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Prosthodontic stents
Chapter · March 2019
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Mohammed M Fouad
Faculty of Dentistry, Mansoura University, Al Mansourah, Egypt
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CHAPTER: 2
STENTS
BY
Mohammed M Fouad
Professor of Prosthodontics
Faculty of Dentistry
Mansoura University
2019
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01
INTRODUCTION
Definition:
Stents are appliances constructed to cover the tissues and/or the teeth
for their protection; to carry medicaments and/or radium material; to
control bleeding or to determine radiographically the prospective site of
dental implant and guide its placement.
Uses:
1.For determining the best prospective site for dental implant
placement (radiographic diagnostic template).
2.For guiding the insertion of dental implants (surgical guide template).
3.Protect the tissues after skin and mucosal grafts.
4.keep skin and mucosal grafts in place until their revascularization.
5.Prevent contamination of the wounds and promote healing through
stimulation of underlying tissues.
6.Preserve the depth of the vestibules after vestibuloplasty and ridge
augmentation.
7.Help to control bleeding, especially in hemophiliacs.
8.Protect teeth and associated structures in contact sports.
9.Carry and keep fluoride, bleaching materials, medicaments and
surgical packs.
10.Carry and keep radium materials in place for treatment of
malignancy.
Materials used:
1.Acrylic resin: Whether heat-curing or self-curing resins, they may be
lined with soft materials.
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2.Soft materials: Soft rubber or soft resins are used for special
purposes. It can also be fabricated from silicon vinyl rubber but an
additional reinforcement of resin is usually required.
3.Modeling plastic and silicone: In emergency cases where there is no
time to construct a stent, these materials may be used directly in the
oral cavity on the bleeding area.
Types of stents:
I-INTRA ORAL STENTS:
1.Stents for dental implantation.
2.Surgical stents used after removal of exostosis.
3.Surgical stents used in conjunction with Vestibuloplasty.
4.Stent for epulis fissuratum.
5.Stent for resected maxilla.
6.Palatal stent.
7.Antihaemorrhagic stents.
8.Cyst plugs.
9.Drainage stent
1.Occlusal stent.
2.Periodontal stent.
3.For lip and check support.
4.Pedodontic stents.
5.Mouth guard.
6.Oral screen.
7.Fluoride Carrier.
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8.Medicament Carrier.
9.Paraplegic stents.
10.Trismus appliances.
11.Radiotherapy stents.
II-EXTRAORAL STENTS:
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I-Intra oral stents
Surgical stents:
1)Stents for dental implant placement.
Use of radiographic stent (during treatment planning to locate the
optimal prospective implant site) and surgical stent (for implant
placement into the predetermined site) in conjunction with dental CT
scan can play an important role in ideal placement of implant as
determined by favourable design of the definitive restoration.
THREE TYPES OF STENTS CAN BE USED FOR ENDOSSEOUS
DENTAL IMPLANTATION:
1.Radiographic diagnostic stent.
2.Lab. constructed surgical guide template (Positioning stent).
3.CAD/CAM constructed surgical guide template (steriolethographic or
cone-beam stent).
1)Types of stents used for dental implant placement.
1.Radiographic diagnostic stent: A clear acrylic template constructed
on a stone model of the patient (or a clear duplicate of denture)
Radiographic Stent. CBCT using the radiographic stent.
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with radiopaque marks in different locations of the fitting surface to be used as a
guide for radiographic determination of the best prospective sites for dental
implants.
2.LAB. CONSTRUCTED SURGICAL GUIDE TEMPLATE (POSITIONING STENT):
A clear acrylic surgical template constructed on a stone model of the patient (or a
clear duplicate of denture) with tubing in the predetermined sites for guiding the
surgical drills during osteotomy and insertion of dental implants.
Surgical guide template for completely edentulous mandible
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Surgical guide template for partially edentulous mandible
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3.CAD/CAM CONSTRUCTED SURGICAL GUIDE TEMPLATE
(STERIOLETHOGRAPHIC OR CONE-BEAM STENT):
A stent constructed according to the cone-beam computed tomography
(CBCT) using CAD/CAM technique and milling machine. It is used for
guiding the surgical drills (during osteotomy) and dental implant (with a
definite length, width and inclination) during insertion into the
predetermined site. This type of stent enables the dental team to
identify specific sites of prospective implant surgery and hence
determines the optimal position and angulation of implant relative to
occlusal load. Thus the surgeon can avoid undesirable implant site
preparation and minimize unnecessary osteotomy, resulting in
favorable design of prosthesis, reduced surgical trauma, reduced
surgical time and increased patient comfort.
Steriolethographic surgical template
Surgical palatal stents used after removal of exostosis :
•
Simple acrylic plate covering the palate after surgery to:
1)Facilitates heamostasis,
2)Protects the healing of raw surface, and
3)Apply pressure to soft tissue to facilitate healing and prevent
collapse.
•
It is constructed before surgery on modified maxillary cast.
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Torus palatinus Palatal stent in place after surgery
Surgical stents used in conjunction with vestibuloplasty
and ridge augmentation procedures:
Surgical stents used in conjunction with Vestibuloplasty (surgical
deepening of the mucobuccal vestibule) and for holding mucous
membrane and skin grafts.
This stent is also used with ridge augmentation procedures to maintain
the ridge height.
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Surgical stent to be used after Surgical stent in place after
vestibuloplasty and ridge vestibuloplasty and ridge
augmentation augmentation
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Ridge augmentation
Antihaemorrhagic stents:
A partial acrylic plate used to control bleeding by applying gentle
pressure to the extraction wound.
Constructed in clear acrylic resin with suitable relief to accommodate
the haemostatic agent.
Clear resin makes inspection and detection of pressure spots easy.
Lining with soft resin is advised.
Before surgery, the impressions are made and the casts are mounted.
The tooth to be extracted is removed from the stone cast. A layer of
molding wax is then adapted on the cast to cover the buccal and
lingual surfaces and the top of the ridge. The articulator is then closed
to allow the opposing teeth to touch the top of the wax. Process the
wax in clear heat or cold cure resin.
The stent is inserted immediately after extraction.
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Bleeding is controlled as the patient closes and applies gentle pressure
over the extraction site.
In hemophiliacs no pressure should be applied. They are designed
only to protect the socket and blood clot from the tongue and to hold a
hemostatic dressing in place.
It can be left in the mouth for a week or even more if needed.
Stent for epulis fissuratum:
Acrylic base used to prevent obliteration of the sulcus after removal of
epulis fissuratum.
Primary alginate impression to make diagnostic cast before surgery,
remove the epulis fissuratum from the cast and acrylic plate is made
on the modified cast to the proper sulcus depth.
After surgery, tissue conditioner is applied to the stent till healing
occurs.
If old denture present it may be used as a stent after modification of its
border.
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Stent for resected maxilla (immediate surgical obturator):
Functions:
Carry medications and dressing to the surgical site.
Carry skin graft to the surgical site (compound used on the stent to
support the skin graft)
Restore normal palatal contour and allow the patient to speak and
swallow normally.
Improve patient psychology
Constructed as immediate surgical obturator.
Immediate surgical obturator Immediate surgical obturator in place
after surgery
Cyst plugs:
It is constructed to fit the neck of the cyst cavity and prevent its healing
before the main body of the cyst is completely healed.
The cyst is plugged with gauze or wet cotton wool leaving the neck part
of the cavity free. Impressions are made and a cast is produced with a
small depression representing the cyst neck.
If the patient is wearing a denture then plug the cavity with compound
and attach it to the denture. The plug is replaced by acrylic.
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The plug should have a labial and buccal flange with an acrylic
projection in the cyst cavity but not to the full depth.
Gradual reduction from the depth of the acrylic plug until it is almost
removed entirely as the cyst cavity will be decreasing in size.
Drainage stent:
An acrylic plate used to allow the escape of blood or other tissue fluids
from chronic periapical lesions with a fistula.
An impression is made and the fistula is reproduced and marked on
the stone cast. A polyethylene tube is inserted in the hole and the
labial aspect of the cast is covered with two layers of base plate wax.
Then the stent is processed with clear acrylic resin and cured in
conjunction with the polyethylene tube and polished. This type can be
constituted in an existing partial or complete denture by modifying the
prosthesis.
Drainage stent
Pedodontic stents:
Acrylic stents constructed and inserted in the mouth to:
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•
Prevent the healing of surgically uncovered teeth to facilitate its
eruption.
•
Act as space maintainers.
•
Hold the luxated teeth.
Periodontal stent:
Acrylic stent constructed to:
•
Hold the periodontal dressing in
place during the healing phase.
•
Cover exposed roots after
gingivectomy (Cosmetic and
protective).
•
Cover exposed parts of dental
implants supporting fixed bridges.
Periodontal stent
Occlusal stent (Occlusal bite plate):
A removable artificial occlusal surface used to adjust occlusal
discrepancies through:
1.Elimination of occlusal interferences.
2.Minimizing of the effect of bruxism and clenching on teeth (wearing).
3.Guiding the mandible into retruded position for treatment of T.M.J
disorders.
Impression of both jaws are made and poured. Interocclusal records
for proper mounting of casts on an articulator. The articulator is opened
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slightly and the upper or lower model is used for waxing a base plate,
which extends to occlusal surface.
Hard acrylic or soft rubber material may be used.
1.Smooth flat occlusal surface for relaxation of TMJ and allowing
contact of all opposing teeth.
2.Indentation and/or ramps for mandibular repositioning device.
3.Soft device is more comfortable to patient with bruxism or clenching
to distribute the pressure equally.
Occlusal stent (Occlusal bite plate)
Mouth guard (mouth protector):
A resilient intra-oral device that is constructed to reduce mouth injury
and protect the teeth and surrounding structures from injury.
These stents are widely used for protection of dental and alveolar
structures:
1)During contact sports as boxing to help in minimizing the effect of
blows that may cause fracture of teeth and or jaw.
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2)Maxillary anterior fixed prosthesis or crowns are present and surgery
under general anesthesia considered.
3)Periodontal pack need to be placed more securely.
The stents are made of elastic materials that are fitted to the upper
arch. The material covering the occlusal surface should be about 3-4
mm to be able to absorb the impact.
There are three types and different methods for construction of these
appliances:
1-Stock type:
They are marketed in different sizes.
This type has many disadvantages:
i.Ill-fitting and looseness during use.
Ii.Interferes with speech and breathing.
Iii.The mouth should be closed to keep it in position.
Iv.It is thick on the occlusal surface.
2-Constructed directly in the mouth:
Preformed tray like stents used in conjunction with self-curing acrylic
resin to give better fit. The soft acrylic is mixed and the stent filled then
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pressed in the player’s mouth. After polymerization the stent is
removed from the mouth and the excess is trimmed by sharp scissors.
Stock type mouth guard Constructed directly in the mouth
3-Custom made:
Impressions that should be made for every player. The stent is
constructed on the casts. Wide variety of materials can be used. Soft
curing material is used. The material is applied by a brush in layers.
Silicone sheets are adapted to the cast by using vacuum machine and
the excess is trimmed by sharp scissors.
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Custom made mouth guard
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Oral screen:
1.Stimulate proper nasal breathing as a major function.
2.Control finger and thumb sucking.
3.Control lip biting.
4.Be considered as an orthodontic appliance for protrusive upper
incisor teeth through the pressure applied.
laterally and by the teeth medially.
Impression is made including all tissues to the buccal fold. The models
should be articulated according to the patient’s centric occlusion. Wax
is then adhered to the models on the labial and buccal surfaces in
double thickness, so that it extends well to thelimits of buccal fold with
freeing frena and any muscle attachments. The screen is then
processed in clear acrylic.
Oral screen
Fluoride carrier and bleaching stent:
A custom-made stent for applying fluoride gel.
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It is fabricated in much the same manner as the mouth protector,
except that the teeth are covered with a layer of tin foil to allow for a
reservoir of fluoride.
Fluoride Carrier
Medicament Carrier:
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This acrylic stent is designed to maintain therapeutic pastes in contact
with the oral mucosa. It may be adapted for use with chemotherapy or
in the treatment of osteonecrosis to carry and retain a palliative paste
in a desired location.
The base plate is constructed on a plaster cast, with relief incorporated
in the area of the lesion.
Medicament Carrier
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Burn Stent:
A device constructed to minimize contraction of burned tissues during
healing. Electrical burns to the oral commissure are the most common
type in children.
Contracture of wound margins does not usually begin until about 5
days after injury. The use of stent or splint therapy before the start of
wound contracture minimizes post burn scaring and the development
of microstomia.
Management of the patient depends not only on the area involved, but
also on the extent and the severity of the burns.
Diagnostic impression of the recently burned patient is best made with
irreversible hydrocolloid impression materials. The impressions are
poured in artificial stone to create cast from which the stent can be
fabricated.
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Mouth control devices for assisting the handicapped
patients:
A.Interocclusal device for aiding the patient in nourishment:
incisors.
freedom during use.
B.Interocclusal stent for for aiding the patient in typing (writing or
painting):
piece of aluminum tubing can be attached. At the tube end a rubber tip
is placed for use in turning pages and typing.
with self-curing acrylic to fabricate quickly a mouthpiece or
interocclusal stent.
Interocclusal device for aiding the Interocclusal stent for typing (writing
patient in nourishment or painting)
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Trismus appliances:
Many mechanical devices can be used to increase mouth opening on a
slow, incremental basis including:
1-Simple devices:
The simple devices allow patient to control timing and degree of
pressure required to gradually increase jaw separation, but produce a
unilateral force. These include:
between the teeth to apply an opening force to the mandible.
and placed between the arches for I minute to increase opening.
Additional depressors can be added one at a time to increase opening.
the patient applies gradual pressure.
A tapered threaded acrylic screw Tongue depressors.
2-Dynamic bite opener or trismus stents:
Consists of a steel framework attached to maxillary and mandibular
stents.
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The device is inserted in the mouth, and elastic bands produce
bilateral opening force that may be varied by using different elastics.
The device should be used intermittently to avoid fatigue.
The dynamic opening device
Consists of maxillary and mandibular stents, an inflatable pediatric
blood pressure bag, rubber bulb and tubing. The stents are inserted
and the inflatable bag is placed between the stents. The bag is inflated
by squeezing the rubber bulb, forcing the stents apart. The pressure is
maintained for 10 seconds followed by 1 minutes of rest. The
procedure is followed for 10 minutes three times a day. There are four
basic parts of appliance; acrylic maxillary plate, acrylic mandibular
plate, inflatable pediatric blood pressure bag, and rubber blood
pressure hand bulb with lock-nut attachment and connecting tubing.
Can be used for dentulous and edentulous patients. The spring clips
are attached to mandibular stent and the free end of the clip locks into
a latch on the maxillary stent. The springs provide a constant force
bilaterally which is controlled by adjusting the size of loop.
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The inflatable bite opener An intraoral prosthesis with
interarach spring
Auditory stents or inserts:
This appliance may be used as:
a stent during surgical reconstruction of an external auditory meatus.
a custom ear plug to enlarge auditory meatus following mastoid
surgery for protection.
It can be constructed from acrylic resin, polyvinylchloride or silicone
rubber.
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Auditory stents or inserts
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Nasal stent:
A removable intranasal prosthesis to support the form of the nose. It
provides support for cartilage transplants during post-surgical healing
for the correction of nasal deformities in cleft lip patients .
Nasal stent maintains contour and minimizes scar contraction following
skin grafting procedures to the nostrils, to counteract previously formed
scar tissues and to widen the nostrils after trauma or burn prior to
grafting procedures.
Nasal stent
Intraoral radiotherapy stents :
1.It reduces the side effects of the treatment
2.It protects tissues that are not meant to receive radiation.
3.It is safer for the radiotherapist to treat this patient.
4.It increases the accuracy of radiation source and assures that the
area of treatment is the same every time the patient is irradiated.
5.It results in a more cooperative patient since discomfort and injuries
are reduced.
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1.Fluoride carrier (Fluoride stent)
2.Positioning stent or prosthesis to displace the tissues
3.Peroral cone positioning devices or beam locator or beam director
(Docking device):
4.Positioning radioactive sources or carrier or applicator:
5.Shielding or tongue protectors
Questions:
Write short account on the prosthetic procedures used for construction
of intraoral stents?
Write short account on intraoral surgical stents?
Write short account on occlusal stents?
===========++++++++++++++++++++==========
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