Splints/ dentistry dental implants

SPLINTS IN PERIODONTICSSPLINTS IN PERIODONTICS

INDIAN DENTAL ACADEMY

Leader in continuing dental education www.indiandentalacademy.com

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CONTENTSCONTENTS IntroductionIntroduction DefinitionsDefinitions

SplintSplint StabilizationStabilization

Rationale for stabilizationRationale for stabilization Biologic reasons for splintingBiologic reasons for splinting Ideal requirements of a splintIdeal requirements of a splint Basic consideration before construction of any splintsBasic consideration before construction of any splints Mode of actionMode of action Classification of splintsClassification of splints Packs and splintsPacks and splints Disadvantages of splintingDisadvantages of splinting Maintenance of splintsMaintenance of splints conclusionconclusion ReferencesReferences


IntroductionIntroduction

Periodontal diseases are characterized by subgingival plaque formation, gingival inflammation, loss of connective tissue attachment and loss of alveolar bone.

As a result of the progressive loss of attachment tissue, the teeth involved in the disease process eventually exhibit increased tooth mobility.

Thus the reduction of mobility is an important objective of periodontal therapy.


Root planning, curettage, oral hygiene and surgery may cause teeth to tighten as inflammation is resolved. However a transient increase in mobility may occur immediately after surgery.

Occlusal adjustment, periodontal orthodontics and restorative dentistry may alter occlusal relationships and redirect forces, there by reducing traumatism. This may result in the teeth becoming firmer.

Increasing the support of loose teeth may also increase their firmness, the device used for such treatment is the “SPLINT”.


Splint may be used to maintain periodontally migrated teeth that have been repositioned.

It may also be used prior to surgery where splinting is considered necessary to stabilize mobile teeth during post surgical healing.

Dental splints have been used since the 8th century B.C. thus, while hardly a recent innovation splinting is still generally regarded as an integral part of periodontal therapy.

Splinting creates a multi-rooted unit, increasing the total area of root resistance. The center of rotation of each tooth is so altered as to afford greater resistance to mesiodistal forces.


Splinting is commonly performed on the assumption that it will create a more favorable environment for periodontal repair.

Etruscans from the 8th century B.C. to the 1st century A.D. utilized wire ligation and small gold rings and bands to stabilize mobile teeth.

Fauchard in 1723 ligated and banded teeth to stabilize them.


DEFINITIONSDEFINITIONS

SPLINT:SPLINT:

Splint is defined as an any apparatus, appliance device employed to prevent motion or displacement of fractured or movable parts (Francis G. Serio).

Grant defined splint is an any appliance that joins two or more teeth to provide support.

According to Macphee and Cowley – Splint is a rigid flexible appliance used to stabilize and protect an injured part.


Manson and Eley defined splint is a device for supporting weakened tissues. It serves two purposes

1. Provides rest where wound healing is in process

2. Permits function where the tissues alone cannot perform adequately .

Splint is an appliance for immobilization or stabilization of injured or diseased parts (Keith Lemmerman).

Page and Schluger defined splint is a device used to immobilize teeth and it is one of the oldest forms of aids to periodontal therapy

Clark, Weatherford and Mann defined splint is an appliance to stabilize or immobilize an injured or diseased part.www.indiandentalacademy.comwww.indiandentalacademy.com

STABILIZATION (SPLINTING):-STABILIZATION (SPLINTING):-

Stabilization or splinting commonly refers to tying teeth together either unilaterally or bilaterally, to convey increased stability to the entire unit. (Francis G. Serio)

Jenkins defined stabilization or splinting is the procedure by which a tooth’s resistance to an applied force is increased by joining it to a neighbouring tooth or teeth.

According to Keith Lemmerman – Stabilization of a tooth is an increase in resistance to applied force by providing reciprocal antagonisms and increasing the effective root area. The force may remain the same, but the resistance is increased.


Dawson defines splinting as “the joining together teeth into a rigid unit by means of fixed or removable restorations or devices.

Splinting is defined as the “joining of two or more teeth into a rigid unite by means of fixed or removable restorations or devices”. (Sharon C. Seigel, Carl F. Driscoll and Sylvan Feldman)


RATIONALE FOR STABILIZATION:RATIONALE FOR STABILIZATION:

The benefits of splinting teeth are based on clinical The benefits of splinting teeth are based on clinical impression rather than on scientific studies. Clinicians have impression rather than on scientific studies. Clinicians have used both fixed and removable splints to restore occlusal used both fixed and removable splints to restore occlusal stability effectively.stability effectively.

I. Splinting the normal periodontiumI. Splinting the normal periodontium Prevention of mobility.Prevention of mobility. Prevention of drifting.Prevention of drifting.

II. Splinting the diseased periodontiumII. Splinting the diseased periodontium Prevention of mobility.Prevention of mobility.

To allow repair during periodontal treatment To allow repair during periodontal treatment Prevention of Trauma from occlusionPrevention of Trauma from occlusion

Prevention of drifting.Prevention of drifting.www.indiandentalacademy.comwww.indiandentalacademy.com

I. Splinting the normal periodontiumI. Splinting the normal periodontium:_:_

This includes cases where, a clinical point of view, the This includes cases where, a clinical point of view, the periodontium is periodontium is healthyhealthy..

A. Prevention of mobility:- The increased tooth mobility is detrimental, and if allowed to The increased tooth mobility is detrimental, and if allowed to

continue, could cause other damage. The dividing line continue, could cause other damage. The dividing line between normal mobility and mobility that should be treated between normal mobility and mobility that should be treated widely.widely.

B. B. Prevention of driftingPrevention of drifting:-:- The rationale for stabilization here is that drifting of The rationale for stabilization here is that drifting of

teeth can lead to or enhance the potential for the development teeth can lead to or enhance the potential for the development of periodontal problems.of periodontal problems.


eg :: eg :: Replacement of missing teethReplacement of missing teeth: : Hirschfeld 1937. The classic case used as an illustration was the Hirschfeld 1937. The classic case used as an illustration was the

early loss of the mandibular first molar. Failure to replace it resulted early loss of the mandibular first molar. Failure to replace it resulted in in

mesial drifting of the mandibular 2nd and 3rd molars,mesial drifting of the mandibular 2nd and 3rd molars,distal drifting of the mandibular premolars, extrusion of distal drifting of the mandibular premolars, extrusion of

the maxillary first molar, the maxillary first molar, marginal ridge discrepancies, open contacts, increased marginal ridge discrepancies, open contacts, increased

plaque retention pocket formation and development plaque retention pocket formation and development occlusion interferences.occlusion interferences.

Replacement of four missing 1st molars has been shown Replacement of four missing 1st molars has been shown to result in a 50% increase in masticatory efficiency. to result in a 50% increase in masticatory efficiency.


II.II. Splinting the diseased periodontiumSplinting the diseased periodontium:-:-

A) A) Prevention of mobility:-Prevention of mobility:-

Splinting for functional reasonsSplinting for functional reasons:- The rationale in this case is :- The rationale in this case is to splint where increased mobility makes function difficult or to splint where increased mobility makes function difficult or impossible.impossible.

Stern and Clark stated that one of the rationales for Stern and Clark stated that one of the rationales for stabilization is to decrease mobility and that one of its benefits stabilization is to decrease mobility and that one of its benefits was an increase in function for the patient.was an increase in function for the patient.

Simring reported that temporary stabilization may be done to Simring reported that temporary stabilization may be done to “increase the morale” of patients with multiple mobile teeth.“increase the morale” of patients with multiple mobile teeth.


To allow repair during periodontal treatmentTo allow repair during periodontal treatment

The rationale is that mobility may either cause or The rationale is that mobility may either cause or accelerate the progression of periodontal disease, or the accelerate the progression of periodontal disease, or the very least inhibit tissue repair.very least inhibit tissue repair.

HirschfieldHirschfield advocated that the use of stabilization 1 to 2 advocated that the use of stabilization 1 to 2 years post-treatment in anterior teeth with residual years post-treatment in anterior teeth with residual mobility to encourage the consolidation of supporting mobility to encourage the consolidation of supporting structures.structures.

FriedmanFriedman believed that unless splinted, mobile teeth believed that unless splinted, mobile teeth may not respond as well to reattachment procedures.may not respond as well to reattachment procedures.


CrossCross stated that in the absence of infection, mobility stated that in the absence of infection, mobility will inhibit repair and therefore splinting indicated..will inhibit repair and therefore splinting indicated..

Ward Ward considered “pathologic movement” to be considered “pathologic movement” to be an etiologic factor in periodontal disease and advocated an etiologic factor in periodontal disease and advocated temporary splinting to prevent it.temporary splinting to prevent it.

AmsterdamAmsterdam and others have stated that splinting was and others have stated that splinting was also indicted following hemisection or root resection also indicted following hemisection or root resection procedures to allow better healing.procedures to allow better healing.


B. B. Prevention of drifting:-Prevention of drifting:-

Replacement of missing teeth:-Replacement of missing teeth:-

This is basically the same as in normal periodontium with This is basically the same as in normal periodontium with increased function as a secondary benefit. increased function as a secondary benefit.

Post orthodontics:-Post orthodontics:-

Splints used as retainers after orthodontic therapy in the Splints used as retainers after orthodontic therapy in the periodontic patient..periodontic patient..


BIOLOGIC REASONS FOR SPLINTING:BIOLOGIC REASONS FOR SPLINTING:

1. 1. RESTREST

Occlusal rest provided by splint therapy of one form or another helps to eliminate or atleast to neutralize some of the adverse occlusal factors that compound the effects of an already existing inflammatory disease, such as periodontitis.

Many involved teeth are hypermobile because of a widened periodontal space, and one of the main objectives of splinting is to reestablish a narrow ligament space.


2. 2. REDISTRIBUTION OF FORCESREDISTRIBUTION OF FORCES:-:-

The stabilization of weakened teeth by splinting increases The stabilization of weakened teeth by splinting increases resistance to applied forces. resistance to applied forces.

The redistribution of forces ensures that the excessive force The redistribution of forces ensures that the excessive force on a single tooth does not exceed the adaptive capacity of the on a single tooth does not exceed the adaptive capacity of the surrounding tissue and that jiggling movements which can surrounding tissue and that jiggling movements which can contribute to further bone loss in an existing periodontitis are contribute to further bone loss in an existing periodontitis are prevented .prevented .


3. 3. REDIRECTION OF FORCES:-REDIRECTION OF FORCES:-

Splinting effects a redirection of force in a more axial direction Splinting effects a redirection of force in a more axial direction over all the teeth included in the splint. over all the teeth included in the splint.

Hypothetically, occlusal force on a mesially tilted molar will have Hypothetically, occlusal force on a mesially tilted molar will have a mesial vector and an apical vector, but no vector along the long a mesial vector and an apical vector, but no vector along the long axis of the tooth. axis of the tooth.

Splinting such teeth prevents the tilting affect of the unfavourably Splinting such teeth prevents the tilting affect of the unfavourably directed occlusal force.directed occlusal force.


4) 4) PRESERVATION OF ARCH INTEGRITYPRESERVATION OF ARCH INTEGRITY:-:-

Splinting restores proximal contacts that have been disrupted Splinting restores proximal contacts that have been disrupted by missing and migrated teeth & makes the patient more by missing and migrated teeth & makes the patient more comfortable and reduces the likely hood of food impaction and comfortable and reduces the likely hood of food impaction and consequent breakdown.consequent breakdown.

5) 5) RESTORATION OF FUNCTIONAL STABILITYRESTORATION OF FUNCTIONAL STABILITY:-:-

Splinting in conjunction with replacement of missing teethSplinting in conjunction with replacement of missing teeth, if, if necessary, necessary, not only restores a functional occlusionnot only restores a functional occlusion, but , but stabilizes the remaining mobile abutment teethstabilizes the remaining mobile abutment teeth..


6) 6) To prevent tipping, migration, or overeruption of teeth To prevent tipping, migration, or overeruption of teeth following extraction and to stabilize proximal contacts of following extraction and to stabilize proximal contacts of mobile teeth and reduce food impaction into the embrasures.mobile teeth and reduce food impaction into the embrasures.

7)7) Masticatory function may be improved. Masticatory function may be improved.

8) 8) Discomfort and pain are eliminated.Discomfort and pain are eliminated.

9) 9) Appearance may be improved.Appearance may be improved.

10) 10) PSYCHOLOGICAL WELL-BEINGPSYCHOLOGICAL WELL-BEING:-:- Hyper mobility can become so severe that patients become Hyper mobility can become so severe that patients become

fearful of losing teeth. fearful of losing teeth.

Stabilization by splinting and restoration not only improves Stabilization by splinting and restoration not only improves function, but it also can restore a sense of a solid-feeling function, but it also can restore a sense of a solid-feeling dentition as well as of comfort and good looks. dentition as well as of comfort and good looks.


The attainment of comfort and good looks as a basis for The attainment of comfort and good looks as a basis for splinting cannot be disregarded; however splinting must not be splinting cannot be disregarded; however splinting must not be misused as a cosmetic procedure. misused as a cosmetic procedure.

Many patients who require long-term stabilization by the Many patients who require long-term stabilization by the extensive use of fixed prosthodontics are concerned more with extensive use of fixed prosthodontics are concerned more with the cosmetic benefits that might result form such treatment the cosmetic benefits that might result form such treatment than with improved functional qualities. than with improved functional qualities.

The use of an expensive, irreversible procedure must not based The use of an expensive, irreversible procedure must not based solely on a patient’s cosmetic demands. solely on a patient’s cosmetic demands.

Often patients concerned with cosmetic results remain Often patients concerned with cosmetic results remain dissatisfied despite the best efforts to restore their dentitions.dissatisfied despite the best efforts to restore their dentitions.


IDEAL REQUIREMENTS OF A SPLINT:IDEAL REQUIREMENTS OF A SPLINT:

1.1. Simple.Simple.

2.2. EconomicEconomic

3.3. Stable and efficientStable and efficient

4.4. Esthetically acceptableEsthetically acceptable

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

6.6. It should hold the teeth rigid and not impose torsional stresses It should hold the teeth rigid and not impose torsional stresses on any incorporated teeth.on any incorporated teeth.www.indiandentalacademy.comwww.indiandentalacademy.com

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

8. It should not interfere with the occlusion. If possible gross tooth 8. It should not interfere with the occlusion. If possible gross tooth disharmonies should be eliminated before the application of the disharmonies should be eliminated before the application of the splint.splint.

9.9. It should be designed so that it can be kept clean interdental It should be designed so that it can be kept clean interdental embrassure spaces should not be blocked by the splint.embrassure spaces should not be blocked by the splint.

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

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

12.12. It should not provoke iatrogenic disease. It should not provoke iatrogenic disease.www.indiandentalacademy.comwww.indiandentalacademy.com

BASIC CONSIDERATION BEFORE CONSTRUCTION OF BASIC CONSIDERATION BEFORE CONSTRUCTION OF ANY SPLINT:ANY SPLINT:

1.1. For most patients, splinting should be considered only after the For most patients, splinting should be considered only after the preliminary phase of periodontalpreliminary phase of periodontal therapy has been completed, therapy has been completed, including the including the elimination of all local factors contributing to elimination of all local factors contributing to inflammationinflammation and and occlusal adjustmentocclusal adjustment by selective grinding. by selective grinding.

- Exceptions are dentitions with so much mobility that adequate - Exceptions are dentitions with so much mobility that adequate occlusal adjustment is impossible. occlusal adjustment is impossible.

-In these circumstances the teeth should be stabilized as early as -In these circumstances the teeth should be stabilized as early as possible, and then the occlusion can be definitely adjusted.possible, and then the occlusion can be definitely adjusted.


2.2. The The method of splintingmethod of splinting is dictated by the is dictated by the cause and degree of cause and degree of mobilitymobility,, whether,, whether temporary temporary or or permanent. permanent.

If the If the coronal portionscoronal portions of the teeth are in of the teeth are in relatively goodrelatively good condition, the condition, the extra coronalextra coronal method of splinting should be method of splinting should be used. used.

If, however, the teeth obviously If, however, the teeth obviously requirerequire extensive restorativeextensive restorative therapytherapy, as well as periodontal therapy, a form of , as well as periodontal therapy, a form of intracoronal intracoronal splintingsplinting is justified and preferable. is justified and preferable.


3.3. The The extent of splintingextent of splinting is dictated primarily by the number of is dictated primarily by the number of teeth involved and the degree of their mobility. teeth involved and the degree of their mobility.

In all cases, a sufficient number of non mobile teeth should In all cases, a sufficient number of non mobile teeth should be included in the splint. be included in the splint.

If all the teeth in a quadrant demonstrate hypermobility, If all the teeth in a quadrant demonstrate hypermobility, splinting should be extensive enough to include the support of splinting should be extensive enough to include the support of anterior teeth and, on occasion, teeth on the opposite side of anterior teeth and, on occasion, teeth on the opposite side of the arch. the arch.

For the same reason, the support of posterior teeth is often For the same reason, the support of posterior teeth is often necessary when anterior segments are mobile.necessary when anterior segments are mobile.


4.4. If, in a case of occlusal traumatism associated with severe If, in a case of occlusal traumatism associated with severe bone loss, all the teeth demonstrate hypermobility, bone loss, all the teeth demonstrate hypermobility, corss-arch corss-arch splinting is beneficialsplinting is beneficial, because the pattern of mobility of , because the pattern of mobility of some teeth is in a buccolingual direction and of others is in a some teeth is in a buccolingual direction and of others is in a mesiodistal direction. (with splinting, a group of single rooted mesiodistal direction. (with splinting, a group of single rooted teeth in effect becomes a multirooted unitteeth in effect becomes a multirooted unit.)

5.5. The method of splinting should neither impede normal The method of splinting should neither impede normal functions nor frustrate the oral hygiene and physiotherapeutic functions nor frustrate the oral hygiene and physiotherapeutic efforts of the patient.efforts of the patient.

The splint must not irritate the gingival tissues, and The splint must not irritate the gingival tissues, and whenever possible it should be esthetically acceptable.whenever possible it should be esthetically acceptable.


The patient must be informed that future restorative measures The patient must be informed that future restorative measures are usually necessary when any form of intra or are usually necessary when any form of intra or circumcoronal splinting is used.circumcoronal splinting is used.


MODE OF ACTIONMODE OF ACTION:: Loose teeth splinted to adjacent firm teeth may become stabilized. When Loose teeth splinted to adjacent firm teeth may become stabilized. When

many teeth are loose, adjacent sextants should be included in the splint. many teeth are loose, adjacent sextants should be included in the splint.

Teeth tend to loosen buccolingually yet may remain firm mesiodistally. Teeth tend to loosen buccolingually yet may remain firm mesiodistally. Adjacent sextants therefore have complimentary strengths. Adjacent sextants therefore have complimentary strengths.

Cross-arch splinting reduces mobility to the least common denominator. Teeth Cross-arch splinting reduces mobility to the least common denominator. Teeth are thus immobilized and occlusal forces are better distributed. are thus immobilized and occlusal forces are better distributed.

Traumatism is minimized, repair is enhanced, and teeth may become firm Traumatism is minimized, repair is enhanced, and teeth may become firm again. Even when teeth do not tighten, the splint serves as an orthopedic brace again. Even when teeth do not tighten, the splint serves as an orthopedic brace that permits useful function of loose teeth. that permits useful function of loose teeth.

Teeth with reduced support often are hypermobile. This mobility may Teeth with reduced support often are hypermobile. This mobility may gradually increase if the teeth are not splinted. Hypermobility decreases bone gradually increase if the teeth are not splinted. Hypermobility decreases bone density in the coronal interproximal periodontium but does not change the density in the coronal interproximal periodontium but does not change the level of the crest.level of the crest. www.indiandentalacademy.comwww.indiandentalacademy.com

CLASSIFICATION OF SPLINTS CLASSIFICATION OF SPLINTS

Splints can be classified as either Splints can be classified as either ‘temporary’‘temporary’ or ‘ or ‘permanent’permanent’ and as and as ‘removable’‘removable’ or or ‘fixed’.‘fixed’.

RAMFJORD & ASHRAMFJORD & ASH have classified splints into: have classified splints into:

1.1. TemporaryTemporary

2.2. Diagnostic or provisionalDiagnostic or provisional

3.3. PermanentPermanent

Such splints have also been grouped as either Such splints have also been grouped as either EXTERNAL EXTERNAL or or INTERNALINTERNAL to the circumference of the tooth. to the circumference of the tooth.


TEMPORARY SPLINTS:-TEMPORARY SPLINTS:- This is used on a short term basis, This is used on a short term basis, usually less than 6 months, and is often usually less than 6 months, and is often advocated to stabilize advocated to stabilize teethteeth during periodontal therapy or after a traumatic episodeduring periodontal therapy or after a traumatic episode..

PROVISIONAL SPLINTS:-PROVISIONAL SPLINTS:- (Diagnostic):- This is used for (Diagnostic):- This is used for several months to several years for several months to several years for diagnostic informationdiagnostic information. . Provisional splints allow the clinician Provisional splints allow the clinician to observe the healing to observe the healing response to treatment and to make changes based on patient response to treatment and to make changes based on patient response to treatmentresponse to treatment, this enables the clinician to properly , this enables the clinician to properly design a more permanent and biologically acceptable form of design a more permanent and biologically acceptable form of stabilization & better treatment.stabilization & better treatment.

PERMANENT SPLINTS:_PERMANENT SPLINTS:_ This is used indefinitely. These This is used indefinitely. These are usually used in a more reduced periodontium.are usually used in a more reduced periodontium.


Intra coronal splints (Internal Splints):-Intra coronal splints (Internal Splints):-

These are the most commonly used type of splint.These are the most commonly used type of splint.

This type of splint involves cavity preparation. This type of splint involves cavity preparation.

This preparation is used to increase the strength and retention This preparation is used to increase the strength and retention of the restoration material. of the restoration material.

The preparation may be continuous or discontinuous. The preparation may be continuous or discontinuous.

The continuous type is used in the mandibular segment The continuous type is used in the mandibular segment because of relatively short mesiodistal dimension of because of relatively short mesiodistal dimension of mandibular incisors. The discontinuous splint is used in mandibular incisors. The discontinuous splint is used in maxillary segment.maxillary segment.


INDICATIONS OF INTERNAL SPLINTS :-INDICATIONS OF INTERNAL SPLINTS :-

1.1. Teeth with a more reduced periodontium.Teeth with a more reduced periodontium.

2.2. Dentition with a deep overbite.Dentition with a deep overbite.

3.3. Teeth with very short roots or resorbed roots.Teeth with very short roots or resorbed roots.

4.4. To evaluate potential abutment teeth.To evaluate potential abutment teeth.

5.5. Teeth with root amputations and mobility.Teeth with root amputations and mobility.

6.6. To avoid dislodgement during regenerative procedures.To avoid dislodgement during regenerative procedures.

7.7. Post orthodontics, specially in cases involving intrusions, Post orthodontics, specially in cases involving intrusions, extrusions, rotations, pathologic migrations, or molar uprighting.extrusions, rotations, pathologic migrations, or molar uprighting.

8.8. When teeth advanced mobility cannot be treated any other way.When teeth advanced mobility cannot be treated any other way.www.indiandentalacademy.comwww.indiandentalacademy.com

EXTRACORONAL SPLINTS (EXTERNAL SPLINTS):-EXTRACORONAL SPLINTS (EXTERNAL SPLINTS):-

These are usually temporary in nature. & this type of splint does not involve any These are usually temporary in nature. & this type of splint does not involve any tooth preparation. tooth preparation.

These can be reinforced with wire or mesh if additional strength is needed. These can be reinforced with wire or mesh if additional strength is needed.

Use of extra coronal splints is usually confined to anterior teeth.Use of extra coronal splints is usually confined to anterior teeth.

Indications:-Indications:- Anterior teeth with moderate mobility.Anterior teeth with moderate mobility.

Post orthodontic retention without mobility, especially where retainer compliance Post orthodontic retention without mobility, especially where retainer compliance is a concern.is a concern.

To provide stability in cases of acute trauma and allow for healing of the To provide stability in cases of acute trauma and allow for healing of the periodontal ligament, remodeling of alveolar bone, maintenance of tooth position, periodontal ligament, remodeling of alveolar bone, maintenance of tooth position, and comfort during function.and comfort during function.

Regenerative procedures, where mobility may temporarily increase.Regenerative procedures, where mobility may temporarily increase.

Endodontic – periodontic lesions.Endodontic – periodontic lesions.www.indiandentalacademy.comwww.indiandentalacademy.com

CLASSIFICATION CLASSIFICATION

TEMPORARY SPLINTSTEMPORARY SPLINTS i) i) EXTRACORONALEXTRACORONAL --

1.1. Wire ligature – acrylic splintWire ligature – acrylic splint2.2. Splints of enamel bonding materialSplints of enamel bonding material3.3. Welded bands (Orthodontic bands)Welded bands (Orthodontic bands)4.4. Continuous claspsContinuous clasps5.5. Removable acrylic splintsRemovable acrylic splints

A) Occlusal splintsA) Occlusal splints

- Bite guards- Bite guards - Maxillary occlusal splint- Maxillary occlusal splint - Mandibular occlusal splint- Mandibular occlusal splint - Soft occlusal splint- Soft occlusal splint

B) Bite platesB) Bite plates

- Hawley biteplate- Hawley biteplate - Sved biteplate- Sved biteplate www.indiandentalacademy.comwww.indiandentalacademy.com

ii) ii) INTRA CORONALINTRA CORONAL

1) Wire acrylic splint (‘A’splint)1) Wire acrylic splint (‘A’splint)

2) Wire composite resin splint2) Wire composite resin splint

3) Amalgam splint3) Amalgam splint

4) Acrylic full crowns4) Acrylic full crowns

5) Combined amalgam – wire – acrylic splint 5) Combined amalgam – wire – acrylic splint

PROVISIONAL SPLINTINGPROVISIONAL SPLINTING 1) Metal – Band – and acrylic type1) Metal – Band – and acrylic type

2) All – Acrylic type2) All – Acrylic type


PERMANENT SPLINTINGPERMANENT SPLINTING1.1. Removable – External Removable – External

Continuous clasp devicesContinuous clasp devices Swing lock devicesSwing lock devices Over denture (full or partial)Over denture (full or partial)

2.2. Fixed – internal Fixed – internal Full coverage, 3/4th coverage crowns and inlaysFull coverage, 3/4th coverage crowns and inlays Posts in root canalsPosts in root canals Horizontal pin splintsHorizontal pin splints

3.3. Cast-metal-resin-bonded fixed partial dentures Cast-metal-resin-bonded fixed partial dentures

Maryland splintsMaryland splints


4. 4. CombinedCombined Partial dentures and splinted abutmentsPartial dentures and splinted abutments Removable – Fixed splintsRemovable – Fixed splints Full or partial dentures on splinted rootsFull or partial dentures on splinted roots Fixed bridges incorporated in partial dentures Fixed bridges incorporated in partial dentures

seated on posts or copingsseated on posts or copings..

5. 5. Endodontics


I. I. TEMPORARY STABILIZATION:TEMPORARY STABILIZATION:

Temporary splinting is the joining of two or more teeth, to increase Temporary splinting is the joining of two or more teeth, to increase resistance to an applied force.resistance to an applied force.

Temporary splinting should be considered as part of the initial Temporary splinting should be considered as part of the initial preparation of the tissues, and should thus be done prior to preparation of the tissues, and should thus be done prior to periodontal surgery.periodontal surgery.

Temporary splints are employed for a limited period of time to aid Temporary splints are employed for a limited period of time to aid healing by limiting the mobility of a tooth or teeth and therefore healing by limiting the mobility of a tooth or teeth and therefore assisting in healing. assisting in healing.

Temporary splints may also be used as a diagnostic measure to Temporary splints may also be used as a diagnostic measure to assist in the determination of prognosis of questionable teeth.assist in the determination of prognosis of questionable teeth.


INDICATIONS OF TEMPORARY SPLINTS:-INDICATIONS OF TEMPORARY SPLINTS:-

These are used either until hypermobility is satisfactorily These are used either until hypermobility is satisfactorily reduced or eliminated and the teeth can function without the reduced or eliminated and the teeth can function without the help of the splint or until the dentition clearly requires help of the splint or until the dentition clearly requires longterm stabilization.longterm stabilization.

These are used until stabilization is no longer necessary , These are used until stabilization is no longer necessary , for example, in cases of mobility caused by orthodontic for example, in cases of mobility caused by orthodontic repositioning accidental or surgical trauma, or occlusal repositioning accidental or surgical trauma, or occlusal traumatism, all of a reversible nature.traumatism, all of a reversible nature.

These are used in the therapy being undertaken to determine These are used in the therapy being undertaken to determine whether hypermobility can be resolved by conservative whether hypermobility can be resolved by conservative methods or whether the mobility is caused by loss of support methods or whether the mobility is caused by loss of support sufficient to create permanent hypermobility, by root sufficient to create permanent hypermobility, by root resorption or any extrinsic or intrinsic precipitating factors.resorption or any extrinsic or intrinsic precipitating factors.www.indiandentalacademy.comwww.indiandentalacademy.com

In advanced periodontal diseases when the permanent fixation In advanced periodontal diseases when the permanent fixation cannot be done either because of economic reasons, poor cannot be done either because of economic reasons, poor prognosis for all remaining teeth, poor health which affects the prognosis for all remaining teeth, poor health which affects the longevity of the dentition, or even the life of the patient.longevity of the dentition, or even the life of the patient.

In patients who cannot emotionally accept the lengthy procedures In patients who cannot emotionally accept the lengthy procedures of permanent fixation.of permanent fixation.

In cases of infrabony defects treated with heterografts and In cases of infrabony defects treated with heterografts and autografts.autografts.

In cases of stabilizing the hemisectinoed teeth.In cases of stabilizing the hemisectinoed teeth.

These can be used as a diagnostic and to evaluate the prognosis These can be used as a diagnostic and to evaluate the prognosis before instituting extensive permanent splinting. before instituting extensive permanent splinting.

To improve the morale of the patient with mobile teeth.To improve the morale of the patient with mobile teeth.www.indiandentalacademy.comwww.indiandentalacademy.com

FUNCTIONS OF TEMPORARY SPLINTING:-FUNCTIONS OF TEMPORARY SPLINTING:- Protection of traumatized teeth from further injury.Protection of traumatized teeth from further injury.

Distribution of occlusal forces on teeth that have lost periodontal Distribution of occlusal forces on teeth that have lost periodontal support.support.

Retention of orthodontically moved teeth.Retention of orthodontically moved teeth.

Aiding in the determination of whether teeth with borderline Aiding in the determination of whether teeth with borderline prognosis will respond to therapy.prognosis will respond to therapy.

Immobilization of loose teeth to facilitate occlusal adjustment Immobilization of loose teeth to facilitate occlusal adjustment procedures.procedures.

To prevent pathologic migration.To prevent pathologic migration.

Temporary splints have been further classified into extracoronal, intracoronalTemporary splints have been further classified into extracoronal, intracoronal..www.indiandentalacademy.comwww.indiandentalacademy.com

EXTRA CORONAL SPLINTS:EXTRA CORONAL SPLINTS:

1)1) LIGATURE SPLINTS:-LIGATURE SPLINTS:-

The most common and easiest method. In some case The most common and easiest method. In some case only wire is used, but the acrylic resin offers the advantage of only wire is used, but the acrylic resin offers the advantage of increased stable and improved esthetics, especially where increased stable and improved esthetics, especially where diastema are present.diastema are present.

WIRE LIGATURE ACRYLIC SPLINTS:-

Indications:-

1) Short – term stabilization of anterior teeth.1) Short – term stabilization of anterior teeth.

2) Mobile anterior teeth not suitable for bonding or A-splint.2) Mobile anterior teeth not suitable for bonding or A-splint.

3) May be indicated when a questionable prognosis for a tooth 3) May be indicated when a questionable prognosis for a tooth or teeth persists past the active treatment phase. or teeth persists past the active treatment phase. www.indiandentalacademy.comwww.indiandentalacademy.com

Advantages:-Advantages:-

Non invasive and reversible.Non invasive and reversible. Ease of insertion, Ease of insertion,

adjustment, removal and adjustment, removal and replacement.replacement.

Simple, inexpensive.Simple, inexpensive. Can be done in one sitting in Can be done in one sitting in

a short-period of time.a short-period of time. Not requiring any alteration Not requiring any alteration

of crown.of crown.

Disadvantages:-Disadvantages:-

Non rigid.Non rigid. Not usable for posterior Not usable for posterior

teeth or anterior teeth teeth or anterior teeth tapered toward incisal edge.tapered toward incisal edge.

Can act as an orthodontic Can act as an orthodontic appliance.appliance.

Wires may stretch or break Wires may stretch or break if improperly tightened.if improperly tightened.

Collects plaque more Collects plaque more rapidly.rapidly.

Plaque control becomes Plaque control becomes more difficult.more difficult.

Advantage & Disadvantage Of Wire Ligature Acrylic Splints


Procedure :Procedure :1.1. Dead-soft stainless steel wire 0.007 to 0.010 inch thick is used. Dead-soft stainless steel wire 0.007 to 0.010 inch thick is used.

Brass or silk ligatures are not as desirable.Brass or silk ligatures are not as desirable.

2.2. Double a 12-inch length for use as an arch wire, and bend it Double a 12-inch length for use as an arch wire, and bend it about the six anterior teeth.about the six anterior teeth.

3.3. Position it apical to the contact points and incisal to the cingula, Position it apical to the contact points and incisal to the cingula, then loosely twist one end. Provide for edentulous spaces by then loosely twist one end. Provide for edentulous spaces by twisting the buccal and lingual strands of the arch wire together.twisting the buccal and lingual strands of the arch wire together.

4.4. Place single, hairpin bent wires interdentally around the arch Place single, hairpin bent wires interdentally around the arch wires and below the contact point. wires and below the contact point.

Tighten them by twisting clockwise with a needle holder or Tighten them by twisting clockwise with a needle holder or Howe pliers. Howe pliers.

The interdental strands should not be so tight that they bring the The interdental strands should not be so tight that they bring the arch wires into contact or produce tooth movement.arch wires into contact or produce tooth movement.www.indiandentalacademy.comwww.indiandentalacademy.com

5.5. To properly distribute force tighten the last interdental ligature To properly distribute force tighten the last interdental ligature after all the other interdental ligatures and the arch wire have been after all the other interdental ligatures and the arch wire have been tightened tightened

6.6. Clip the ends of the wires short (2-3 mm) and bend them into the Clip the ends of the wires short (2-3 mm) and bend them into the interdental space to minimize catching food and to prevent interdental space to minimize catching food and to prevent injuring soft tissues. injuring soft tissues.

7.7. When the wires are properly positioned, both splint and teeth are When the wires are properly positioned, both splint and teeth are held fast.held fast.

8.8. The slippage can be controlled by additional cervical loops.The slippage can be controlled by additional cervical loops.

9.9. Check the occlusion for interferences before dismissing the Check the occlusion for interferences before dismissing the patient. Instruct the patient in oral hygiene procedures around the patient. Instruct the patient in oral hygiene procedures around the splinted teeth.splinted teeth.

10.10. Self-care acrylic or composite acid etch resin may be placed over Self-care acrylic or composite acid etch resin may be placed over the wires. This will improve esthetics, reduce irritation and tend to the wires. This will improve esthetics, reduce irritation and tend to prevent displacement.prevent displacement. www.indiandentalacademy.comwww.indiandentalacademy.com

INTRA CORONAL SPLINTS:-INTRA CORONAL SPLINTS:-

1) 1) Wire Acrylic splints Wire Acrylic splints (‘A’ Splints) (‘A’ Splints)

The The ‘A’‘A’ splint was first popularized by Berliner. It splint was first popularized by Berliner. It consists of a preparation, or series of preparations, through the consists of a preparation, or series of preparations, through the lingual surfaces of anterior teeth. lingual surfaces of anterior teeth.

The preparation are filled with acrylic and sometimes The preparation are filled with acrylic and sometimes ‘reinforced’‘reinforced’ with wire. Although the with wire. Although the ‘A’‘A’ splint can be used in splint can be used in posterior teeth, it is most commonly used in anterior teeth.posterior teeth, it is most commonly used in anterior teeth.


2) 2) Wire and composite reins:-Wire and composite reins:- The restorative properties of composite materials are The restorative properties of composite materials are

different and superior to those of acrylic resins.different and superior to those of acrylic resins.

Composites have better strength, better dimensional Composites have better strength, better dimensional stability and a sealing effect when used with enamel etching.stability and a sealing effect when used with enamel etching.

These splints are used commonly for anterior teeth.These splints are used commonly for anterior teeth.


3) 3) Amalgam splints:-Amalgam splints:- Advantages:-Advantages:- Simple.Simple. Inexpensive.Inexpensive. Time saving.Time saving. Effective device for posterior teeth.Effective device for posterior teeth. Does not require parallelism in preparations.Does not require parallelism in preparations. Adequate margins are easy to obtain.Adequate margins are easy to obtain. Good oral hygiene can be maintained.Good oral hygiene can be maintained. It is of an advantage in an amalgam preparation to effect It is of an advantage in an amalgam preparation to effect

undercuts for retention. These undercuts resist apical undercuts for retention. These undercuts resist apical displacement of the tooth from the splint.displacement of the tooth from the splint.


Disadvantages:-Disadvantages:- Limited to posterior teeth.Limited to posterior teeth.

Amalgam splints tend to fracture more easily.Amalgam splints tend to fracture more easily.

A technique has been devised in which contiguous mesial-A technique has been devised in which contiguous mesial-occlusal-distal preparations in adjoining teeth can be prepared occlusal-distal preparations in adjoining teeth can be prepared and a continuous amalgam filling can be replaced successfully and a continuous amalgam filling can be replaced successfully with relative case. This is termed the “Amalgam splint”.with relative case. This is termed the “Amalgam splint”.


4) Acrylic Full Crowns:-4) Acrylic Full Crowns:- Fixed temporary bridgesFixed temporary bridges may be made of acrylic crowns and may be made of acrylic crowns and

pontics and may also serve as temporary splints. They are pontics and may also serve as temporary splints. They are used when permanent fixed splints will ultimately replace used when permanent fixed splints will ultimately replace them.them.

Many ways exist to make acrylic splints. Many ways exist to make acrylic splints. One simple method employs duplicates of the patients study One simple method employs duplicates of the patients study

models. The temporary acrylic splint is then made on the models. The temporary acrylic splint is then made on the models of the prepared teeth.models of the prepared teeth.

Another method was a pressure molded splint. Either is Another method was a pressure molded splint. Either is rebased in the mouth after the teeth are prepared.rebased in the mouth after the teeth are prepared.


5) Combined Amalgam – wire – Acrylic splint5) Combined Amalgam – wire – Acrylic splint:: To overcome the drawbacks of an amalgam splint the To overcome the drawbacks of an amalgam splint the

combined Amalgam –wire-Acrylic splint has been combined Amalgam –wire-Acrylic splint has been developed.developed.


II.II. Provisional splinting: Provisional splinting: The provisional splint not only serves as a transitional The provisional splint not only serves as a transitional

fixed appliance to protect the prepared teeth until the final fixed appliance to protect the prepared teeth until the final restorations are inserted, but also serves several other restorations are inserted, but also serves several other important functions that are most necessary if periodontal important functions that are most necessary if periodontal prosthetic therapy is to be successful.prosthetic therapy is to be successful.

Provisional restorations play a key role in the Provisional restorations play a key role in the management of patients who require both periodontal therapy management of patients who require both periodontal therapy and restorative dentistry.and restorative dentistry.

Provisional restorations serve to Provisional restorations serve to stabilize a permanently stabilize a permanently mobile dentition form the time of initial tooth preparation until mobile dentition form the time of initial tooth preparation until the time the dentition is periodontally stable enough for the time the dentition is periodontally stable enough for permanent restorations.permanent restorations.www.indiandentalacademy.comwww.indiandentalacademy.com

Advantages:-Advantages:-

Reduces the pathologic mobility.Reduces the pathologic mobility. Protects the dental pulp from irritation following tooth Protects the dental pulp from irritation following tooth

preparation.preparation. It also affords the opportunity to determine the correct esthetic, It also affords the opportunity to determine the correct esthetic,

phonetic and functional occlusal qualities necessary for each phonetic and functional occlusal qualities necessary for each individual patient.individual patient.

The operator can proceed with confidence, knowing that the The operator can proceed with confidence, knowing that the above qualities can be attained in the final reconstruction.above qualities can be attained in the final reconstruction.

If a tooth included in the splint requires extraction it can be If a tooth included in the splint requires extraction it can be separated from the splint extracted, and the acrylic crown filled separated from the splint extracted, and the acrylic crown filled in with self curing acrylic. in with self curing acrylic.

Additional teeth can be crowned and added to the existing splint Additional teeth can be crowned and added to the existing splint if additional support becomes necessary.if additional support becomes necessary.

It can be placed any time after the initial periodontal therapy is It can be placed any time after the initial periodontal therapy is complete.complete.


III. III. PERMANENT SPLINTING:-PERMANENT SPLINTING:- (PERIODONTAL (PERIODONTAL PROSTHESIS)PROSTHESIS)

Introduction:-Introduction:- Permanent splinting is employed during complex and Permanent splinting is employed during complex and

rehabilitation where abutments are highly mobile or where a few rehabilitation where abutments are highly mobile or where a few abutments must support the entire prosthesis, particularly when abutments must support the entire prosthesis, particularly when such abutment teeth have minimal periodontal support but have such abutment teeth have minimal periodontal support but have been successfully treated periodontally.been successfully treated periodontally.

Splinting may also be necessary in cases of intractable Splinting may also be necessary in cases of intractable parafunctions. If such teeth are not splinted, the danger of parafunctions. If such teeth are not splinted, the danger of progressively increasing tooth mobility exists (Nyman and Lindhe progressively increasing tooth mobility exists (Nyman and Lindhe 1979).1979).


Complete dental treatment includes periodontal and restorative Complete dental treatment includes periodontal and restorative aspects, which are extensively interrelated successful treatment aspects, which are extensively interrelated successful treatment most often requires both types of therapy. most often requires both types of therapy.

Permanent splinting is indicated whenever periodontal treatment Permanent splinting is indicated whenever periodontal treatment does not reduce mobility to the point at which the teeth can does not reduce mobility to the point at which the teeth can function without added support. Such devices serve to stabilize function without added support. Such devices serve to stabilize loose teeth, to redistribute occlusal forces, to reduce traumatism, loose teeth, to redistribute occlusal forces, to reduce traumatism, and to aid in the repair of the periodontal tissues.and to aid in the repair of the periodontal tissues.

Permanent splints are fabricated after periodontal treatment has Permanent splints are fabricated after periodontal treatment has been completed, when their use will extend the functional life time been completed, when their use will extend the functional life time of the teeth.of the teeth.


Objectives:-Objectives:-

The major objective of periodontal prosthetics is to restore the The major objective of periodontal prosthetics is to restore the dentition to a state of health in which it can safely resist the dentition to a state of health in which it can safely resist the stresses of normal functions and also be better equipped to stresses of normal functions and also be better equipped to resist parafunctional forces.resist parafunctional forces.

The other objectives of periodontal prosthesis are to replace The other objectives of periodontal prosthesis are to replace missing teeth to enhance the patient’s cosmetic appearance missing teeth to enhance the patient’s cosmetic appearance and to improve phonetics.and to improve phonetics.

Ideally these objectives must be reached so that the procedures Ideally these objectives must be reached so that the procedures involved are biologically compatible with the hard and soft involved are biologically compatible with the hard and soft tissues of the mouth and so that the results will optimally tissues of the mouth and so that the results will optimally afford protection to the periodontium against further afford protection to the periodontium against further deterioration of its supporting qualities.deterioration of its supporting qualities.


PACKS AND SPLINTS:PACKS AND SPLINTS:

Nonspecific inflammation of the gingival tissue may Nonspecific inflammation of the gingival tissue may prove slow to resolve during hygiene phase therapy inspite of prove slow to resolve during hygiene phase therapy inspite of thorough scaling and polishing and an adequate standard of thorough scaling and polishing and an adequate standard of patient selfcare. Resolution of inflammation may be expedited patient selfcare. Resolution of inflammation may be expedited by the use of a periodontal pack.by the use of a periodontal pack.

Following scaling and polishing of the teeth, the role of Following scaling and polishing of the teeth, the role of pack is to protect the swollen tissues from trauma of normal pack is to protect the swollen tissues from trauma of normal function and the pack should remain in position for periods function and the pack should remain in position for periods upto seven days.upto seven days.

The dressing should be positioned, by packing each The dressing should be positioned, by packing each embrassures firmly, to obtain retention and by placing a strip embrassures firmly, to obtain retention and by placing a strip of pack across the whole field, which becomes bonded to the of pack across the whole field, which becomes bonded to the packed embrasures.packed embrasures.


The pack has the advantage that it has considerable powers of The pack has the advantage that it has considerable powers of retention when properly positioned. It is relatively inert with retention when properly positioned. It is relatively inert with respect to the soft tissues, and it is easy to remove cleanly. respect to the soft tissues, and it is easy to remove cleanly.

There is an increasing tendency to replace the use of pressure There is an increasing tendency to replace the use of pressure packs with chemotherapeutic plaque control agents such as 0.2 packs with chemotherapeutic plaque control agents such as 0.2 percent chlorhexidine mouth washes.percent chlorhexidine mouth washes.


DISADVANTAGES OF SPLINTSDISADVANTAGES OF SPLINTS : :

1. 1. Technical difficulty:_Technical difficulty:_ Unfortunately, few techniques are Unfortunately, few techniques are trained adequately to create a periodontal prosthetic trained adequately to create a periodontal prosthetic reconstruction that is truly biologically compatible with the reconstruction that is truly biologically compatible with the stomatognathic system. stomatognathic system.

The achievement of excellent marginal adaptation, good The achievement of excellent marginal adaptation, good contour, functional occlusion, and esthetic acceptance by the contour, functional occlusion, and esthetic acceptance by the patient usually is expected in single restorations or in small patient usually is expected in single restorations or in small segment bridges, but is difficult and rarely attained in full arch segment bridges, but is difficult and rarely attained in full arch splints.splints.


2. 2. CostCost:-:- Socio-economic factors could deflect treatment away Socio-economic factors could deflect treatment away from the ideal. Quality cannot be compromised on any part of from the ideal. Quality cannot be compromised on any part of the splint. Each unit of the splint is like a link of a chain, and the splint. Each unit of the splint is like a link of a chain, and the splint is no better than its weakest chain.the splint is no better than its weakest chain.

3. 3. Plaque removalPlaque removal:-:- Difficult plaque removal is a criticism Difficult plaque removal is a criticism often used by periodontists, well-designed periodontal often used by periodontists, well-designed periodontal prosthetic splints, however need not compromise plaque prosthetic splints, however need not compromise plaque removal. They may interfere with patient selfcare, and the self removal. They may interfere with patient selfcare, and the self cleaning action of teeth and gingival tissues. This is of great cleaning action of teeth and gingival tissues. This is of great importance in a patient with a high susceptibility to importance in a patient with a high susceptibility to periodontitis.periodontitis.

4. 4. Increased occlusal forcesIncreased occlusal forces:-:- Glickman, Stein and Smulow Glickman, Stein and Smulow reported the influences of increased occlusal forces on the reported the influences of increased occlusal forces on the periodontium of monkeys both when the teeth were splinted periodontium of monkeys both when the teeth were splinted and when they were not.and when they were not.


5. 5. Faulty contacts and contoursFaulty contacts and contours:-:- Nabers reported that Nabers reported that night-guard appliances can open interproximal contacts night-guard appliances can open interproximal contacts between teeth and Saturn reported that wire ligatures induce between teeth and Saturn reported that wire ligatures induce active forces on the ligated teeth, causing them to be moved active forces on the ligated teeth, causing them to be moved into new positions.into new positions.

6. 6. CariesCaries :- :- Extensive caries may be developed under loose Extensive caries may be developed under loose abutments and gross sepsis may follow with minimal abutments and gross sepsis may follow with minimal symptoms.symptoms.

7. 7. Additional tooth reductionAdditional tooth reduction:-:- All the teeth in a rigidity All the teeth in a rigidity splinted segment require composite draw, which requires splinted segment require composite draw, which requires addition tooth reduction and pulpal damage is not uncommon.addition tooth reduction and pulpal damage is not uncommon.


8. 8. Repair and maintenanceRepair and maintenance :- :-

The repair of, one unit of an extensive splint, however The repair of, one unit of an extensive splint, however can be difficult and expensive, at best the result is often a can be difficult and expensive, at best the result is often a compromise mechanical failures, such as porcelain fracture compromise mechanical failures, such as porcelain fracture and solder joint separation, are more frequent in multiunit and solder joint separation, are more frequent in multiunit splints than in smaller segments. splints than in smaller segments.

Cement washouts can occur without showing any Cement washouts can occur without showing any signs until the pulp has become involved. signs until the pulp has become involved.

Endodontic problems are difficult to resolve.Endodontic problems are difficult to resolve.


MAINTAINING THE ORAL HEALTH OF SPLINTED MAINTAINING THE ORAL HEALTH OF SPLINTED TEETH:TEETH:

Maintaining oral health in and around fixed splints poses a Maintaining oral health in and around fixed splints poses a significant challenge to the patient and the dental practitioner significant challenge to the patient and the dental practitioner because access to teeth and visibility for plaque control and because access to teeth and visibility for plaque control and periodontal maintenance techniques require extra skill and periodontal maintenance techniques require extra skill and effort.effort.

Effective personal plaque control, professional caries Effective personal plaque control, professional caries risk assessment, and periodontal maintenance are crucial to the risk assessment, and periodontal maintenance are crucial to the longevity of the splint and health of the splinted teeth.longevity of the splint and health of the splinted teeth.


Patient and provider roles in therapy:-Patient and provider roles in therapy:-

Both the dental provider and the patient contribute to Both the dental provider and the patient contribute to the success and longevity of the dental splint and to the health the success and longevity of the dental splint and to the health of the supporting soft and hard tissues. During the fabrication of the supporting soft and hard tissues. During the fabrication and placement of the splint, the dental provider must be and placement of the splint, the dental provider must be conscious of access and visibility factors that facilitate conscious of access and visibility factors that facilitate effective patient oral hygiene procedures.effective patient oral hygiene procedures.

Access:_Access:_

To facilitate adequate access for cleaning, a splint To facilitate adequate access for cleaning, a splint must be placed with open gingival embrasures and be properly must be placed with open gingival embrasures and be properly contoured with no overhanging margins. Posteriorly placed contoured with no overhanging margins. Posteriorly placed splints pose additional patient access challenges. splints pose additional patient access challenges.


Visibility:_Visibility:_

visibility issues also influence effectiveness of patient visibility issues also influence effectiveness of patient self care. If gaps between restoration materials and tooth self care. If gaps between restoration materials and tooth surfaces exist, bacterial plaque retention may occur.surfaces exist, bacterial plaque retention may occur.

Patients must be able to discriminate between Patients must be able to discriminate between restoration natural tooth surface, plaque, and calcified tooth restoration natural tooth surface, plaque, and calcified tooth deposits while practicing self-care. deposits while practicing self-care.

After splint placement, the oral health care provider After splint placement, the oral health care provider must deliver extensive home care instruction to the patient. must deliver extensive home care instruction to the patient. The patient then must assume responsibility for plaque The patient then must assume responsibility for plaque control and the adoption of any other suggested preventive control and the adoption of any other suggested preventive measures.measures.


Manual plaque control devices:-Manual plaque control devices:-

Selection and recommendation of mechanical plaque Selection and recommendation of mechanical plaque control devices depend on the type of splint, spacing control devices depend on the type of splint, spacing surrounding splints, personal preferences, and dexterity of the surrounding splints, personal preferences, and dexterity of the patient.patient.

Interdental plaque control:-Interdental plaque control:-

Increased bacterial plaque retention occurs in areas Increased bacterial plaque retention occurs in areas surroundings splints where other anatomic changes, including surroundings splints where other anatomic changes, including loss of gingival attachment, papilla, bone and teeth, presence loss of gingival attachment, papilla, bone and teeth, presence of malpositioned teeth and tooth movement, are common. of malpositioned teeth and tooth movement, are common.

Specifically designed devices are required for Specifically designed devices are required for accessing interproximal splinted surfaces. accessing interproximal splinted surfaces.

A variety of floss and brush devices can be used to A variety of floss and brush devices can be used to access these surfaces.access these surfaces.


Mechanical plaque control devices:-Mechanical plaque control devices:- For most patients, the choice between mechanical For most patients, the choice between mechanical

plaque control devices and manual devices is a matter of plaque control devices and manual devices is a matter of personal preference. personal preference.

Mechanical devices tend to be easier to use compared Mechanical devices tend to be easier to use compared with manual devices because the powered motion is built in with manual devices because the powered motion is built in and the patient need only place the device next to a and the patient need only place the device next to a surrounding splinted structure to ensure effective plaque surrounding splinted structure to ensure effective plaque removal.removal.

Powered tooth brushes, traditional mechanical tooth Powered tooth brushes, traditional mechanical tooth brushes, sonic ultrasonic tooth brushes, and powered brushes, sonic ultrasonic tooth brushes, and powered interdental devices are used as mechanical plaque control interdental devices are used as mechanical plaque control devices.devices.


Oral irrigating devices:-Oral irrigating devices:- Oral irrigation can be an important part of selfcare for patients Oral irrigation can be an important part of selfcare for patients

who cannot control their gingivitis with only brushing and who cannot control their gingivitis with only brushing and interproximal cleaning.interproximal cleaning.

Oral irrigation is an adjunctive therapy, not a replacement for Oral irrigation is an adjunctive therapy, not a replacement for brushing and interproximal plaque removal.brushing and interproximal plaque removal.

Oral irrigators are most effective when patients adhere to Oral irrigators are most effective when patients adhere to stringent instructions for use. stringent instructions for use.

Oral irrigators may be used after brushing and flossing to Oral irrigators may be used after brushing and flossing to deliver antimicrobial agents. deliver antimicrobial agents.

Patients should be provided with instructions for careful use of Patients should be provided with instructions for careful use of home oral irrigating devices.home oral irrigating devices.


Periodontal Health challenges:Periodontal Health challenges: Bacterial plaque is the primary cause of periodontal Bacterial plaque is the primary cause of periodontal

disease. Daily plaque removal, especially in interproximal disease. Daily plaque removal, especially in interproximal areas, has been reported to help prevent periodontal areas, has been reported to help prevent periodontal breakdown and is considered to be an essential component of breakdown and is considered to be an essential component of oral hygiene. oral hygiene.

Another important aspect in the prevention of periodontal Another important aspect in the prevention of periodontal disease is routine professional care. Because periodontal disease is routine professional care. Because periodontal health must be monitored after splint placement, frequent health must be monitored after splint placement, frequent evaluation by the oral health care provider is warranted. evaluation by the oral health care provider is warranted.

Regularly scheduled periodontal debridement also is essential.Regularly scheduled periodontal debridement also is essential.


Professional periodonatal debridementProfessional periodonatal debridement:-:- Periodontal health can be best maintained by frequent Periodontal health can be best maintained by frequent

maintenance visits and careful subgingival and supramarginal maintenance visits and careful subgingival and supramarginal debridement of hard and soft tissues surrounding the splint. debridement of hard and soft tissues surrounding the splint.

Advances in hand instruments, such as the after five Graceys and Advances in hand instruments, such as the after five Graceys and Mini-Five Graceys curets provide increased adaptability in the Mini-Five Graceys curets provide increased adaptability in the periodontal patient. periodontal patient.

The use of air and magnification may aid in visibility during The use of air and magnification may aid in visibility during instrumentation. These clinical aids are of particular importance instrumentation. These clinical aids are of particular importance during periodontal debridement of splinted teeth, where the splint during periodontal debridement of splinted teeth, where the splint material often blends with surrounding natural tooth surfaces. material often blends with surrounding natural tooth surfaces.


Ultrasonic and sonic scalers are not recommended on or near Ultrasonic and sonic scalers are not recommended on or near restorative splinting materials.restorative splinting materials.

Air polishing and high abrasives also are contraindicated and Air polishing and high abrasives also are contraindicated and are detrimental to the integrity of the splinted material.are detrimental to the integrity of the splinted material.

Post splint periodontal maintenance and frequent assessment Post splint periodontal maintenance and frequent assessment of specific clinical parameters promote continued periodontal of specific clinical parameters promote continued periodontal health.health.


Periodontal status:-Periodontal status:-

Composite reins, exhibiting superior esthetics, often are the Composite reins, exhibiting superior esthetics, often are the preferred restorative material in splint fabrication. preferred restorative material in splint fabrication.

Marginal adaptation difficulties of composite resin restorations Marginal adaptation difficulties of composite resin restorations combined with ineffective plaque control, however, can combined with ineffective plaque control, however, can exacerbate gingival inflammation adjacent to these materials, exacerbate gingival inflammation adjacent to these materials, thus increasing periodontal disease risk in susceptible thus increasing periodontal disease risk in susceptible individuals. individuals.

Progression of periodontal disease is one cause of splint failure.Progression of periodontal disease is one cause of splint failure.

Initial patient follow-up should occur 2 weeks after splint Initial patient follow-up should occur 2 weeks after splint placement. Follow-up assessment is recommended to evaluate placement. Follow-up assessment is recommended to evaluate patient home care compliance and effectiveness and to evaluate patient home care compliance and effectiveness and to evaluate gingival health status surroundings the splint.gingival health status surroundings the splint.


Professional periodontal evaluation of splinted teeth is Professional periodontal evaluation of splinted teeth is recommended at 3-month intervals.recommended at 3-month intervals.

Bleeding on probing, pocket depths, and presence or absence of Bleeding on probing, pocket depths, and presence or absence of gingival inflammation are periodontal parameters to note when gingival inflammation are periodontal parameters to note when evaluating supportive soft tissues surrounding splinted teeth evaluating supportive soft tissues surrounding splinted teeth comparative radiographic evaluation of alveolar bone levels also comparative radiographic evaluation of alveolar bone levels also should be performed at appropriate intervals.should be performed at appropriate intervals.

Occlusal interferences and parafunctional occlusal habits must Occlusal interferences and parafunctional occlusal habits must also be addressed as part of the periodontal evaluation because also be addressed as part of the periodontal evaluation because they can contribute splint failure.they can contribute splint failure.


Challengers to caries prevention:Challengers to caries prevention: Chemical adhesives and composite resins are Chemical adhesives and composite resins are

commonly used to splint teeth together. The roughness of the commonly used to splint teeth together. The roughness of the composite resin surfaces attracts plaque and debris, however, composite resin surfaces attracts plaque and debris, however, and can increase the caries risk to the surrounding supportive and can increase the caries risk to the surrounding supportive splinted structures. splinted structures.

A high number of composite resin are replaced because of A high number of composite resin are replaced because of recurrent caries. Both composite resin restorations and recurrent caries. Both composite resin restorations and composite resin splints require close examination at composite resin splints require close examination at maintenance visits because of the potential for breakdown and maintenance visits because of the potential for breakdown and marginal leakage.marginal leakage.

Caries risk assessment is required for long-term retention Caries risk assessment is required for long-term retention of splinted teeth. Caries risk factors may include splint of splinted teeth. Caries risk factors may include splint fracture, marginal leakage and poor plaque control. fracture, marginal leakage and poor plaque control. www.indiandentalacademy.comwww.indiandentalacademy.com

Recurrent decay may occur in the presence of fractured Recurrent decay may occur in the presence of fractured splints, and poor plaque control can contribute to splints, and poor plaque control can contribute to decalcification of splinted teeth. decalcification of splinted teeth.

Neutral sodium fluoride preparations are preferred because Neutral sodium fluoride preparations are preferred because they do not cause unsightly staining as stannous fluoride they do not cause unsightly staining as stannous fluoride preparations may, and they do not cause the etching effect on preparations may, and they do not cause the etching effect on composite and porcelain restorative materials that acidulated composite and porcelain restorative materials that acidulated phosphate fluoride.phosphate fluoride.

A risk oriented post operative program consists of effective A risk oriented post operative program consists of effective

plaque control, fluoride applications, and frequent evaluation plaque control, fluoride applications, and frequent evaluation of splint integrity through radiographic and clinical of splint integrity through radiographic and clinical examinations. examinations.


Conclusion Conclusion

With the combination of clinical skill, appropriate dental With the combination of clinical skill, appropriate dental material selection, good communication and comprehensive material selection, good communication and comprehensive health education, both providers and patients can benefit from health education, both providers and patients can benefit from esthetic, functional and healthy dental splints.esthetic, functional and healthy dental splints.

“ “ The dentist of the future should seek his The dentist of the future should seek his rewards more in the teeth he has saved rewards more in the teeth he has saved from the ravages of dental diseases than from the ravages of dental diseases than in the prostheses he makes it he fails with in the prostheses he makes it he fails with

the prevention .” the prevention .” www.indiandentalacademy.comwww.indiandentalacademy.com

References References

J P 1980;51;469-472( A new method for stabilization of J P 1980;51;469-472( A new method for stabilization of periodontally involved teeth.)periodontally involved teeth.)

JADA 1980;101;926-929( Cast metal resin bonding)JADA 1980;101;926-929( Cast metal resin bonding) DCNA;1964;213-219( The amalgam splint)DCNA;1964;213-219( The amalgam splint) DCNA ; 1969; 213-227( Principles & technique of the DCNA ; 1969; 213-227( Principles & technique of the

stabilization of loose teeth.stabilization of loose teeth. DCNA; 1999( Tooth splinting and stabilization) DCNA; 1999( Tooth splinting and stabilization) Text books of GRANT , CARRANZA & ROSE.Text books of GRANT , CARRANZA & ROSE.


TEMPORARY SPLINTS TEMPORARY SPLINTS

EXTRACORONAL.EXTRACORONAL.


2) 2) SPLINTS OF ENAMEL-BONDING MATERIAL:-SPLINTS OF ENAMEL-BONDING MATERIAL:-

A simple method of external temporary splinting tooth-bonding A simple method of external temporary splinting tooth-bonding material:material:

Self polymerized, Self polymerized, Ultraviolet polymerized and Ultraviolet polymerized and White light polymerized composite rein.White light polymerized composite rein.

ADVANTAGES:ADVANTAGES: Esthetic.Esthetic. Noninvasive and reversible.Noninvasive and reversible. May be reinforced with wire or plastic mesh.May be reinforced with wire or plastic mesh. Does not irritate the gingiva.Does not irritate the gingiva. Local anesthesia is not needed.Local anesthesia is not needed.


DISADVANTAGES DISADVANTAGES ( ( splints of enamel-bonding materialsplints of enamel-bonding material::

Depends for strength on bond to enamel and bulk of Depends for strength on bond to enamel and bulk of material.material.

No mechanical retention.No mechanical retention. Requires meticulous polishing of teeth immediately prior to Requires meticulous polishing of teeth immediately prior to

etching.etching. Dry field is imperative.Dry field is imperative. Caries hazard exists if seepage occurs.Caries hazard exists if seepage occurs. Plaque control becomes more difficult.Plaque control becomes more difficult.


Indication & Contraindication Splints Of Enamel-bonding Material:-Indication & Contraindication Splints Of Enamel-bonding Material:-

INDICATIONINDICATION Mobile anterior teeth when esthetics is important.Mobile anterior teeth when esthetics is important. Temporary mobility due to trauma.Temporary mobility due to trauma. Need for long term stabilization is unlikely.Need for long term stabilization is unlikely.

CONTRAINDICATIONS:CONTRAINDICATIONS: teeth subjected to severe stress.teeth subjected to severe stress. Posterior teeth.Posterior teeth.


a) a) Self-polymerized resin bonding materialsSelf-polymerized resin bonding materials:_:_

1.1. The teeth selected for splinting are polished with pumice prior to The teeth selected for splinting are polished with pumice prior to their isolation under a rubber dam.their isolation under a rubber dam.

2.2. After isolation the teeth are dried with a stream of air. The etchant After isolation the teeth are dried with a stream of air. The etchant is then place on the labial, lingual and proximal surfaces of the is then place on the labial, lingual and proximal surfaces of the teeth with a cotton pellet. After 2 minutes, the teeth are thoroughly teeth with a cotton pellet. After 2 minutes, the teeth are thoroughly rinsed off with water and allow them to dry.rinsed off with water and allow them to dry.

3.3. Following the etching procedure, the enamel has a dull chalky Following the etching procedure, the enamel has a dull chalky appearance. If this is not achieved, re-etching is necessary.appearance. If this is not achieved, re-etching is necessary.

4.4. To facilitate the later trimming of the polymerized resin, one or To facilitate the later trimming of the polymerized resin, one or more wooden interdental stimulators are placed interproximally to more wooden interdental stimulators are placed interproximally to fill the embrassure spaces and thereby limit the flow of the resin.fill the embrassure spaces and thereby limit the flow of the resin.


5.5. Mix the appropriate proportions of the powder and liquid, the resin Mix the appropriate proportions of the powder and liquid, the resin is placed in a continuous layer on the facial surfaces of the teeth.is placed in a continuous layer on the facial surfaces of the teeth.

6.6. The material is compressed on the labial surfaces and into the The material is compressed on the labial surfaces and into the interproximal areas with a celluloid matrix strip which is held in interproximal areas with a celluloid matrix strip which is held in place during the initial setting period of 3 minutes.place during the initial setting period of 3 minutes.

7.7. The procedure is now repeated on the lingual surfaces. A thin, The procedure is now repeated on the lingual surfaces. A thin, continuous layer of polymerized rein now covers the labial and continuous layer of polymerized rein now covers the labial and lingual surfaces of the teeth, and forms an interproximal bridge lingual surfaces of the teeth, and forms an interproximal bridge above and below the contact areas.above and below the contact areas.

8.8. After 10 minutes have elapsed, during which time the early After 10 minutes have elapsed, during which time the early adhesive bonds mature, the material is trimmed and polished.adhesive bonds mature, the material is trimmed and polished.

9.9. The occlusion must be checked and adjusted as necessary to The occlusion must be checked and adjusted as necessary to relieve prematurities resulting from excess resin.relieve prematurities resulting from excess resin.www.indiandentalacademy.comwww.indiandentalacademy.com

b) b) Ultraviolet –light polymerized bonding materials:_Ultraviolet –light polymerized bonding materials:_ The procedure is same as for self-polymerized bonding The procedure is same as for self-polymerized bonding

materials but only the difference is the type of polymerization. materials but only the difference is the type of polymerization. This type of bonding materials need ultraviolet-light for This type of bonding materials need ultraviolet-light for polymerization.polymerization.

ADVANTAGES :-ADVANTAGES :- Rigid and durable.Rigid and durable. No destruction of tooth structure.No destruction of tooth structure. Esthetically acceptable.Esthetically acceptable. Well tolerated by patients.Well tolerated by patients. They do not polymerize until they are exposed to ultra-violet They do not polymerize until they are exposed to ultra-violet

light, they provide prolonged workinglight, they provide prolonged working times for placement, times for placement, shaping and contouring over extensive areas of enamel.shaping and contouring over extensive areas of enamel.


3) 3) Welded band splints:-Welded band splints:- (Orthodontic bands): (Orthodontic bands):

Advantages:_Advantages:_ Provides rigidity, oral Provides rigidity, oral

hygiene is maintained.hygiene is maintained. Useful for stabilization of Useful for stabilization of

posterior teeth.posterior teeth. At any time additional teeth At any time additional teeth

may be incorporated into the may be incorporated into the splint.splint.

Can be used as a provisional Can be used as a provisional splint.splint.

Proper positioning of bands Proper positioning of bands allow the use of night allow the use of night guards or bite planes.guards or bite planes.

Disadvantages:Disadvantages: Construction is tedious.Construction is tedious. Time consuming.Time consuming.


Procedure:Procedure:

Herein is described a technique for the fabrication of Herein is described a technique for the fabrication of a wire band splint which blends the advantages of wire a wire band splint which blends the advantages of wire ligation with its means of tension adjustment and orthodontic ligation with its means of tension adjustment and orthodontic bands which may be placed on teeth without cutting into bands which may be placed on teeth without cutting into enamel or gold crowns.enamel or gold crowns.

1.1. Select the prefabricated stainless steel bands which fit the Select the prefabricated stainless steel bands which fit the teeth snugly. The band pushing instrument can be used for teeth snugly. The band pushing instrument can be used for proper setting of band.proper setting of band.

2.2. It must come to rest with the occlusal edge of the band at or It must come to rest with the occlusal edge of the band at or slightly below the marginal ridge.slightly below the marginal ridge.

3.3. The gingival edge of the bands should not touch the gingiva.The gingival edge of the bands should not touch the gingiva.www.indiandentalacademy.comwww.indiandentalacademy.com

4.4. If the interproximal contacts are too tight the adjacent tooth If the interproximal contacts are too tight the adjacent tooth surfaces can be lightly stripped with sandpaper strips or surfaces can be lightly stripped with sandpaper strips or separating wires are placed for a period of 2-3 days.separating wires are placed for a period of 2-3 days.

5.5. Once the bands are placed on the teeth, they are scored with Once the bands are placed on the teeth, they are scored with sharp instrument at mesial and distal angles at a level midway sharp instrument at mesial and distal angles at a level midway between the occlusal and gingival edges of the band.between the occlusal and gingival edges of the band.

6.6. On the lingual surface of each band a mark is made which is On the lingual surface of each band a mark is made which is centered occluso gingivally and mesiodistatlly. The bands are centered occluso gingivally and mesiodistatlly. The bands are removed using band removing pliers without causing any removed using band removing pliers without causing any distortion.distortion.

7.7. Preformed loops can now be spot welded to the bands at the Preformed loops can now be spot welded to the bands at the locations previously marked.locations previously marked.

8.8. After welding, all rough edges are smoothed with free stones After welding, all rough edges are smoothed with free stones and rubber wheels.and rubber wheels. www.indiandentalacademy.comwww.indiandentalacademy.com

9.9. The finished bands are reseated the teeth and the margins are The finished bands are reseated the teeth and the margins are burnished down.burnished down.

10.10. The bands are removed, lined with Znpo4 cement and reseated on The bands are removed, lined with Znpo4 cement and reseated on the dried teeth.the dried teeth.

11.11. Once the cement has set, excess is removed. Once the cement has set, excess is removed.

12.12. The banded teeth are now ligated together with wire in a manner The banded teeth are now ligated together with wire in a manner similar to that used to wire anterior teeth.similar to that used to wire anterior teeth.

13.13. The main wire is (0.018) is threaded through all the buccal lingual The main wire is (0.018) is threaded through all the buccal lingual loops. Where spacing exists between teeth, the wire is given loops. Where spacing exists between teeth, the wire is given sufficient twists to take up the space. The main wire is indented sufficient twists to take up the space. The main wire is indented interproximally with a plastic instrument and then interproximal interproximally with a plastic instrument and then interproximal wires are placed.wires are placed.

14.14. The final step is to tighten the main wire and tuck it The final step is to tighten the main wire and tuck it interproximally.interproximally. www.indiandentalacademy.comwww.indiandentalacademy.com

4) 4) CONTINUOUS CLASPS:_CONTINUOUS CLASPS:_(Removable Cast Continuous Clasp Appliances)(Removable Cast Continuous Clasp Appliances)

ADVANTAGES:-ADVANTAGES:- Rigid and strong.Rigid and strong. Non invasive.Non invasive. Usable on posterior teeth.Usable on posterior teeth. Removable by patient for Removable by patient for

cleaning.cleaning. Pontics may be added when ever Pontics may be added when ever

extractions become necessary.extractions become necessary. Economic way of controlling Economic way of controlling

hypermobility.hypermobility. They can be removed for social They can be removed for social

engagements.engagements. They may also be used at night They may also be used at night

only.only.

DISADVANTAGESDISADVANTAGES:-:- Unaesthetic.Unaesthetic. Caries risk.Caries risk. Laboratory procedure required.Laboratory procedure required. They may impede speech.They may impede speech. Removable splints generally Removable splints generally

donot contribute to a permanent donot contribute to a permanent decrease in mobility.decrease in mobility.


Indication & Contraindication Of Continuous Clasps:_Indication & Contraindication Of Continuous Clasps:_

INDICATIONS:-INDICATIONS:-

Mobile teeth any where in Mobile teeth any where in either arch if esthetics is not either arch if esthetics is not a serious concern.a serious concern.

Need for inexpensive Need for inexpensive replacement of missing replacement of missing teeth when hopeless teeth teeth when hopeless teeth are extracted.are extracted.

CONTRINDICATIONS:-CONTRINDICATIONS:-

When esthetics are When esthetics are important.important.

Poor patient cooperation in Poor patient cooperation in plaque control.plaque control.


The removable cast continuous clasp appliances can be seated The removable cast continuous clasp appliances can be seated and removed in the fashion of a partial denture or they can be and removed in the fashion of a partial denture or they can be ligated to place.ligated to place.

Using them as freely removable appliances is advantageous, Using them as freely removable appliances is advantageous, since adequate oral hygiene is possible.since adequate oral hygiene is possible.

It rests at the height of contour and the cingulum of anterior It rests at the height of contour and the cingulum of anterior teeth and at the buccal and lingual surfaces of posterior teeth. teeth and at the buccal and lingual surfaces of posterior teeth.

The appliance is rigid and does not enter undercuts as does a The appliance is rigid and does not enter undercuts as does a partial denture clasp. Retention is achieved by frictional grip partial denture clasp. Retention is achieved by frictional grip on the broad areas of tooth surface contacted.on the broad areas of tooth surface contacted.


5. REMOVABLE ACRYLIC APPLIANCES:_5. REMOVABLE ACRYLIC APPLIANCES:_

The clinician must be aware of the fact that when utilizes any form The clinician must be aware of the fact that when utilizes any form of acrylic appliance, the dimensional instability of the material of acrylic appliance, the dimensional instability of the material may cause distortions to occur. It is imperative to check these may cause distortions to occur. It is imperative to check these appliances frequently and to make any necessary adjustments.appliances frequently and to make any necessary adjustments.

i) i) Occlusal splints:-Occlusal splints:-

Maxillary and mandibular bite guard Maxillary and mandibular bite guard Maxillary occlusal splint.Maxillary occlusal splint. Mandibular occlusal splint.Mandibular occlusal splint. Soft occusal splint.Soft occusal splint.

ii) ii) Bite plates:-Bite plates:-

Hawley bite plate.Hawley bite plate. Sved bite plate.Sved bite plate.www.indiandentalacademy.comwww.indiandentalacademy.com

I) I) OCCULSAL SPLINTS:_OCCULSAL SPLINTS:_

USES:-USES:-

1) These are not only used for stabilizing the mobile teeth but also 1) These are not only used for stabilizing the mobile teeth but also for protecting the dentition , muscles and TMJ from the damaging for protecting the dentition , muscles and TMJ from the damaging effects of parafunctional activity, such as bruxism.effects of parafunctional activity, such as bruxism.

2) During orthodontic therapy the variations of occlusal splints are 2) During orthodontic therapy the variations of occlusal splints are used for treating the simple types of tooth movement, and for the used for treating the simple types of tooth movement, and for the retention of the teeth after the teeth have been moved.retention of the teeth after the teeth have been moved.

3) Myospasm can be reduced.3) Myospasm can be reduced.

4) Can be used during the treatment of problems related to the TMJ.4) Can be used during the treatment of problems related to the TMJ.

5) Economical to construct.5) Economical to construct.www.indiandentalacademy.comwww.indiandentalacademy.com

A) A) MAXILLARY AND MANDIBULAR BITE GUARDSMAXILLARY AND MANDIBULAR BITE GUARDS (NIGHT (NIGHT GUARDSGUARDS))

ADVANTAGES:_ADVANTAGES:_ Non invasiveNon invasive Protects teeth from stresses of Protects teeth from stresses of

clenching and grinding habits clenching and grinding habits (Para functional activities)(Para functional activities)

Provides smooth, had, flat Provides smooth, had, flat occlusal surface for group occlusal surface for group function during tooth grinding.function during tooth grinding.

Able to withstand severe Able to withstand severe occlusal stress.occlusal stress.

Occlusal surface may be Occlusal surface may be adjusted as desired.adjusted as desired.

DISADVANTAGES:_DISADVANTAGES:_ Some patients are unable to Some patients are unable to

tolerate guards because of tolerate guards because of gagging, encroachment on gagging, encroachment on free way space or inability free way space or inability to sleep with a foreign to sleep with a foreign object in mouth.object in mouth.


INDICATION & CONTRAINDICATION OF THE NIGHT GURDINDICATION & CONTRAINDICATION OF THE NIGHT GURD

INDICATIONS:_INDICATIONS:_ Presence of tooth clenching Presence of tooth clenching

or grinding habit (bruxism).or grinding habit (bruxism).

When retainer is needed When retainer is needed following orthodontic following orthodontic therapy.therapy.

Prevention of extrusion of a Prevention of extrusion of a tooth when the opposing tooth when the opposing tooth is missing and difficult tooth is missing and difficult to replace (Eg:- missing to replace (Eg:- missing mandibular second molar)mandibular second molar)

CONTRAINDICATIONS:CONTRAINDICATIONS: Allergy to methacrylate Allergy to methacrylate

resins.resins.

Patient refuses to wear Patient refuses to wear appliances.appliances.


An occlusal guard (night guard, bite guard, bruxism splint) is a An occlusal guard (night guard, bite guard, bruxism splint) is a removable, rigid acrylic appliance that fits over the occlusal removable, rigid acrylic appliance that fits over the occlusal surface of the teeth. surface of the teeth.

Retention is provided by small ball clasps or by frictional grip of Retention is provided by small ball clasps or by frictional grip of the plastic on the teeth .the plastic on the teeth .

The guard presents a smooth hard surface to the opposing teeth, The guard presents a smooth hard surface to the opposing teeth, allowing them to glide over its surface easily and distributing the allowing them to glide over its surface easily and distributing the forces produced on all the teeth in the arch during clenching.forces produced on all the teeth in the arch during clenching.

An occlusal guard is usually made for the maxillary teeth because An occlusal guard is usually made for the maxillary teeth because coverage of atleast part of the palate makes it more rigid. coverage of atleast part of the palate makes it more rigid. Moreover, the tongue is less likely to dislodge a maxillary guardMoreover, the tongue is less likely to dislodge a maxillary guard


. However, if the mandibular teeth are much more mobile that . However, if the mandibular teeth are much more mobile that those in the upper arch, the guard is made for the lower arch those in the upper arch, the guard is made for the lower arch only. only.

Occasionally if all the teeth are severely involved, guards for Occasionally if all the teeth are severely involved, guards for both arches are made.both arches are made.

Occlusal adjustment should be completed before an occlusal Occlusal adjustment should be completed before an occlusal guard is made.guard is made.


FABRICATION OF THE GUARD:-FABRICATION OF THE GUARD:- 1)1) Take the impression:-Take the impression:-

Take alginate impressions of both arches. Try to avoid Take alginate impressions of both arches. Try to avoid air bubbles in the tooth part of the impression. Take a wax air bubbles in the tooth part of the impression. Take a wax registration bite in intercuspal position to articulate the models.registration bite in intercuspal position to articulate the models.

2)2) Fit the guard:- Fit the guard:-

Try the guard in the mouth. It should seat completely Try the guard in the mouth. It should seat completely without wobbling and it should feel snug, but not uncomfortably without wobbling and it should feel snug, but not uncomfortably tight, to the patient. tight, to the patient.

It is best to leave the guard in place for a few minutes It is best to leave the guard in place for a few minutes before attempting to relieve excessive tightness or “wedging”, before attempting to relieve excessive tightness or “wedging”, the teeth may have shifted slightly since the impressions were the teeth may have shifted slightly since the impressions were taken. Leaving the guard in place will reposition the teeth if the taken. Leaving the guard in place will reposition the teeth if the shifting was minor.shifting was minor.

If required, the guard is adjusted by removing plastic If required, the guard is adjusted by removing plastic from its interior surfaces.from its interior surfaces.www.indiandentalacademy.comwww.indiandentalacademy.com

3)3) Adjust occlusion of the guard with opposing teeth. Adjust occlusion of the guard with opposing teeth.

a) Intercuspal position, a) Intercuspal position,

b) Lateral and protrusive excursions.b) Lateral and protrusive excursions.

4)4) Teach the patient to insert and remove appliance. Give Teach the patient to insert and remove appliance. Give the patient instructions for use of the guard.the patient instructions for use of the guard.

5)5) Management of problems in fitting night guards.Management of problems in fitting night guards.

Excessive tightness – relieve the interior of the guard. Where Excessive tightness – relieve the interior of the guard. Where the patient feels tightness or wedging of teeth.the patient feels tightness or wedging of teeth.

Guard does not seat completely: If the guard is so distorted, take Guard does not seat completely: If the guard is so distorted, take a new impression and make a new one.a new impression and make a new one.


Maxillary occlusal splint:Maxillary occlusal splint:

Indications:-Indications:- These are used for stabilization when the mandibular anterior teeth These are used for stabilization when the mandibular anterior teeth

either are relatively sound or protect an extensively restored either are relatively sound or protect an extensively restored dentition.dentition.

Used as an diagnostic splint during TMJ therapy.Used as an diagnostic splint during TMJ therapy.

Used in a modified fashion as a device to change the vertical or Used in a modified fashion as a device to change the vertical or horizontal relationship of the mandible to maxilla during treatment horizontal relationship of the mandible to maxilla during treatment of meniscus derangement problems.of meniscus derangement problems.

They can be made of heat-processed or auto They can be made of heat-processed or auto polymerizing acrylic rein, or they can be vaccum formed. The heat polymerizing acrylic rein, or they can be vaccum formed. The heat cured types are usually more durable, stronger and have less cured types are usually more durable, stronger and have less porosity but more expensive.porosity but more expensive.www.indiandentalacademy.comwww.indiandentalacademy.com

Procedure:_Procedure:_ They can be made either by mounting both maxillary and They can be made either by mounting both maxillary and

mandibular casts on a semi adjustable articulator or with mandibular casts on a semi adjustable articulator or with unmounted maxillary casts.unmounted maxillary casts.

Procedure accuracy in constructing casts of the teeth is Procedure accuracy in constructing casts of the teeth is mandatory. If the casts are articulated, the incisal pin should mandatory. If the casts are articulated, the incisal pin should be opened to allow for approximately 1.5-2 mm of clearance be opened to allow for approximately 1.5-2 mm of clearance in the molar region. in the molar region.

The splint should be waxed to the heights of the contour The splint should be waxed to the heights of the contour of the teeth. The splint should have a flat occlusal surface with of the teeth. The splint should have a flat occlusal surface with small occlusal contacts, approximately 1 mm in diameter, for small occlusal contacts, approximately 1 mm in diameter, for all or more of the centric holding opposing cusps and incisal all or more of the centric holding opposing cusps and incisal edges. edges.


The waxing can be completed in a conventional manner The waxing can be completed in a conventional manner and processed with either heat-cured or autopolymerized and processed with either heat-cured or autopolymerized acrylic resin.acrylic resin.

An excellent variation of this splint can be made by using An excellent variation of this splint can be made by using a vaccum-or air-pressure forming process. Final adjustments a vaccum-or air-pressure forming process. Final adjustments to the splint of achieve precise occlusal contacts always must to the splint of achieve precise occlusal contacts always must be completed intraorally.be completed intraorally.


Mandibular occlusal splints:-Mandibular occlusal splints:-

An interacting variation of the occlusal splint is the single An interacting variation of the occlusal splint is the single mandibular splint, referred by Shore as the auto repositioning mandibular splint, referred by Shore as the auto repositioning appliance. appliance.

The maxillary occlusal splint is the easier of the two splints to The maxillary occlusal splint is the easier of the two splints to construct. construct.

The single mandibular appliance occasionally interferes with The single mandibular appliance occasionally interferes with lip position and if bruxism is an ingrained habit, tends to lip position and if bruxism is an ingrained habit, tends to increase mobility of the maxillary anterior teeth.increase mobility of the maxillary anterior teeth.


Soft occlusal splints:-Soft occlusal splints:-

Occlusal splints can be made of soft acrylic resin, later Occlusal splints can be made of soft acrylic resin, later rubber, or vinyl material. Some believe that this material rubber, or vinyl material. Some believe that this material acts as a shock absorber during bruxism. acts as a shock absorber during bruxism.

Some believe that these appliances may stimulate Some believe that these appliances may stimulate parafunction. Except whenparafunction. Except when used as mouth guards during used as mouth guards during sports activities, their usefulness is limited.sports activities, their usefulness is limited.


Bite plates:-Bite plates:-

Bite plates are acrylic resin plates that cover most of the hard Bite plates are acrylic resin plates that cover most of the hard palate and are retained either by clasps and labial arch wire or palate and are retained either by clasps and labial arch wire or by clasps alone. by clasps alone.

A flat or inclined plane of acrylic is built up lingually to reach A flat or inclined plane of acrylic is built up lingually to reach the incisal edges and articulate evenly with mandibular the incisal edges and articulate evenly with mandibular incisors and canines. incisors and canines.

The contacts should be at right angles to the long axis of the The contacts should be at right angles to the long axis of the mandibular teeth.mandibular teeth.


As early as 1771 As early as 1771 John HunterJohn Hunter described a Wrought silver described a Wrought silver inclined plane to be worn on the lower anterior teeth for inclined plane to be worn on the lower anterior teeth for correction of an anterior cross bite. correction of an anterior cross bite.

In 1803 In 1803 Joseph FoxJoseph Fox advocated placing a bite block over the advocated placing a bite block over the posterior teeth so that the force of occlusion could be removed posterior teeth so that the force of occlusion could be removed before attempting to move the teeth. before attempting to move the teeth.

In 1883 In 1883 Henry QuimbyHenry Quimby described a maxillary bite plate described a maxillary bite plate constructed to eliminate pressure from the posterior teeth and constructed to eliminate pressure from the posterior teeth and allow them to elongate.allow them to elongate.

In 1889 In 1889 BonwillBonwill described a maxillary biteplate which had described a maxillary biteplate which had the effect of decreasing overbite.the effect of decreasing overbite.

In 1892 In 1892 KingrleyKingrley described a maxillary bite plane for the described a maxillary bite plane for the purpose of jumping the bite.purpose of jumping the bite.www.indiandentalacademy.comwww.indiandentalacademy.com

Indications:_Indications:_ The bite plate can be used as a dignostic appliance.The bite plate can be used as a dignostic appliance. It can be used when there is mobility caused by occlusal It can be used when there is mobility caused by occlusal

trauma.trauma. It can be used to allow for extrusion of teeth with periodontal It can be used to allow for extrusion of teeth with periodontal

osseous deformities in an attempt to alter the osseous osseous deformities in an attempt to alter the osseous topography.topography.

BerlenerBerlener popularized the use of the bite plate as a popularized the use of the bite plate as a mode therapy in periodontal diseases.mode therapy in periodontal diseases.

GratzingerGratzinger showed dramatic changes in a case treated showed dramatic changes in a case treated with a bite plate.with a bite plate.


Advantages:-Advantages:- To make mobile teeth that are in trauma out of trauma by To make mobile teeth that are in trauma out of trauma by

disarticulating them and putting them at rest. This will decrease the disarticulating them and putting them at rest. This will decrease the mobility, prevent further damage and allow for healing.mobility, prevent further damage and allow for healing.

To allow orthodontic movement of teeth without interference from To allow orthodontic movement of teeth without interference from the inclined planes of the opposing teeth.the inclined planes of the opposing teeth.

To eliminate superimposed occlusal trauma that may be caused by To eliminate superimposed occlusal trauma that may be caused by the parafunctional habits that can develop and / or be accentuated the parafunctional habits that can develop and / or be accentuated by the prematurities that occur during orthodontic tooth movement.by the prematurities that occur during orthodontic tooth movement.

To allow for extrusion of teeth with periodontal osseous To allow for extrusion of teeth with periodontal osseous deformities and the attendant coronal movement of the alveolar deformities and the attendant coronal movement of the alveolar bone and cementum. This may have a tendency to shallow out the bone and cementum. This may have a tendency to shallow out the osseous lesions.osseous lesions.

Eliminate pain from TMJ and muscle dysfunction. Eliminate pain from TMJ and muscle dysfunction. They can incorporate missing teeth.They can incorporate missing teeth.


Disadvantages:-Disadvantages:- In a high angle case (open bite skeletal pattern) the bite plate In a high angle case (open bite skeletal pattern) the bite plate

may cause the development of an anterior open bite.may cause the development of an anterior open bite.

When fixed orthodontic appliances are being used, the bite When fixed orthodontic appliances are being used, the bite plate may interfere with tooth movement in the arch in which plate may interfere with tooth movement in the arch in which it is placed.it is placed.

Cusp to fossa and cusp-to-cusp relationships may be altered.Cusp to fossa and cusp-to-cusp relationships may be altered.

The use of biteplates as a longterm appliance can cause The use of biteplates as a longterm appliance can cause unwanted passive eruption of the disarticulated posterior teeth unwanted passive eruption of the disarticulated posterior teeth or intrusion of the mandibular anterior teeth.or intrusion of the mandibular anterior teeth.


1.HAWLEY BITE PLATE:_1.HAWLEY BITE PLATE:_

ADVANTAGES:-ADVANTAGES:- More vertical redirection of the More vertical redirection of the

forces on the maxillary anterior forces on the maxillary anterior teeth and stabilization of the teeth and stabilization of the maxillary posterior teeth.maxillary posterior teeth.

Disarticulation of the posterior Disarticulation of the posterior teeth, provides occlusal rest, teeth, provides occlusal rest, allows muscle rest, relief form allows muscle rest, relief form trauma, allows mandible to trauma, allows mandible to function freely without tooth function freely without tooth interferences.interferences.

Also used to facilitate Also used to facilitate orthodontic tooth movement.orthodontic tooth movement.

Can be used daily as well as Can be used daily as well as nightly.nightly.

DISADVANTAGES:-DISADVANTAGES:- Prolonged use may cause Prolonged use may cause

alteration of the alteration of the maxillomandibular relationship maxillomandibular relationship caused by a change in condyle caused by a change in condyle to fossa position.to fossa position.

Amsterdam considers the modified version of this appliance to be one of the most useful appliances in achieving a therapeutic occlusion.


2) 2) SVED BITEPLATE:-SVED BITEPLATE:-

It is a variation of the Hawley appliances, is designed to It is a variation of the Hawley appliances, is designed to exclude the labial bow or arch wire. exclude the labial bow or arch wire.

The acrylicThe acrylic is brought forward to cover the incisal edges of the is brought forward to cover the incisal edges of the anterior teeth, thus contributing their stabilization may be anterior teeth, thus contributing their stabilization may be needed if the maxillary anterior segment has been traumatized needed if the maxillary anterior segment has been traumatized from occlusal dysfunction or is suffering from some loss of from occlusal dysfunction or is suffering from some loss of bone support. bone support.

The splinting action achieved on the anterior teeth is superior The splinting action achieved on the anterior teeth is superior to that achieved by the other bite plates because it directs the to that achieved by the other bite plates because it directs the forces more axially. forces more axially.

The saved biteplate is an excellent appliance to use when The saved biteplate is an excellent appliance to use when restored anterior teeth are unsplinted yet need protection from restored anterior teeth are unsplinted yet need protection from nocturnal bruxism.nocturnal bruxism.


PROVISIONAL SPLINTING:PROVISIONAL SPLINTING:


Types of provisional splints:-Types of provisional splints:- Metal – band – and – acrylic type.Metal – band – and – acrylic type. All – acrylic type.All – acrylic type.


1) 1) Metal – band – and – acrylic type:-Metal – band – and – acrylic type:- If the provisional splint is to serve the patient for more than 1 If the provisional splint is to serve the patient for more than 1

year, the metal-band-and-acrylic provisional splinting technique is used.year, the metal-band-and-acrylic provisional splinting technique is used.

Amsterdam Amsterdam and and Fox citeFox cite the following advantages of this type of splint over the following advantages of this type of splint over the all acrylic splint.the all acrylic splint.

Ease of construction and maintenance.Ease of construction and maintenance. Accurate marginal fit and knife like margins with good gingival contour.Accurate marginal fit and knife like margins with good gingival contour. Optimal embrasure pattern.Optimal embrasure pattern. Increased strength.Increased strength. Facilitation of carving.Facilitation of carving. Ability to be removed and reset with minimal disturbance of relationships.Ability to be removed and reset with minimal disturbance of relationships. Ease of maintenance of periodontal environment before during, and after Ease of maintenance of periodontal environment before during, and after

periodontal surgery.periodontal surgery. Marginal protection against cervical sensitivity.Marginal protection against cervical sensitivity. Ease of repair.Ease of repair.


2) All Acrylic Type:-2) All Acrylic Type:-

All acrylic type can be used if it is fairly certain that All acrylic type can be used if it is fairly certain that the final restorations will be inserted in a relatively short time the final restorations will be inserted in a relatively short time (upto 1 year) after the provisional splinting phase.(upto 1 year) after the provisional splinting phase.

After this period of time, the gingival margins of all acrylic After this period of time, the gingival margins of all acrylic provisional splint usually demonstrate progressive provisional splint usually demonstrate progressive deterioration, mainly because of the chemical action of the deterioration, mainly because of the chemical action of the temporary cement.temporary cement.

Such deterioration contributes to plaque retention and Such deterioration contributes to plaque retention and cervical sensitivity and, if allowed to progress, result in cervical sensitivity and, if allowed to progress, result in gingival disturbances and even root caries.gingival disturbances and even root caries.

The entire splint becomes weakened and is frequently subject The entire splint becomes weakened and is frequently subject to fracture.to fracture. www.indiandentalacademy.comwww.indiandentalacademy.com

INDICATIONSINDICATIONS When periodontal surgery prior to splinting is not required.When periodontal surgery prior to splinting is not required.

When all periodontal surgical correction and extraction of When all periodontal surgical correction and extraction of hopelessly involved teeth is completed prior to provisional hopelessly involved teeth is completed prior to provisional splinting.splinting.

When a favorable prognosis makes the periods between When a favorable prognosis makes the periods between periodontal or endodontic therapy and final restorations short periodontal or endodontic therapy and final restorations short (less than 1 year).(less than 1 year).

When the treatment plan includes no minor orthodontic tooth When the treatment plan includes no minor orthodontic tooth movement because minor tooth movement necessarily movement because minor tooth movement necessarily prolongs the total time of rehabilitation.prolongs the total time of rehabilitation.


The longterm provisional restoration should fulfill the The longterm provisional restoration should fulfill the following characteristics:-following characteristics:-

Resist washout and dimensional change to provide protection Resist washout and dimensional change to provide protection for prepared tooth structure against increased caries for prepared tooth structure against increased caries susceptibility and tooth sensitivity.susceptibility and tooth sensitivity.

Provide a physiologic environment conducive to the Provide a physiologic environment conducive to the maintenance and /or propagation of a healthy, supporting maintenance and /or propagation of a healthy, supporting structure by means of structure by means of Knife-like marginal adaptation.Knife-like marginal adaptation. Lack of impingement on the attachment apparatus.Lack of impingement on the attachment apparatus. Proper crown-tissue relationship through contour and Proper crown-tissue relationship through contour and

design.design. Adequate embrasures.Adequate embrasures. Minimal chemical gingival irritation.Minimal chemical gingival irritation.www.indiandentalacademy.comwww.indiandentalacademy.com

Provide a harmonious occlusal relationship with potential for Provide a harmonious occlusal relationship with potential for ease of adjustment.ease of adjustment.

Provide a superior degree of comfort and esthetics including Provide a superior degree of comfort and esthetics including proper form and function, shade, compatible adaptability, and proper form and function, shade, compatible adaptability, and lack of pulpal or gingival irritation.lack of pulpal or gingival irritation.

Be durable, including resistance to fracture and ease of Be durable, including resistance to fracture and ease of removal, reinsertion, alteration and repair.removal, reinsertion, alteration and repair.

Be easy to fabricate, allowing utilization of common Be easy to fabricate, allowing utilization of common materials, chair side construction and minimal time materials, chair side construction and minimal time involvement.involvement.


PERMANENT SPLINTSPERMANENT SPLINTS


Types of permanent splintsTypes of permanent splints

1) 1) Removable permanent splints – External:Removable permanent splints – External: A) A) Continuous clasp devices:-Continuous clasp devices:- Removable permanent devices incorporate continuous clasps Removable permanent devices incorporate continuous clasps

and fingers that brace loose teeth. and fingers that brace loose teeth. They strongly resemble partial dentures, and their features They strongly resemble partial dentures, and their features

may be included in partial dentures. may be included in partial dentures. They support the teeth from the lingual surface and may They support the teeth from the lingual surface and may

incorporate additional support from the labial surface or use incorporate additional support from the labial surface or use intracoronal rests. intracoronal rests.

Palatal bars may also be added to provide a cross-arch Palatal bars may also be added to provide a cross-arch splinting effect. Some partial dentures use pins that fit into splinting effect. Some partial dentures use pins that fit into grooves or holes in inlays.grooves or holes in inlays.


B) Swing – lock devices:-B) Swing – lock devices:- The cosmetic disadvantages of labial continuous The cosmetic disadvantages of labial continuous

clasping can be overcome by use of the swing-lock clasping can be overcome by use of the swing-lock appliance, which tends to conceal the metal of the splintappliance, which tends to conceal the metal of the splint and avoid torque. and avoid torque.

Swing-lock appliances may also be useful in situations in Swing-lock appliances may also be useful in situations in which fixed splinting is not possible or desirable. For example, which fixed splinting is not possible or desirable. For example, in advanced age, the dentist chooses to avoid full coverage.in advanced age, the dentist chooses to avoid full coverage.


C. C. Over denture:-Over denture:- Bio mechanically, treatment of patients with overdentures is Bio mechanically, treatment of patients with overdentures is

a valid practical alternative to complete dentures. a valid practical alternative to complete dentures. Over dentures have been reported to decrease the progressive Over dentures have been reported to decrease the progressive

reduction of the residual ridges to increase masticatory reduction of the residual ridges to increase masticatory performance, to be of positive psychological benefit, and to performance, to be of positive psychological benefit, and to contribute to periodontal health of the abutment roots.contribute to periodontal health of the abutment roots.

When a few teeth with questionable prognoses remain, an When a few teeth with questionable prognoses remain, an overdenture may be used. overdenture may be used.

The teeth are treated endodontically. They are than shortened close The teeth are treated endodontically. They are than shortened close to the gum and fitted with a round nonanatomic gold dome, which to the gum and fitted with a round nonanatomic gold dome, which may incorporate retention device. may incorporate retention device.

A full or partial denture is then constructed over these remaining A full or partial denture is then constructed over these remaining abutments. Among the advantages are more favorable crown-root abutments. Among the advantages are more favorable crown-root ratio and retention of alveolar bone around the roots.ratio and retention of alveolar bone around the roots.


The major problem in the long term use of overdenture is the The major problem in the long term use of overdenture is the high incidence of recurrent periodontal disease, although high incidence of recurrent periodontal disease, although failure may be caused by endodontic and prosthetic failures. failure may be caused by endodontic and prosthetic failures.

The patient must carry on adequate plaque control measures The patient must carry on adequate plaque control measures and the dentist must regularly monitor the patients periodontal and the dentist must regularly monitor the patients periodontal status and adequacy in plaque control.status and adequacy in plaque control.


2) 2) Fixed permanent splints – InternalFixed permanent splints – Internal : :

Fixed permanent devices may incorporate a series of Fixed permanent devices may incorporate a series of soldered castings, such as crowns, three-quarter crowns, telescope soldered castings, such as crowns, three-quarter crowns, telescope crowns, inlays, horizontal pin splints and pin ledges. The splint is crowns, inlays, horizontal pin splints and pin ledges. The splint is cemented to place.cemented to place.

Full coverage is simple to perform if recession is not extensive and Full coverage is simple to perform if recession is not extensive and teeth are parallel. Otherwise inlays or pin ledges may be more teeth are parallel. Otherwise inlays or pin ledges may be more conserving of tooth structure and simpler to use. It is important that conserving of tooth structure and simpler to use. It is important that these splints be rigid. these splints be rigid.

They should be of narrow buccolingual diameter the interproximal They should be of narrow buccolingual diameter the interproximal solder joint should not impinge on the dental papilla. solder joint should not impinge on the dental papilla.

The occlusal relationship should be harmonious. Ideally, the teeth The occlusal relationship should be harmonious. Ideally, the teeth and splint should be reciprocally stabilized in all directions. and splint should be reciprocally stabilized in all directions. (mesial, distal, vestibular and apical ). Others wise the splint may (mesial, distal, vestibular and apical ). Others wise the splint may be still move about some fulcrum point, and traumatism may result.be still move about some fulcrum point, and traumatism may result.

Traumatism can also occur in the presence of improper occlusion.Traumatism can also occur in the presence of improper occlusion.www.indiandentalacademy.comwww.indiandentalacademy.com

A)Full coverage, three-fourths coverage crowns and A)Full coverage, three-fourths coverage crowns and inlays:-inlays:-

Cast gold crowns joined in a series are utilized in the final type Cast gold crowns joined in a series are utilized in the final type of splint. It is the most durable and esthetic of all of splint. It is the most durable and esthetic of all constructions.constructions.

Three-quarter crown construction, although probably the least Three-quarter crown construction, although probably the least irritating to the gingival, and least desirable of this group if irritating to the gingival, and least desirable of this group if extensive splinting is involved. extensive splinting is involved.

Full cast crown and veneer crown construction although the Full cast crown and veneer crown construction although the costliest are recognized as the safest and provide the greatest costliest are recognized as the safest and provide the greatest disadvantages in splinting, reconstruction and esthetics disadvantages in splinting, reconstruction and esthetics


Unfortunately gingival irritation is frequently provoked by Unfortunately gingival irritation is frequently provoked by cast gold crowns, especially the veneer crowns, but this is cast gold crowns, especially the veneer crowns, but this is minimized when the castings are fitted with precision at the minimized when the castings are fitted with precision at the gingival margin and placed at the level of the free gingival gingival margin and placed at the level of the free gingival border. border.

One of the most common hazards associated with the use of One of the most common hazards associated with the use of periodontal prosthetics is pulp irritation of the teeth should be periodontal prosthetics is pulp irritation of the teeth should be carried out with utmost care, employing coolants and sparing carried out with utmost care, employing coolants and sparing the tooth structure. In so far as is possible, oral hygiene must the tooth structure. In so far as is possible, oral hygiene must be maintained at a very high level to reduce the tendency to be maintained at a very high level to reduce the tendency to gingival inflammation and the possibility of root caries.gingival inflammation and the possibility of root caries.


B) PIN SPLINTSB) PIN SPLINTS:_:_ Attempt patients to minimize tooth reduction by use of pins, as in Attempt patients to minimize tooth reduction by use of pins, as in

the pin ledge technique, have to often proven disastrous because of the pin ledge technique, have to often proven disastrous because of inadvertent loosening following inadequate tooth preparation. inadvertent loosening following inadequate tooth preparation.

The pin splints are a fairy recent development, especially applicable The pin splints are a fairy recent development, especially applicable to the stabilization of anterior teeth.to the stabilization of anterior teeth.

They require some what less reduction of tooth structure than the They require some what less reduction of tooth structure than the cavity preparation type, but pulp injuries may be sustained because cavity preparation type, but pulp injuries may be sustained because of the necessity of preparing multiple pin holes which in some of the necessity of preparing multiple pin holes which in some techniques must pass entirely through the crowns.techniques must pass entirely through the crowns.

Sophisticated techniques and material have been developed to Sophisticated techniques and material have been developed to expedite their construction, but training and practice are required. expedite their construction, but training and practice are required.

There is still present the possibility of dislodgement of teeth from There is still present the possibility of dislodgement of teeth from the splint, and recurrent caries is a potential hazard.the splint, and recurrent caries is a potential hazard.


C) PALATAL BAR :-C) PALATAL BAR :- A palatal bar connecting two fixed bridges in the upper molar A palatal bar connecting two fixed bridges in the upper molar

and premolar areas is useful. and premolar areas is useful. This palatal bar is secured to the bridges on both sides by This palatal bar is secured to the bridges on both sides by

means of precision attachments and provides cross-arch splinting means of precision attachments and provides cross-arch splinting where the span of one or both of these bridges is large or when where the span of one or both of these bridges is large or when one of the bridges is weak, such palatal bars provide added one of the bridges is weak, such palatal bars provide added stabilization.stabilization.

When all segments cannot be paralleled, jeweler’s screws When all segments cannot be paralleled, jeweler’s screws or internal attachments may be used to combine segments of the or internal attachments may be used to combine segments of the splint. Sectional splinting or splinted telescope crown-copings splint. Sectional splinting or splinted telescope crown-copings also can overcome divergent parallelism.also can overcome divergent parallelism.

The teeth must be capable of supporting a splint. The The teeth must be capable of supporting a splint. The fixed splint, properly made, is one of the most effective dental fixed splint, properly made, is one of the most effective dental restorations for the stabilization of teeth. It is comfortable and restorations for the stabilization of teeth. It is comfortable and esthetic.esthetic. www.indiandentalacademy.comwww.indiandentalacademy.com

3) 3) Cast – Metal Resin – Bonded fixed partial denturesCast – Metal Resin – Bonded fixed partial dentures:-:- Cast-metal resin bonded fixed partial dentures are Cast-metal resin bonded fixed partial dentures are

used with intact or very slightly altered enamel surfaces. used with intact or very slightly altered enamel surfaces. This type of fixed prosthesis is functional , esthetic reversible This type of fixed prosthesis is functional , esthetic reversible

and economic. and economic. It consists of a metal frame bonded with resin to tooth enamel. It consists of a metal frame bonded with resin to tooth enamel. It may carry pontics. It may carry pontics. Retention is enhanced by perforations or by slots. Retention is enhanced by perforations or by slots. The success rate is good. Although the original use was for The success rate is good. Although the original use was for

anterior teeth, this type of fixed prosthesis can be designed for anterior teeth, this type of fixed prosthesis can be designed for posterior teeth. posterior teeth.

The enamel bond is fairly strong, however excessively mobile The enamel bond is fairly strong, however excessively mobile teeth under a strong occlusal load can break loose from the teeth under a strong occlusal load can break loose from the metal frame work.metal frame work.


4) 4) Combined permanent splintsCombined permanent splints:: Despite the advantages inherent in fixed splinting, instances Despite the advantages inherent in fixed splinting, instances

occur of periodontally weakened dentitions in which a combination occur of periodontally weakened dentitions in which a combination of fixed splinting and partial dentures will best answer the needs of of fixed splinting and partial dentures will best answer the needs of the patient. the patient.

There instances are governed by the distribution of remaining teeth. There instances are governed by the distribution of remaining teeth. When partial dentures are used the abutment teeth placed that When partial dentures are used the abutment teeth placed that stabilization is afforded in all directions. stabilization is afforded in all directions.

Recessed retainers and precision attachments are extremely useful Recessed retainers and precision attachments are extremely useful in this regard. in this regard.

When the teeth are mobile, they may be jeopardized if the partial When the teeth are mobile, they may be jeopardized if the partial denture is completely dependent on the abutments.denture is completely dependent on the abutments.


In these cases stress breakers may be used. On occasion, In these cases stress breakers may be used. On occasion, tissue borne appliances may be necessary.tissue borne appliances may be necessary.

Sometimes a partial denture can be supported by crowns or Sometimes a partial denture can be supported by crowns or endodontically treated roots splinted by a bar. The cross-endodontically treated roots splinted by a bar. The cross-section of the bar is elliptical, with the longer diameter section of the bar is elliptical, with the longer diameter oriented vertically. oriented vertically.

The bar must be 1 to 3 mm above the gingival margin for good The bar must be 1 to 3 mm above the gingival margin for good hygiene. The denture is constructed over the bar. hygiene. The denture is constructed over the bar.

When a few teeth remain, a partial denture partly supported by When a few teeth remain, a partial denture partly supported by means of telescope crowns can be used. means of telescope crowns can be used.

The partial denture then serves as the splint.The partial denture then serves as the splint.www.indiandentalacademy.comwww.indiandentalacademy.com

5) Endodontic splints5) Endodontic splints:-:- (Endodontic endosseous implants) (Endodontic endosseous implants) Is a new procedure devised to extend the length of the root Is a new procedure devised to extend the length of the root

when the alveolar housing has been substantially reduced as a result when the alveolar housing has been substantially reduced as a result of disease.of disease.

A post is passed through the root canal to extend several A post is passed through the root canal to extend several millimeters beyond its apex into the spongiosa. Extra long reamers, millimeters beyond its apex into the spongiosa. Extra long reamers, intraosseous drills, and chrome coabalt implants have been intraosseous drills, and chrome coabalt implants have been designed to accomplish this.designed to accomplish this.

The development, which was reported by Frank requires wider The development, which was reported by Frank requires wider clinical experience before an adequate evaluation of its clinical experience before an adequate evaluation of its effectiveness can be made.effectiveness can be made.


SEMI PERMANENT SPLINTING:-SEMI PERMANENT SPLINTING:- Schmid, Lutz , Imfeld classified splints as temporary Schmid, Lutz , Imfeld classified splints as temporary

semipermanent and permanent. Semipermanent splints are may be removable semipermanent and permanent. Semipermanent splints are may be removable or fixed, extracoronal or intracoronal.or fixed, extracoronal or intracoronal.

INDICATIONSINDICATIONS These are used when a fixed or removable prosthetics involving These are used when a fixed or removable prosthetics involving

mobile abutment teeth, is indicated but is postponed indefinitely mobile abutment teeth, is indicated but is postponed indefinitely

because of a questionable prognosis of those teeth or personabecause of a questionable prognosis of those teeth or persona

considerations of the patient.considerations of the patient. May be used to stabilize highly mobile teeth that impair the patient’s May be used to stabilize highly mobile teeth that impair the patient’s

chewing.chewing. Orthodontic retention may also be viewed as a type of semipermanent Orthodontic retention may also be viewed as a type of semipermanent

splinting.splinting.

DISADVANTAGES:-DISADVANTAGES:- Failure of cases because tend to fracture easily.Failure of cases because tend to fracture easily. Unsatisfactory esthetics.Unsatisfactory esthetics. Discomfort of mastication.Discomfort of mastication.


Semipermanent splinting – Anterior area:-Semipermanent splinting – Anterior area:-

The most commonly used fixed semipermanent splint in the The most commonly used fixed semipermanent splint in the anterior area is the acid-etch composite resin splint applied anterior area is the acid-etch composite resin splint applied after tooth preparation.after tooth preparation.

Removable semipermanent splint may be fabricated as cast Removable semipermanent splint may be fabricated as cast chrome-cobalt alloy frameworks incorporating finger clasps chrome-cobalt alloy frameworks incorporating finger clasps for retention. This is indicated only in nights, as a retention for retention. This is indicated only in nights, as a retention appliance after orthodontic treatment.appliance after orthodontic treatment.


Semipermanent splinting – Posterior area:-Semipermanent splinting – Posterior area:- The splints for posterior area are commonly made of The splints for posterior area are commonly made of

amalgam or resin with or without reinforcing wires or pins. amalgam or resin with or without reinforcing wires or pins. The splints are attached to the teeth either extra or The splints are attached to the teeth either extra or intracornally.intracornally.

When splinting intracoronally, grooves are prepared in the When splinting intracoronally, grooves are prepared in the teeth and reinforcing polyester fibers placed in them and lied. teeth and reinforcing polyester fibers placed in them and lied. The grooves are then acid etched, filled with composite and The grooves are then acid etched, filled with composite and adhered. adhered.

This technique also requires the reduction of a great deal This technique also requires the reduction of a great deal of healthy tooth structure. Such splints are very time of healthy tooth structure. Such splints are very time consuming to fabricate.consuming to fabricate.


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Transcript of Splints/ dentistry dental implants