Splinting of teeth in periodontics

DETAIL PPT ON SPLINTING Of TEETH .

1. A boon or A bane..??? SPLINTING BY VIGNESH PRABHU.T C.R.I

2. WHAT IS SPLINT..??? It is defined as rigid or flexible device that maintains in position of a displaced or movable part , also used to keep in place and protect an injured part. Splinting in dentistry ..?? “the joining of 2 or more teeth into a rigid unit by means of fixed or removable restorations or devices.

3. History..!!! A Phoenician mandible from 500BC found in modern day Lebanon which has two carved ivory teeth attached to four natural teeth by gold wire. Obin and Arvin's (1951) - self curing internal splint. Harrington(1957) modified the splint by incorporating cemented stainless steel wire.

4. Ward & Weinberg (1961 ) – developed new techniques using a plastic matrix or using wire reinforcement. Splints have thus come a far way to INTRACORONAL BONDABLE FIBER SPLINTING of the present.

5. Should reduce movement 3 dimensionally Centre of rotation of the affected teeth must be located in the remaining supporting bone. No inflammation Minimum one third of bone support remaining. Should allow for oral hygiene methods Should not irritate soft tissues. principles

6. objectives To provide rest For redirection of forces For redistribution of forces To preserve arch integrity

7. Continue… Restore of functional stability Psychological well being To stabilize mobile teeth during surgery , especially during regenerative therapy To prevent the eruption of unopposed teeth

8. Indications To stabilize moderate to advance tooth mobility, that cannot be reduced by other means that has not responded to occlusal adjustment and periodontal therapy. Stabilize teeth in secondary occlusal trauma Stabilize teeth with increased mobility which interfere with normal masticatory function Facilitate scaling and surgical procedures. Prevent tipping & drifting of teeth. Prevent extrusion of unopposed teeth. Stabilize teeth after acute dental trauma i.e. .sub luxation , avulsion.etc.

9. Contra indications Moderate to severe tooth mobility in the presence of periodontal inflammation & or primary occlusal trauma Insufficient number of firm/ sufficient firm teeth to stabilize mobile teeth. Prior occlusal adjustment has not been done on teeth with occlusal trauma or interferences. Patient not maintaining oral hygiene. When the sole objective of splinting is to decrease tooth mobility following the removal of splint.

10. classification According to the period of stabilization According to the type of material According to the location on the tooth

11. According to the period of stabilization Temporary stabilization (worn for less than 6 months) Removable fixed Occlusal splint with wire Hawley with splinting arch wire Intra coronal Extra coronal Ss wire with resins Wire & resin with & acid etching Enamel etching & composite resin Ortho soldered bands Brackets& wire Amalgam Amalgam & wire Amalgam , wire, resin Composite, resin, wire

12. PROVISIONAL STABILZATION To be used for months up to several years e.g. acrylic splints, metal band permanent splints ; used definitely Removable / fixed Extra / Intra coronal Full / Partial veneer crowns soldered together Inlay / Onlay soldered together

13. According to the type of material Bonded composite resin button splint. Braided wire splint. A- SPLINTS

14. ACCORDING TO THE LOCATION ON THE TOOTH Intra coronal Extra coronal Tooth bonded plastic Night guard Welded bands Composite resin with wire Inlays Nylon wire

15. Commonly used splints Splinting for anterior teeth Splinting of posterior teeth Direct bonding system Intra coronal wire Acrylic wire resin splint Intra coronal amalgam wire splints Bite guard Rigid occlusal splint Composite splint

16. Splinting of anterior teeth

17. Splintee Tooth that needs support Splinters Adjacent teeth that provide support .

18. Direct bonding system Acid etching Bonding agent Composite curing

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

20. Variation of the “a” splint A 1mm deep M / D box is prepared parallel to the long axis of tooth SnF/CA(OH)2 varnish is applies & threaded pin is then placed. Ss is wire is adapted around the pin .

21. Splinting for posterior teeth

22. Intra coronal amalgam wire splints

23. Bite(night) guard Bruxism with occlusal wear Primary or secondary occlusal traumatism. Anterior open bite with trauma. Impinging over bite with periodontal involvement. Following orthodontic treatment.( as retainer).

24. Rigid occlusal splint Head & neck pain as a result of muscle spasm is usually treated with maxillary occlusal splint. Rigid & covers all occlusal surfaces. Designed such that all opposing teeth contact the splint in centric relations.

25. Fiber reinforced splinting Fibre reinforced splinting

26. PROCEDURE Coronoplasty Acid etching Flowable composite

27. It have good flexural strength and do not require mechanical retention. Faster & easier technique. Superior in all properties compared to all other splinters. Composite curing Post operative

28. Strength May establish final stability & comfort for patient with occlusal trauma. Helpful to decrease mobility and accelerate healing following acute trauma to the teeth. Allows remodelling of alveolar bone and PDL for orthodontically , splinted teeth. Helpful in decreasing mobility favouring regenerative therapy. Distributes occlusal forces over a wider area.

29. Weakness Hygienic Mechanical Biological

30. refrences World workshop 1989 iii -4 Lemmerman k; rationale for stabilization JP 1976; 47 (7) : 405 – 411. Trochtchberg delhi : combined amalgam – wire acrylic splint jp 198: 39 : 255 – 259/ Singer B : intracoronal aesthetic splinting comp. 1996: 17 (5) : 459- 48. Leib et al : occlusal bite splint comp .1996: 17 (11) : 1081 -1090. The periodontics syallabus 2 nd ed 82- 85.

31. Doubts???

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