.I Oral Maxillofac
Splint Construction Light-Cured Resin
MAJ JOHN R. SCUBA, DDS, DC, USA,* AND COL JOHN P. MCLAUGHLIN, DDS, DC, USAt 4. The material is trimmed with a scissors to the exact shape desired (Fig 2). The clear covering sheet is then removed and the uncured material is readapted to remove minor irregularities caused by its handling. It is then trimmed to the final desired shape. 5. The casts are placed on the articulator and closed into the desired occlusal relationship (Fig 3). The material has sufficient body to enable it to maintain its shape while accurately registering the occlusal pattern. 6. The material is completely adapted and the air barrier coating (ABC) is applied to the exposed surfaces of the resin. 7. The articulated casts are placed on the rotating turntable, the timer adjusted, and the casts are elevated into the curing chamber. The material is cured for 5 minutes (Fig 4). 8. Following this preliminary curing, the splint is removed from the casts, painted with ABC, replaced on the models, and rearticulated. The splint is then cured for an additional 8 minutes. 9. The splint is washed with soap and water and
The construction of splints for surgical correction of dentofacial deformities can be time consuming and it exposes the surgeon or the laboratory technician to noxious chemicals. The completed model surgery is often at risk for damage when placed in water to enhance curing of the methylmethacrylate resin, and there is additional time needed to duplicate the surgical models before splint fabrication. The technique described uses a visible-light-cured resin system (Triad VLC System, Dentsply/York Division, Dentsply International, York, PA) that enables the construction of a surgical splint in a brief time with minimal exposure to organic chemicals. The material is simple to use and it produces a superior quality splint with no unpleasant odors or contact of the skin with irritating substances. Technique The material is removed from the package and the clear sheet covering the material is removed from one side. A thin coating of Triad model release agent (MRA) is applied to any surface of the surgical models where the resin material may be adapted. Excess MRA is wiped off. The Triad material is adapted to the maxillary cast by putting it on a flat surface and placing the cast on it (Fig 1). The clear covering is left on the opposite side of the material to facilitate ease of handling. Received from the Oral and Maxillofacial Surgery Service, Brooke Army Medical Center, Fort Sam Houston, TX. * Chief Resident. t Chief. The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense. Address correspondence and reprint requests to Major Scuba: Oral and Maxillofacial Surgery, Beach Pavilion, Brooke Army Medical Center. Fort Sam Houston, TX 78234-6200. This is a US government work. There are no restrictions its use. 0278-2391190/4812-0018$0.00/O
FlGURE 1. Occlusal rim/final splint framework.
SPLINTS WITH LIGHT-CURED
Occlusal rim/final splint framework.
Trimming uncured resin.
finished in the usual fashion, with final contouring, placement of wire holes, and polishing, if desired. Discussion The fabrication of surgical splints has always been a critical step in the treatment of dentofacial deformities. It has, however, been a universally unpleasant and time-consuming process requiring the sureeon to manipulate toxic materials, with the attendant health risks. The Triad material is a visible-
Final occlusal index made from uncured resin.
ganic solvents and monomers, and the reduced fabrication time. The operator also experiences no unpleasant odors or the possible contact of skin with irritating substances. Curing of the resin is accomplished with visible light rather than with pressure and heat in a water bath; this eliminates the need for duplication of casts of the final model surgery before immersion in a pressure cooker. Because the material is very closely adapted to its final shape, finishing time is virtually eliminated. The finished splint has strength equal to that of heat-cured acrylics, and higher than that of self-curing materials. The dimensional stability of the material is excellent, assuring an accurate occlusal registration. In addition to the fabrication of surgical splints for orthognathic surgical cases, two other situations are much more easily and safely handled by this system. The first is in cases of mutilated occlusion and missing teeth, requiring the fabrication of an occlusion rim-type appliance with ridge saddles. This material allows fabrication of the occlusion rim for obtaining the bite registration, after which the same appliance is modified by the addition of material to construct the final splint (Fig 5). If an in-
terim registration is necessary for two jaw cases, this may be made quickly and simply as well. The second situation, which is even more easily addressed with the material described, is in the traumatized patient when impressions must be taken and splints fabricated for reduction of fractures. The impressions are obtained, and casts are prepared and sectioned in the usual manner to realign the dentition into an acceptable occlusion. The Triad material is then adapted to the casts, trimmed, cured, and finished. Summary The technique described in this article involves the use of a relatively new material that has reduced the time required for the production of a finished surgical splint to approximately 20 minutes (including the 1Zminute curing time of the material). It eliminates exposure to toxic materials, unpleasant odor, skin and mucous membrane irritation, and the myriad of additional time-consuming steps usually required for fabrication of conventional self- or heatcured acrylic resin splints. The system is inexpensive, compact , nonhazardous, and readily available.