Stents and Splints in Prostho Guide

STENTS AND SPLINTS IN
PROSTHODONTICS
-Presented by
NAVEEN GOKUL R
CRI
DEPARTMENT OF PROSTHODONTICS
PRIYADARSHINI DENTAL COLLEGE

CONTENTS
 INTRODUCTION
 DEFINITION –STENTS
 MATERIALS USED FOR STENTS
 FUNCTIONS OF STENTS
 TYPES OF STENTS
 DEFINITION –SPLINTS
 MATERIALS USED FOR SPLINTS
 FUNCTIONS OF SPLINTS
 TYPES OF SPLINTS
RECENT ADVANCEMENTS IN STENTS AND SPLINT THERAPIES
NAVEEN GOKUL R, CRI- PDCH

STENTS
 GPT 9th ed :
Any supplementary device used in
conjunction with a surgical procedure to keep a
skin graft in place, often modified with acrylic
resin or dental modeling plastic impression
compound1 .
1 THE GLOSSARY OF PROSTHODONTIC TERMS (GPT-9) 9TH ED

2 https://www.slideshare.net/ffofr/2use-of-splints-and-stents-during-radiation-therapy-12122328

Radiographic
diagnostic template
Prevent
contamination of
wounds
Surgical guide
template
Protection of teeth
& associated
structures
Stabilize the
tissue for
revascularisation
FUNCTIONS OF STENTS3 :
3 M M Fouad et al Prosthodontic stent - GUIDELINES FOR MAXILLOFACIAL PROSTHESIS 2019

Preserve the depth of
vestibules
(vestibuloplasty & ridge
augmentation)
Control bleeding in
hemophiliacs
In Radiation therapy Protection of skin and
mucosal grafts
For placement of
Fluoride, bleaching
materials,
medicaments &
surgical packs
FUNCTIONS OF STENTS3 :

STENTS
INTRA
ORAL
STENTS
SURGICAL
STENTS
NON
SURGICAL
STENTS
EXTRA
ORAL
STENTS
TYPES OF STENTS3:

1. INTRA ORAL STENTS
A] SURGICAL STENTS
1. Stents for dental implantation.
2. Surgical stents used after removal of exostosis.
3. Surgical stents used in conjunction with Vestibuloplasty.
4. Stent for epulis fissuratum.
5. Stent for resected maxilla.
6. Antihaemorrhagic stents.
7. Drainage stent.

B] NON SURGICAL STENTS
1. Occlusal stent.
2. Periodontal stent.
3. Pedodontic stents.
4. Mouth guard.
5. Oral screen.
6. Fluoride Carrier and Medicament Carrier.
7. Paraplegic stents.
8. Trismus appliances.
9.Radiotherapy stents.

2. EXTRA ORAL STENTS
1. Oro-facial plug
2. Nasal stent
3. Auditory stent
4. Burn stent
5. Stent for neck scar

1] A. INTRAORAL – SURGICAL STENTS :
i) STENTS FOR DENTAL IMPLANTATION
 Use of radiographic stent (to locate the best implant site) and surgical
stent (for implant placement into predetermined site) along with CT
scan plays an important role in placement of implant.
 A clear acrylic template constructed on a stone model of the patient ,
with radiopaque marks indicating different locations, used as a guide for
sites for dental implants.

ii) STENTS AFTER REMOVAL OF EXOSTOSIS
 EXOSTOSIS4 - Oral exostosis (OEs) are bony protuberances arising from the
buccal or lingual cortical plates of the maxilla and/or the mandible4
 Simple acrylic plate covering the palate after surgery to:
1) Facilitates hemostasis
2) Protects the raw surface and
3) Apply pressure to soft tissue to facilitate healing
4 Kitajima S, Yasui A. Images in clinical medicine. Oral maxillary exostosis. N Engl J Med. 2015;373(15):1457‐1457

iii) STENTS FOR VESTIBULOPLASTY AND RIDGE
AUGMENTATION :
Surgical stents used in conjunction with Vestibuloplasty (surgical
deepening of the mucobuccal vestibule) and for holding mucous
membrane and skin grafts.
 This stent is also used with ridge augmentation procedures to
maintain the ridge height.

iv) ANTIHEMORRHAGIC STENTS:
 A partial acrylic plate used to control bleeding by applying gentle
pressure to the extraction wound.
Constructed in clear acrylic resin with relief areas to accommodate
the haemostatic agent.
Clear resin makes inspection and detection of pressure spots easy.

CASE REPORT ON ANTIHEMORRHAGIC STENTS 5
A case report of a 13-year old child diagnosed with hemophilia A. He
reported with a bleeding wound in the middle part of the hard palate,
due to trauma from a lead pencil. An intraoral palatal stent was planned
to provide continuous pressure, stabilize the clot and allow local delivery
of hemostatic agent. The stent was fabricated with a thermoplastic
silicone rubber under vacuum.

5 Madan N, Rathnam A, Bajaj N. Treatment of an intraoral bleeding in hemophilic patient with a thermoplastic palatal
stent - A novel approach. Int J Crit Illn Inj Sci. 2011 Jan;1(1):79-83.

v) STENTS FOR EPULIS FISSURATUM:
 Acrylic base used to prevent obliteration of the sulcus after removal
of epulis fissuratum.
 After surgery, tissue conditioner is applied to the stent till healing
occurs.

vi) STENTS FOR RESECTED MAXILLA:
 Acrylic base used to preserve surgical site promotes healing.
Constructed as immediate surgical obturator.

vii) DRAINAGE STENTS :
 An acrylic plate used to allow the escape of blood or other tissue
fluids from chronic periapical lesions with a fistula.

1] B. INTRAORAL – NON SURGICAL STENTS :
i) OCCLUSAL STENTS :
 A removable artificial occlusal surface used to adjust occlusal
discrepancies through:
1. Elimination of occlusal interferences.
2. Minimizing of the effect of bruxism and clenching on teeth.
3. Guiding the mandible into retruded position for treatment of T.M.J
disorders
TYPES
FLAT PLANES
RAMPS
SOFT DEVICES

ii) PERIODONTAL STENTS :
 Hold the periodontal dressing in place during the healing phase.
Cover exposed roots after gingivectomy (Cosmetic and protective).
Cover exposed parts of dental implants supporting fixed bridges
 For vertical and horizontal probing for CAL calculation

iii) MOUTH GUARDS:
A resilient intra-oral device that is constructed to reduce mouth injury
and protect the teeth and surrounding structures from injury.
 These stents are widely used for protection of dental and alveolar
structures

TYPES OF MOUTH GUARDS :
A. STOCK TYPE: Bought over-the-counter and designed to be used without further
modification, such mouth guards are no longer widely available
B. BOIL AND BITE MOUTH GUARDS: Made from thermoplastic material. It is placed
in hot water to soften, then placed in the mouth and shaped around the teeth using
finger and tongue pressure
C. CUSTOM TYPE: Impressions made perfectly for every individual, vacuum formed.


iv) ORAL SCREEN:
 Stimulate proper nasal breathing as a major function.
1. Control finger and thumb sucking.
2. Control lip biting.
3. Be considered as an orthodontic appliance for protrusive upper
incisor teeth through the pressure applied.
It is worn during night around lip and cheek -laterally and by the
teeth medially

6Wertsén, Madeleine et al. (2017). Measuring lip force by oral screens, Wiley clinical and experimental dental research
7Zainab Chaudhary et al. A novel method to prevent biting through nasolabial flap: Modified oral screen, Journal of Oral and Maxillofacial Surgery, Medicine, and
Pathology, Volume 30, Issue 2, 2018,ISSN 2212-5558,

v) FLOURIDE CARRIER, BLEACHING AND MEDICAMENT
STENT:
 A custom-made stent for applying fluoride gel.
 It is fabricated similar to mouth protector, except that the teeth are
covered with a layer of tin foil to allow for a reservoir of fluoride.

vi) PARAPLEGIC STENTS :

vii) STENT APPLIANCES FOR TRISMUS:
 Used to increase mouth opening on a slow, incremental basis including:
1] SIMPLE DEVICES:
The simple devices allow patient to control timing and degree of
pressure required to gradually increase jaw separation, but produce a
unilateral force .fore

2] DYNAMIC DEVICES:
 Consists of a steel framework attached to maxillary and mandibular
stents.
 The device should be used intermittently to avoid fatigue.

viii) RADIOTHERAPY STENT8:
1. Positioning radioactive sources or carrier or applicator:
 This kind of prostheses is required when radiation treatment is to be
regulated to limited territories by methods for containers, dabs,
tubes or needles of radiation transmitting materials.
fore

TYPES OF RADIATION STENTS:
1. Positioning radioactive sources or carrier or
applicator
2. Positioning stent or prosthesis to displace the
tissues
3. Peroral cone positioning devices or beam locator or
beam director (Docking device)
4. Shielding or tongue protectors

2. Positioning stent or prosthesis to displace the tissues :
 It is used to position structures which are to be taken continously and
repeatable positions for different treatment sessions.
 They are utilized to position versatile structures like tongue, inner palatal
areas, throat .

3. Peroral cone positioning devices or beam locator or beam director (Docking
device) :
 This kind of stent is usually utilized while boosting the radiation to the
desired site.
 It holds the cone in the repeatable and the correct position as wanted by
the radiotherapist.
fore

4. Radiation Protection/ Shielding Stents8 :
 They are utilized to shield the crucial
structures which are contiguous radiation
treatment from overdose dose of
radiation.
 Low melting alloys like Cerroband, Pb-Bi-
Sn, and Lipowitz are used as shielding
materials.
8Ashish.R.Jain et al /J. Pharm. Sci. & Res. Vol. 8(12), 2016, 1358-1366

ix) PEDODONTIC STENT:
 Bruxism is very common among children, both in the primary dentition and
in the mixed dentition.
 Acrylic resin bite splints are widely used for bruxism treatment among
children and adults reduce the habit or eliminates the symptoms caused by
bruxism.

2] EXTRAORAL STENTS :
AUDITORY STENT: NASAL STENT:

2] EXTRAORAL STENTS :
BURN STENT:

3D
PRINTED
STENTS9
9 Wilke, Christopher et al (2017). Design and fabrication of a 3D–printed oral stent for head and neck radiotherapy from routine diagnostic
imaging, 3D Printing in Medicine

SPLINTS
GPT 9th ed
A rigid or flexible device that maintains in
position of a displaced or movable part; also
used to protect and assists in stabilization and
immobilization of an injured part.
-

Treatment of jaw
fractures
Aids in plastic
surgery of the
facial structures
Surgical
retreatment of
prognathism
Protection and
mobilisation of
teeth
Conjunction with
bone or metal
graft of
jawbones
FUNCTIONS OF SPLINTS10 :
10M M Fouad et al Prosthodontic splints - GUIDELINES FOR MAXILLOFACIAL PROSTHESIS 2019

SPLINTS
DENTULOUS
SPLINTS
REMOVABLE
SPLINTS
FIXED
SPLINTS
EDENTULOUS
SPLINTS
TYPES OF STENTS10:
10M M Fouad et al Prosthodontic splints - GUIDELINES FOR MAXILLOFACIAL PROSTHESIS 2019

1. DENTULOUS SPLINTS
A] REMOVABLE SPLINTS
1. Labiolingual Splints.
2. Fenestrated Splints.
3. Cast metal Splints.
4. Occlusal Splints.
5. Lingual Splints.
6. Palatal Splints
7. Kingsley Splints.

B] FIXED SPLINTS
1. Metal Cap Splints

2. EDENTULOUS SPLINTS
1. Gunning Splints
2. Kingsley Splints

1] A. DENTULOUS – REMOVABLE SPLINTS :
i) LABIOLINGUAL SPLINTS11 :
 This type is used when the patient is dentulous or partially
edentulous to aid in treatment of fractures without or with minimum
displacement.
11Gad, Hamed et al, (2016). INDIRECT IMPACT OF AN ACRYLIC LABIOLINGUAL SPLINTS MANGING FRACTURED PEDIATRIC MANDIBULAR DENTAL BEARING AREAS ON
TEMPOROMANDIBULAR JOINT FUNCTIO. EGYPTIAN DENTAL JOURNAL. Vol. 62.

 An acrylic band fits around the labiobuccal surfaces as well as the
lingual aspects and a stainless steel wire connects the two acrylic
portions, the wire acts as a hinge

ii) FENESTRATED SPLINTS :
 This splint is utilized primarily when there are deciduous teeth or
when the clinical crowns are not available.
 It is constructed in an one-piece acrylic to fit the dentition through
fenestrations in the occlusal surfaces.


1] A. DENTULOUS – REMOVABLE
SPLINTS :
iii) LINGUAL SPLINTS :
 Lingual splint is useful in parasymphyseal
fractures of the mandible to prevent the adverse
muscular forces - causing lingual collapse and
overlap of the fractured segments.
 Sufficiently rigid and stabilizes jaw fragments,
used for -6 weeks

iv) OCCLUSAL SPLINTS/ BITE GUARDS12 :
 The occlusal wafer is generally used for intermaxillary fixation of fully
dentulous patients who have poor or defective occlusion.
 A custom-fabricated acrylic device that fits over the occlusal and
incisal surfaces of either the maxillary or mandibular teeth.
 BASED ON MATERIALS – SOFT AND HARD OCCLUSAL SPLINTS
¹2 Stephen J. Stefanac et al, in Treatment Planning in Dentistry (Second Edition), 2007

ADVANTAGES :
 Occlusal appliance therapy is that the treatment is reversible and
noninvasive
INDICATIONS13 :
1. Symptoms of temperomandibular dysfunction (TMD)
2. Reduces the frequency of RMMA and sleep bruxism
3. Prevent tissue damage (e.g., tooth wear or chipping)
4. For obstructive sleep apnea – reduces aggravation of respiratory
disturbances
13 Samuel P. Nesbit et al, Carlos Barrero, in Diagnosis and Treatment Planning in Dentistry (Third Edition), 2017

14Deepthi SS, Sudeep S et al,
JPID – The journal of
Prosthetic and Implant
Dentistry / Volume 4 Issue 1
/ Sept–Dec 2020

1] B. DENTULOUS – FIXED SPLINTS :
i) METAL CAP SPLINTS15 :
 These are metallic cap that covers the whole occlusal segments, used
in multiple fractures of sphenoid, zygoma, orbital floor and mandible
unable to receive surgical treatment for reduction and fixation of
fractured segments.
15 Yuffa, A. D., Bruzual et al. (2014). Cast metal cap splint use for immobilisation of mandibular fracture. Oral Surgery,
8(1), 63–64.

2] EDENTULOUS SPLINTS :
i) GUNNING SPLINTS :
An acrylic device used to immobilize the edentulous jaws in occlusion
and to hold together fractured segments of mandibular or maxillary
bones
TYPES :
• One piece gunning splint.
• Two piece gunning splint.
• Sectional gunning splint
• Modified gunning splint.

A. ONE PIECE GUNNING SPLINT:
It is constructed for both arches as one
piece.
Disadvantage - overworked, difficult
to manipulate and cannot be wired to the
jawbones
B. TWO PIECE GUNNING SPLINT :
Two separate splints with V-shaped
grooves on the occlusal surface of one arch
and projections to fit these grooves on the
opposite arch gives better results

C. SECTIONAL GUNNING SPLINT :
Designed for immediate immobilization of
the resected mandible to minimize
postsurgical deviation. It is basically
a two-piece gunning splint and a locking
mechanism for immobilization.
D. MODIFIED GUNNING SPLINT :
A modified gunning splint may be produced
by altering existing complete dentures or by
repairing and altering fractured complete
dentures. It is similar to the two-piece
Gunning splint..

2] EDENTULOUS SPLINTS :
ii) KINGLSEY SPLINTS :
A modified stock tray in emergency of fractured maxilla or cast metal
splint for long term treatments .
May be designed to fit dentulous or edentulous patient.

AQUALISER™ 16,17 has unique water system that
immediately optimizes biomechanics, supports
the jaw in a comfortable position.
16 Srivastava R, Jyoti B et al, Oral splint for temporomandibular joint disorders with revolutionary fluid system. Dent Res J (Isfahan). 2013
May;10(3):307-13
17 https://www.dentrade.com/media/69/07/6b/1608036574/AQB%20English%202015.pdf

REFERENCES:
1. THE GLOSSARY OF PROSTHODONTIC TERMS (GPT-9) 9TH ED
2. https://www.slideshare.net/ffofr/2use-of-splints-and-stents-during-radiation-therapy-12122328
3. M M Fouad et al Prosthodontic stent - GUIDELINES FOR MAXILLOFACIAL PROSTHESIS
2019
4. Kitajima S, Yasui A. Images in clinical medicine. Oral maxillary exostosis. N Engl J Med.
2015;373(15):1457‐1457
5. Madan N, Rathnam A, Bajaj N. Treatment of an intraoral bleeding in hemophilic patient with a
thermoplastic palatal stent - A novel approach. Int J Crit Illn Inj Sci. 2011 Jan;1(1):79-83.
6. Wertsén, Madeleine et al. (2017). Measuring lip force by oral screens, Wiley clinical and
experimental dental research
7. Zainab Chaudhary et al. A novel method to prevent biting through nasolabial flap: Modified oral
screen, Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology, Volume 30, Issue 2,
2018,ISSN 2212-5558,

REFERENCES:
8. Ashish.R.Jain et al /J. Pharm. Sci. & Res. Vol. 8(12), 2016, 1358-1366
9. Wilke, Christopher et al (2017). Design and fabrication of a 3D–printed oral stent for head and
neck radiotherapy from routine diagnostic imaging, 3D Printing in Medicine
10. M M Fouad et al Prosthodontic splints - GUIDELINES FOR MAXILLOFACIAL PROSTHESIS
2019
11. Gad, Hamed et al, (2016). INDIRECT IMPACT OF AN ACRYLIC LABIOLINGUAL SPLINTS
MANGING FRACTURED PEDIATRIC MANDIBULAR DENTAL BEARING AREAS ON
TEMPOROMANDIBULAR JOINT FUNCTIO. EGYPTIAN DENTAL JOURNAL. Vol. 62.
12. Stephen J. Stefanac et al, in Treatment Planning in Dentistry (Second Edition), 2007
13. Samuel P. Nesbit et al, Carlos Barrero, in Diagnosis and Treatment Planning in Dentistry (Third
Edition), 2017
14.Deepthi SS, Sudeep S et al, JPID – The journal of Prosthetic and Implant Dentistry / Volume 4
Issue 1 / Sept–Dec 2020

REFERENCES:
15. Yuffa, A. D., Bruzual et al. (2014). Cast metal cap splint use for immobilisation of mandibular
fracture. Oral Surgery, 8(1), 63–64.
16. Srivastava R, Jyoti B et al, Oral splint for temporomandibular joint disorders with revolutionary fluid
system. Dent Res J (Isfahan). 2013 May;10(3):307-13
17. https://www.dentrade.com/media/69/07/6b/1608036574/AQB%20English%202015.pdf

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