Photocure acrylic individual splints in orthognathic surgery.

wafer splints are commonly used in orthog-nathic surgery after osteotomy of the jaws for a correct intraoperative jaw positioning, before the osteosyn-thesis. 1-3 Considerable time and, consequently, high cost are frequently involved in the fabrication of high-quality splints with durable and stable occlusal profile, smooth surfaces, and sufficient elasticity; in addition, a dental technician may also be required. If a splint should fit badly or a last-minute change of surgical planning is needed, a new appointment for the operation , or a " night shift, " may be required. Most splints are made from polymethylmethacrylate. These materials have shown changes in dimension on autoclaving. I have searched for an economic and easy-to-handle material for splint construction that can be autoclaved and united with an intraoperative-positioning facebow. A fast and versatile preparation should ensure that the surgeon can work without the aid of the dental technician. TECHNIQUE Triad transparent VLC custom tray material (Triad; Dentsply, York, Pa) is a filled photocure dimethacrylate that polymerizes through exposure to 400-to 500-nm wavelengths ultraviolet-A. Casts are set and modified through model surgery in a semiadjustable articulator. Cast isolation was performed before the adaptation of half a Triad layer to the occlusal plane. The modified casts are put into occlusion with 1 to 2 mm of distance so that the splint has sufficient height and stability. All labial and buccal excess is removed. The upper cast is removed, and the lower jaw model with the now-mold-able splint set into the photo-polymerization chamber. Three minutes of polymerization on the cast is sufficient ; after removal of the cast, another 2 minutes for the lower side is needed. The edges are smoothed, and steam-cleaning is performed. Two more minutes of vacuum photo-polymerization removed the oxygen inhibition layer on the splint surfaces. All splints were autoclaved preoperatively. The fabrication time for each splint was 10 minutes, and splints fit well after autoclaving. The costs per splint made by the surgeon were negligible ($3 for the acrylic, plus the one-time investment of $150 for a polymerization chamber). A polymethylmethacrylate splint manufactured by an outside lab takes, on average, 90 minutes to make and costs about $100. Fifteen patients tolerated the Triad splints well. No mucosal inflammation could be discerned—and, likewise , no sign of tooth decalcification was found. I advocated only little covering of the cusps to the lips and vestibule, because the fit could be checked more easily …