PERIODONTAL SPLINTING


WHAT IS SPLINTING?

SPLINTING IN DENTISTRY IS “the joining of 2 or more teeth into a rigid unit by means of fixed or removable restorations or devices.”

Dental splint: An appliance designed to immobilize and stabilize mobile loose teeth. (AAP1986 Glossary)


RATIONALE FOR SPLINTING

1. To provide rest.

2. Redirects the force in a more axial direction.  

3. Redistribution of force so that forces do not exceed the adaptive capacity of the periodontium.

4. To preserve the arch integrity

5. Restores a functional occlusion, stabilizes mobile abutment teeth and increases masticatory efficiency.

6. Gives the patient freedom from mobile teeth

7. To stabilize mobile teeth during surgical, especially regenerative therapy.


IDEAL REQUIREMENTS OF A SPLINT

 1. Simple.

 2. Economic

 3. Stable and efficient

4. Esthetically acceptable

 5. It should incorporate as many firm teeth as is necessary to reduce the extra load on individual teeth to a minimum.

 6. It should hold the teeth rigid and not impose torsional stress.

 7. It should extend around the arch, so that antero-posterior forces and facio-lingual forces are counteracted.

8.  It should not interfere with the occlusion.

9.  It should not irritate the pulp, soft tissues, gingiva, cheeks, lips or tongue.

10.   It should not impair or disturb the phonetic pattern of the patient

 11.   It should not provoke iatrogenic disease.  


Types of splint:

I. Temporary:

a) Fixed-Fixed external type (2-6 months) e.g. Ligature wire, orthodontic bands, acrylic splints, composite splints.

b) Removable-RPD, Night guards, removable acrylic splints .

II. Provisional:  8-12 months diagnostic used in borderline cases where the outcome of treatment cannot be predicted.

eg. Temporary external splints.

III. Permanent:

a) Fixed-Full crowns, pin ledge type of abutment retainers.

 b) Semi-rigid.

c) Removable-Telescopic crowns, clasp supported partial denture.
    

Commonly used splints :

1. Splints for anterior teeth:

a. Direct bonding system using acid-etch techniques and alight cured resin.

b. Intracoronal wire and acrylic wire resin splint-it involves the teeth with stainless steel wire placed in the slots thus stabilizing the teeth.

2. Splints for posterior teeth:

 a. Intracoronal amalgam wire splints

 b. Bite guard

c. Rigid occlusal splint

 d. Composite splint.


Indications

·        To stabilize moderate to advance tooth mobility, that cannot be reduced by other means that has not responded to occlusal adjustment and periodontal therapy.

·        Stabilize teeth in secondary occlusal trauma

·        Stabilize teeth with increased mobility which interfere with normal masticatory function

·        Facilitate scaling and surgical procedures.

·        Prevent tipping & drifting of teeth.

·        Prevent extrusion of unopposed teeth.

·        Stabilize teeth after acute dental trauma i.e. .sub luxation , avulsion.etc


CONTRA INDICATIONS

·        Severe tooth mobility in the presence of periodontal inflammation & or primary occlusal trauma

·        Insufficient number of firm teeth to stabilize mobile teeth.

·        Prior occlusal adjustment has not been done on teeth with occlusal trauma or interferences.

·        Patient not maintaining oral hygiene.
   
                                                                          DR. ANJUSHA SHARDA
   

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