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Dental Traumatology 2010; 26: 120–128; doi: 10.1111/j.1600-9657.2009.00860.

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An evaluation of the PeriotestÒ method as a tool for monitoring tooth mobility in dental traumatology
Christine Berthold1, Stefan Holst2, Johannes Schmitt2, Matthias Goellner2, Anselm Petschelt1
1 Dental Clinic 1 – Operative Dentistry and Periodontology; 2Dental Clinic 2 – Prosthodontics, Friedrich-Alexander-University, Erlangen, Germany

Correspondence to: Dr. Christine Berthold, Dental Clinic 1 – Operative Dentistry and Periodontology, Friedrich-AlexanderUniversity Erlangen-Nuremberg, Glueckstr.11, 91054 Erlangen, Germany Tel.: +49-9131-85 34638 Fax: +49-9131-85 33603 e-mail: berthold@dent.uni-erlangen.de; christine_berthold@yahoo.de Accepted 18 October, 2009

Abstract – Background/aim: The PeriotestÒ method is a technique for the objective assessment of tooth mobility. The aims of this study were to determine normal PeriotestÒ values in the vertical and horizontal dimensions of periodontally healthy teeth in individuals aged 20–35 years and investigate the reliability of PeriotestÒ in terms of intra-series and inter-series reproducibility before and after applying a dental trauma splint in vivo. Materials and methods: PeriotestÒ values were measured in periodontally healthy dental students (n = 33; mean age 24.7 years) at reproducible measuring points in the vertical and horizontal dimensions, before and after splint insertion. Three readings were taken per series to observe the intra-series reproducibility; three series were measured to test inter-series reproducibility (Friedman-test; P £ 0.001). Two different wire-composite splints, 0.45 mm Dentaflex and 0.8 · 1.8 Strengtheners, were inserted and the PeriotestÒ values were measured. Results: The median PeriotestÒ values before splinting were: canines -2.5, lateral incisors -0.9, and central incisors 0.0 for the vertical dimension, and canines 1.1, lateral incisors 3.2, and central incisors 3.6 for the horizontal dimension. The intra-series and inter-series PeriotestÒ values were highly reproducible. Conclusion: The PeriotestÒ method provides highly reproducible results. Focused on dental trauma, the method can be applied diagnostically during the splint and follow-up period and for evaluating splint rigidity.

Tooth mobility assessment is often applied as a diagnostic tool for clinical monitoring and follow-up, as well as for treatment outcome evaluation in periodontology, prosthodontics, implantology, orthodontics, and dental traumatology (1–8). Methods for measuring tooth mobility can be classified as subjective or objective. One subjective method was introduced by Miller; the tooth is deflected between two instrument handles (4) and the amplitude is described using a four-step index (9). This method is widely accepted and mainly applied in clinical routine because it is fast and easy to perform. The disadvantage is that reproducibility is inconsistent and is operator-dependent (9). Objective tooth mobility assessment is necessary. Some methods evaluate periodontal pulsation or tooth mobility free of contact (10, 11). However, most techniques are based on the principle of the direct application of a defined load for tooth deflection, which can be measured. Examples are periodontometry (12–14), the mobilometer (15), dental holographic interferometry (16, 17), laser vibrometry (18), the device developed by Persson and Sevensson (19) in which the deflecting force is generated by compressed air. These methods are time consuming and use complex technical equipment therefore, they are more applicable for scientific investigations than routine clinical use (20).
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An exception is the PeriotestÒ method (21, 22) which is a well established and accepted technique for measuring tooth mobility in vivo and in vitro in periodontology (6, 23, 24), implantology (25, 26), orthodontics (4, 8, 15) and dental traumatology (1, 2, 27–29). The advantages of the PeriotestÒ are easy application, the ability to measure both the horizontal and vertical dimensions, as well as reproducible results (2, 27, 30–32). The treatment of teeth with injuries to the periodontal ligament or root fractures should involve repositioning followed by splinting to facilitate the positioning of displaced teeth or fragments in their original location. Splints should ensure adequate fixation, prevent accidental ingestion or inhalation, and should protect teeth against traumatic forces during the vulnerable healing period (28, 33, 34). Splints should also allow the transmission of physiological load to injured teeth. Studies concerning splinting time and splint rigidity have shown that the application of physiological load to teeth that suffered dentoalveolar trauma leads to better healing results than long-term rigid tooth immobilization (35, 36). Modern tooth splinting is based predominantly on the principles of adhesive bonding using the acid etching technique (37) with resin composite alone (27, 38), as well as with different reinforcement wires (27, 28,

Ó 2010 The Authors. Journal compilation Ó 2010 John Wiley & Sons A/S

PeriotestÒ values before splinting (PTVpre) Before applying WCS1. whereas high values represent loose objects. Loerrach. 39). three series with a total of nine readings in the horizontal (PTV (h) pre S1) and vertical (PTV (v) pre S1) dimensions were measured. Germany). the measurements for each specific tooth took place at 15-min intervals. Germany) consists of a handpiece with a tapping rod inside. Bensheim. onto a dry surface using a waterproof pencil. 29. recessions. Three PeriotestÒ readings were taken in both. During the measuring procedure. 4 mm from the incisal edge) and a second hole. 39) or commercially available splinting systems (27. The second objective was to investigate the reliability of the PeriotestÒ (PTV v and PTV h) in terms of intra-series (within one measuring cycle) and interseries (between different measuring cycles) reproducibility before and after applying dental trauma splints. After the PeriotestÒ procedure the splints were removed using a hand scaler. The study was conducted on 33 dental students (13 males. Germany) was used to measure the vertical and horizontal mobility of all maxillary incisors and canines before splinting and for all incisors while the splint was in situ. Splint preparation and application The PeriotestÒ device (Gulden. dimensions for each tooth per series. A small amount of Tetric flowÒ chroma was applied to the bottom of each adhesive dot and the splint reattached to the tooth. The wires were cut to the desired length from the left to right lateral incisor and were extra-orally adjusted to the patient’s cast until they passively fit. no orthodontic treatment or anterior crowding at the time of investigation. The resin composite was again light-cured for 40 s. 24.0/120 mm. 20 females) with a mean age of 24. Splint rigidity can be influenced by the selected resin composite material.5 years). bleeding on probing. To ensure reproducible measuring points. were measured. Ó 2010 The Authors. 34. such as periodontally affected teeth or dental trauma (6. This study had two specific objectives. the type of reinforcement. tooth loosening. The prepared wire splints were bonded to the middle third of the labial surface using Tetric flowÒ chroma (Ivoclar Vivadent. A small hole on the labial aspect of all incisors (middle of the tooth.8 mm Denture Strengtheners (Dentaurum.7 years (range 19. Negative values represent maximal fixation. The second cast was used to prepare and passively adjust the wires before splinting. inside the device. no restorations or root canal treatment on maxillary incisors or canines.2 m s)1). Germany) for placing reproducible measuring points on the teeth. and the dimension of the adhesive points (15). Pfalzgrafenweiler. the previously prepared vacuum splint was used as a template to transfer the vertical and horizontal reading points. were made. 33). The two wire-composite splints (WCS) tested were prepared using 0. including a total of nine readings per tooth in the horizontal and vertical dimensions. Erkodent. PeriotestÒ values after splinting (PTVpost) Three series for WCS1 (PTVpost S1) and WCS2 (PTVpost S2). After this primary fixation. restorations. followed by the application of ElmexÒ fluid (GABA AG. All volunteers received written and oral information about the procedure and signed a consent form. Schaan. One cast was used to prepare a vacuum splint (Erkodur 1. only one series with a total of three readings in the horizontal (PTV (h) pre S2) and vertical (PTV (v) pre S2) dimensions was measured. Liechtenstein). The PeriotestÒ device (Gulden. Kettenbach. vertical and horizontal. for each tooth. The tooth surfaces were than cleaned with pumice and polished.8–36. the splint position. Our first objective was to determine normal PeriotestÒ values (PTV) in the vertical (v) and horizontal (h) dimensions of periodontally healthy teeth in individuals aged 20– 35 years. The teeth were scanned for enamel cracks. The tooth surface was again cleaned with alcohol and dried. the rod taps against the vestibular or occlusal surface of the tooth 16 times in 4 s (force 8 g. Modautal. Eschenburg. Pforzheim. Germany) for WCS1 and 0. All potential participants were asked about medical history and underwent a clinical examination (pocket depth. Measuring tooth mobility and splint effect The study design was approved by the Ethics Commission of the University of Erlangen-Nuremberg (#3673). The time elapsed between the beginning of each series was 15 min therefore. in the middle of the incisal edge. Germany) for WCS2. a maxillary dual-phase polyvinyl siloxane impression (PanasilÒ Binetics Putty and PanasilÒ contact plus. Germany) was taken and two casts made (GC FujiRock EP. the wire and the attached adhesive dots were removed using a hand scaler. no loosening or inflammation).8 · 1. and the investigation was carried out according to the Helsinki Declaration. and no signs or history of dental trauma. All readings were taken by the same experienced operator.Evaluation of the PeriotestÒ method in dental traumatology 33. The volunteers had to fulfill the following criteria: no periodontal disease (pocket depth < 3 mm.45 mm DentaflexÒ (Dentaurum. per the manufacturer’s instructions. After placing cotton rolls in the vestibule. velocity 0. Germany). Material and methods Volunteer selection 121 The maxillary incisors were cleaned using pumice with a rubber cup and the slurry was removed. no general health problems or medical contraindications. Journal compilation Ó 2010 John Wiley & Sons A/S . After the clinical examination. as in osseo-integrated implants or ankylosed teeth. converts it to a scaled number between -8 and 50. and endodontic treatment. and percussion – pain and sound). Before fixing WCS2. the teeth were rubbed with an alcohol soaked cotton pellet and air dried. sensibility. Pforzheim. Muenchen. The deflection time is measured and a computer.

001) was applied. the absence of the periodontal ligament could be considered a disadvantage. 28) human teeth. 20. 11. results. The form. The measurements were highly reproducible in the vertical and horizontal dimensions (Table 3).9–5. Significant differences between the three measurements per series were detected only for the canines (P £ 0. no significant differences were found (Table 4).122 Berthold et al. and crown-root relationship of sheep incisors are similar to those of human teeth.1 (range -2. 29.and inter-series reproducibility. Chicago.8) for the lateral incisors and 0. For evaluating intra.001). the potential for damage to the Ó 2010 The Authors. and 21 after inserting WCS1 and for tooth 22 after inserting WCS2. Descriptive statistics for the vertical and horizontal PTVpre showed a statistical spread (Table 1). and series 3 (t = 30 min) were averaged per series. however. Intra-series reproducibility of PTVpre The Friedman-test found that the three readings. 40) and orthodontic retainers (15.9). per series. the PTV per series was highly reproducible for the vertical and horizontal measurements for both WCS (Table 2). non-parametric tests were applied. The horizontal and vertical PTVpre and PTVpost were not normally distributed (Kolmokorov-Smirnow test. Tooth mobility can be easily manipulated by placing silicon rubber pieces between the root and alveolar socket but.001) was used. including 3564 values for PTVpre S1.001). all incisors showed highly reproducible There are various in vitro and in vivo models for evaluating tooth mobility or rigidity of dental trauma splints (27–29. and 2376 for PTVpost S1 and S2. PTVpre were used as a covariate for analyzing the splint effect. USA) for statistical analysis.7). 38. 40). The only exception was found for PTV (h) pre on tooth 21 as significant differences were detected between the series (P £ 0. with the exception of WCS2 on tooth 12. Journal compilation Ó 2010 John Wiley & Sons A/S . Slight differences were observed in the vertical dimension for teeth 12.0 (SPSS Inc. but they cannot accurately represent uninjured teeth. Inter-series reproducibility of PTVpost We recorded a total of 9504 values..0) for the central incisors.5 (range -5. in the vertical dimension were highly reproducible for all tested teeth (Table 1).2) for the lateral incisors. and the Friedman-test (P £ 0.8–10. Other possible disadvantages are the potential risk of prion transmission from Scrapie infected sheep and the extensive variability between the specimens.7–7. Another advantage is the ability to bond splints to human enamel. Intra-series reproducibility of PTVpost Statistical analysis Data were recorded using individually developed acquisition sheets and transferred to SPSS 14. Different in vivo studies have reported tooth mobility evaluations and trauma splint rigidity testing in human volunteers with uninjured (1. To compare the PeriotestÒ values before splinting with WCS1 and WCS2. Discussion Methodological factors Comparing vertical PTV before and after splinting showed a decrease in vertical tooth mobility after splinting.7) for the central incisors. In previous in vitro studies. 288 per individual.001).6 (range -0. in either dimension were detected. 15. however. There were significant differences between PTVpre and PTVpost for all teeth (P £ 0. Thus. series 2 (t = 15 min). Both inserted splints caused a significant change in lateral tooth mobility (P £ 0.2 (range -0.001). In vitro models include commercially available acrylic resin models (27). Sheep incisors are normally very loose and may simulate injured teeth well. 20). IL. size.001). the Friedman-test for paired samples (P £ 0. There were also slight differences observed on tooth 11 in the horizontal dimension after splinting with WCS1. The median PTVpre in the horizontal dimension for canines was 1. 1188 for PTVpre S2. Inter-series reproducibility of PTVpre The three PTV of series 1 (t = 0 min). P £ 0. The Wilcoxon test was also used for comparing PTVpre and PTVpost (P £ 0.8–11. The advantage of this approach is the presence of a periodontal ligament and natural enamel.0 (range -4.9 (range -4. and 3. 2. The main advantage is the presence of a periodontal ligament. -0. 31) or injured (1. providing normal or pathological tooth mobility. Individual custom-made models have also been introduced (15.001).001) was applied to compare series values. thus. dissected sheep mandibles were utilized to test splint rigidity (38). Results Mobility measurements After splinting. In the horizontal dimension. there were more considerable reductions detected in horizontal mobility (WCS1 < WCS2). the Wilcoxon test for paired samples (P £ 0. Horizontal PTVpre and PTVpost Compared to the changes in vertical mobility. Vertical PTVpre and PTVpost The inter-series reproducibility for PTVpost was lower in the vertical dimension than the horizontal. 3.5– 13. In the vertical dimension the median PTVpre for canines was -2. Comparison of PTVpre (h + v) for WCS1 and WCS2 Applying the Wilcoxon test to the comparison of PTV before the insertion of WCS1 and WCS2 no significant differences for all tested teeth.6–5.

7 )0.7 3.1 3.3 3.1 7.065 99 0.9 )0.3 2.401 33 0.3 2.9 2.0 )0.1 )0.1 6.2 2.0 3.8 0.5 3.5 )2.412 33 )0.1 7.3 4.5 )1.1 5.4 4.6 5.9 2.001 2 15.452 2 1.8 2.9 )5.0 6.9 )0.648 33 Evaluation of the PeriotestÒ method in dental traumatology The Chi-squared test was used to detect differences between M1.8 )4. Intra-series reproducibility of all three PeriotestÒ measurements (M) in the vertical and horizontal dimension before splinting with WCS1 or WCS2 Tooth 12 M3 )2.96 2.4 3.6 )4.3 )4.8 5.294 33 )1.1 9.8 )0.0 )4.0 3.889 2 0.9 6.7 3.8 5.176 99 2.526 )1.3 )2.729 33 )2.0 )4.1 )0.048 1.145 2 3.8 8.7 )0.8 )4.6 4.9 1.525 99 0.3 4.7 3.5 5.993 99 0.7 5. IQR Variance n P df v2 Median Min.4 10.4 2.9 2.8 2.1 3. 3.0 )0.578 0.7 2.3 3.134 33 0.332 99 3. Journal compilation Ó 2010 John Wiley & Sons A/S WCS 2 vertical )2.3 3.4 10.865 99 0.9 5.6 )4.2 )4.820 99 3.297 3.4 2.3 3.231 33 )2.8 3.6 2.9 5.713 3.6 3.7 )4.2 2.7 11.095 3.1 )0.3 8.1 2.258 2 2.3 )2.0 3.8 8.1 )4.2 3.8 5.3 2.1 )4.0 3.362 33 3.2 2.0 2.0 )4.423 99 WCS 1 horizontal 1.0 2.869 1.4 2.Table 1. Max.8 4.793 99 <0.1 2.9 3.319 3.6 )2.4 11.452 3.001 33 0.7 2.6 7.226 )0.8 5.6 )4.9 2.363 2 2.4 3. Max.9 3.2 6.8 )0.5 7.3 2.036 99 0.211 99 0.9 3.9 3.8 2.0 5.3 4.3 5.8 )5.370 0.0 3.7 7.4 2.169 33 0.6 5.8 2.224 2 2.6 4.8 )4.7 2.6 0.8 2.780 99 0.762 99 Tooth 11 Tooth 21 Tooth 22 Tooth 23 Tooth 13 M1 M2 WCS 1 vertical )2.6 4.6 8.5 )2.3 2.001 2 16.2 5.5 5.2 4.1 )4.9 )0.306 2 2.7 )3.5 )4.068 2 5.8 5.4 4.5 13.4 3.6 5.708 99 0.378 3.542 2 1.8 9.8 2.0 7.661 33 )0.2 2.0 2.6 3.041 99 )2.0 )0.1 2.3 7.273 33 0.3 )4.3 )5.814 )2.904 99 Ó 2010 The Authors.7 11.586 33 0.4 3.8 )2.976 2 0.9 3.465 99 0.590 0.8 5.3 5..1 12.2 2.1 3.0 5.4 3.5 9.1 )0.1 )2.9 2.324 99 )1.3 11.6 4.8 10.6 2.6 2.752 0.335 33 )0.6 )2.238 2 2.7 )4.107 0.9 4.5 )5.028 99 3. Max. Max.5 6.5 7.253 2 0.5 2.0 )0.4 10.3 5.1 )0.4 3.4 )5.5 )5.4 4.116 99 <0.5 4.1 3.8 5.278 99 0.0 2.4 12.9 2.1 11.228 33 )1.1 10.5 6.9 2.387 99 3.2 5.7 2. IQR Variance n P dF v2 Median Min.0 )5.8 2.670 99 0.1 3.8 3.6 5.797 99 0.178 33 0.1 8.8 5.0 5.1 )0.6 )2.1 4.2 2.3 3.1 )5.2 2.213 2 3.864 0.041 99 3.842 2 0.6 7.8 9.2 3.879 33 0.1 )0.8 3.3 4.001 2 32. IQR Variance n P df v2 Median Min.030 2 6.320 33 3.2 )4.4 4.968 33 <0.790 99 M1 M2 M3 M1 M2 M3 M1 M2 M3 M1 M2 M3 M1 M2 M3 )2.912 33 0.7 5.990 99 )0.3 4.7 3.3 2.255 99 )1.6 4.0 3.239 33 0.743 33 WCS 2 horizontal Median Min.1 9.6 )4.5 7.484 2 1.371 33 )2.2 3.386 )0.3 2.104 2 4.4 5.6 2.413 99 0.2 5.0 )0.3 )5.1 4.6 4.2 5.020 33 2.852 99 3.7 5.2 11.993 33 0. 2.1 3.8 3.219 33 0.8 2.988 33 )1.7 2.6 )2.0 7.443 99 3.7 6.312 )2.3 )5.303 2 2.1 5.7 6.992 2.7 3.338 33 3.575 2 1.0 3.344 1.341 33 2.2 3.4 )2.712 99 0. M2 und M3 123 .028 )0.2 )4.853 2 0.6 7.3 3.9 3.8 6.5 )5.808 33 3.4 )5.795 33 0.574 99 0.872 99 1. IQR Variance n P df v2 1.5 4.7 3.862 2 0.1 3.7 3.5 7.4 5.3 4.815 33 )1.6 6.234 )2.254 99 )0.086 33 )3.175 33 3.6 7.5 )4.9 2.8 0.837 33 2.0 )0.1 2.4 5.992 3.4 12.4 2.372 99 0.2 5.0 5.9 5.659 33 0 )4.9 5.

8 1.3 2.268 99 0.586 99 1. however.3 6.6 )2.6 2.3 )2. aged 20–35 years.0 3.598 2 1.7 6.5 3.5 2. it is essential that single values are insignificant.8 )3.794 2 0.4 3.8 3.810 99 0.4 )3.0 3.2 )8.1 1.425 M2 )1.0 3.771 99 2. In our investigation.170 2.2 2.2 4.7 2. we selected two types of WCS with different rigidity characteristics (27). we use the PeriotestÒmethod as a standard procedure in all dental trauma cases as well as an extra diagnostic tool in endodontic cases.9 1.557 2 1.9 2. For both dimensions.302 99 0.1 2.5 5.7 )2.5 8.5 4.5 4.2 2. further studies have to be conducted on this topic.109 1.8 )4.9 5.4 )0.2 2.229 1.1 7.694 99 0.9 3.4 7.0 2.2 2.892 99 0. There is no prospective study published that proves this fact.241 99 )2.968 99 Tooth 21 M1 )0. We have found that the vertical PeriotestÒ values respond earlier and more sensitive to pathological changes than the horizontal measurements.0 )5.4 2.2 2.6 )5. In the case of flexible splinting.3 1.9 )5.9 2.111 99 0.4 4.9 2.4 2.773 1. Max.4 2.1 2.0 1.4 )0. the PeriotestÒ values in both dimension decrease from the time of injury over a certain period to physiological values when healing without complication occurs.809 99 )1.6 5.9 3.7 )5.7 )2.033 99 WCS 1 horizontal 2. Beside the commonly used horizontal measurements.6 )5. we selected volunteering dental students.6 0.8 )5. Table 2.6 2.934 99 1.3 6. Reduced or negative vertical values are often an early indicator for ankylosis which can be transient (PTV increase after 2–6 weeks again) or permanent (PTV remain reduced or decrase further). beside other diagnostic methods.8 1.947 2 0.048 )1.5 3. For our investigation. M2 und M3.1 )1.4 )4.6 4.525 99 1.529 99 )1.849 99 0.2 )4. Max.6 )2.3 2.796 99 1.613 99 M3 )1.018 2 8.127 99 M3 )0. IQR Variance n P df v2 Median Min.357 99 M3 )0.6 2. Further investigations need to focus on vertical PTV in this age group.6 5.6 2.8 2.955 99 2.176 99 WCS 2 vertical )1.4 1.5 )5.747 99 )1.1 2. Max.954 99 1.5 1.1 3.3 8.008 99 0.192 2 3.251 99 0.855 99 Tooth 11 M1 )0.5 1.6 )2.1 1. Normally.4 8.218 2 3. provide valuable information about the tooth condition.7 4.5 )5.856 M2 )1.1 2.5 3.5 2.377 99 The Chi-squared test was used to detect differences between M1.3 )5.2 6.7 2.4 9.792 99 WCS 2 horizontal 2.8 2.7 3. to investigate the reproducibility of the PeriotestÒ method before and after insertion of different dental trauma splints.980 99 0.417 99 Tooth 22 M1 )1.2 3.395 2 1.3 3.8 )4.2 )1.3 4.305 2.325 99 )1.2 3.417 99 2.8 4.426 99 0.097 99 0.7 )0.0 2.7 4. the decrease of the horizontal PTV follows delayed (42).0 3.8 2.258 99 0.2 )1.624 )1.3 )4.892 2 0.6 4.7 2.1 4.1 1.7 2.1 2.5 6.655 99 1.6 1. IQR Variance n P df v2 Median Min.462 M2 )0.222 99 )1.4 4.183 2 3.738 99 0. (2) and Mackie et al.3 2.4 2.7 )5.7 2. Max. we focused also on the vertical dimension because in our prospective the vertical PeriotestÒ values are more meaningful for assessing and interpreting the healing process.9 2.4 3.5 2. enamel during splint removal and the absence of traumatically loosened teeth can be considered a disadvantage.1 3.6 2.7 5.4 2.4 )1.1 7.7 2.1 9.250 2 2. In our clinic.9 0.5 4. IQR Variance n P df v2 )1.381 99 0.5 4. The flexible Ó 2010 The Authors.3 3.1 2.1 2.2 6. IQR Variance n P df v2 Median Min.3 )4.3 )2.7 )2.902 99 0.9 2. The majority of dentoalveolar injuries happen in the period between 8 and 12 years (41).403 )1.1 8.6 3.3 )1.0 3.9 4.4 2.5 )0.473 99 M3 )1.6 7.7 4.806 M2 )0.6 )5.064 2.8 2.182 2 3.0 3.401 )1.0 1.6 2.6 )5.5 2.5 5.1 8.3 )5.124 Berthold et al.9 )5.2 2. Intra-series reproducibility of all three PeriotestÒ measurements (M) in the vertical and horizontal dimension after splinting with WCS1 or WCS2 Tooth 12 M1 WCS 1 vertical Median Min.405 2 1.7 1. (31) measured physiological horizontal PeriotestÒ values and tested the method’s reliability in the age group 8–16 years.5 1.750 99 1. Increased vertical values.7 )4. the horizontal values can be used to help decision-making about the timing of splint removal.121 99 1.5 3.5 2.4 2.732 2 0.8 2.3 )1.8 6.120 2 4.0 2.0 2.279 99 0.7 3.7 3.3 )4.180 2 3.5 4.9 3.1 2. Andresen et al.4 4. compared to the reference tooth.661 99 )1.2 )5.245 1.3 2.029 0.3 )4. values taken at different appointments over the healing period can.1 3.4 2.394 99 0.834 99 2.2 2.3 )2. after completion of periodontal and osseous healing.2 3. can be an indicator for apical breakdown. Journal compilation Ó 2010 John Wiley & Sons A/S .8 1.

597 1.277 99 2.0 2.2 5.4 10.9 3.6 )4.6 )2.7 1.600 99 3.357 99 0.7 4.3 12.0 7.887 99 0.478 99 <0.150 0.9 )0.6 7.Table 3.538 99 0.1 5.2 9.4 )2.1 3.3 )2.480 0.4 5.6 5.084 99 )0.9 3.4 5.5 12.2 )0.2 7.131 99 )0.318 2 2.876 3.5 5.6 4.2 6.405 2 1.351 0.3 4.7 3.9 )0.429 0.566 99 0.6 3.9 3.3 3.1 3.3 )4.255 99 0.3 6.154 2 3.290 2 2.5 5.391 99 )1.7 )0.0 2.320 99 3.884 99 )0.0 )0.9 2.2 )4.742 99 0.2 3.4 )4.5 5.9 2.246 99 Tooth 13 S1 S2 WCS 1 vertical )2.5 8.4 5.001 2 15.9 6.014 2 8.5 7.3 10.8 3.0 5.4 )4.7 3.0 3.391 2 1.4 2.1 5.8 4.1 11.5 3.1 0.1 )4.3 7.3 2.743 99 0.7 )2.4 13.9 7.2 3.717 99 0.9 7.5 4.9 )4.7 2.6 )5.3 4.295 99 2.685 2 0.9 2.314 99 0.8 3.9 3.8 2. Max.1 5.6 2.928 2 0.7 5.217 99 Ó 2010 The Authors.6 3.758 3.1 )0.4 2.6 10.0 11.5 7.745 3.8 9.7 9.538 99 )0.8 2.489 2 1.2 4.3 2. Inter-series reproducibility of the three serials (S) of the vertical and horizontal PeriotestÒ values before splinting with WCS1 Tooth 12 S3 )2.7 5.7 3.9 )0.2 2.7 2.9 3.903 99 0.898 99 )2.8 5.862 1.3 )5.120 99 3.1 2.3 2.291 2.1 )0.375 99 3.0 3.7 5.8 )4. Journal compilation Ó 2010 John Wiley & Sons A/S WCS 1 horizontal Median Min.4 )4.3 )4.8 2. IQR Variance n P df v2 Median Min.289 99 0.7 )0.131 99 Evaluation of the PeriotestÒ method in dental traumatology The Chi-squared test was used to detect differences between S1.5 4.278 99 S3 )2.4 3.5 5.808 3.0 4.279 99 0.4 )4.025 2 7.0 0.0 3.1 3.244 99 )1.6 )5.639 99 0.356 99 Tooth 11 Tooth 21 Tooth 22 Tooth 23 S1 S2 )2.4 8.5 )5.9 )0.5 4.7 2.9 2.650 2 0.8 3.2 )4. IQR Variance n P df v2 1.0 3.1 4.3 4. Max.345 99 S1 S2 S3 S1 S2 S3 S1 S2 S3 S1 S2 S3 )0.0 )4.3 9.3 )5.5 )2.9 2.9 3.2 5.7 3.8 3. S2 und S3 125 .8 4.7 3.085 99 3.767 99 0.476 )0.8 5.5 )2.664 99 )2.

644 99 0.4 5. No loosening or de-bonding was found in any cases.112 99 M3 )0.7 0.6 3.2 3.2 2. Inter-series reproducibility of the three serials (S) of the vertical and horizontal PeriotestÒ values after splinting with WCS1 or WCS2 Tooth 12 M1 WCS 1 vertical Median Min.6 4. and splint removal was easy without visible damage to the enamel. Max.743 99 0.0 2.654 99 1.021 99 )1.5 8.3 3.812 )1.0 4.6 6.3 6.527 99 M3 )1.691 2 0.7 )5.526 2. Max.8 1.2 3.0 2.6 2.491 99 0. one promising method was further tested in vivo.7 3.4 1.7 )1.586 99 0.0 )5. dye was applied around the fixing points.076 2 5.9 5. Table 4.554 99 1.5 5.389 99 0.4 )0.5 2.0 )4. 38). Concerning the possible tooth damage while removing WCS attached using the conventional acid etching technique.7 )3. 34.200 99 0.945 2 0.966 99 WCS 1 horizontal 2. after an injury. IQR Variance n P df v2 Median Min.771 99 0.2 9.4 )4.2 3.0 1. Journal compilation Ó 2010 John Wiley & Sons A/S . The advantage of WCS is that the required materials are inexpensive and usually available in dental offices (29.1 8.042 2 6.7 )2.0 2. impressions were taken from each volunteer to prepare the vacuum splint as template. Max.536 99 Tooth 11 M1 )0.659 2 0.270 99 Tooth 21 M1 )0.7 2.9 3. Instead.608 99 0.738 0.8 )4.4 4.053 2 5.778 99 )1.5 )0.609 99 2.7 3.5 )8.6 3. Max.1 2.126 Berthold et al.664 2 0.5 4.6 6.5 2.1 2.3 2.7 2.701 99 )2.112 99 )1.2 4.1 7.4 2. IQR Variance n P df v2 )1.3 4.833 M2 )1.4 2.5 2. in this investigation.6 )5. IQR Variance n P df v2 Median Min.388 M2 )0.0 2.9 2.2 2.433 2 1.4 3.025 99 2.2 )4.0 4.7 2.1 2.2 2.238 2 2.5 4.1 2.6 3. 39).8 4.9 3.4 2.380 99 1.5 1.2 )1.7 2.096 2 4.3 2.1 4. To reveal possible de-bonding or to detect gaps between the tooth surface and the resin composite after the PeriotestÒ procedure.5 3.666 2 0.3 6.5 3.9 2.8 3.1 1.7 5. fulfill most of the demands of splinting after dental trauma (27–29.870 99 0.6 2.4 2.874 M2 )1.229 99 2.2 1.812 99 1.6 1. at the first Ó 2010 The Authors.4 )1.4 3.643 99 1.7 )2.235 99 1.7 2.530 99 0.2 3.2 2.011 2 9.3 )4.8 )0.5 6.3 8.2 4.3 2.5 4.8 0.3 )2.0 7.672 )1.3 3.2 )1. as well as the titanium ring splint (TRS) and titanium trauma splint (TTS).991 99 M3 )1. Semi-rigid or rigid splinting is applied after alveolar process fractures or in cervical root fractures when flexible splinting is not stable enough (33). Because of the finding of these experiments.2 )5.0 4.1 )0.4 1. In the clinical situation.4 )0.7 )2.0 2.2 1.8 )4.050 99 0.5 2.9 )5.2 8.7 2.112 )1.8 3.0 3.341 1.7 6.5 2. this technique was selected for splint application in the main study.2 2. Both splint types were applied using this technique and 20 PeriotestÒ measurements were taken in the vertical and horizontal dimensions to determine the bonding ability under test conditions.9 2.8 2.218 1.999 99 Tooth 22 M1 )1.880 1.839 99 1.2 6.1 2.0 2. To mark reproducible measuring points.927 99 1.7 )2.0 2.2 )4.069 99 The Chi-squared test was used to detect differences between S1.3 1.3 )4.037 99 0.0 2.3 8.3 2.577 99 2.6 5.679 1.806 99 WCS 2 horizontal 2.0 2.109 )1.8 2.5 1.6 2.8 4.6 )5.5 4.5 3. compared to the acid etch technique.097 2.2 1.4 )5. IQR Variance n P df v2 Median Min.7 1.2 3.6 )1.1 2.6 3.0 2.3 )5.027 2 7.1 2.991 99 0.6 3.758 99 )1.793 99 WCS 2 vertical )1.017 2 8. Wirecomposite splints.736 99 0.039 99 0.6 )5.5 )4.4 2.184 2 3.2 2.820 M2 0.1 2.936 99 )1.7 )5.595 99 )1.6 2. 44). The preliminary results as well as the results of the main study proved that the splints were securely attached to all supporting teeth over the whole test period.9 2.4 )4. it is not recommended to take impressions or PeriotestÒ readings of the injured area to avoid further traumatization.9 2.3 )2. Therefore.3 2.1 )4.7 3.572 99 M3 )1.0 )1.8 2.2 2.5 1.9 2. Different potential bonding materials and techniques were tested in vitro on bovine deciduous teeth using the shear bond strength test.2 6.5 1.2 1.2 )3.2 2.003 2 11.093 99 0.9 4.1 )5.1 )1.146 2. preliminary experiments were conducted to find a bonding technique that guarantees secure attachment during the measurement process with concomitant easy removal without damage.6 )5.4 9.4 2. S2 und S3 splint is indicated in all injuries involving the periodontal ligament and in cases with intra-alveolar root fractures (43. These findings lead to the presumption that the splint mechanics should not be influenced by this bonding technique.4 2.0 2.0 2.3 )5.668 99 0.0 2.1 )1.918 99 0.

however. and tooth development explains the lower PTV found in our study. A second factor could be that all PeriotestÒ measurements were made by the same experienced operator to reduce interexaminer variability. Chai et al. To reduce variability. only one series with three measurements was taken for PTVpre WCS2 to reduce volunteers’ inconvenience. Mackie I. Van Steenberghe et al. showed a significant reduction of tooth mobility after splint application. References 1. Clinically. The Periotest in traumatology. (2) and Mackie et al. all splints were applied by the same operator. Galgut PN. irrespective of the splint type. Considering these factors. Eur J Orthod 2000. Acknowledgements We thank A. Less reproducible results were found for PTV (h) pre with both canines. This timing may positively influence reproducibility. Part I. in addition to the features of the PeriotestÒ device. We observed that the reduction was higher in the horizontal dimension than the vertical.Evaluation of the PeriotestÒ method in dental traumatology appointment. Levander E. WCS1 was also found to be more flexible than WCS2 (27). and the uninjured contralateral tooth should always serve as a reference. A comparison of diagnostic screening data derived from general dental practitioners and periodontists used for initial treatment planning in periodontitis patients. Calabrese N. physiological tooth mobility should be expressed as a PTV range. whereas Mackie et al. Stefenelli of Statistical Data Services. We found that WCS1 caused less tooth mobility reduction compared to WCS2. three PeriotestÒ readings were taken without pausing between the measurements. whereas we focused on individuals aged 20–23 years. Rupp.9:106–11. Worthington H. Andresen et al. Wuerzburg for the statistical analysis. in this study. Special attention was paid to ensure similar attachment point dimensions and splint localization. the second series was measured after 15 min. Andresen M. Baumert. but the mean PTV (h) pre in our study was considerably lower. Because of the high inter-individual variability. The Periotest in traumatology. Statistical analysis revealed considerable intra-series reproducibility for PTVpre and PTVpost. The more convex surface of these teeth compared to the almost flat surface of the incisors complicates the PeriotestÒ measurement. rather than a value. 27. The difference in bone structure. high inter-individual variabilities for PTV (v) pre and PTV (h) pre were found. (2) found similar results.19:214–7. Mackie I. This discrepancy can be explained by differences in the significance levels used in both studies. Dent Traumatol 2003. who found significant differences between the first and second readings. J Int Acad Periodontol 2007. Splint rigidity can be influenced by the attachment point extension (15). (31) waited for 10 min and Andresen et al. The high reproducibility could be explained by. They investigated a group of children aged 8–12 years. the utilization of reproducible measuring points. Another factor is the experimental design. Malmgren O. periodontal ligament. and the time between measurements. U. The comparison of PTVpre and PTVpost. the PeriotestÒ can be applied as a sensitive and reliable diagnostic tool during the splinting and the follow-up period to receive additional information during and after the healing process. which could be explained by the higher PTV (h) pre compared to PTV (v) pre. This finding corresponds with the results of other studies (15.19:218–20. Part II. In our study. (31). E. Andresen M. These differences may be caused by a lack of reproducible measuring points. Focusing on dental trauma. 3. Worthington H. and S. Study outcome 127 Within the test group. Future investigations will focus on this factor. Sney for preparing the vacuum and wire-composite-splints. The results could be positively influenced by the fact that the measurements were performed by a single examiner along with the use of reproducible measuring points. We also found high inter-series reproducibility. Similar to intra-series reproducibility. (32) found acceptable inter-series reproducibility resulting in slight differences with five measurements taken over a 24-h period. Does it have the properties necessary for use as a clinical device and can the measurements be interpreted?. the measurement of the uninjured contralateral tooth is recommended to determine the comparative physiological PTVpre. (45) found no inter-examiner differences. In dental trauma cases.22:85–92. In previous in vitro studies. The Periotest as a special test for assessing the periodontal status of teeth in children that have suffered trauma. Because the comparison between the PTVpre of WCS1 and WCS2 revealed no significant differences. We would also like to acknowledge U. Long-term follow-up of maxillary incisors with severe apical root resorption. 29). a future study will aim to investigate the influence of operator experience. the second series would be measured during the first recall after 1 or 2 weeks. the position of the measuring points significantly influenced the results. In an in vitro study. 2. Dent Traumatol 2003. Journal compilation Ó 2010 John Wiley & Sons A/S . 4. we form an individual key covering the palatal tooth surface and part of the labial surface up to the splint wire using polyvinyl siloxane putty impression material. Doerr. (2) paused for 5–60 min between the measurements. Ó 2010 The Authors. the use of defined measuring points and the operator’s experience can be positive influence factors. It seems reasonable to express the physiological PTV for each tooth group as range. Conclusion This in vivo study indicates that the PeriotestÒ method provides highly reproducible results for PTVpre and PTVpost measurements in the vertical and horizontal dimensions in adult test persons. These differences were expected because of the different material properties of the selected wires. This replaceable mould can be utilized during further appointments to place reproducible measuring points. the marking of defined measuring points. These findings are in contrast to reports from Andresen et al.

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