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INDIAN DENTAL ACADEMY
Leader in continuing dental education
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Splinting

www.indiandentalacademy.com


The ultimate goal in successful management of mobile teeth is to restore
function and comfort by establishing a stable ...


Tooth splinting have been accomplished since ancient civilizations to
decrease tooth mobility, to replace missing teeth...
Definitions


A splint is a device used to immobilize the teeth, and it is one of the oldest
form of aids to periodontal ...


According to Glossary of Periodontic Terms 1986 a splint is “an appliance
designed to stabilize mobile teeth”.



Acco...
TERMINOLOGY:
STABILIZATION:


Stabilization of a tooth is an increase in resistance to applied force by
providing recipro...


It allows the clinician to see how teeth will respond to treatment.



It usually leads to more permanent forms of sta...
EARLY HISTORY OF SPLINTING:


A Phoenician mandible from 500BC and another Phoenician prosthetic
appliance was found from...


Archeological excavations of the Etruscan society (Eighth century BC to the
first century AD) have found evidence of th...
WHEN TO SPLINT?


The splinting of mobile teeth is often, of value as a means of stabilization
before, during, and after ...


In addition, it is important that occlusal relationship be initially corrected
and again after definitive periodontal t...
INCREASED VERSUS INCREASING TOOTH MOBILITY:


Two clinical features should be analyzed to understand the full scope of th...


Removal of the excess occlusal load through equilibration and perhaps,
conventional splint therapy can decrease and, of...


Those individuals diagnosed with increasing tooth mobility must first
receive periodontal therapy.



Treatment should...
PRINCIPLES OF SPLINTING:


The main objective of splinting is to decrease movement threedimensionally.



This objective...
INDICATIONS FOR SPLINTING:


Splinting is indicated when moderate to advanced mobilities (2 degrees or
more) are present ...


One obvious indication for splinting is when a patient presents with multiple
teeth that have become mobile as a direct...


To stabilize teeth in their new positions after orthodontic repositioning.



As supportive measure to facilitate peri...
The following qualifications identify an ideal splint : It should


be simple,



economic,



stable and efficient,

...
OBJECTIVES OF SPLINTING:


Rest is created for the supporting tissues giving them a favorable climate for
repair of traum...


To preserve arch integrity - restores proximal contacts, reducing food
impaction & consequent break down.



To stabil...
MODE OF ACTION:


Loose teeth splinted to adjacent firm teeth may become stabilized.



Teeth tend to loosen buccolingua...


Teeth are thus immobilized and occlusal forces are better distributed.



Traumatism is minimized, repair is enhanced,...
TYPES OF SPLINTS:


Splints, like bridges may be fixed, removable, or a combination of both.



They may be temporary, p...
A) According to the period of stabilization:
a) Temporary Stabilization: worn for less than 6 months.


Removable



Occ...


Extracoronal



Stainless steel wire with resins



Wire & Resin with acid etching



Enamel etching & composite res...
B) According to the type of material:


Bonded composite resin splint



Braided wire splint



A – Splints.

C) Accord...
Goldman, Cohen and Chacker Classification:
Temporary splints
A. Extra coronal type


Wire ligation



Orthodontic bands
...
Ross, Weisgold and Wright Classification:
A. Temporary stabilization


Removable extra coronal splints



Fixed extra co...


Before construction of any splint for periodontally involved dentitions,
certain basic considerations should be applied...


If the coronal portions of the teeth are in relatively good condition, the
extracoronal method of splinting should be u...


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



If, in a ...
TEMPORARY STABILIZATION


Temporary stabilization is essentially a diagnostic procedure that, ideally,
should be reversib...
The term temporary is applied


To a splint that is used until stabilization is no longer necessary, for
example, in case...


(a) For economic reasons or



(b) Because prognosis for all remaining teeth is extremely doubtful or



(c) Because ...
The functions of a temporary splint may be listed as follows:


To protect mobile teeth from further injury by stabilizin...
EXTRACORONAL TYPES


Unfortunately almost all the extracoronal forms of stabilization have
certain inherent disadvantages...
Wire ligation:


Wire ligation is probably the most commonly used type of stabilization.



It is easy to construct and ...


This method may offer the advantage of greater stability while producing a
splint that is thin in a buccolingual direct...
www.indiandentalacademy.com
Orthodontic bands:


Orthodontic bands tend to stabilize both anterior and posterior teeth and
therefore have the advanta...
www.indiandentalacademy.com
www.indiandentalacademy.com
Removable acrylic appliances:


The clinician must be aware of the fact that when he utilizes any form of
acrylic applian...
Acrylic bite guards ( Night Guards):


Night guards can be constructed in many ways, and they have a wide
variety of uses...


When there is no overbite a labial lip of acrylic over the maxillary anterior
teeth will often suffice.



An importan...
Removable cast appliances:


The removable cast appliance is usually a rigid casting either of gold or of
chrome cobalt, ...
www.indiandentalacademy.com
Ultraviolet Light Polymerizing bonding materials:


Restorative materials that are polymerized by ultraviolet light are v...
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com


The composite resin splint can be strengthened by adding wire,
monofilament line, fiberglass or by using a fibre meshwo...
www.indiandentalacademy.com


Extracoronal resin-bonded retainers, which can be fabricated in the dental
laboratory, serve to strengthen the overall ...


Newly developed laboratory-cured composite resins such as DiamondCrown
(Biodent Inc., Mont-Saint-Hilaire, QC) claim imp...
www.indiandentalacademy.com
Thank you all….
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Splinting part i /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
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Splinting part i /certified fixed orthodontic courses by Indian dental academy

  1. 1. G O O D M O R N I N G www.indiandentalacademy.com
  2. 2. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  3. 3. Splinting www.indiandentalacademy.com
  4. 4.  The ultimate goal in successful management of mobile teeth is to restore function and comfort by establishing a stable occlusion that promotes tooth retention and the maintenance of periodontal health.  The clinical management of mobile teeth can be a perplexing problem, especially if the underlying causes for that mobility have not been properly diagnosed.  In some cases, mobile teeth are retained because patients decline multidisciplinary treatment that might otherwise also include strategic extractions.  Some mobile teeth can be treated through occlusal equilibration alone (primary occlusal trauma) where as mobile teeth with a compromised periodontium can be stabilized with the aid of provisional and/or definitive www.indiandentalacademy.com splinting (secondary occlusal trauma).
  5. 5.  Tooth splinting have been accomplished since ancient civilizations to decrease tooth mobility, to replace missing teeth & to improve form, function, and esthetics.  Still splinting remains one of the poorly understood & controversial areas of dental therapy.  This seminar discusses splinting…its, rationale, basic principles, indications, contraindications, limitations and classifications.  Different types of tooth splinting are also reviewed. www.indiandentalacademy.com
  6. 6. Definitions  A splint is a device used to immobilize the teeth, and it is one of the oldest form of aids to periodontal therapy.  A Splint is an appliance for immobilization or stabilization of injured & diseased parts. In dentistry, splinting is the joining together of two or more teeth to increase resistance to applied force through stabilization.  A splint is an appliance that “joins two or more teeth in order to distribute & redirect functional and parafunctional forces so as to bring them within tolerance of the supporting tissues”.  Splinting is defined as “…the joining of two or more teeth into a rigid unit by means of fixed or removable restorations or devices.”  A splint is any appliance that joins two or more teeth to provide support. www.indiandentalacademy.com
  7. 7.  According to Glossary of Periodontic Terms 1986 a splint is “an appliance designed to stabilize mobile teeth”.  According to AAP (1996), a splint has been defined “as an apparatus, appliance, or device employed to prevent motion or displacement of fractured or removable parts.”  The Glossary of Prosthodontic Terms defines splint as “a rigid or flexible device that maintains in position a displaced or movable part; also used to keep in place & protect the injured part.”  Dawson defines splinting as “the joining of two or more teeth for the purpose of stabilization”. www.indiandentalacademy.com
  8. 8. TERMINOLOGY: STABILIZATION:  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. TEMPORARY SPLINT:  This is used on a short term basis, usually less than 6 months, and is often advocated to stabilize teeth during periodontal treatment. It may or may not 1ead to other types of splinting. PROVISIONAL SPLINT:  This type of splint is used for a longer period of time from several months to as long as several years. It is used for diagnostic purposes. www.indiandentalacademy.com
  9. 9.  It allows the clinician to see how teeth will respond to treatment.  It usually leads to more permanent forms of stabilization. PERMANENT SPLINTS:  Permanent splinting of teeth that have been treated periodontally is also referred to as Periodontal prosthesis.  Periodontal prosthesis may be defined as those restorative and prosthetic endeavors that are indicated and essential in the total treatment of advanced periodontal disease. www.indiandentalacademy.com
  10. 10. EARLY HISTORY OF SPLINTING:  A Phoenician mandible from 500BC and another Phoenician prosthetic appliance was found from 400 BC in modern day Lebanon that is comprised of two carved ivory teeth attached to four natural teeth by gold wire. www.indiandentalacademy.com
  11. 11.  Archeological excavations of the Etruscan society (Eighth century BC to the first century AD) have found evidence of their use of wire ligation and gold bands to stabilize teeth.  In early 1700s Fauchard attempted tooth ligation.  In the 1900s several authors described splinting techniques that dated back to the 1800s.  Hirschfeld (1950) was one of the first modern periodontal authors to advocate ligation of periodontally diseased teeth using either stainless steel wire or silk. His technique was extracoronal and involved only the anterior teeth.  In the last 50 years, scientific principles evolved to treat patients with compromised dentitions. www.indiandentalacademy.com
  12. 12. WHEN TO SPLINT?  The splinting of mobile teeth is often, of value as a means of stabilization before, during, and after periodontal therapy.  For most patients, splinting should be considered only after the preliminary phase of periodontal therapy has been completed.  Cohen and Chacker have noted, "When large areas of attachment apparatus have been destroyed, the artificial support offered by temporary stabilization may allow a new, healthy tooth-bone relationship to be established.  Therefore it would seem advisable that when the treatment plan is being formulated the need for stabilization be determined on the basis of the, nature and extent of the destructive process present. www.indiandentalacademy.com
  13. 13.  In addition, it is important that occlusal relationship be initially corrected and again after definitive periodontal therapy.  Root planing, curettage, oral hygiene, and surgery may cause teeth to tighten as inflammation is resolved.  Occlusal adjustment, periodontal orthodontics, and restorative dentistry may alter occlusal relationships and redirect forces, thereby 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. www.indiandentalacademy.com
  14. 14. INCREASED VERSUS INCREASING TOOTH MOBILITY:  Two clinical features should be analyzed to understand the full scope of the relationship between occlusal trauma and tooth mobility.  The first is increased tooth mobility.  This process is the adaptation of the periodontium to occlusal forces that may not necessarily be considered pathologic.  In the absence of inflammation, mobile teeth with a complete and healthy connective tissue attachment can be maintained.  The radiographic appearance of a widened periodontal ligament (PDL) space coupled with a clinical diagnosis of increased tooth mobility may merely be manifestations of adaptive changes to increased functional demand. www.indiandentalacademy.com
  15. 15.  Removal of the excess occlusal load through equilibration and perhaps, conventional splint therapy can decrease and, often at times, eliminate tooth mobility.  An occlusal equilibration that equalizes the occlusal stresses, produces simultaneous tooth contacts, or harmonizes cuspal relations may be all that is needed to reverse this mobility.  The second clinical feature is increasing tooth mobility.  This clinical condition is best managed by treating any localized inflammation, performing an occlusal equilibration, and perhaps stabilizing or splinting the affected mobile teeth.  Consequently, patients diagnosed with increased tooth mobility may need only an occlusal equilibration and perhaps conventional splint therapy. www.indiandentalacademy.com
  16. 16.  Those individuals diagnosed with increasing tooth mobility must first receive periodontal therapy.  Treatment should include an occlusal analysis and equilibration, if needed, followed by a reevaluation for extraction or splinting of the affected teeth. www.indiandentalacademy.com
  17. 17. PRINCIPLES OF SPLINTING:  The main objective of splinting is to decrease movement threedimensionally.  This objective often can be met with the proper placement of a cross-arch splint.  Conversely, unilateral splints that do not cross the midline tend to permit the affected teeth to rotate in a faciolingual direction about a mesio-distal linear axis. www.indiandentalacademy.com
  18. 18. INDICATIONS FOR SPLINTING:  Splinting is indicated when moderate to advanced mobilities (2 degrees or more) are present and cannot be treated by any other means.  There is no reason for splinting non mobile teeth or teeth with a slight, non progressive mobility as a preventive measure.  Splinting should only be used with other necessary measures such as oral hygiene instructions, root planing, pocket elimination, and occlusal adjustment.  When pre-prosthetic surgery or orthodontic measures are called for they should be completed before splinting whenever possible. www.indiandentalacademy.com
  19. 19.  One obvious indication for splinting is when a patient presents with multiple teeth that have become mobile as a direct result of gradual alveolar bone loss, a reduced periodontium.  A second indication for splinting is when the patient presents with increased tooth mobility accompanied by pain or discomfort in the affected teeth.  Splinting may be a way to gain stability, reduce or eliminate the mobility, and relieve the pain and discomfort.  Following loosening of teeth by accidental (or) surgical trauma.  To immobilize excessively mobile teeth so that the patient can chew more comfortably.  To avoid dislodging teeth prior to and during re-constructive procedures (Occlusal reconstruction). www.indiandentalacademy.com
  20. 20.  To stabilize teeth in their new positions after orthodontic repositioning.  As supportive measure to facilitate periodontal therapeutic procedures for hypermobile teeth. CONTRAINDICATIONS FOR SPLINTING:  Splinting teeth is not recommended if occlusal stability and optimal periodontal conditions cannot be obtained.  Any tooth mobility present before treatment must be reduced by means of occlusal equilibration combined with periodontal therapy.  Otherwise if the tooth involved does not respond, it must be extracted prior to proceeding from provisional restorations to definitive treatment.  Insufficient number of firm / sufficiently firm teeth to stabilize mobile teeth. www.indiandentalacademy.com
  21. 21. The following qualifications identify an ideal splint : It should  be simple,  economic,  stable and efficient,  hygienic,  nonirritating,  not interfere with treatment,  esthetically acceptable, and  not provoke iatrogenic disease. www.indiandentalacademy.com
  22. 22. OBJECTIVES OF SPLINTING:  Rest is created for the supporting tissues giving them a favorable climate for repair of trauma.  Reduction of mobility immediately and hopefully permanently. In particular jiggling movements are reduced or eliminated.  Redirection of forces - redirected in a more axial direction over all the teeth included in the splint.  Redistribution of forces - ensures that forces do not exceed the adaptive capacity. Forces/received by one tooth are distributed to a number of teeth.  Restoration of functional stability - functional occlusion stabilizes mobile abutment teeth. www.indiandentalacademy.com
  23. 23.  To preserve arch integrity - restores proximal contacts, reducing food impaction & consequent break down.  To stabilize mobile teeth during surgical, especially during regenerative periodontal therapy.  To prevent migration and over eruption.  Psychologic well being - gives the patient comfort from mobile teeth a sense of well being.  Masticatory function is improved.  Discomfort and pain are eliminated. www.indiandentalacademy.com
  24. 24. MODE OF ACTION:  Loose teeth splinted to adjacent firm teeth may become stabilized.  Teeth tend to loosen buccolingually yet may remain firm mesiodistally.  When many teeth are loose, adjacent sextants should be included in the splint.  Cross-arch splinting reduces mobility to the least common denominator. www.indiandentalacademy.com
  25. 25.  Teeth are thus immobilized and occlusal forces are better distributed.  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 that permits useful function of mobile teeth.  Teeth with reduced support often are hypermobile and may gradually increase if the teeth are not splinted. www.indiandentalacademy.com
  26. 26. TYPES OF SPLINTS:  Splints, like bridges may be fixed, removable, or a combination of both.  They may be temporary, provisional, or permanent, according to the type of material and duration of use.  They may be internal or external, depending on whether tooth preparation is required or not.  Permanent splinting of teeth that have been treated periodontally is also referred to as periodontal prosthesis.  However, splints are classified into the basic types for purposes of discussion. www.indiandentalacademy.com
  27. 27. A) According to the period of stabilization: a) Temporary Stabilization: worn for less than 6 months.  Removable  Occlusal Splint with wire  Hawley appliance with arch wire  Fixed  Intracoronal  Amalgam  Amalgam & Wire  Amalgam , Wire & Resin  Composite Resin & Wire www.indiandentalacademy.com
  28. 28.  Extracoronal  Stainless steel wire with resins  Wire & Resin with acid etching  Enamel etching & composite resin  Orthodontic soldered bands, Brackets & Wire b) Provisional splinting: to be used for months up to several years. e.g. Acrylic splints, Metal band etc. c) Permanent Splints: used indefinitely  Removable/Fixed  Extra/Intracoronal  Full/Partial veneer crowns soldered together.  www.indiandentalacademy.com Inlay/Onlay soldered together.
  29. 29. B) According to the type of material:  Bonded composite resin splint  Braided wire splint  A – Splints. C) According to the location on the tooth:  Intracoronal  Composite resin with wire  Inlays  Onlays  Extracoronal  Night Guard  Tooth Bonded plastic and Welded bands www.indiandentalacademy.com
  30. 30. Goldman, Cohen and Chacker Classification: Temporary splints A. Extra coronal type  Wire ligation  Orthodontic bands  Removable acrylic appliances  Removable cast appliances  Ultraviolet-light-polymerizing bonding materials B. Intracoronal type  Wire and acrylic  Wire and amalgam  Wire, amalgam, and acrylic  Cast chrome-cobalt alloy bars with acrylic, or both. Provisional splints  All acrylic  Adapted metal band and www.indiandentalacademy.com acrylic
  31. 31. Ross, Weisgold and Wright Classification: A. Temporary stabilization  Removable extra coronal splints  Fixed extra coronal splints  Intracoronal splints  Etched metal resin-bonded splints B. Provisional stabilization  Acrylic splints  Metal-band-and-acrylic splints C. Long-term stabilization  Removable splints  Fixed splints  Combination removable and fixed splints www.indiandentalacademy.com
  32. 32.  Before construction of any splint for periodontally involved dentitions, certain basic considerations should be applied whenever possible:  For most patients, splinting should be considered only after the preliminary phase of periodontal therapy has been completed, including the elimination of all local factors contributing to inflammation and occlusal adjustment by selective grinding.  Exceptions are dentitions with so much mobility that adequate occlusal adjustment is impossible.  In these circumstances the teeth should be stabilized as early as possible, and then the occlusion can be definitively adjusted.  The method of splinting is dictated by the cause and degree of mobility, the coronal condition of the teeth to be incorporated in the splint and evaluation of the state of hypermobility, whether temporary or permanent. www.indiandentalacademy.com
  33. 33.  If the coronal portions of the teeth are in relatively good condition, the extracoronal method of splinting should be used.  If, however, the teeth obviously require extensive restorative therapy, as well as periodontal therapy, a form of intracoronal splinting is justified and preferable.  The extent of splinting is dictated primarily by the number of teeth involved and the degree of their mobility.  In all cases, a sufficient number of nonmobile teeth should be included in the splint.  If all the teeth in a quadrant demonstrate hypermobility, splinting should be extensive enough to include the support of anterior teeth and, on occasion, teeth on the opposite side of the arch. www.indiandentalacademy.com
  34. 34.  For the same reason, the support of posterior teeth is often necessary when anterior segments are mobile.  If, in a case of occlusal traumatism associated with severe bone loss, all the teeth demonstrate hypermobility, cross arch splinting is beneficial.  With splinting, a group of single rooted teeth in effect becomes a multirooted unit.  The patient must be informed that future restorative measures are usually necessary when any form of intra or circumcoronal splinting is used.  All methods of splinting have advantages and disadvantages.  Ironically, some methods of stabilization by splinting are so time consuming and demanding in construction that they are most impractical and expensive. www.indiandentalacademy.com
  35. 35. TEMPORARY STABILIZATION  Temporary stabilization is essentially a diagnostic procedure that, ideally, should be reversible in nature.  By splinting, we expect a mechanical stabilization and hope that a decrease of hypermobility of the involved teeth will result with time. Indications for Temporary Stabilization  Temporary splints are used both until hypermobility is satisfactorily reduced or eliminated and the teeth can function without the help of the splint or until the dentition clearly requires long term stabilization. www.indiandentalacademy.com
  36. 36. The term temporary is applied  To a splint that is used until stabilization is no longer necessary, for example, in cases of mobility caused by orthodontic repositioning, accidental or surgical trauma, or occlusal traumatism, all of a reversible nature.  As a phase in the therapy being undertaken to determine whether mobility can be resolved by conservative methods or whether mobility is caused by loss of support sufficient to create permanent mobility (as in occlusal traumatism associated with periodontitis), by root resorption, or any extrinsic or intrinsic precipitating factors.  When advanced periodontal disease dictates permanent fixation by extensive restorative methods, but this cannot be done either www.indiandentalacademy.com
  37. 37.  (a) For economic reasons or  (b) Because prognosis for all remaining teeth is extremely doubtful or  (c) Because poor health seriously affects the longevity of the dentition, or even the life of the patient or  (d) Because the patient cannot emotionally accept the lengthy procedures of permanent fixation.  For temporary stabilization, the method chosen should be the simplest, least expensive, and least time consuming to construct, should be esthetically acceptable to the patient, and should meet the needs of the individual. www.indiandentalacademy.com
  38. 38. The functions of a temporary splint may be listed as follows:  To protect mobile teeth from further injury by stabilizing them in a favorable occlusal relationship.  To distribute occlusal forces so that teeth that have lost periodontal support are not further traumatized.  To aid in determining whether teeth with a borderline prognosis will respond to therapy. www.indiandentalacademy.com
  39. 39. EXTRACORONAL TYPES  Unfortunately almost all the extracoronal forms of stabilization have certain inherent disadvantages.  They usually are a detriment to good oral physiotherapy because of their bulk, thus interrupting proper coronal forms.  It is often difficult to perform various surgical procedures in these areas because of the nature of the appliance.  The appliances frequently leave a great deal to be desired cosmetically. www.indiandentalacademy.com
  40. 40. Wire ligation:  Wire ligation is probably the most commonly used type of stabilization.  It is easy to construct and rather sturdy.  However, one of its basic limitations is that it can be utilized only where coronal form permits.  Because of this shortcoming it has its greatest use in stabilizing the mandibular incisors.  Hirschfeld suggests a loop tied at the cervical line on poorly contoured teeth to prevent slippage of the main wire.  After an interproximal tie is made, connecting the buccal and lingual segments of the mesh, tooth-colored, self-curing acrylic is painted over the wire to obtain a more pleasing aesthetic result. www.indiandentalacademy.com
  41. 41.  This method may offer the advantage of greater stability while producing a splint that is thin in a buccolingual direction and quite acceptable to the patient. www.indiandentalacademy.com
  42. 42. www.indiandentalacademy.com
  43. 43. Orthodontic bands:  Orthodontic bands tend to stabilize both anterior and posterior teeth and therefore have the advantage over wire ligation in that they are not limiting.  It is important to give proper attention to the contours of the bands and to check their relationship to the adjacent gingival tissue.  Often the contacts between the teeth must be opened so that a band or bands can be inserted.  Again, acrylic may be placed over the bands for cosmetic purposes. The bands may be welded directly or indirectly.  When the multiple bands are welded together, it is necessary to have a common path of insertion so that the composite fit of the multiple bands is the same as the fit of eachwww.indiandentalacademy.com individual band.
  44. 44. www.indiandentalacademy.com
  45. 45. www.indiandentalacademy.com
  46. 46. Removable acrylic appliances:  The clinician must be aware of the fact that when he utilizes any form of acrylic appliance, the dimensional instability of the material may cause distortions to occur.  It is imperative to check these appliances frequently and to make any necessary adjustments.  It is also vital to check the path of insertion of the appliance, since the appliance must not be traumatic as it goes to its final seat. www.indiandentalacademy.com
  47. 47. Acrylic bite guards ( Night Guards):  Night guards can be constructed in many ways, and they have a wide variety of uses like treatment of bruxism and clenching.  The most common type of appliance is one that covers the occlusal surfaces of the teeth. For additional support the palate is often covered.  Another appliance frequently used is the maxillary Hawley bite plane with a labial wire.  This appliance has an advantage in that the posterior teeth are freed of occlusal contact in all positions and excursions of the mandible.  It can be used only when there is an anterior overbite so that the palatal bite plane can disarticulate the posterior teeth. www.indiandentalacademy.com
  48. 48.  When there is no overbite a labial lip of acrylic over the maxillary anterior teeth will often suffice.  An important consideration with all these appliances is that they must not obliterate the interocclusal distance (free-way space). www.indiandentalacademy.com
  49. 49. Removable cast appliances:  The removable cast appliance is usually a rigid casting either of gold or of chrome cobalt, made to fit around the teeth.  Friedman has suggested a useful variation utilizing a double continuous clasp casting.  One end usually the anterior section, is not joined but is left open so that the casting can be sprung over the undercuts and then ligated.  The posterior end is continuous from the buccal to the lingual surface and is distal to the most posterior tooth.  Another modification is an interlocking attachment on the distal end so that the appliance can be locked after being sprung over the teeth.  Obviously, with any form of removable splint, it is only effective if the www.indiandentalacademy.com patient wears the appliance.
  50. 50. www.indiandentalacademy.com
  51. 51. Ultraviolet Light Polymerizing bonding materials:  Restorative materials that are polymerized by ultraviolet light are very useful in providing stabilization of excessively mobile teeth.  As Polson and Billen have stated, "Because the materials do not polymerize until they are exposed to ultraviolet light, they provide prolonged working times for placement. shaping, and contouring, over extensive areas of enamel."  One of the more popular polymerizing kits is the Nuva System (Caulk, Division of Dentsply lnternational Inc. Milford, Delaware).  Basically the technique is a simple one and provides adequate stabilization if care is taken during the actual operative procedures. www.indiandentalacademy.com
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  55. 55.  The composite resin splint can be strengthened by adding wire, monofilament line, fiberglass or by using a fibre meshwork (e.g., Ribbond, Ribbond Inc., Seattle, WA) to reinforce the material. www.indiandentalacademy.com
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  57. 57.  Extracoronal resin-bonded retainers, which can be fabricated in the dental laboratory, serve to strengthen the overall bonded situation.  The splints are usually cast from metals, usually non noble alloys that can be electrolytically or chemically etched.  This type of splint has greater inherent strength than a composite-resin splint created intraorally.  Extra features such as grooves, pins and parallel preparations increase the www.indiandentalacademy.com retentive capacity of these splints.
  58. 58.  Newly developed laboratory-cured composite resins such as DiamondCrown (Biodent Inc., Mont-Saint-Hilaire, QC) claim improved diametric tensile strength and bonding capabilities.  These materials may be considered for use in extracoronal applications.  No long-term clinical data are available for these materials; however, they seem promising at this time. www.indiandentalacademy.com
  59. 59. www.indiandentalacademy.com
  60. 60. Thank you all…. To be www.indiandentalacademy.com

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