28 PERIODONTAL SPLINTS A boon in disguise .

Periodontics have different and difficult aspects to deal with one of it being handling the loss of supporting structures. Supporting structure - gingiva, pdl, alveolar bone . Damage to any of the above starts periodontitis . Tackling of the losses are difficult but with advancements it is eaier

1. PERIODONTAL SPLINTS

2. DEFINITIONDEFINITION
•A splint has been defined as any apparatus, A splint has been defined as any apparatus,
appliance or device employed to prevent appliance or device employed to prevent
motion or displacement of fractured or motion or displacement of fractured or
movable parts movable parts ((AAP 1996AAP 1996))..
•Glossary of Prosthodontic TermsGlossary of Prosthodontic Terms (1999) (1999)
defines splint “as a rigid or flexible device that defines splint “as a rigid or flexible device that
maintains in position a displaced or movable maintains in position a displaced or movable
part; also used to keep in place or protect an part; also used to keep in place or protect an
inured part.” inured part.” ((Van Blarcom, 1999Van Blarcom, 1999)). .

3. GOALSGOALS
•Rest is created for the supporting tissues, Rest is created for the supporting tissues,
permitting repair of traumapermitting repair of trauma
•Mobility is reduced immediately and, it is Mobility is reduced immediately and, it is
hoped, permanently. In particular, jiggling hoped, permanently. In particular, jiggling
movements are reduced or eliminatedmovements are reduced or eliminated
•Forces received by any one tooth are Forces received by any one tooth are
distributed to a number of teeth along the distributed to a number of teeth along the
long axis of the teethlong axis of the teeth

4. •Proximal contacts are stabilized, and food Proximal contacts are stabilized, and food
impaction (but not retention) is preventedimpaction (but not retention) is prevented
•Migration and supraeruption are preventedMigration and supraeruption are prevented
•Masticatory function may be improvedMasticatory function may be improved
•Discomfort and pain are eliminatedDiscomfort and pain are eliminated
•Appearance may be improvedAppearance may be improved

5. PROPERTIES OF AN IDEAL SPLINTPROPERTIES OF AN IDEAL SPLINT
•Strength (i.e. ability to support a significant load Strength (i.e. ability to support a significant load
with minimal elastic distortion)with minimal elastic distortion)
•Toughness (i.e. a great amount of energy should Toughness (i.e. a great amount of energy should
be required to break it)be required to break it)
•SimplicitySimplicity
•EconomicEconomic

6. •Stability & EfficiencyStability & Efficiency
•HygienicHygienic
•Non irritatingNon irritating
•Non interfering with treatmentNon interfering with treatment
•Aesthetically acceptableAesthetically acceptable
•Not provoke iatrogenic disease Not provoke iatrogenic disease

7. CLASSIFICATIONCLASSIFICATION
SPLINTS
COMBINATION
OF BOTH
FIXED REMOVABLE

8. TYPE OF MATERIAL &
DURATION OF USE
TEMPORARY
SPLINTS PROVISIONAL
SPLINTS
PERMANENT
SPLINTS

9. LOCATION OF SPLINT IN
RELATION TO TEETH
INTRACORONAL
SPLINTS
EXTRACORONAL
SPLINTS
- Fixed into teeth / crown of Fixed onto teeth
teeth Eg: Interdental ligatures,
Eg: cast restoration Acrylic splints
- Requires preparation of
teeth

10. TEMPORARY SPLINTSTEMPORARY SPLINTS
•Worn for less than 6 months , not followed by Worn for less than 6 months , not followed by
additional splint therapyadditional splint therapy
•Facilitates instrumentation (root planing, Facilitates instrumentation (root planing,
curettage, occlusal corrections) that might be curettage, occlusal corrections) that might be
difficult on loose teethdifficult on loose teeth
•Of benefit following periodontal regenerative Of benefit following periodontal regenerative
surgery as they aid to achieve uneventful surgery as they aid to achieve uneventful
healing or regenerationhealing or regeneration
•As anchorage during, or provide retention after, As anchorage during, or provide retention after,
orthodontic movementorthodontic movement

11. PROVISIONAL SPLINTSPROVISIONAL SPLINTS
•When prognosis is not definiteWhen prognosis is not definite
•In such cases, it is utilized during periodontal In such cases, it is utilized during periodontal
therapy and the mobile teeth are stabilized therapy and the mobile teeth are stabilized
permitting healing to take placepermitting healing to take place
•May be used for months up to several years May be used for months up to several years
with a definitive end to splint therapywith a definitive end to splint therapy
•After a reasonable period of time (6 months -1 After a reasonable period of time (6 months -1
year) the splint is removed and the status of year) the splint is removed and the status of
the teeth evaluated. If mobility is reduced the teeth evaluated. If mobility is reduced
significantly, permitting teeth to function significantly, permitting teeth to function
normally – splint can be discarded. normally – splint can be discarded.

12. •Provisional splinting is done to stabilize a Provisional splinting is done to stabilize a
permanently mobile dentition from the time of permanently mobile dentition from the time of
initial tooth preparation until the time the initial tooth preparation until the time the
dentition is periodontally stable enough for dentition is periodontally stable enough for
periodontal prostheses. periodontal prostheses.
•It provides stability, occlusal function and a good It provides stability, occlusal function and a good
esthetic / functional design to be incorporated in esthetic / functional design to be incorporated in
the future splint.the future splint.

13. PERMANENT SPLINTSPERMANENT SPLINTS
•Indicated whenever periodontal treatment does Indicated whenever periodontal treatment does
not reduce mobility to the point at which the not reduce mobility to the point at which the
teeth can function without added supportteeth can function without added support
•Fabricated after periodontal treatment has Fabricated after periodontal treatment has
been completed when their use will extend the been completed when their use will extend the
functional lifetime of the teethfunctional lifetime of the teeth
•Such devices serve to stabilize loose teeth, Such devices serve to stabilize loose teeth,
redistribute occlusal forces and aid in repair of redistribute occlusal forces and aid in repair of
periodontal tissues.periodontal tissues.

14. •The following teeth may be splinted –The following teeth may be splinted –
1.1.Mobile teeth with reduced periodontium so Mobile teeth with reduced periodontium so
as to facilitate masticationas to facilitate mastication
2.2.Mobile teeth following periodontal Mobile teeth following periodontal
regenerative therapy so that uneventful regenerative therapy so that uneventful
healing resultshealing results
3.3.Mobile maxillary anterior teeth in cases Mobile maxillary anterior teeth in cases
with deep bite so that the vertical with deep bite so that the vertical
dimension of occlusion is taken care ofdimension of occlusion is taken care of
INDICATIONSINDICATIONS

15. 44.. A multi rooted teeth that has undergone
root resection, for additional support
55. Potential abutment teeth showing some
mobility
6.6. Following orthodontic therapy, especially
those involving extrusion or intrusion of teeth,
rotation of teeth, pathologic migrations and
uprighting of molars

16. •Stabilization of mobile teeth for masticatory Stabilization of mobile teeth for masticatory
comfortcomfort
•Control of forces of parafunctional or bruxism. Control of forces of parafunctional or bruxism.
•Traumatic occlusion should be relieved Traumatic occlusion should be relieved
•The design of the splint should facilitate plaque The design of the splint should facilitate plaque
control (open gingival embrasures, no control (open gingival embrasures, no
overhanging margins and smooth surfaces), overhanging margins and smooth surfaces),
esthetics and non-interference with occlusionesthetics and non-interference with occlusion

17. EXTERNAL SPLINTSEXTERNAL SPLINTS
•LigaturesLigatures
•Tooth bonding plastic splintsTooth bonding plastic splints
•Welded band splintsWelded band splints
•Continuous claspsContinuous clasps
•Night guardsNight guards

18. ADVANTAGESADVANTAGES
• EconomicalEconomical
• Easily preparedEasily prepared
• Removed and replaced readily Removed and replaced readily
• Does not cause pulpal damage Does not cause pulpal damage
• Tooth structure is not removedTooth structure is not removed

19. DISADVANTAGESDISADVANTAGES
• Lack of durability, rigidity & dimensional Lack of durability, rigidity & dimensional
stabilitystability
• Unaesthetic and unhygienic Unaesthetic and unhygienic
• Materials of other devices may stretch, wrap, Materials of other devices may stretch, wrap,
loosen loosen
• Poor retentionPoor retention
• These conditions may permit decay or on These conditions may permit decay or on
occasion, cause teeth to shiftoccasion, cause teeth to shift
• Some tend to break and may not last longSome tend to break and may not last long

20. LIGATURESLIGATURES
•Satisfactory means of stabilizing Satisfactory means of stabilizing
anterior teethanterior teeth
•Ligation is a form of temporary splinting Ligation is a form of temporary splinting
and may be retained for several months and may be retained for several months
if tighten and replaced periodically.if tighten and replaced periodically.
0.4 mm diameter soft stainless
steel wire is used
Offers no protection against
occlusal forces, but can reinforce
periodontal dressings & acrylic
splints

21. TOOTH BONDING PLASTIC SPLINTSTOOTH BONDING PLASTIC SPLINTS
•Self polymerized,ultraviolet light polymerized, Self polymerized,ultraviolet light polymerized,
and white light polymerized composite resins.and white light polymerized composite resins.
•They are cosmetic fairly durable and well They are cosmetic fairly durable and well
tolerated by the patients.tolerated by the patients.
•They are not able to resist heavy interocclusal They are not able to resist heavy interocclusal
forces and fracture often occur.forces and fracture often occur.
Composite resin splint without
tooth preparation
Apical area of interdental space
must be left open for oral
hygiene

22. •They are reinforced with variety of materials They are reinforced with variety of materials
like wire monofilament line or orthodontic like wire monofilament line or orthodontic
grid materials.grid materials.
•The latest innovative technique is The latest innovative technique is
reinforcement of composite resins with pre reinforcement of composite resins with pre
impregnated glass fibers which is called impregnated glass fibers which is called
Fiber Reinforced Composites.Fiber Reinforced Composites.
Fiber Reinforced
Composite
fixed partial denture

23. CONTINUOUS CLASPSCONTINUOUS CLASPS
Made up of acrylic, gold or cast stainless steelMade up of acrylic, gold or cast stainless steel
They are seated and removed in the form of a They are seated and removed in the form of a
partial denture and ligated into placepartial denture and ligated into place
They are freely removable appliances,They are freely removable appliances,
Hence it is advantageous, since oral hygiene is Hence it is advantageous, since oral hygiene is
also possible also possible
Disadvantages – unaesthetic and may impede Disadvantages – unaesthetic and may impede
speechspeech

24. NIGHT GUARDSNIGHT GUARDS
•Special splints used for alleviation of bruxism and Special splints used for alleviation of bruxism and
clenching as well as they are deleterious influencesclenching as well as they are deleterious influences
•Night guards are made of heat cured acrylic and Night guards are made of heat cured acrylic and
cover the occlusal surfaces of the teeth. They can cover the occlusal surfaces of the teeth. They can
be constructed for one or more jaws. be constructed for one or more jaws.

25. •If Freeway space permits, both arches could If Freeway space permits, both arches could
be covered for the patient to be quite be covered for the patient to be quite
comfortable while wearing.comfortable while wearing.
•The acrylic should extent just to the height of The acrylic should extent just to the height of
the tooth contour and be finish with a thin the tooth contour and be finish with a thin
edge for ease of insertion and removable, edge for ease of insertion and removable,
and retention when worn. and retention when worn.

26. INTRACORONAL SPLINTSINTRACORONAL SPLINTS
Preparation of the teeth are needed to fix the Preparation of the teeth are needed to fix the
splint intra coronally. splint intra coronally.
Types - Types -
• A- splintsA- splints
• Composite splintsComposite splints
• Amalgam splintsAmalgam splints
• Acrylic full crownsAcrylic full crowns

27. ADVANTAGESADVANTAGES
• More serviceable than external temporary More serviceable than external temporary
splintssplints
DISADVANTAGESDISADVANTAGES
• Value varies with their rigidity and accuracy of fit Value varies with their rigidity and accuracy of fit
& &
patient susceptibility to cariespatient susceptibility to caries
• Materials tend to wear or break, dependant on Materials tend to wear or break, dependant on
thethe
strength of the bonding mediumstrength of the bonding medium
• The position of the splint, marginal adaptation The position of the splint, marginal adaptation
and and
interproximal joints tend to create plaque interproximal joints tend to create plaque
harbours harbours
leading to caries, calculus deposition leading to caries, calculus deposition

28. •Maintenance needs are increased and oral Maintenance needs are increased and oral
hygiene procedures are made more difficulthygiene procedures are made more difficult
•Extensive gingival recession, root indentations Extensive gingival recession, root indentations
and furcations make tooth preparation more and furcations make tooth preparation more
difficult and pulp involvement may resultdifficult and pulp involvement may result

29. A-SPLINTSA-SPLINTS
•A channel approximately 3 mm wide and 2 A channel approximately 3 mm wide and 2
mm depth is made at the interproximal area mm depth is made at the interproximal area
between two to three teethbetween two to three teeth
•The preparation should be slightly undercut The preparation should be slightly undercut
for retentionfor retention
•The pulpal surface should be coated with a The pulpal surface should be coated with a
protectantprotectant
•Lay a piece of platinized knurled wire Lay a piece of platinized knurled wire
•Put acrylic resin and cure it Put acrylic resin and cure it
Acrylic (A) Splint
– Lingual view

30. COMPOSITE SPLINTSCOMPOSITE SPLINTS
•Place grooves in enamel circumferentially Place grooves in enamel circumferentially
•A 0.010 mm dead soft single or double wire, A 0.010 mm dead soft single or double wire,
polyester filament yarn or nylon monofilament polyester filament yarn or nylon monofilament
is placed in the grooves, ligating the teeth with is placed in the grooves, ligating the teeth with
continuous figure eight loopscontinuous figure eight loops
•Enamel is then etched. Self polymerizing or Enamel is then etched. Self polymerizing or
light polymerizing composite resin is then light polymerizing composite resin is then
placed, cured & polished.placed, cured & polished.
Existing Class III cavities were
prepared, etched and filled with
light cured composite resins

31. AMALGAM SPLINTSAMALGAM SPLINTS
•Similar to A-splintSimilar to A-splint
•Limited to posterior teeth Limited to posterior teeth
•Amalgam is condensed in one unit and a Amalgam is condensed in one unit and a
wire may be used for reinforcementwire may be used for reinforcement
•Disadvantages : tend to fracture easilyDisadvantages : tend to fracture easily

32. ACRYLIC FULL CROWNSACRYLIC FULL CROWNS
•Fixed temporary bridges may be made of acrylic Fixed temporary bridges may be made of acrylic
crowns and pontics and serve as temporary crowns and pontics and serve as temporary
splints splints
•They are used when permanent fixed splints will They are used when permanent fixed splints will
ultimately replace them ultimately replace them
•Simple method of making acrylic splints is on Simple method of making acrylic splints is on
patient’s study modelspatient’s study models
•Other methods are pressure moulded splints and Other methods are pressure moulded splints and
rebasing in the mouth after the teeth are rebasing in the mouth after the teeth are
preparedprepared

33. NEW GENERATION MATERIALS
FOR
PERIODONTAL STABILIZATION
AND
SPLINTING

34. FIBERSFIBERS
Glass FibersGlass Fibers
1. Consists of glass interlaced filaments1. Consists of glass interlaced filaments
2. Improve the impact strength of the composite.2. Improve the impact strength of the composite.
3.They have appreciable esthetic properties.3.They have appreciable esthetic properties.
DisadvantagesDisadvantages
These fibers do not easily stick to the resinous These fibers do not easily stick to the resinous
matrix matrix

35. Etching the teeth Light Curing
Flow composite was added Final Polishing

36. CARBON FIBERSCARBON FIBERS
KEVLAR FIBERSKEVLAR FIBERS
VECTRAN FIBERSVECTRAN FIBERS
POLYETHYLENE FIBERSPOLYETHYLENE FIBERS

37. Composite resin application Placement of ribbon
Polishing Finishing

38. CONCLUSIONCONCLUSION
•With the combination of proficient clinical skill, With the combination of proficient clinical skill,
appropriate dental material selection, good appropriate dental material selection, good
communication and comprehensive health communication and comprehensive health
education, both providers and patients can benefit education, both providers and patients can benefit
from esthetic, functional and healthy dental splints.from esthetic, functional and healthy dental splints.
•Therefore, a careful execution of treatment plan Therefore, a careful execution of treatment plan
achieves illusion of tooth individuality and achieves illusion of tooth individuality and
separation of a three-dimensional appearance in separation of a three-dimensional appearance in
the interproximal area giving a esthetically pleasing the interproximal area giving a esthetically pleasing
smile. smile.