Transdental fixation (synonyms: transfixation, endodontic splinting) is a surgical procedure used in dental surgery to preserve a loosened tooth in special cases. In this procedure, a pin is inserted into the root of the tooth, which protrudes beyond the root tip of the tooth. The post is thus anchored in the bone located around the root tip, and tooth loosening is reduced.
Indications (areas of application)
Artificial lengthening of the tooth root transdentally (beyond the natural root tip) results in more favorable leverage ratios between the tooth crown and root in a loosened tooth. Causes of tooth loosening may include:
- Periodontitis marginalis (inflammation of the upper (near the neck of the tooth) parts of the periodontium with advanced degradation of the bone surrounding the tooth: gum, periodontal membrane, root cementum, tooth socket bone).
- Periodontitis apicalis (inflammation in the area of the root apex).
- Root transverse fracture (root transverse fracture)
In all cases, transdental fixation is not the only necessary therapy for the preservation of the loosened tooth: in the first case, marginal periodontitis must be brought to healing surgically and by home hygiene measures. Apical periodontitis (inflammation of the periodontium (tooth-supporting apparatus) just below the tooth root; apical = “tooth rootward”) requires root canal treatment with surgical root tip resection. If the fracture gap of a transversely fractured root is located in the third near the root apex, this portion is surgically removed.
The surgical procedures
- First, the root apex and the surrounding inflammatory tissue or the root portion separated by the transverse fracture are removed (apicoectomy).
- The root canal is instrumentally prepared and expanded to make room for the stabilizing post made of titanium or ceramic.
- The post is driven or rotated beyond the resection cavity under vision (open technique) into the surrounding bone, artificially lengthening the root and achieving the stabilizing effect.
- On the transversely fractured (broken) tooth, whose root fragment can be preserved, a closed technique procedure is possible, i.e. without surgical opening of the apical space.
- The surgical wound is closed in a saliva-proof manner, and the tooth is initially treated with a filling.
Contraindications
The indication for transdental fixation must be narrow. For example, it should not be performed in the case of:
- Periodontitis marginalis
- Too little bone substance to be used for stabilization around the root apex area
- Treatment measures in the remaining dentition that do not allow uncertain long-term prognosis of the treated tooth.
- Inadequate oral hygiene, which suggests a rapid progression of marginal periodontitis.
