. The tongue depression may be e!tended further posteriorly for patients receiving radiation to the soft palate. /n other patients$ a flange may be built to displace the tongue or the cheeks. "ll modifications are before flasking the stent. The wa! pattern is flasked$ the wa! is eliminated. The flask is packed$ cured$ deflasked$ finished and polished. The stent is kept in sterili2ing solution in the radiotherapy department and is placed in the mouth during the treatment period$ and then it is removed$ cleaned and kept until the following treatment period.

10

11

@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@

11