Periodontal splinting

periodontal splinting

1. Periodontal splinting Guided by: Dr. Lalbabu K amait Department of Periodontics and I mplantology Submitted by Bibek Jha BDS 3 rd batch Roll no. 13

2. contents Introduction Definition Rationale Ideal requirements of splint Classification Indications Contraindications Principle Advantages Disadvantages

3. Introduction Periodontal disease are characterized by sub-gingival plaque formation, gingival inflammation, loss of connective tissue attachment and loss of alveolar bone. As a result of progressive loss of attachment , the tooth involved in the disease process eventually exhibit increased tooth mobility.

4. 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.

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

6. Definitions Splint: Any apparatus, appliance, or device employed to prevent motion or displacement of fractured or movable parts. ( Hallmen et al 1996) An appliance for immobilization or stabilization of injured or diseased parts. (Glickman 1972)

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

8. Rationale To provide rest . For redirection of forces ― the forces of occlusion are directed in a more axial direction over all the teeth included in the splint.

9. For redistribution of forces ― redistribution ensures that forces do not exceed the adaptive capacity of the periodontium . To preserve the arch integrity ― splinting restores the proximal contacts, reducing food impaction and consequent breakdown of the periodontium .

10. Restoration of the functional stability ― restores a functional occlusion, stabilizes mobile abutment teeth and increases masticatory efficiency. Psychological well-being ― gives the patient freedom from mobile teeth thereby giving him a sense of well-being.

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

12. Ideal requirements of splint

13. Classification RAMFJORD’S CLASSIFICATION (1979) Temporary: Fixed- Fixed external type (2-6 months) e.g. Ligature wire, orthodontic bands. Removable-RPD, Night guards, removable acrylic splints .

14. Ligature wire and Night guard

15. Provisional: 8-12 months diagnostic used in borderline cases where the outcome of treatment cannot be predicted. eg . Temporary external splints.

16. Permanent: Fixed- Full crowns, pin ledge type of abutment retainers. Semi-rigid. Removable- Telescopic crowns, clasp supported partial denture.

17. Grant, Stern and Listgarten (1988) TEMPORARY : Extracoronal (External )-Ligature splint, Enamel bonding material, welded bond splints, night guards Intracoronal (Internal)- Acrylic splints, Composite splints, acrylic full crowns

18. PROVISIONAL SPILNTS Serves to stabilize a permanently mobile dentition from the time of initial tooth preparation until the time the dentition is periodontally healthy enough for permanent restorations.

19. PERMANENT SPLINTS may be classified as follows: Removable—external Continuous clasp devices Swing-lock devices Overdenture (full or partial).

20. Fixed—internal Full coverage, three-fourths coverage crowns and inlays Posts in root canals Horizontal pin splints . Cast-metal resin-bonded fixed partial dentures (Maryland splints)

21. Combined Partial dentures and splinted abutments Removable—fixed splints Full or partial dentures on splinted roots Fixed bridges incorporated in partial dentures, seated on posts or copings Endodontic

22. According to duration( Ferencz 1991) Short-term splint. Provisional splint. Long-term permanent splint

23. WELDED BAND SPLINTS

24. Various commonly used splints Splints for anterior teeth: Direct bonding system using acid-etch techniques and alight cured resin. Intracoronal wire and acrylic wire resin splint -it involves the teeth with stainless steel wire placed in the slots thus stabilizing the teeth.

25. Direct bonding system Acid etching Bonding agent Composite curing

26. Intra coronal wire splint Slot preparation Ss wire adapted into the slot Sealed with resin

27. Splints for posterior teeth: Intracoronal amalgam wire splints Bite guard Rigid occlusal splint Composite splint.

28. Indications mobility of teeth that is increasing or that impairs patient comfort. Migration of teeth. prosthetics where multiple abutments are necessary. carranza 10 th edition

29. Indications (AAP) Stabilize moderate to advance tooth mobility that cannot be treated by other means. Stabilize teeth when increased tooth mobility interferes with normal masticatory function and comfort of the patient. Stabilize teeth in secondary occlusal trauma.

30. Prevent tipping or drifting of the teeth. Prevent extrusion of unopposed teeth. Stabilization of mobile teeth during surgical especially regenerative therapy. ( Serio 1999).

31. Stabilize teeth following acute trauma. Stabilize teeth following orthodontic movement. Ascertain whether occlusal therapy will be effective or not.

32. Containdication Moderate to severe tooth mobility in presence of periodontal inflammation and/or primary occlusal trauma. Insufficient number of firm/sufficiently firm teeth to stabilize mobile teeth.

33. Prior occlusal adjustment has not been done on teeth with occlusal trauma or occlusal interference. Patient not maintaining oral hygiene.

34. Principle of splinting Inclusion of sufficient number of healthy teeth Splint around the arch Coronoplasty may be performed to relieve traumatic occlusion.

35. The splint should be fabricated in such a way as to facilitate proper plaque control. Splint should be esthetically acceptable and should not interfere with occlusion.

36. Advantages Helpful to decrease mobility and accelerate healing following acute trauma to the teeth. Allows remodeling of alveolar bone and periodontal ligament for orthodontically , splinted teeth.

37. May establish final stability and comfort for patient with occlusal trauma. Helpful in decreasing mobility thereby favoring regenerative therapy. Distributes the occlusal force over the large area.

38. disadvantages All the splints hamper the patients self care. Accumulation of plaque at the splinted margins can lead to further periodontal breakdown in a patient with already compromised periodontal support.

39. Number of studies has shown that splinting does not actually reduce tooth mobility(once the splint is removed)

40. The splint being rigid may acts as lever with uneven distribution of forces, even if one tooth of the splint is in traumatic occlusion, it can injure the peridontium of all the teeth within the splint.

41. Development of caries is an unavoidable risk. Thus, it obviates the need of excellent oral hygiene in the patient.

42. References Clinical periodontology : Shanatipriya Reddy 4 th edition. International Journal of Science and Research (IJSR) ISSN (Online): 2319-7064 Index Copernicus Value (2013): 6.14 | Impact Factor (2013): 4.438 Clinical periodontology : Carranza 10 th edition