Splints/ dentistry dental implants

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Splints/ dentistry dental implants

  1. 1. SPLINTS IN PERIODONTICSSPLINTS IN PERIODONTICS INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.comwww.indiandentalacademy.com
  2. 2. CONTENTSCONTENTS  IntroductionIntroduction  DefinitionsDefinitions  SplintSplint  StabilizationStabilization  Rationale for stabilizationRationale for stabilization  Biologic reasons for splintingBiologic reasons for splinting  Ideal requirements of a splintIdeal requirements of a splint  Basic consideration before construction of any splintsBasic consideration before construction of any splints  Mode of actionMode of action  Classification of splintsClassification of splints  Packs and splintsPacks and splints  Disadvantages of splintingDisadvantages of splinting  Maintenance of splintsMaintenance of splints  conclusionconclusion  ReferencesReferences www.indiandentalacademy.comwww.indiandentalacademy.com
  3. 3. IntroductionIntroduction  Periodontal diseases are characterized by subgingival plaque formation, gingival inflammation, loss of connective tissue attachment and loss of alveolar bone.  As a result of the progressive loss of attachment tissue, the teeth involved in the disease process eventually exhibit increased tooth mobility.  Thus the reduction of mobility is an important objective of periodontal therapy. www.indiandentalacademy.comwww.indiandentalacademy.com
  4. 4. www.indiandentalacademy.comwww.indiandentalacademy.com
  5. 5.  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.  Occlusal adjustment, periodontal orthodontics and restorative dentistry may alter occlusal relationships and redirect forces, there by 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.comwww.indiandentalacademy.com
  6. 6.  Splint may be used to maintain periodontally migrated teeth that have been repositioned.  It may also be used prior to surgery where splinting is considered necessary to stabilize mobile teeth during post surgical healing.  Dental splints have been used since the 8th century B.C. thus, while hardly a recent innovation splinting is still generally regarded as an integral part of periodontal therapy.  Splinting creates a multi-rooted unit, increasing the total area of root resistance. The center of rotation of each tooth is so altered as to afford greater resistance to mesiodistal forces. www.indiandentalacademy.comwww.indiandentalacademy.com
  7. 7.  Splinting is commonly performed on the assumption that it will create a more favorable environment for periodontal repair.  Etruscans from the 8th century B.C. to the 1st century A.D. utilized wire ligation and small gold rings and bands to stabilize mobile teeth.  Fauchard in 1723 ligated and banded teeth to stabilize them. www.indiandentalacademy.comwww.indiandentalacademy.com
  8. 8. DEFINITIONSDEFINITIONS SPLINT:SPLINT:  Splint is defined as an any apparatus, appliance device employed to prevent motion or displacement of fractured or movable parts (Francis G. Serio).  Grant defined splint is an any appliance that joins two or more teeth to provide support.  According to Macphee and Cowley – Splint is a rigid flexible appliance used to stabilize and protect an injured part. www.indiandentalacademy.comwww.indiandentalacademy.com
  9. 9.  Manson and Eley defined splint is a device for supporting weakened tissues. It serves two purposes 1. Provides rest where wound healing is in process 2. Permits function where the tissues alone cannot perform adequately .  Splint is an appliance for immobilization or stabilization of injured or diseased parts (Keith Lemmerman).  Page and Schluger defined splint is a device used to immobilize teeth and it is one of the oldest forms of aids to periodontal therapy  Clark, Weatherford and Mann defined splint is an appliance to stabilize or immobilize an injured or diseased part.www.indiandentalacademy.comwww.indiandentalacademy.com
  10. 10. STABILIZATION (SPLINTING):-STABILIZATION (SPLINTING):-  Stabilization or splinting commonly refers to tying teeth together either unilaterally or bilaterally, to convey increased stability to the entire unit. (Francis G. Serio)  Jenkins defined stabilization or splinting is the procedure by which a tooth’s resistance to an applied force is increased by joining it to a neighbouring tooth or teeth.  According to Keith Lemmerman – 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. www.indiandentalacademy.comwww.indiandentalacademy.com
  11. 11.  Dawson defines splinting as “the joining together teeth into a rigid unit by means of fixed or removable restorations or devices.  Splinting is defined as the “joining of two or more teeth into a rigid unite by means of fixed or removable restorations or devices”. (Sharon C. Seigel, Carl F. Driscoll and Sylvan Feldman) www.indiandentalacademy.comwww.indiandentalacademy.com
  12. 12. RATIONALE FOR STABILIZATION:RATIONALE FOR STABILIZATION:  The benefits of splinting teeth are based on clinicalThe benefits of splinting teeth are based on clinical impression rather than on scientific studies. Clinicians haveimpression rather than on scientific studies. Clinicians have used both fixed and removable splints to restore occlusalused both fixed and removable splints to restore occlusal stability effectively.stability effectively. I. Splinting the normal periodontiumI. Splinting the normal periodontium  Prevention of mobility.Prevention of mobility.  Prevention of drifting.Prevention of drifting. II. Splinting the diseased periodontiumII. Splinting the diseased periodontium  Prevention of mobility.Prevention of mobility.  To allow repair during periodontal treatmentTo allow repair during periodontal treatment  Prevention of Trauma from occlusionPrevention of Trauma from occlusion  Prevention of drifting.Prevention of drifting. www.indiandentalacademy.comwww.indiandentalacademy.com
  13. 13.  I. Splinting the normal periodontiumI. Splinting the normal periodontium:_:_ This includes cases where, a clinical point of view, theThis includes cases where, a clinical point of view, the periodontium isperiodontium is healthyhealthy..  A. Prevention of mobility:-  The increased tooth mobility is detrimental, and if allowed toThe increased tooth mobility is detrimental, and if allowed to continue, could cause other damage. The dividing linecontinue, could cause other damage. The dividing line between normal mobility and mobility that should be treatedbetween normal mobility and mobility that should be treated widely.widely.  B.B. Prevention of driftingPrevention of drifting:-:-  The rationale for stabilization here is that drifting of teethThe rationale for stabilization here is that drifting of teeth can lead to or enhance the potential for the development ofcan lead to or enhance the potential for the development of periodontal problems.periodontal problems. www.indiandentalacademy.comwww.indiandentalacademy.com
  14. 14. eg ::eg :: Replacement of missing teethReplacement of missing teeth::  Hirschfeld 1937. The classic case used as an illustration was theHirschfeld 1937. The classic case used as an illustration was the early loss of the mandibular first molar. Failure to replace it resultedearly loss of the mandibular first molar. Failure to replace it resulted inin mesial drifting of the mandibular 2nd and 3rd molars,mesial drifting of the mandibular 2nd and 3rd molars, distal drifting of the mandibular premolars, extrusion ofdistal drifting of the mandibular premolars, extrusion of the maxillary first molar,the maxillary first molar, marginal ridge discrepancies, open contacts, increasedmarginal ridge discrepancies, open contacts, increased plaque retention pocket formation and developmentplaque retention pocket formation and development occlusion interferences.occlusion interferences. Replacement of four missing 1st molars has beenReplacement of four missing 1st molars has been shown to result in a 50% increase in masticatoryshown to result in a 50% increase in masticatory efficiency.efficiency. www.indiandentalacademy.comwww.indiandentalacademy.com
  15. 15.  II.II. Splinting the diseased periodontiumSplinting the diseased periodontium:-:-  A)A) Prevention of mobility:-Prevention of mobility:-  Splinting for functional reasonsSplinting for functional reasons:- The rationale in this case is:- The rationale in this case is to splint where increased mobility makes function difficult orto splint where increased mobility makes function difficult or impossible.impossible.  Stern and Clark stated that one of the rationales forStern and Clark stated that one of the rationales for stabilization is to decrease mobility and that one of its benefitsstabilization is to decrease mobility and that one of its benefits was an increase in function for the patient.was an increase in function for the patient.  Simring reported that temporary stabilization may be done toSimring reported that temporary stabilization may be done to “increase the morale” of patients with multiple mobile teeth.“increase the morale” of patients with multiple mobile teeth. www.indiandentalacademy.comwww.indiandentalacademy.com
  16. 16. To allow repair during periodontal treatmentTo allow repair during periodontal treatment  The rationale is that mobility may either cause orThe rationale is that mobility may either cause or accelerate the progression of periodontal disease, or theaccelerate the progression of periodontal disease, or the very least inhibit tissue repair.very least inhibit tissue repair.  HirschfieldHirschfield advocated that the use of stabilization 1 to 2advocated that the use of stabilization 1 to 2 years post-treatment in anterior teeth with residualyears post-treatment in anterior teeth with residual mobility to encourage the consolidation of supportingmobility to encourage the consolidation of supporting structures.structures.  FriedmanFriedman believed that unless splinted, mobile teethbelieved that unless splinted, mobile teeth may not respond as well to reattachment procedures.may not respond as well to reattachment procedures. www.indiandentalacademy.comwww.indiandentalacademy.com
  17. 17.  CrossCross stated that in the absence of infection, mobilitystated that in the absence of infection, mobility will inhibit repair and therefore splinting indicated..will inhibit repair and therefore splinting indicated..  WardWard considered “pathologic movement” to be anconsidered “pathologic movement” to be an etiologic factor in periodontal disease and advocatedetiologic factor in periodontal disease and advocated temporary splinting to prevent it.temporary splinting to prevent it.  AmsterdamAmsterdam and others have stated that splinting wasand others have stated that splinting was also indicted following hemisection or root resectionalso indicted following hemisection or root resection procedures to allow better healing.procedures to allow better healing. www.indiandentalacademy.comwww.indiandentalacademy.com
  18. 18.  B.B. Prevention of drifting:-Prevention of drifting:-  Replacement of missing teeth:-Replacement of missing teeth:- This is basically the same as in normal periodontium withThis is basically the same as in normal periodontium with increased function as a secondary benefit.increased function as a secondary benefit.  Post orthodontics:-Post orthodontics:- Splints used as retainers after orthodontic therapy in theSplints used as retainers after orthodontic therapy in the periodontic patient..periodontic patient.. www.indiandentalacademy.comwww.indiandentalacademy.com
  19. 19. BIOLOGIC REASONS FOR SPLINTING:BIOLOGIC REASONS FOR SPLINTING: 1.1. RESTREST  Occlusal rest provided by splint therapy of one form or another helps to eliminate or atleast to neutralize some of the adverse occlusal factors that compound the effects of an already existing inflammatory disease, such as periodontitis.  Many involved teeth are hypermobile because of a widened periodontal space, and one of the main objectives of splinting is to reestablish a narrow ligament space. www.indiandentalacademy.comwww.indiandentalacademy.com
  20. 20. 2.2. REDISTRIBUTION OF FORCESREDISTRIBUTION OF FORCES:-:-  The stabilization of weakened teeth by splinting increasesThe stabilization of weakened teeth by splinting increases resistance to applied forces.resistance to applied forces.  The redistribution of forces ensures that the excessive forceThe redistribution of forces ensures that the excessive force on a single tooth does not exceed the adaptive capacity of theon a single tooth does not exceed the adaptive capacity of the surrounding tissue and that jiggling movements which cansurrounding tissue and that jiggling movements which can contribute to further bone loss in an existing periodontitis arecontribute to further bone loss in an existing periodontitis are prevented .prevented . www.indiandentalacademy.comwww.indiandentalacademy.com
  21. 21. 3.3. REDIRECTION OF FORCES:-REDIRECTION OF FORCES:-  Splinting effects a redirection of force in a more axial directionSplinting effects a redirection of force in a more axial direction over all the teeth included in the splint.over all the teeth included in the splint.  Hypothetically, occlusal force on a mesially tilted molar will haveHypothetically, occlusal force on a mesially tilted molar will have a mesial vector and an apical vector, but no vector along the longa mesial vector and an apical vector, but no vector along the long axis of the tooth.axis of the tooth.  Splinting such teeth prevents the tilting affect of the unfavourablySplinting such teeth prevents the tilting affect of the unfavourably directed occlusal force.directed occlusal force. www.indiandentalacademy.comwww.indiandentalacademy.com
  22. 22. 4)4) PRESERVATION OF ARCH INTEGRITYPRESERVATION OF ARCH INTEGRITY:-:-  Splinting restores proximal contacts that have been disruptedSplinting restores proximal contacts that have been disrupted by missing and migrated teeth & makes the patient moreby missing and migrated teeth & makes the patient more comfortable and reduces the likely hood of food impaction andcomfortable and reduces the likely hood of food impaction and consequent breakdown.consequent breakdown. 5)5) RESTORATION OF FUNCTIONAL STABILITYRESTORATION OF FUNCTIONAL STABILITY:-:-  Splinting in conjunction with replacement of missing teethSplinting in conjunction with replacement of missing teeth, if, if necessary,necessary, not only restores a functional occlusionnot only restores a functional occlusion, but, but stabilizes the remaining mobile abutment teethstabilizes the remaining mobile abutment teeth.. www.indiandentalacademy.comwww.indiandentalacademy.com
  23. 23. 6)6) To prevent tipping, migration, or overeruption of teethTo prevent tipping, migration, or overeruption of teeth following extraction and to stabilize proximal contacts offollowing extraction and to stabilize proximal contacts of mobile teeth and reduce food impaction into the embrasures.mobile teeth and reduce food impaction into the embrasures. 7)7) Masticatory function may be improved.Masticatory function may be improved. 8)8) Discomfort and pain are eliminated.Discomfort and pain are eliminated. 9)9) Appearance may be improved.Appearance may be improved. 10)10) PSYCHOLOGICAL WELL-BEINGPSYCHOLOGICAL WELL-BEING:-:-  Hyper mobility can become so severe that patients becomeHyper mobility can become so severe that patients become fearful of losing teeth.fearful of losing teeth.  Stabilization by splinting and restoration not only improvesStabilization by splinting and restoration not only improves function, but it also can restore a sense of a solid-feelingfunction, but it also can restore a sense of a solid-feeling dentition as well as of comfort and good looks.dentition as well as of comfort and good looks. www.indiandentalacademy.comwww.indiandentalacademy.com
  24. 24.  The attainment of comfort and good looks as a basis forThe attainment of comfort and good looks as a basis for splinting cannot be disregarded; however splinting must not besplinting cannot be disregarded; however splinting must not be misused as a cosmetic procedure.misused as a cosmetic procedure.  Many patients who require long-term stabilization by theMany patients who require long-term stabilization by the extensive use of fixed prosthodontics are concerned more withextensive use of fixed prosthodontics are concerned more with the cosmetic benefits that might result form such treatmentthe cosmetic benefits that might result form such treatment than with improved functional qualities.than with improved functional qualities.  The use of an expensive, irreversible procedure must not basedThe use of an expensive, irreversible procedure must not based solely on a patient’s cosmetic demands.solely on a patient’s cosmetic demands.  Often patients concerned with cosmetic results remainOften patients concerned with cosmetic results remain dissatisfied despite the best efforts to restore their dentitions.dissatisfied despite the best efforts to restore their dentitions. www.indiandentalacademy.comwww.indiandentalacademy.com
  25. 25. IDEAL REQUIREMENTS OF A SPLINT:IDEAL REQUIREMENTS OF A SPLINT: 1.1. Simple.Simple. 2.2. EconomicEconomic 3.3. Stable and efficientStable and efficient 4.4. Esthetically acceptableEsthetically acceptable 5.5. It should incorporate as many firm teeth as is necessary toIt should incorporate as many firm teeth as is necessary to reduce the extra load on individual teeth to a minimum.reduce the extra load on individual teeth to a minimum. 6.6. It should hold the teeth rigid and not impose torsional stressesIt should hold the teeth rigid and not impose torsional stresses on any incorporated teeth.on any incorporated teeth.www.indiandentalacademy.comwww.indiandentalacademy.com
  26. 26. 7.7. It should extend around the arch, so that antero-posterior forces andIt should extend around the arch, so that antero-posterior forces and facio lingual forces are counteracted.facio lingual forces are counteracted. 8. It should not interfere with the occlusion. If possible gross tooth8. It should not interfere with the occlusion. If possible gross tooth disharmonies should be eliminated before the application of thedisharmonies should be eliminated before the application of the splint.splint. 9.9. It should be designed so that it can be kept clean interdentalIt should be designed so that it can be kept clean interdental embrassure spaces should not be blocked by the splint.embrassure spaces should not be blocked by the splint. 10.10. It should not irritate the pulp, soft tissues, gingiva, cheeks, lips orIt should not irritate the pulp, soft tissues, gingiva, cheeks, lips or tongue.tongue. 11.11. It should not impair or disturb the phonetic pattern of the patient.It should not impair or disturb the phonetic pattern of the patient. 12.12. It should not provoke iatrogenic disease.It should not provoke iatrogenic disease. www.indiandentalacademy.comwww.indiandentalacademy.com
  27. 27. BASIC CONSIDERATION BEFORE CONSTRUCTION OFBASIC CONSIDERATION BEFORE CONSTRUCTION OF ANY SPLINT:ANY SPLINT: 1.1. For most patients, splinting should be considered only after theFor most patients, splinting should be considered only after the preliminary phase of periodontalpreliminary phase of periodontal therapy has been completed,therapy has been completed, including theincluding the elimination of all local factors contributing toelimination of all local factors contributing to inflammationinflammation andand occlusal adjustmentocclusal adjustment by selective grinding.by selective grinding. - Exceptions are dentitions with so much mobility that adequate- Exceptions are dentitions with so much mobility that adequate occlusal adjustment is impossible.occlusal adjustment is impossible. -In these circumstances the teeth should be stabilized as early as-In these circumstances the teeth should be stabilized as early as possible, and then the occlusion can be definitely adjusted.possible, and then the occlusion can be definitely adjusted. www.indiandentalacademy.comwww.indiandentalacademy.com
  28. 28. 2.2. TheThe method of splintingmethod of splinting is dictated by theis dictated by the cause and degree ofcause and degree of mobilitymobility,, whether,, whether temporarytemporary oror permanent.permanent. If theIf the coronal portionscoronal portions of the teeth are inof the teeth are in relatively goodrelatively good condition, thecondition, the extra coronalextra coronal method of splinting should bemethod of splinting should be used.used. If, however, the teeth obviouslyIf, however, the teeth obviously requirerequire extensive restorativeextensive restorative therapytherapy, as well as periodontal therapy, a form of, as well as periodontal therapy, a form of intracoronalintracoronal splintingsplinting is justified and preferable.is justified and preferable. www.indiandentalacademy.comwww.indiandentalacademy.com
  29. 29. 3.3. TheThe extent of splintingextent of splinting is dictated primarily by the number ofis dictated primarily by the number of teeth involved and the degree of their mobility.teeth involved and the degree of their mobility. In all cases, a sufficient number of non mobile teeth should beIn all cases, a sufficient number of non mobile teeth should be included in the splint.included in the splint. If all the teeth in a quadrant demonstrate hypermobility,If all the teeth in a quadrant demonstrate hypermobility, splinting should be extensive enough to include the support ofsplinting should be extensive enough to include the support of anterior teeth and, on occasion, teeth on the opposite side ofanterior teeth and, on occasion, teeth on the opposite side of the arch.the arch. For the same reason, the support of posterior teeth is oftenFor the same reason, the support of posterior teeth is often necessary when anterior segments are mobile.necessary when anterior segments are mobile. www.indiandentalacademy.comwww.indiandentalacademy.com
  30. 30. 4.4. If, in a case of occlusal traumatism associated with severeIf, in a case of occlusal traumatism associated with severe bone loss, all the teeth demonstrate hypermobility,bone loss, all the teeth demonstrate hypermobility, corss-archcorss-arch splinting is beneficialsplinting is beneficial, because the pattern of mobility of, because the pattern of mobility of some teeth is in a buccolingual direction and of others is in asome teeth is in a buccolingual direction and of others is in a mesiodistal direction. (with splinting, a group of single rootedmesiodistal direction. (with splinting, a group of single rooted teeth in effect becomes a multirooted unitteeth in effect becomes a multirooted unit.) 5.5. The method of splinting should neither impede normalThe method of splinting should neither impede normal functions nor frustrate the oral hygiene and physiotherapeuticfunctions nor frustrate the oral hygiene and physiotherapeutic efforts of the patient.efforts of the patient. The splint must not irritate the gingival tissues, andThe splint must not irritate the gingival tissues, and whenever possible it should be esthetically acceptable.whenever possible it should be esthetically acceptable. www.indiandentalacademy.comwww.indiandentalacademy.com
  31. 31.  The patient must be informed that future restorative measuresThe patient must be informed that future restorative measures are usually necessary when any form of intra orare usually necessary when any form of intra or circumcoronal splinting is used.circumcoronal splinting is used. www.indiandentalacademy.comwww.indiandentalacademy.com
  32. 32. MODE OF ACTIONMODE OF ACTION::  Loose teeth splinted to adjacent firm teeth may become stabilized.Loose teeth splinted to adjacent firm teeth may become stabilized. When many teeth are loose, adjacent sextants should be included inWhen many teeth are loose, adjacent sextants should be included in the splint.the splint.  Teeth tend to loosen buccolingually yet may remain firmTeeth tend to loosen buccolingually yet may remain firm mesiodistally. Adjacent sextants therefore have complimentarymesiodistally. Adjacent sextants therefore have complimentary strengths.strengths.  Cross-arch splinting reduces mobility to the least commonCross-arch splinting reduces mobility to the least common denominator. Teeth are thus immobilized and occlusal forces aredenominator. Teeth are thus immobilized and occlusal forces are better distributed.better distributed.  Traumatism is minimized, repair is enhanced, and teeth mayTraumatism is minimized, repair is enhanced, and teeth may become firm again. Even when teeth do not tighten, the splintbecome firm again. Even when teeth do not tighten, the splint serves as an orthopedic brace that permits useful function of looseserves as an orthopedic brace that permits useful function of loose teeth.teeth. www.indiandentalacademy.comwww.indiandentalacademy.com
  33. 33. CLASSIFICATION OF SPLINTSCLASSIFICATION OF SPLINTS  Splints can be classified as eitherSplints can be classified as either ‘temporary’‘temporary’ or ‘or ‘permanent’permanent’ and asand as ‘removable’‘removable’ oror ‘fixed’.‘fixed’.  RAMFJORD & ASHRAMFJORD & ASH have classified splints into:have classified splints into: 1.1. TemporaryTemporary 2.2. Diagnostic or provisionalDiagnostic or provisional 3.3. PermanentPermanent  Such splints have also been grouped as eitherSuch splints have also been grouped as either EXTERNALEXTERNAL oror INTERNALINTERNAL to the circumference of the tooth.to the circumference of the tooth. www.indiandentalacademy.comwww.indiandentalacademy.com
  34. 34.  TEMPORARY SPLINTS:-TEMPORARY SPLINTS:- This is used on a short term basis,This is used on a short term basis, usually less than 6 months, and is oftenusually less than 6 months, and is often advocated to stabilizeadvocated to stabilize teethteeth during periodontal therapy or after a traumatic episodeduring periodontal therapy or after a traumatic episode..  PROVISIONAL SPLINTS:-PROVISIONAL SPLINTS:- (Diagnostic):- This is used for(Diagnostic):- This is used for several months to several years forseveral months to several years for diagnostic informationdiagnostic information.. Provisional splints allow the clinicianProvisional splints allow the clinician to observe the healingto observe the healing response to treatment and to make changes based on patientresponse to treatment and to make changes based on patient response to treatmentresponse to treatment, this enables the clinician to properly, this enables the clinician to properly design a more permanent and biologically acceptable form ofdesign a more permanent and biologically acceptable form of stabilization & better treatment.stabilization & better treatment.  PERMANENT SPLINTS:_PERMANENT SPLINTS:_ This is used indefinitely. TheseThis is used indefinitely. These are usually used in a more reduced periodontium.are usually used in a more reduced periodontium. www.indiandentalacademy.comwww.indiandentalacademy.com
  35. 35. Intra coronal splints (Internal Splints):-Intra coronal splints (Internal Splints):-  These are the most commonly used type of splint.These are the most commonly used type of splint.  This type of splint involves cavity preparation.This type of splint involves cavity preparation.  This preparation is used to increase the strength and retentionThis preparation is used to increase the strength and retention of the restoration material.of the restoration material.  The preparation may be continuous or discontinuous.The preparation may be continuous or discontinuous.  The continuous type is used in the mandibular segmentThe continuous type is used in the mandibular segment because of relatively short mesiodistal dimension ofbecause of relatively short mesiodistal dimension of mandibular incisors. The discontinuous splint is used inmandibular incisors. The discontinuous splint is used in maxillary segment.maxillary segment. www.indiandentalacademy.comwww.indiandentalacademy.com
  36. 36. INDICATIONS OF INTERNAL SPLINTS :-INDICATIONS OF INTERNAL SPLINTS :- 1.1. Teeth with a more reduced periodontium.Teeth with a more reduced periodontium. 2.2. Dentition with a deep overbite.Dentition with a deep overbite. 3.3. Teeth with very short roots or resorbed roots.Teeth with very short roots or resorbed roots. 4.4. To evaluate potential abutment teeth.To evaluate potential abutment teeth. 5.5. Teeth with root amputations and mobility.Teeth with root amputations and mobility. 6.6. To avoid dislodgement during regenerative procedures.To avoid dislodgement during regenerative procedures. 7.7. Post orthodontics, specially in cases involving intrusions,Post orthodontics, specially in cases involving intrusions, extrusions, rotations, pathologic migrations, or molar uprighting.extrusions, rotations, pathologic migrations, or molar uprighting. 8.8. When teeth advanced mobility cannot be treated any other way.When teeth advanced mobility cannot be treated any other way. www.indiandentalacademy.comwww.indiandentalacademy.com
  37. 37. EXTRACORONAL SPLINTS (EXTERNAL SPLINTS):-EXTRACORONAL SPLINTS (EXTERNAL SPLINTS):-  These are usually temporary in nature. & this type of splint does not involve anyThese are usually temporary in nature. & this type of splint does not involve any tooth preparation.tooth preparation.  These can be reinforced with wire or mesh if additional strength is needed.These can be reinforced with wire or mesh if additional strength is needed.  Use of extra coronal splints is usually confined to anterior teeth.Use of extra coronal splints is usually confined to anterior teeth. Indications:-Indications:-  Anterior teeth with moderate mobility.Anterior teeth with moderate mobility.  Post orthodontic retention without mobility, especially where retainer compliancePost orthodontic retention without mobility, especially where retainer compliance is a concern.is a concern.  To provide stability in cases of acute trauma and allow for healing of theTo provide stability in cases of acute trauma and allow for healing of the periodontal ligament, remodeling of alveolar bone, maintenance of tooth position,periodontal ligament, remodeling of alveolar bone, maintenance of tooth position, and comfort during function.and comfort during function.  Regenerative procedures, where mobility may temporarily increase.Regenerative procedures, where mobility may temporarily increase.  Endodontic – periodontic lesions.Endodontic – periodontic lesions.www.indiandentalacademy.comwww.indiandentalacademy.com
  38. 38. CLASSIFICATIONCLASSIFICATION TEMPORARY SPLINTSTEMPORARY SPLINTS  i)i) EXTRACORONALEXTRACORONAL -- 1.1. Wire ligature – acrylic splintWire ligature – acrylic splint 2.2. Splints of enamel bonding materialSplints of enamel bonding material 3.3. Welded bands (Orthodontic bands)Welded bands (Orthodontic bands) 4.4. Continuous claspsContinuous clasps 5.5. Removable acrylic splintsRemovable acrylic splints A) Occlusal splintsA) Occlusal splints - Bite guards- Bite guards - Maxillary occlusal splint- Maxillary occlusal splint - Mandibular occlusal splint- Mandibular occlusal splint - Soft occlusal splint- Soft occlusal splint B) Bite platesB) Bite plates - Hawley biteplate- Hawley biteplate - Sved biteplate- Sved biteplate www.indiandentalacademy.comwww.indiandentalacademy.com
  39. 39.  ii)ii) INTRA CORONALINTRA CORONAL 1) Wire acrylic splint (‘A’splint)1) Wire acrylic splint (‘A’splint) 2) Wire composite resin splint2) Wire composite resin splint 3) Amalgam splint3) Amalgam splint 4) Acrylic full crowns4) Acrylic full crowns 5) Combined amalgam – wire – acrylic splint5) Combined amalgam – wire – acrylic splint  PROVISIONAL SPLINTINGPROVISIONAL SPLINTING 1) Metal – Band – and acrylic type1) Metal – Band – and acrylic type 2) All – Acrylic type2) All – Acrylic type www.indiandentalacademy.comwww.indiandentalacademy.com
  40. 40.  PERMANENT SPLINTINGPERMANENT SPLINTING 1.1. Removable – ExternalRemovable – External  Continuous clasp devicesContinuous clasp devices  Swing lock devicesSwing lock devices  Over denture (full or partial)Over denture (full or partial) 2.2. Fixed – internalFixed – internal  Full coverage, 3/4th coverage crowns and inlaysFull coverage, 3/4th coverage crowns and inlays  Posts in root canalsPosts in root canals  Horizontal pin splintsHorizontal pin splints 3.3. Cast-metal-resin-bonded fixed partial denturesCast-metal-resin-bonded fixed partial dentures  Maryland splintsMaryland splints www.indiandentalacademy.comwww.indiandentalacademy.com
  41. 41. 4.4. CombinedCombined  Partial dentures and splinted abutmentsPartial dentures and splinted abutments  Removable – Fixed splintsRemovable – Fixed splints  Full or partial dentures on splinted rootsFull or partial dentures on splinted roots  Fixed bridges incorporated in partial denturesFixed bridges incorporated in partial dentures seated on posts or copingsseated on posts or copings.. 5.5. Endodontics www.indiandentalacademy.comwww.indiandentalacademy.com
  42. 42. I.I. TEMPORARY STABILIZATION:TEMPORARY STABILIZATION:  Temporary splinting is the joining of two or more teeth, to increaseTemporary splinting is the joining of two or more teeth, to increase resistance to an applied force.resistance to an applied force.  Temporary splinting should be considered as part of the initialTemporary splinting should be considered as part of the initial preparation of the tissues, and should thus be done prior topreparation of the tissues, and should thus be done prior to periodontal surgery.periodontal surgery.  Temporary splints are employed for a limited period of time to aidTemporary splints are employed for a limited period of time to aid healing by limiting the mobility of a tooth or teeth and thereforehealing by limiting the mobility of a tooth or teeth and therefore assisting in healing.assisting in healing.  Temporary splints may also be used as a diagnostic measure toTemporary splints may also be used as a diagnostic measure to assist in the determination of prognosis of questionable teeth.assist in the determination of prognosis of questionable teeth. www.indiandentalacademy.comwww.indiandentalacademy.com
  43. 43. INDICATIONS OF TEMPORARY SPLINTS:-INDICATIONS OF TEMPORARY SPLINTS:-  These are used either until hypermobility is satisfactorilyThese are used either until hypermobility is satisfactorily reduced or eliminated and the teeth can function without thereduced or eliminated and the teeth can function without the help of the splint or until the dentition clearly requireshelp of the splint or until the dentition clearly requires longterm stabilization.longterm stabilization.  These are used until stabilization is no longer necessary ,These are used until stabilization is no longer necessary , for example, in cases of mobility caused by orthodonticfor example, in cases of mobility caused by orthodontic repositioning accidental or surgical trauma, or occlusalrepositioning accidental or surgical trauma, or occlusal traumatism, all of a reversible nature.traumatism, all of a reversible nature.  These are used in the therapy being undertaken to determineThese are used in the therapy being undertaken to determine whether hypermobility can be resolved by conservativewhether hypermobility can be resolved by conservative methods or whether the mobility is caused by loss of supportmethods or whether the mobility is caused by loss of support sufficient to create permanent hypermobility, by rootsufficient to create permanent hypermobility, by root resorption or any extrinsic or intrinsic precipitating factors.resorption or any extrinsic or intrinsic precipitating factors.www.indiandentalacademy.comwww.indiandentalacademy.com
  44. 44.  In advanced periodontal diseases when the permanent fixationIn advanced periodontal diseases when the permanent fixation cannot be done either because of economic reasons, poorcannot be done either because of economic reasons, poor prognosis for all remaining teeth, poor health which affects theprognosis for all remaining teeth, poor health which affects the longevity of the dentition, or even the life of the patient.longevity of the dentition, or even the life of the patient.  In patients who cannot emotionally accept the lengthy proceduresIn patients who cannot emotionally accept the lengthy procedures of permanent fixation.of permanent fixation.  In cases of infrabony defects treated with heterografts andIn cases of infrabony defects treated with heterografts and autografts.autografts.  In cases of stabilizing the hemisectinoed teeth.In cases of stabilizing the hemisectinoed teeth.  These can be used as a diagnostic and to evaluate the prognosisThese can be used as a diagnostic and to evaluate the prognosis before instituting extensive permanent splinting.before instituting extensive permanent splinting.  To improve the morale of the patient with mobile teeth.To improve the morale of the patient with mobile teeth. www.indiandentalacademy.comwww.indiandentalacademy.com
  45. 45. FUNCTIONS OF TEMPORARY SPLINTING:-FUNCTIONS OF TEMPORARY SPLINTING:-  Protection of traumatized teeth from further injury.Protection of traumatized teeth from further injury.  Distribution of occlusal forces on teeth that have lost periodontalDistribution of occlusal forces on teeth that have lost periodontal support.support.  Retention of orthodontically moved teeth.Retention of orthodontically moved teeth.  Aiding in the determination of whether teeth with borderlineAiding in the determination of whether teeth with borderline prognosis will respond to therapy.prognosis will respond to therapy.  Immobilization of loose teeth to facilitate occlusal adjustmentImmobilization of loose teeth to facilitate occlusal adjustment procedures.procedures.  To prevent pathologic migration.To prevent pathologic migration. Temporary splints have been further classified into extracoronal, intracoronalTemporary splints have been further classified into extracoronal, intracoronal.. www.indiandentalacademy.comwww.indiandentalacademy.com
  46. 46. EXTRA CORONAL SPLINTS:EXTRA CORONAL SPLINTS: 1)1) LIGATURE SPLINTS:-LIGATURE SPLINTS:- The most common and easiest method. In some case onlyThe most common and easiest method. In some case only wire is used, but the acrylic resin offers the advantage ofwire is used, but the acrylic resin offers the advantage of increased stable and improved esthetics, especially whereincreased stable and improved esthetics, especially where diastema are present.diastema are present. WIRE LIGATURE ACRYLIC SPLINTS:- Indications:- 1) Short – term stabilization of anterior teeth.1) Short – term stabilization of anterior teeth. 2) Mobile anterior teeth not suitable for bonding or A-splint.2) Mobile anterior teeth not suitable for bonding or A-splint. 3) May be indicated when a questionable prognosis for a tooth3) May be indicated when a questionable prognosis for a tooth or teeth persists past the active treatment phase.or teeth persists past the active treatment phase.www.indiandentalacademy.comwww.indiandentalacademy.com
  47. 47.  Advantages:-Advantages:-  Non invasive and reversible.Non invasive and reversible.  Ease of insertion,Ease of insertion, adjustment, removal andadjustment, removal and replacement.replacement.  Simple, inexpensive.Simple, inexpensive.  Can be done in one sitting inCan be done in one sitting in a short-period of time.a short-period of time.  Not requiring any alterationNot requiring any alteration of crown.of crown.  Disadvantages:-Disadvantages:-  Non rigid.Non rigid.  Not usable for posteriorNot usable for posterior teeth or anterior teethteeth or anterior teeth tapered toward incisal edge.tapered toward incisal edge.  Can act as an orthodonticCan act as an orthodontic appliance.appliance.  Wires may stretch or breakWires may stretch or break if improperly tightened.if improperly tightened.  Collects plaque moreCollects plaque more rapidly.rapidly.  Plaque control becomesPlaque control becomes more difficult.more difficult. Advantage & Disadvantage Of Wire Ligature Acrylic Splints www.indiandentalacademy.comwww.indiandentalacademy.com
  48. 48. Procedure :Procedure : 1.1. Dead-soft stainless steel wire 0.007 to 0.010 inch thick is used.Dead-soft stainless steel wire 0.007 to 0.010 inch thick is used. Brass or silk ligatures are not as desirable.Brass or silk ligatures are not as desirable. 2.2. Double a 12-inch length for use as an arch wire, and bend itDouble a 12-inch length for use as an arch wire, and bend it about the six anterior teeth.about the six anterior teeth. 3.3. Position it apical to the contact points and incisal to the cingula,Position it apical to the contact points and incisal to the cingula, then loosely twist one end. Provide for edentulous spaces bythen loosely twist one end. Provide for edentulous spaces by twisting the buccal and lingual strands of the arch wire together.twisting the buccal and lingual strands of the arch wire together. 4.4. Place single, hairpin bent wires interdentally around the archPlace single, hairpin bent wires interdentally around the arch wires and below the contact point.wires and below the contact point. Tighten them by twisting clockwise with a needle holder orTighten them by twisting clockwise with a needle holder or Howe pliers.Howe pliers. The interdental strands should not be so tight that they bring theThe interdental strands should not be so tight that they bring the arch wires into contact or produce tooth movement.arch wires into contact or produce tooth movement.www.indiandentalacademy.comwww.indiandentalacademy.com
  49. 49. 5.5. To properly distribute force tighten the last interdental ligatureTo properly distribute force tighten the last interdental ligature after all the other interdental ligatures and the arch wire have beenafter all the other interdental ligatures and the arch wire have been tightenedtightened 6.6. Clip the ends of the wires short (2-3 mm) and bend them into theClip the ends of the wires short (2-3 mm) and bend them into the interdental space to minimize catching food and to preventinterdental space to minimize catching food and to prevent injuring soft tissues.injuring soft tissues. 7.7. When the wires are properly positioned, both splint and teeth areWhen the wires are properly positioned, both splint and teeth are held fast.held fast. 8.8. The slippage can be controlled by additional cervical loops.The slippage can be controlled by additional cervical loops. 9.9. Check the occlusion for interferences before dismissing theCheck the occlusion for interferences before dismissing the patient. Instruct the patient in oral hygiene procedures around thepatient. Instruct the patient in oral hygiene procedures around the splinted teeth.splinted teeth. 10.10. Self-care acrylic or composite acid etch resin may be placed overSelf-care acrylic or composite acid etch resin may be placed over the wires. This will improve esthetics, reduce irritation and tend tothe wires. This will improve esthetics, reduce irritation and tend to prevent displacement.prevent displacement. www.indiandentalacademy.comwww.indiandentalacademy.com
  50. 50. INTRA CORONAL SPLINTS:-INTRA CORONAL SPLINTS:-  1)1) Wire Acrylic splintsWire Acrylic splints (‘A’ Splints)(‘A’ Splints)  TheThe ‘A’‘A’ splint was first popularized by Berliner. Itsplint was first popularized by Berliner. It consists of a preparation, or series of preparations, through theconsists of a preparation, or series of preparations, through the lingual surfaces of anterior teeth.lingual surfaces of anterior teeth.  The preparation are filled with acrylic and sometimesThe preparation are filled with acrylic and sometimes ‘reinforced’‘reinforced’ with wire. Although thewith wire. Although the ‘A’‘A’ splint can be used insplint can be used in posterior teeth, it is most commonly used in anterior teeth.posterior teeth, it is most commonly used in anterior teeth. www.indiandentalacademy.comwww.indiandentalacademy.com
  51. 51.  2)2) Wire and composite reins:-Wire and composite reins:-  The restorative properties of composite materials areThe restorative properties of composite materials are different and superior to those of acrylic resins.different and superior to those of acrylic resins.  Composites have better strength, better dimensionalComposites have better strength, better dimensional stability and a sealing effect when used with enamel etching.stability and a sealing effect when used with enamel etching.  These splints are used commonly for anterior teeth.These splints are used commonly for anterior teeth. www.indiandentalacademy.comwww.indiandentalacademy.com
  52. 52.  3)3) Amalgam splints:-Amalgam splints:-  Advantages:-Advantages:-  Simple.Simple.  Inexpensive.Inexpensive.  Time saving.Time saving.  Effective device for posterior teeth.Effective device for posterior teeth.  Does not require parallelism in preparations.Does not require parallelism in preparations.  Adequate margins are easy to obtain.Adequate margins are easy to obtain.  Good oral hygiene can be maintained.Good oral hygiene can be maintained.  It is of an advantage in an amalgam preparation to effectIt is of an advantage in an amalgam preparation to effect undercuts for retention. These undercuts resist apicalundercuts for retention. These undercuts resist apical displacement of the tooth from the splint.displacement of the tooth from the splint. www.indiandentalacademy.comwww.indiandentalacademy.com
  53. 53.  Disadvantages:-Disadvantages:-  Limited to posterior teeth.Limited to posterior teeth.  Amalgam splints tend to fracture more easily.Amalgam splints tend to fracture more easily.  A technique has been devised in which contiguous mesial-A technique has been devised in which contiguous mesial- occlusal-distal preparations in adjoining teeth can be preparedocclusal-distal preparations in adjoining teeth can be prepared and a continuous amalgam filling can be replaced successfullyand a continuous amalgam filling can be replaced successfully with relative case. This is termed the “Amalgam splint”.with relative case. This is termed the “Amalgam splint”. www.indiandentalacademy.comwww.indiandentalacademy.com
  54. 54. 4) Acrylic Full Crowns:-4) Acrylic Full Crowns:-  Fixed temporary bridgesFixed temporary bridges may be made of acrylic crowns andmay be made of acrylic crowns and pontics and may also serve as temporary splints. They arepontics and may also serve as temporary splints. They are used when permanent fixed splints will ultimately replaceused when permanent fixed splints will ultimately replace them.them. Many ways exist to make acrylic splints.Many ways exist to make acrylic splints.  One simple method employs duplicates of the patients studyOne simple method employs duplicates of the patients study models. The temporary acrylic splint is then made on themodels. The temporary acrylic splint is then made on the models of the prepared teeth.models of the prepared teeth.  Another method was a pressure molded splint. Either isAnother method was a pressure molded splint. Either is rebased in the mouth after the teeth are prepared.rebased in the mouth after the teeth are prepared. www.indiandentalacademy.comwww.indiandentalacademy.com
  55. 55.  5) Combined Amalgam – wire – Acrylic splint5) Combined Amalgam – wire – Acrylic splint::  To overcome the drawbacks of an amalgam splint theTo overcome the drawbacks of an amalgam splint the combined Amalgam –wire-Acrylic splint has beencombined Amalgam –wire-Acrylic splint has been developed.developed. www.indiandentalacademy.comwww.indiandentalacademy.com
  56. 56. II.II. Provisional splinting:Provisional splinting:  The provisional splint not only serves as a transitionalThe provisional splint not only serves as a transitional fixed appliance to protect the prepared teeth until the finalfixed appliance to protect the prepared teeth until the final restorations are inserted, but also serves several otherrestorations are inserted, but also serves several other important functions that are most necessary if periodontalimportant functions that are most necessary if periodontal prosthetic therapy is to be successful.prosthetic therapy is to be successful.  Provisional restorations play a key role in theProvisional restorations play a key role in the management of patients who require both periodontal therapymanagement of patients who require both periodontal therapy and restorative dentistry.and restorative dentistry.  Provisional restorations serve toProvisional restorations serve to stabilize a permanentlystabilize a permanently mobile dentition form the time of initial tooth preparation untilmobile dentition form the time of initial tooth preparation until the time the dentition is periodontally stable enough forthe time the dentition is periodontally stable enough for permanent restorations.permanent restorations.www.indiandentalacademy.comwww.indiandentalacademy.com
  57. 57. Advantages:-Advantages:-  Reduces the pathologic mobility.Reduces the pathologic mobility.  Protects the dental pulp from irritation following toothProtects the dental pulp from irritation following tooth preparation.preparation.  It also affords the opportunity to determine the correct esthetic,It also affords the opportunity to determine the correct esthetic, phonetic and functional occlusal qualities necessary for eachphonetic and functional occlusal qualities necessary for each individual patient.individual patient.  The operator can proceed with confidence, knowing that theThe operator can proceed with confidence, knowing that the above qualities can be attained in the final reconstruction.above qualities can be attained in the final reconstruction.  If a tooth included in the splint requires extraction it can beIf a tooth included in the splint requires extraction it can be separated from the splint extracted, and the acrylic crown filledseparated from the splint extracted, and the acrylic crown filled in with self curing acrylic.in with self curing acrylic.  Additional teeth can be crowned and added to the existing splintAdditional teeth can be crowned and added to the existing splint if additional support becomes necessary.if additional support becomes necessary.  It can be placed any time after the initial periodontal therapy isIt can be placed any time after the initial periodontal therapy is complete.complete. www.indiandentalacademy.comwww.indiandentalacademy.com
  58. 58. III.III. PERMANENT SPLINTING:-PERMANENT SPLINTING:- (PERIODONTAL(PERIODONTAL PROSTHESIS)PROSTHESIS)  Introduction:-Introduction:-  Permanent splinting is employed during complex andPermanent splinting is employed during complex and rehabilitation where abutments are highly mobile or where a fewrehabilitation where abutments are highly mobile or where a few abutments must support the entire prosthesis, particularly whenabutments must support the entire prosthesis, particularly when such abutment teeth have minimal periodontal support but havesuch abutment teeth have minimal periodontal support but have been successfully treated periodontally.been successfully treated periodontally.  Splinting may also be necessary in cases of intractableSplinting may also be necessary in cases of intractable parafunctions. If such teeth are not splinted, the danger ofparafunctions. If such teeth are not splinted, the danger of progressively increasing tooth mobility exists (Nyman and Lindheprogressively increasing tooth mobility exists (Nyman and Lindhe 1979).1979). www.indiandentalacademy.comwww.indiandentalacademy.com
  59. 59.  Complete dental treatment includes periodontal and restorativeComplete dental treatment includes periodontal and restorative aspects, which are extensively interrelated successful treatmentaspects, which are extensively interrelated successful treatment most often requires both types of therapy.most often requires both types of therapy.  Permanent splinting is indicated whenever periodontal treatmentPermanent splinting is indicated whenever periodontal treatment does not reduce mobility to the point at which the teeth candoes not reduce mobility to the point at which the teeth can function without added support. Such devices serve to stabilizefunction without added support. Such devices serve to stabilize loose teeth, to redistribute occlusal forces, to reduce traumatism,loose teeth, to redistribute occlusal forces, to reduce traumatism, and to aid in the repair of the periodontal tissues.and to aid in the repair of the periodontal tissues.  Permanent splints are fabricated after periodontal treatment hasPermanent splints are fabricated after periodontal treatment has been completed, when their use will extend the functional life timebeen completed, when their use will extend the functional life time of the teeth.of the teeth. www.indiandentalacademy.comwww.indiandentalacademy.com
  60. 60.  Objectives:-Objectives:-  The major objective of periodontal prosthetics is to restore theThe major objective of periodontal prosthetics is to restore the dentition to a state of health in which it can safely resist thedentition to a state of health in which it can safely resist the stresses of normal functions and also be better equipped tostresses of normal functions and also be better equipped to resist parafunctional forces.resist parafunctional forces.  The other objectives of periodontal prosthesis are to replaceThe other objectives of periodontal prosthesis are to replace missing teeth to enhance the patient’s cosmetic appearancemissing teeth to enhance the patient’s cosmetic appearance and to improve phonetics.and to improve phonetics.  Ideally these objectives must be reached so that the proceduresIdeally these objectives must be reached so that the procedures involved are biologically compatible with the hard and softinvolved are biologically compatible with the hard and soft tissues of the mouth and so that the results will optimallytissues of the mouth and so that the results will optimally afford protection to the periodontium against furtherafford protection to the periodontium against further deterioration of its supporting qualities.deterioration of its supporting qualities. www.indiandentalacademy.comwww.indiandentalacademy.com
  61. 61. PACKS AND SPLINTS:PACKS AND SPLINTS:  Nonspecific inflammation of the gingival tissue mayNonspecific inflammation of the gingival tissue may prove slow to resolve during hygiene phase therapy inspite ofprove slow to resolve during hygiene phase therapy inspite of thorough scaling and polishing and an adequate standard ofthorough scaling and polishing and an adequate standard of patient selfcare. Resolution of inflammation may be expeditedpatient selfcare. Resolution of inflammation may be expedited by the use of a periodontal pack.by the use of a periodontal pack.  Following scaling and polishing of the teeth, the role ofFollowing scaling and polishing of the teeth, the role of pack is to protect the swollen tissues from trauma of normalpack is to protect the swollen tissues from trauma of normal function and the pack should remain in position for periodsfunction and the pack should remain in position for periods upto seven days.upto seven days.  The dressing should be positioned, by packing eachThe dressing should be positioned, by packing each embrassures firmly, to obtain retention and by placing a stripembrassures firmly, to obtain retention and by placing a strip of pack across the whole field, which becomes bonded to theof pack across the whole field, which becomes bonded to the packed embrasures.packed embrasures. www.indiandentalacademy.comwww.indiandentalacademy.com
  62. 62.  The pack has the advantage that it has considerable powers ofThe pack has the advantage that it has considerable powers of retention when properly positioned. It is relatively inert withretention when properly positioned. It is relatively inert with respect to the soft tissues, and it is easy to remove cleanly.respect to the soft tissues, and it is easy to remove cleanly.  There is an increasing tendency to replace the use of pressureThere is an increasing tendency to replace the use of pressure packs with chemotherapeutic plaque control agents such as 0.2packs with chemotherapeutic plaque control agents such as 0.2 percent chlorhexidine mouth washes.percent chlorhexidine mouth washes. www.indiandentalacademy.comwww.indiandentalacademy.com
  63. 63. DISADVANTAGES OF SPLINTSDISADVANTAGES OF SPLINTS ::  1.1. Technical difficulty:_Technical difficulty:_ Unfortunately, few techniques areUnfortunately, few techniques are trained adequately to create a periodontal prosthetictrained adequately to create a periodontal prosthetic reconstruction that is truly biologically compatible with thereconstruction that is truly biologically compatible with the stomatognathic system.stomatognathic system.  The achievement of excellent marginal adaptation, goodThe achievement of excellent marginal adaptation, good contour, functional occlusion, and esthetic acceptance by thecontour, functional occlusion, and esthetic acceptance by the patient usually is expected in single restorations or in smallpatient usually is expected in single restorations or in small segment bridges, but is difficult and rarely attained in full archsegment bridges, but is difficult and rarely attained in full arch splints.splints. www.indiandentalacademy.comwww.indiandentalacademy.com
  64. 64.  2.2. CostCost:-:- Socio-economic factors could deflect treatment awaySocio-economic factors could deflect treatment away from the ideal. Quality cannot be compromised on any part offrom the ideal. Quality cannot be compromised on any part of the splint. Each unit of the splint is like a link of a chain, andthe splint. Each unit of the splint is like a link of a chain, and the splint is no better than its weakest chain.the splint is no better than its weakest chain.  3.3. Plaque removalPlaque removal:-:- Difficult plaque removal is a criticismDifficult plaque removal is a criticism often used by periodontists, well-designed periodontaloften used by periodontists, well-designed periodontal prosthetic splints, however need not compromise plaqueprosthetic splints, however need not compromise plaque removal. They may interfere with patient selfcare, and the selfremoval. They may interfere with patient selfcare, and the self cleaning action of teeth and gingival tissues. This is of greatcleaning action of teeth and gingival tissues. This is of great importance in a patient with a high susceptibility toimportance in a patient with a high susceptibility to periodontitis.periodontitis.  4.4. Increased occlusal forcesIncreased occlusal forces:-:- Glickman, Stein and SmulowGlickman, Stein and Smulow reported the influences of increased occlusal forces on thereported the influences of increased occlusal forces on the periodontium of monkeys both when the teeth were splintedperiodontium of monkeys both when the teeth were splinted and when they were not.and when they were not. www.indiandentalacademy.comwww.indiandentalacademy.com
  65. 65.  5.5. Faulty contacts and contoursFaulty contacts and contours:-:- Nabers reported thatNabers reported that night-guard appliances can open interproximal contactsnight-guard appliances can open interproximal contacts between teeth and Saturn reported that wire ligatures inducebetween teeth and Saturn reported that wire ligatures induce active forces on the ligated teeth, causing them to be movedactive forces on the ligated teeth, causing them to be moved into new positions.into new positions.  6.6. CariesCaries :-:- Extensive caries may be developed under looseExtensive caries may be developed under loose abutments and gross sepsis may follow with minimalabutments and gross sepsis may follow with minimal symptoms.symptoms.  7.7. Additional tooth reductionAdditional tooth reduction:-:- All the teeth in a rigidityAll the teeth in a rigidity splinted segment require composite draw, which requiressplinted segment require composite draw, which requires addition tooth reduction and pulpal damage is not uncommon.addition tooth reduction and pulpal damage is not uncommon. www.indiandentalacademy.comwww.indiandentalacademy.com
  66. 66. 8.8. Repair and maintenanceRepair and maintenance :-:- The repair of, one unit of an extensive splint, howeverThe repair of, one unit of an extensive splint, however can be difficult and expensive, at best the result is often acan be difficult and expensive, at best the result is often a compromise mechanical failures, such as porcelain fracturecompromise mechanical failures, such as porcelain fracture and solder joint separation, are more frequent in multiunitand solder joint separation, are more frequent in multiunit splints than in smaller segments.splints than in smaller segments. Cement washouts can occur without showing any signsCement washouts can occur without showing any signs until the pulp has become involved.until the pulp has become involved. Endodontic problems are difficult to resolve.Endodontic problems are difficult to resolve. www.indiandentalacademy.comwww.indiandentalacademy.com
  67. 67. MAINTAINING THE ORAL HEALTH OF SPLINTEDMAINTAINING THE ORAL HEALTH OF SPLINTED TEETH:TEETH:  Maintaining oral health in and around fixed splints poses aMaintaining oral health in and around fixed splints poses a significant challenge to the patient and the dental practitionersignificant challenge to the patient and the dental practitioner because access to teeth and visibility for plaque control andbecause access to teeth and visibility for plaque control and periodontal maintenance techniques require extra skill andperiodontal maintenance techniques require extra skill and effort.effort.  Effective personal plaque control, professional caries riskEffective personal plaque control, professional caries risk assessment, and periodontal maintenance are crucial to theassessment, and periodontal maintenance are crucial to the longevity of the splint and health of the splinted teeth.longevity of the splint and health of the splinted teeth. www.indiandentalacademy.comwww.indiandentalacademy.com
  68. 68.  Patient and provider roles in therapy:-Patient and provider roles in therapy:- Both the dental provider and the patient contribute to theBoth the dental provider and the patient contribute to the success and longevity of the dental splint and to the health ofsuccess and longevity of the dental splint and to the health of the supporting soft and hard tissues. During the fabrication andthe supporting soft and hard tissues. During the fabrication and placement of the splint, the dental provider must be consciousplacement of the splint, the dental provider must be conscious of access and visibility factors that facilitate effective patientof access and visibility factors that facilitate effective patient oral hygiene procedures.oral hygiene procedures.  Access:_Access:_ To facilitate adequate access for cleaning, a splint mustTo facilitate adequate access for cleaning, a splint must be placed with open gingival embrasures and be properlybe placed with open gingival embrasures and be properly contoured with no overhanging margins. Posteriorly placedcontoured with no overhanging margins. Posteriorly placed splints pose additional patient access challenges.splints pose additional patient access challenges. www.indiandentalacademy.comwww.indiandentalacademy.com
  69. 69.  Visibility:_Visibility:_ visibility issues also influence effectiveness of patientvisibility issues also influence effectiveness of patient self care. If gaps between restoration materials and toothself care. If gaps between restoration materials and tooth surfaces exist, bacterial plaque retention may occur.surfaces exist, bacterial plaque retention may occur. Patients must be able to discriminate between restorationPatients must be able to discriminate between restoration natural tooth surface, plaque, and calcified tooth depositsnatural tooth surface, plaque, and calcified tooth deposits while practicing self-care.while practicing self-care. After splint placement, the oral health care provider mustAfter splint placement, the oral health care provider must deliver extensive home care instruction to the patient. Thedeliver extensive home care instruction to the patient. The patient then must assume responsibility for plaque control andpatient then must assume responsibility for plaque control and the adoption of any other suggested preventive measures.the adoption of any other suggested preventive measures. www.indiandentalacademy.comwww.indiandentalacademy.com
  70. 70.  Manual plaque control devices:-Manual plaque control devices:- Selection and recommendation of mechanical plaqueSelection and recommendation of mechanical plaque control devices depend on the type of splint, spacingcontrol devices depend on the type of splint, spacing surrounding splints, personal preferences, and dexterity of thesurrounding splints, personal preferences, and dexterity of the patient.patient.  Interdental plaque control:-Interdental plaque control:- Increased bacterial plaque retention occurs in areasIncreased bacterial plaque retention occurs in areas surroundings splints where other anatomic changes, includingsurroundings splints where other anatomic changes, including loss of gingival attachment, papilla, bone and teeth, presenceloss of gingival attachment, papilla, bone and teeth, presence of malpositioned teeth and tooth movement, are common.of malpositioned teeth and tooth movement, are common. Specifically designed devices are required for accessingSpecifically designed devices are required for accessing interproximal splinted surfaces.interproximal splinted surfaces. A variety of floss and brush devices can be used to accessA variety of floss and brush devices can be used to access these surfaces.these surfaces. www.indiandentalacademy.comwww.indiandentalacademy.com
  71. 71.  Mechanical plaque control devices:-Mechanical plaque control devices:-  For most patients, the choice between mechanical plaqueFor most patients, the choice between mechanical plaque control devices and manual devices is a matter of personalcontrol devices and manual devices is a matter of personal preference.preference.  Mechanical devices tend to be easier to use comparedMechanical devices tend to be easier to use compared with manual devices because the powered motion is built inwith manual devices because the powered motion is built in and the patient need only place the device next to aand the patient need only place the device next to a surrounding splinted structure to ensure effective plaquesurrounding splinted structure to ensure effective plaque removal.removal.  Powered tooth brushes, traditional mechanical toothPowered tooth brushes, traditional mechanical tooth brushes, sonic ultrasonic tooth brushes, and poweredbrushes, sonic ultrasonic tooth brushes, and powered interdental devices are used as mechanical plaque controlinterdental devices are used as mechanical plaque control devices.devices. www.indiandentalacademy.comwww.indiandentalacademy.com
  72. 72.  Oral irrigating devices:-Oral irrigating devices:-  Oral irrigation can be an important part of selfcare for patientsOral irrigation can be an important part of selfcare for patients who cannot control their gingivitis with only brushing andwho cannot control their gingivitis with only brushing and interproximal cleaning.interproximal cleaning.  Oral irrigation is an adjunctive therapy, not a replacement forOral irrigation is an adjunctive therapy, not a replacement for brushing and interproximal plaque removal.brushing and interproximal plaque removal.  Oral irrigators are most effective when patients adhere toOral irrigators are most effective when patients adhere to stringent instructions for use.stringent instructions for use.  Oral irrigators may be used after brushing and flossing toOral irrigators may be used after brushing and flossing to deliver antimicrobial agents.deliver antimicrobial agents.  Patients should be provided with instructions for careful use ofPatients should be provided with instructions for careful use of home oral irrigating devices.home oral irrigating devices. www.indiandentalacademy.comwww.indiandentalacademy.com
  73. 73.  Periodontal Health challenges:Periodontal Health challenges:  Bacterial plaque is the primary cause of periodontalBacterial plaque is the primary cause of periodontal disease. Daily plaque removal, especially in interproximaldisease. Daily plaque removal, especially in interproximal areas, has been reported to help prevent periodontalareas, has been reported to help prevent periodontal breakdown and is considered to be an essential component ofbreakdown and is considered to be an essential component of oral hygiene.oral hygiene.  Another important aspect in the prevention of periodontalAnother important aspect in the prevention of periodontal disease is routine professional care. Because periodontaldisease is routine professional care. Because periodontal health must be monitored after splint placement, frequenthealth must be monitored after splint placement, frequent evaluation by the oral health care provider is warranted.evaluation by the oral health care provider is warranted.  Regularly scheduled periodontal debridement also is essential.Regularly scheduled periodontal debridement also is essential. www.indiandentalacademy.comwww.indiandentalacademy.com
  74. 74.  Professional periodonatal debridementProfessional periodonatal debridement:-:-  Periodontal health can be best maintained by frequentPeriodontal health can be best maintained by frequent maintenance visits and careful subgingival and supramarginalmaintenance visits and careful subgingival and supramarginal debridement of hard and soft tissues surrounding the splint.debridement of hard and soft tissues surrounding the splint.  Advances in hand instruments, such as the after five Graceys andAdvances in hand instruments, such as the after five Graceys and Mini-Five Graceys curets provide increased adaptability in theMini-Five Graceys curets provide increased adaptability in the periodontal patient.periodontal patient.  The use of air and magnification may aid in visibility duringThe use of air and magnification may aid in visibility during instrumentation. These clinical aids are of particular importanceinstrumentation. These clinical aids are of particular importance during periodontal debridement of splinted teeth, where the splintduring periodontal debridement of splinted teeth, where the splint material often blends with surrounding natural tooth surfaces.material often blends with surrounding natural tooth surfaces. www.indiandentalacademy.comwww.indiandentalacademy.com
  75. 75.  Ultrasonic and sonic scalers are not recommended on or nearUltrasonic and sonic scalers are not recommended on or near restorative splinting materials.restorative splinting materials.  Air polishing and high abrasives also are contraindicated andAir polishing and high abrasives also are contraindicated and are detrimental to the integrity of the splinted material.are detrimental to the integrity of the splinted material.  Post splint periodontal maintenance and frequent assessmentPost splint periodontal maintenance and frequent assessment of specific clinical parameters promote continued periodontalof specific clinical parameters promote continued periodontal health.health. www.indiandentalacademy.comwww.indiandentalacademy.com
  76. 76. Periodontal status:-Periodontal status:-  Composite reins, exhibiting superior esthetics, often are theComposite reins, exhibiting superior esthetics, often are the preferred restorative material in splint fabrication.preferred restorative material in splint fabrication.  Marginal adaptation difficulties of composite resin restorationsMarginal adaptation difficulties of composite resin restorations combined with ineffective plaque control, however, cancombined with ineffective plaque control, however, can exacerbate gingival inflammation adjacent to these materials,exacerbate gingival inflammation adjacent to these materials, thus increasing periodontal disease risk in susceptiblethus increasing periodontal disease risk in susceptible individuals.individuals.  Progression of periodontal disease is one cause of splint failure.Progression of periodontal disease is one cause of splint failure.  Initial patient follow-up should occur 2 weeks after splintInitial patient follow-up should occur 2 weeks after splint placement. Follow-up assessment is recommended to evaluateplacement. Follow-up assessment is recommended to evaluate patient home care compliance and effectiveness and to evaluatepatient home care compliance and effectiveness and to evaluate gingival health status surroundings the splint.gingival health status surroundings the splint.  www.indiandentalacademy.comwww.indiandentalacademy.com
  77. 77.  Professional periodontal evaluation of splinted teeth isProfessional periodontal evaluation of splinted teeth is recommended at 3-month intervals.recommended at 3-month intervals.  Bleeding on probing, pocket depths, and presence or absence ofBleeding on probing, pocket depths, and presence or absence of gingival inflammation are periodontal parameters to note whengingival inflammation are periodontal parameters to note when evaluating supportive soft tissues surrounding splinted teethevaluating supportive soft tissues surrounding splinted teeth comparative radiographic evaluation of alveolar bone levels alsocomparative radiographic evaluation of alveolar bone levels also should be performed at appropriate intervals.should be performed at appropriate intervals.  Occlusal interferences and parafunctional occlusal habits mustOcclusal interferences and parafunctional occlusal habits must also be addressed as part of the periodontal evaluation becausealso be addressed as part of the periodontal evaluation because they can contribute splint failure.they can contribute splint failure. www.indiandentalacademy.comwww.indiandentalacademy.com
  78. 78.  Challengers to caries prevention:Challengers to caries prevention:  Chemical adhesives and composite resins are commonlyChemical adhesives and composite resins are commonly used to splint teeth together. The roughness of the compositeused to splint teeth together. The roughness of the composite resin surfaces attracts plaque and debris, however, and canresin surfaces attracts plaque and debris, however, and can increase the caries risk to the surrounding supportive splintedincrease the caries risk to the surrounding supportive splinted structures.structures.  A high number of composite resin are replaced because ofA high number of composite resin are replaced because of recurrent caries. Both composite resin restorations andrecurrent caries. Both composite resin restorations and composite resin splints require close examination atcomposite resin splints require close examination at maintenance visits because of the potential for breakdown andmaintenance visits because of the potential for breakdown and marginal leakage.marginal leakage.  Caries risk assessment is required for long-term retention ofCaries risk assessment is required for long-term retention of splinted teeth. Caries risk factors may include splint fracture,splinted teeth. Caries risk factors may include splint fracture, marginal leakage and poor plaque control.marginal leakage and poor plaque control.www.indiandentalacademy.comwww.indiandentalacademy.com
  79. 79.  Recurrent decay may occur in the presence of fracturedRecurrent decay may occur in the presence of fractured splints, and poor plaque control can contribute tosplints, and poor plaque control can contribute to decalcification of splinted teeth.decalcification of splinted teeth.  Neutral sodium fluoride preparations are preferred becauseNeutral sodium fluoride preparations are preferred because they do not cause unsightly staining as stannous fluoridethey do not cause unsightly staining as stannous fluoride preparations may, and they do not cause the etching effect onpreparations may, and they do not cause the etching effect on composite and porcelain restorative materials that acidulatedcomposite and porcelain restorative materials that acidulated phosphate fluoride.phosphate fluoride.  A risk oriented post operative program consists of effectiveA risk oriented post operative program consists of effective plaque control, fluoride applications, and frequent evaluationplaque control, fluoride applications, and frequent evaluation of splint integrity through radiographic and clinicalof splint integrity through radiographic and clinical examinations.examinations. www.indiandentalacademy.comwww.indiandentalacademy.com
  80. 80. ConclusionConclusion  With the combination of clinical skill, appropriate dentalWith the combination of clinical skill, appropriate dental material selection, good communication and comprehensivematerial selection, good communication and comprehensive health education, both providers and patients can benefit fromhealth education, both providers and patients can benefit from esthetic, functional and healthy dental splints.esthetic, functional and healthy dental splints. ““ The dentist of the future should seek his rewards more inThe dentist of the future should seek his rewards more in the teeth he has saved from the ravages of dental diseasesthe teeth he has saved from the ravages of dental diseases than in the prostheses he makes it he fails with thethan in the prostheses he makes it he fails with the prevention .”prevention .” www.indiandentalacademy.comwww.indiandentalacademy.com
  81. 81. ReferencesReferences  J P 1980;51;469-472( A new method for stabilization ofJ P 1980;51;469-472( A new method for stabilization of periodontally involved teeth.)periodontally involved teeth.)  JADA 1980;101;926-929( Cast metal resin bonding)JADA 1980;101;926-929( Cast metal resin bonding)  DCNA;1964;213-219( The amalgam splint)DCNA;1964;213-219( The amalgam splint)  DCNA ; 1969; 213-227( Principles & technique of theDCNA ; 1969; 213-227( Principles & technique of the stabilization of loose teeth.stabilization of loose teeth.  DCNA; 1999( Tooth splinting and stabilization)DCNA; 1999( Tooth splinting and stabilization)  Text books of GRANT , CARRANZA & ROSE.Text books of GRANT , CARRANZA & ROSE. www.indiandentalacademy.comwww.indiandentalacademy.com
  82. 82. www.indiandentalacademy.comwww.indiandentalacademy.com
  83. 83. TEMPORARY SPLINTSTEMPORARY SPLINTS EXTRACORONAL.EXTRACORONAL. www.indiandentalacademy.comwww.indiandentalacademy.com
  84. 84. 2)2) SPLINTS OF ENAMEL-BONDING MATERIAL:-SPLINTS OF ENAMEL-BONDING MATERIAL:- A simple method of external temporary splinting tooth-bondingA simple method of external temporary splinting tooth-bonding material:material:  Self polymerized,Self polymerized,  Ultraviolet polymerized andUltraviolet polymerized and  White light polymerized composite rein.White light polymerized composite rein. ADVANTAGES:ADVANTAGES:  Esthetic.Esthetic.  Noninvasive and reversible.Noninvasive and reversible.  May be reinforced with wire or plastic mesh.May be reinforced with wire or plastic mesh.  Does not irritate the gingiva.Does not irritate the gingiva.  Local anesthesia is not needed.Local anesthesia is not needed. www.indiandentalacademy.comwww.indiandentalacademy.com
  85. 85. DISADVANTAGESDISADVANTAGES (( splints of enamel-bonding materialsplints of enamel-bonding material::  Depends for strength on bond to enamel and bulk ofDepends for strength on bond to enamel and bulk of material.material.  No mechanical retention.No mechanical retention.  Requires meticulous polishing of teeth immediately prior toRequires meticulous polishing of teeth immediately prior to etching.etching.  Dry field is imperative.Dry field is imperative.  Caries hazard exists if seepage occurs.Caries hazard exists if seepage occurs.  Plaque control becomes more difficult.Plaque control becomes more difficult. www.indiandentalacademy.comwww.indiandentalacademy.com
  86. 86. Indication & Contraindication Splints Of Enamel-bonding Material:-Indication & Contraindication Splints Of Enamel-bonding Material:-  INDICATIONINDICATION  Mobile anterior teeth when esthetics is important.Mobile anterior teeth when esthetics is important.  Temporary mobility due to trauma.Temporary mobility due to trauma.  Need for long term stabilization is unlikely.Need for long term stabilization is unlikely.  CONTRAINDICATIONS:CONTRAINDICATIONS:  teeth subjected to severe stress.teeth subjected to severe stress.  Posterior teeth.Posterior teeth. www.indiandentalacademy.comwww.indiandentalacademy.com
  87. 87. a)a) Self-polymerized resin bonding materialsSelf-polymerized resin bonding materials:_:_ 1.1. The teeth selected for splinting are polished with pumice prior toThe teeth selected for splinting are polished with pumice prior to their isolation under a rubber dam.their isolation under a rubber dam. 2.2. After isolation the teeth are dried with a stream of air. The etchantAfter isolation the teeth are dried with a stream of air. The etchant is then place on the labial, lingual and proximal surfaces of theis then place on the labial, lingual and proximal surfaces of the teeth with a cotton pellet. After 2 minutes, the teeth are thoroughlyteeth with a cotton pellet. After 2 minutes, the teeth are thoroughly rinsed off with water and allow them to dry.rinsed off with water and allow them to dry. 3.3. Following the etching procedure, the enamel has a dull chalkyFollowing the etching procedure, the enamel has a dull chalky appearance. If this is not achieved, re-etching is necessary.appearance. If this is not achieved, re-etching is necessary. 4.4. To facilitate the later trimming of the polymerized resin, one orTo facilitate the later trimming of the polymerized resin, one or more wooden interdental stimulators are placed interproximally tomore wooden interdental stimulators are placed interproximally to fill the embrassure spaces and thereby limit the flow of the resin.fill the embrassure spaces and thereby limit the flow of the resin.www.indiandentalacademy.comwww.indiandentalacademy.com
  88. 88. 5.5. Mix the appropriate proportions of the powder and liquid, the resinMix the appropriate proportions of the powder and liquid, the resin is placed in a continuous layer on the facial surfaces of the teeth.is placed in a continuous layer on the facial surfaces of the teeth. 6.6. The material is compressed on the labial surfaces and into theThe material is compressed on the labial surfaces and into the interproximal areas with a celluloid matrix strip which is held ininterproximal areas with a celluloid matrix strip which is held in place during the initial setting period of 3 minutes.place during the initial setting period of 3 minutes. 7.7. The procedure is now repeated on the lingual surfaces. A thin,The procedure is now repeated on the lingual surfaces. A thin, continuous layer of polymerized rein now covers the labial andcontinuous layer of polymerized rein now covers the labial and lingual surfaces of the teeth, and forms an interproximal bridgelingual surfaces of the teeth, and forms an interproximal bridge above and below the contact areas.above and below the contact areas. 8.8. After 10 minutes have elapsed, during which time the earlyAfter 10 minutes have elapsed, during which time the early adhesive bonds mature, the material is trimmed and polished.adhesive bonds mature, the material is trimmed and polished. 9.9. The occlusion must be checked and adjusted as necessary toThe occlusion must be checked and adjusted as necessary to relieve prematurities resulting from excess resin.relieve prematurities resulting from excess resin.www.indiandentalacademy.comwww.indiandentalacademy.com
  89. 89. b)b) Ultraviolet –light polymerized bonding materials:_Ultraviolet –light polymerized bonding materials:_  The procedure is same as for self-polymerized bondingThe procedure is same as for self-polymerized bonding materials but only the difference is the type of polymerization.materials but only the difference is the type of polymerization. This type of bonding materials need ultraviolet-light forThis type of bonding materials need ultraviolet-light for polymerization.polymerization. ADVANTAGES :-ADVANTAGES :-  Rigid and durable.Rigid and durable.  No destruction of tooth structure.No destruction of tooth structure.  Esthetically acceptable.Esthetically acceptable.  Well tolerated by patients.Well tolerated by patients.  They do not polymerize until they are exposed to ultra-violetThey do not polymerize until they are exposed to ultra-violet light, they provide prolonged workinglight, they provide prolonged working times for placement,times for placement, shaping and contouring over extensive areas of enamel.shaping and contouring over extensive areas of enamel. www.indiandentalacademy.comwww.indiandentalacademy.com
  90. 90. 3)3) Welded band splints:-Welded band splints:- (Orthodontic bands):(Orthodontic bands): Advantages:_Advantages:_  Provides rigidity, oralProvides rigidity, oral hygiene is maintained.hygiene is maintained.  Useful for stabilization ofUseful for stabilization of posterior teeth.posterior teeth.  At any time additional teethAt any time additional teeth may be incorporated into themay be incorporated into the splint.splint.  Can be used as a provisionalCan be used as a provisional splint.splint.  Proper positioning of bandsProper positioning of bands allow the use of nightallow the use of night guards or bite planes.guards or bite planes. Disadvantages:Disadvantages:  Construction is tedious.Construction is tedious.  Time consuming.Time consuming. www.indiandentalacademy.comwww.indiandentalacademy.com
  91. 91.  Procedure:Procedure: Herein is described a technique for the fabrication of aHerein is described a technique for the fabrication of a wire band splint which blends the advantages of wire ligationwire band splint which blends the advantages of wire ligation with its means of tension adjustment and orthodontic bandswith its means of tension adjustment and orthodontic bands which may be placed on teeth without cutting into enamel orwhich may be placed on teeth without cutting into enamel or gold crowns.gold crowns. 1.1. Select the prefabricated stainless steel bands which fit theSelect the prefabricated stainless steel bands which fit the teeth snugly. The band pushing instrument can be used forteeth snugly. The band pushing instrument can be used for proper setting of band.proper setting of band. 2.2. It must come to rest with the occlusal edge of the band at orIt must come to rest with the occlusal edge of the band at or slightly below the marginal ridge.slightly below the marginal ridge. 3.3. The gingival edge of the bands should not touch the gingiva.The gingival edge of the bands should not touch the gingiva.www.indiandentalacademy.comwww.indiandentalacademy.com
  92. 92. 4.4. If the interproximal contacts are too tight the adjacent toothIf the interproximal contacts are too tight the adjacent tooth surfaces can be lightly stripped with sandpaper strips orsurfaces can be lightly stripped with sandpaper strips or separating wires are placed for a period of 2-3 days.separating wires are placed for a period of 2-3 days. 5.5. Once the bands are placed on the teeth, they are scored withOnce the bands are placed on the teeth, they are scored with sharp instrument at mesial and distal angles at a level midwaysharp instrument at mesial and distal angles at a level midway between the occlusal and gingival edges of the band.between the occlusal and gingival edges of the band. 6.6. On the lingual surface of each band a mark is made which isOn the lingual surface of each band a mark is made which is centered occluso gingivally and mesiodistatlly. The bands arecentered occluso gingivally and mesiodistatlly. The bands are removed using band removing pliers without causing anyremoved using band removing pliers without causing any distortion.distortion. 7.7. Preformed loops can now be spot welded to the bands at thePreformed loops can now be spot welded to the bands at the locations previously marked.locations previously marked. 8.8. After welding, all rough edges are smoothed with free stonesAfter welding, all rough edges are smoothed with free stones and rubber wheels.and rubber wheels. www.indiandentalacademy.comwww.indiandentalacademy.com
  93. 93. 9.9. The finished bands are reseated the teeth and the margins areThe finished bands are reseated the teeth and the margins are burnished down.burnished down. 10.10. The bands are removed, lined with Znpo4 cement and reseated onThe bands are removed, lined with Znpo4 cement and reseated on the dried teeth.the dried teeth. 11.11. Once the cement has set, excess is removed.Once the cement has set, excess is removed. 12.12. The banded teeth are now ligated together with wire in a mannerThe banded teeth are now ligated together with wire in a manner similar to that used to wire anterior teeth.similar to that used to wire anterior teeth. 13.13. The main wire is (0.018) is threaded through all the buccal lingualThe main wire is (0.018) is threaded through all the buccal lingual loops. Where spacing exists between teeth, the wire is givenloops. Where spacing exists between teeth, the wire is given sufficient twists to take up the space. The main wire is indentedsufficient twists to take up the space. The main wire is indented interproximally with a plastic instrument and then interproximalinterproximally with a plastic instrument and then interproximal wires are placed.wires are placed. 14.14. The final step is to tighten the main wire and tuck itThe final step is to tighten the main wire and tuck it interproximally.interproximally. www.indiandentalacademy.comwww.indiandentalacademy.com
  94. 94. 4)4) CONTINUOUS CLASPS:_CONTINUOUS CLASPS:_ (Removable Cast Continuous Clasp Appliances)(Removable Cast Continuous Clasp Appliances) ADVANTAGES:-ADVANTAGES:-  Rigid and strong.Rigid and strong.  Non invasive.Non invasive.  Usable on posterior teeth.Usable on posterior teeth.  Removable by patient forRemovable by patient for cleaning.cleaning.  Pontics may be added when everPontics may be added when ever extractions become necessary.extractions become necessary.  Economic way of controllingEconomic way of controlling hypermobility.hypermobility.  They can be removed for socialThey can be removed for social engagements.engagements.  They may also be used at nightThey may also be used at night only.only. DISADVANTAGESDISADVANTAGES:-:-  Unaesthetic.Unaesthetic.  Caries risk.Caries risk.  Laboratory procedure required.Laboratory procedure required.  They may impede speech.They may impede speech.  Removable splints generallyRemovable splints generally donot contribute to a permanentdonot contribute to a permanent decrease in mobility.decrease in mobility. www.indiandentalacademy.comwww.indiandentalacademy.com
  95. 95. Indication & Contraindication Of Continuous Clasps:_Indication & Contraindication Of Continuous Clasps:_ INDICATIONS:-INDICATIONS:-  Mobile teeth any where inMobile teeth any where in either arch if esthetics is noteither arch if esthetics is not a serious concern.a serious concern.  Need for inexpensiveNeed for inexpensive replacement of missingreplacement of missing teeth when hopeless teethteeth when hopeless teeth are extracted.are extracted. CONTRINDICATIONS:-CONTRINDICATIONS:-  When esthetics areWhen esthetics are important.important.  Poor patient cooperation inPoor patient cooperation in plaque control.plaque control. www.indiandentalacademy.comwww.indiandentalacademy.com
  96. 96.  The removable cast continuous clasp appliances can be seatedThe removable cast continuous clasp appliances can be seated and removed in the fashion of a partial denture or they can beand removed in the fashion of a partial denture or they can be ligated to place.ligated to place.  Using them as freely removable appliances is advantageous,Using them as freely removable appliances is advantageous, since adequate oral hygiene is possible.since adequate oral hygiene is possible.  It rests at the height of contour and the cingulum of anteriorIt rests at the height of contour and the cingulum of anterior teeth and at the buccal and lingual surfaces of posterior teeth.teeth and at the buccal and lingual surfaces of posterior teeth.  The appliance is rigid and does not enter undercuts as does aThe appliance is rigid and does not enter undercuts as does a partial denture clasp. Retention is achieved by frictional grippartial denture clasp. Retention is achieved by frictional grip on the broad areas of tooth surface contacted.on the broad areas of tooth surface contacted. www.indiandentalacademy.comwww.indiandentalacademy.com
  97. 97. 5. REMOVABLE ACRYLIC APPLIANCES:_5. REMOVABLE ACRYLIC APPLIANCES:_  The clinician must be aware of the fact that when utilizes any formThe clinician must be aware of the fact that when utilizes any form of acrylic appliance, the dimensional instability of the materialof acrylic appliance, the dimensional instability of the material may cause distortions to occur. It is imperative to check thesemay cause distortions to occur. It is imperative to check these appliances frequently and to make any necessary adjustments.appliances frequently and to make any necessary adjustments.  i)i) Occlusal splints:-Occlusal splints:-  Maxillary and mandibular bite guardMaxillary and mandibular bite guard  Maxillary occlusal splint.Maxillary occlusal splint.  Mandibular occlusal splint.Mandibular occlusal splint.  Soft occusal splint.Soft occusal splint.  ii)ii) Bite plates:-Bite plates:-  Hawley bite plate.Hawley bite plate.  Sved bite plate.Sved bite plate. www.indiandentalacademy.comwww.indiandentalacademy.com
  98. 98. I)I) OCCULSAL SPLINTS:_OCCULSAL SPLINTS:_  USES:-USES:- 1) These are not only used for stabilizing the mobile teeth but also1) These are not only used for stabilizing the mobile teeth but also for protecting the dentition , muscles and TMJ from the damagingfor protecting the dentition , muscles and TMJ from the damaging effects of parafunctional activity, such as bruxism.effects of parafunctional activity, such as bruxism. 2) During orthodontic therapy the variations of occlusal splints are2) During orthodontic therapy the variations of occlusal splints are used for treating the simple types of tooth movement, and for theused for treating the simple types of tooth movement, and for the retention of the teeth after the teeth have been moved.retention of the teeth after the teeth have been moved. 3) Myospasm can be reduced.3) Myospasm can be reduced. 4) Can be used during the treatment of problems related to the TMJ.4) Can be used during the treatment of problems related to the TMJ. 5) Economical to construct.5) Economical to construct. www.indiandentalacademy.comwww.indiandentalacademy.com
  99. 99. A)A) MAXILLARY AND MANDIBULAR BITE GUARDSMAXILLARY AND MANDIBULAR BITE GUARDS (NIGHT(NIGHT GUARDSGUARDS)) ADVANTAGES:_ADVANTAGES:_  Non invasiveNon invasive  Protects teeth from stresses ofProtects teeth from stresses of clenching and grinding habitsclenching and grinding habits (Para functional activities)(Para functional activities)  Provides smooth, had, flatProvides smooth, had, flat occlusal surface for groupocclusal surface for group function during tooth grinding.function during tooth grinding.  Able to withstand severeAble to withstand severe occlusal stress.occlusal stress.  Occlusal surface may beOcclusal surface may be adjusted as desired.adjusted as desired. DISADVANTAGES:_DISADVANTAGES:_  Some patients are unable toSome patients are unable to tolerate guards because oftolerate guards because of gagging, encroachment ongagging, encroachment on free way space or inabilityfree way space or inability to sleep with a foreignto sleep with a foreign object in mouth.object in mouth. www.indiandentalacademy.comwww.indiandentalacademy.com
  100. 100. INDICATION & CONTRAINDICATION OF THE NIGHT GURDINDICATION & CONTRAINDICATION OF THE NIGHT GURD INDICATIONS:_INDICATIONS:_  Presence of tooth clenchingPresence of tooth clenching or grinding habit (bruxism).or grinding habit (bruxism).  When retainer is neededWhen retainer is needed following orthodonticfollowing orthodontic therapy.therapy.  Prevention of extrusion of aPrevention of extrusion of a tooth when the opposingtooth when the opposing tooth is missing and difficulttooth is missing and difficult to replace (Eg:- missingto replace (Eg:- missing mandibular second molar)mandibular second molar) CONTRAINDICATIONS:CONTRAINDICATIONS:  Allergy to methacrylateAllergy to methacrylate resins.resins.  Patient refuses to wearPatient refuses to wear appliances.appliances. www.indiandentalacademy.comwww.indiandentalacademy.com

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