The joining of two or more teeth into a rigid unit by means of fixed or removable restorations or devices” “The joining of two or more teeth for the purpose of stabilization” A Phoenician mandible from 500BC found in modern day Lebanon which has two carved ivory teeth attached to four natural teeth by gold wire Findings from digging of Egyptians (3000 -2500 B.C.) show similar gold wiring FACTORS TO BE CONSIDERED Mobility patterns of the teeth to be splinted Crown to root ratio of involved teeth Status of the remaining teeth in the arch Nature and the extent of periodontal destruction Method of therapy that will be employed TEMPORARY SPLINTS Essentially a diagnostic procedure; reversible Mechanical stabilization – hypermobility reduction Method chosen – simplest, least expensive, least time consuming, esthetically acceptable, and should meet patient needs Aid in determining whether teeth with a borderline prognosis will respond to therapy EXTRACORONAL SPLINTS 1. Wire Ligation Most common Easy to construct; sturdy Limitation – only where coronal form permits Greatest use in – mandibular incisors Hirschfield – loop tied at cervical line Orthodontic Bands Stabilize both anterior & posterior teeth Attention to the contours of the bands Contacts between teeth must be opened Acrylic over the bands Common path of insertion Removable Acrylic Appliances Dimensional instability of material may cause distortions Imperative to check these frequently & make necessary adjustments. Vital to check the path of insertion of appliance Acrylic Bite Guards (Night Guards) Treatment of bruxism and clenching Most common – covers occlusal surface of teeth For additional support – palate is covered Removable Cast Appliances Usually a rigid casting either of gold or of chrome cobalt Friedman’s variation – double continuous clasp casting One end is not joined but is left open so that the casting can be sprung over the undercuts and then ligated The posterior end is continuous from the buccal to the lingual surface Another modification is an interlocking attachment on the distal end The posterior end is continuous from the buccal to the lingual surface Another modification is an interlocking attachment on the distal end The posterior end is continuous from the buccal to the lingual surface Another modification is an interlocking attachment on the distal end The posterior end is continuous from the buccal to the lingual surface Another modification is an interlocking attachment on the distal end The posterior end is continuous from the buccal to the lingual surface Another modification is an interlocking attachment on the distal end The posterior end is continuous from the buccal to the lingual surface Another modification is an interlocking attachment on the distal end The posterior end is continuous from the buccal to the lingual surface Another modification is an interlocking attachment on the dista

1. OCCLUSAL THERAPY AND
SPLINTING

4. 1. Definitions
2. Terminology
3. Early History
4. Objectives
5. Indications
6. Contraindications
7. Principles
8. Ideal Splint
9. Splintee / Splinters
10. Mode of Action
11. Classifications
12. Temporary Splints
13. Provisional Splints
14. Permanent Splints
15. Commonly Used Splints
16. Disadvantages
17. Case Reports
18. Conclusion
CONTENTS

5. SPLINTING – Definitions
“The joining of two or more teeth into a rigid unit by
means of fixed or removable restorations or devices”
“The joining of two or more teeth for the purpose of
stabilization”
-Dawson

6. TERMINOLOGY
STABILIZATON
TEMPORARY SPLINT
PROVISIONAL SPLINT
PERMANENT SPLINT

7. EARLY HISTORY
A Phoenician mandible from 500BC found in modern day
Lebanon which has two carved ivory teeth attached to four
natural teeth by gold wire
Findings from digging of Egyptians (3000 -2500 B.C.) show
similar gold wiring

8. 1. Providing rest to the supporting tissues
2. Redirection of forces
3. Redistribution of forces
4. Immediate reduction of mobility
6. Preserving arch in
7. iRestoration of functional stability
8. Psychological well being
9. Stabilizing mobile teeth during surgical, especially regenerative therapy
OBJECTIVES

9. OBJECTIVES

10. INDICATIONS (Tarnow & Fletcher, 1986)
1. Stabilization of a severely periodontally compromised tooth
2. Stabilization of teeth after acute dental trauma
3. Stabilization of mobile teeth
for masticatory comfort
4. Redistribution of forces
along the long axis of teeth

11. 5. Cross arch stabilization
6. Control of forces of parafunction or bruxing
7. Stabilize teeth in secondary occlusal trauma
8. Restoration of the vertical dimension of occlusion in case of posterior bite
collapse
9. Prevention of the eruption of an unopposed tooth
10. Post orthodontic retention

12. CONTRAINDICATIONS (Tarnow & Fletcher, 1986)
1. Moderate to severe tooth mobility in the presence of
periodontal inflammation and/or primary occlusal trauma
2. Insufficient number of firm or sufficiently firm teeth to
stabilize mobile teeth

13. 3. Prior occlusal adjustment not done on teeth with occlusal
trauma or occlusal interferences
4. Patient not maintaining oral hygiene

14. CLINICAL FEATURES RADIOGRAPHIC
FEATURES
TREATMENT
REQUIRED
• Increased Mobility • Increased width of
PDL
• Normal bone height
Occlusal
equilibration
• Increased Mobility • Increased width of
PDL
• Reduced bone height
Occlusal
equilibration
• Increased Mobility
• Patient NOT
functioning
comfortably
• Normal width of PDL
• Reduced bone height
Occlusal
equilibration ±
Splinting
• Increased Mobility
• Patient functioning
comfortably
• Normal width of PDL
• Reduced bone height
No occlusal
adjustment required

15. PRINCIPLES
Should decrease movement 3 dimensionally
Centre of rotation of the affected teeth must be located in the
remaining supported bone
No inflammation
Minimum of 1/3rd of bony support remaining

16. Occlusion must be adjusted prior to stabilization
Sufficient number of sound teeth should be involved
Non irritating to other
soft tissues
Should allow for practice of
oral hygiene methods

17. Should not impair or disturb the phonetic pattern
Esthetically pleasing
Crown root ratio should be considered
Favorable tooth position in the arch
No periapical pathology

18. IDEAL SPLINT (Simring & Thaller, 1956)
SIMPLE
ECONOMIC
STABLE & EFFICIENT
HYGIENIC
NON-IRRITATING

19. IDEAL SPLINT
NO INTERFERENCE WITH TREATMENT
ESTHETICALLY ACCEPTABLE
NO IATROGENIC DISEASE
EASY CLEANSABLE
EXTEND AROUND ARCH

20. SPLINTEE 
TOOTH THAT NEEDS SUPPORT
SPLINTERS
ADJACENT TEETH THAT PROVIDE SUPPORT

21. MODE OFACTION
Loose teeth become stabilized
Occlusal forces are
better distributed
Trauma minimized, repair
enhanced

22. CLASSIFICATION OF SPLINTS
PERIOD OF
STABILIZATION
TOOTH
PREPARATION
TYPE OF
MATERIAL
• Bonded composite resin
• Braided wire
• A-splints
• Temporary
• Provisional
• Permanent
• Intracoronal
• Extracoronal

23. GOLDMAN, COHEN, & CHACKER CLASSIFICATION
TEMPORARY PROVISIONAL
EXTRACORONAL INTRACORONAL
1. Wire ligation
2. Orthodontic bands
3. Removable acrylic
appliances
4. Removable cast
appliances
5. UV light
polymerizing
bonding materials
1. Wire and acrylic
2. Wire and
amalgam
3. Wire, amalgam
and acrylic
4. Cast chrome-
cobalt alloy bars
with acrylic
1. All acrylic
2. Adapted metal
band and
acrylic

24. ROSS, WEISGOLD, & WRIGHT CLASSIFICATION
TEMPORARY LONG TERM
PROVISIONAL
1. Removable
extracoronal
2. Fixed
extracoronal
3. Intracoronal
4. Etched metal-
resin bonded
1. Acrylic
2. Metal band &
acrylic
1. Removable
2. Fixed
3. Combination of
removable &
fixed

25. FACTORS TO BE CONSIDERED
Mobility patterns of the teeth to be splinted
Crown to root ratio of involved teeth
Status of the remaining teeth in the arch
Nature and the extent of periodontal destruction
Method of therapy that will be employed

26. TEMPORARY SPLINTS

27. Essentially a diagnostic procedure; reversible
Mechanical stabilization – hypermobility reduction
Method chosen – simplest, least expensive, least time
consuming, esthetically acceptable, and should meet patient
needs
Aid in determining whether teeth with a borderline prognosis
will respond to therapy

28. EXTRACORONAL SPLINTS
1. Wire Ligation
Most common
Easy to construct; sturdy
Limitation – only where coronal form permits
Greatest use in – mandibular incisors
Hirschfield – loop tied at cervical line

30. 2. Orthodontic Bands
Stabilize both anterior & posterior teeth
Attention to the contours of the bands
Contacts between teeth must be opened
Acrylic over the bands
Common path of insertion

33. 3. Removable Acrylic Appliances
Dimensional instability of material may cause distortions
Imperative to check these frequently & make necessary adjustments.
Vital to check the path
of insertion of appliance

34. 4. Acrylic Bite Guards (Night Guards)
Treatment of bruxism and clenching
Most common – covers occlusal surface of teeth
For additional support – palate is covered

35. Maxillary Hawley Bite Plane with a labial wire
Advantage – posterior teeth freed of occlusal contact
Used in – anterior overbite
Disarticulates posterior teeth

36. 5. Removable Cast Appliances
Usually a rigid casting either of gold or of chrome cobalt
Friedman’s variation – double continuous clasp casting
One end is not joined but is left open so that the casting can be sprung over the
undercuts and then ligated

37. The posterior end is
continuous from the buccal
to the lingual surface
Another modification is an
interlocking attachment on
the distal end

38. 6. UV Light Polymerizing Bonding Materials
Polson & Billen – "Because the materials do not polymerize until they are
exposed to ultraviolet light, they provide prolonged working times for placement,
shaping, and contouring over extensive areas of enamel”
One popular kit – NUVA SYSTEM (Caulk, Division of Dentsply lnternational Inc.
Milford, Delaware)

42. The composite resin splint can be strengthened by adding wire,
monofilament line, fiberglass or by using a fibre meshwork to
reinforce the material
E.g.: RIBBOND, Ribbond Inc.,
Seattle, WA

47. Extracoronal resin-bonded retainers can strengthen the overall
bonded situation
The splints are usually cast from metals, usually non noble alloys
Greater inherent strength
than composite-resin splint
Grooves, pins and parallel
preparations increase retention

48. DIAMONDCROWN (Biodent Inc., Mont-Saint-Hilaire, QC)
claims improved diametric tensile strength & bonding
capabilities

49. INTRACORONAL SPLINTS
1. Wire Ligation
Serves well for posterior teeth
A channel is prepared on the labial, lingual and proximal surfaces
Major disadvantage – channels may become undercuts in case crowns are needed
later

52. 2. Wire & Acrylic (A-Splint)
Obin & Arvins – wire fixed with acrylic in channels made in mobile teeth
Utilized on – occlusal surfaces of posteriors and lingual
surfaces of anteriors
Possibility of caries or breakage
Utilized more readily with anterior teeth

53. 3mm wide and
2mm deep channels
Slight undercut
Pulp protection
Platinized knurled wire 22 to 16 gauge (0.64 – 1.3mm
diameter)
Major disadvantage – recurrent caries

54. Kessler’s variation of A-Splint
1 mm deep mesial and distal box is prepared parallel to long axis
SnF2 or Ca(OH)2 varnish is applied and then threaded pin is placed
Stainless steel wire is adapted around the pin while it passes through the slot

55. 3. Amalgam Splint
Limited to posterior teeth
Teeth prepared with sound operative principles and amalgam is condensed
2 to 5 teeth may be splinted
Disadvantage – Tend to fracture easily

56. 4. Fixed Temporary Acrylic Bridges
Used when permanent splints have to be given at a later stage
With time acrylic wears and breaks
Some clinicians prefer cast occlusals
Some prefer metal copings (less irritating and less likely to cause caries due to
cement washout)

57. 5. Wire & Amalgam
Lloyd & Baer – continuous amalgam splint
Series of mesial-occlusal-distal preparations
Restored with amalgam with wire embedded in it
Disadvantages - Limited to posterior teeth and possibility of fracture

59. 6. Wire, Resin, & Amalgam (Trachtenberg)
Embed the wire in
preexisting amalgam
with acrylic
Langeland et al –
tagged acrylic in
experimentally
prepared cavities
in monkeys

60. 7. Cast Chrome-Cobalt Alloy Bars
Baumhammers – condensed amalgam over a 14 gauge chrome-cobalt bar
Corn & Marks – cast bar fabricated on study casts prior to
insertion
A channel is made in the teeth to be stabilized; bar is
inserted with acrylic into grooves prepared

63. PROVISIONAL SPLINTS

64. May be used for months upto several years
Usually fabricated in acrylic
Stabilize a mobile dentition from initial tooth preparation to
the time for permanent restorations
Provide – Stability, Occlusal function, Good esthetic result

65. 1. All Acrylic
Most common
Can be fabricated chairside
Limitation – marginal adaptation

66. 2. Adapted Metal Bands & Acrylic
Amsterdam & Fox – copper / gold bands fitted and incorporated into acrylic
Fulfills all objectives – exact marginal fit (caries control & pulp protection)
Frequent removal is possible – added strength of metal bands

68. PERMANENT SPLINTS

69. REMOVABLE
FIXED
CAST METAL
RESIN BONDED
FPDs
COMBINED
ENDODONTIC
POSTS
Continuous Clasp Devices
Swing Lock Devices
Overdenture
Full Coverage / ¾th Crowns, Inlays
Posts in Root Canals
Horizontal Pin Splints
Partial Dentures &
Splinted Abutments
Removable-Fixed Splints
Full / Partial Dentures on
Splinted Roots
Fixed Bridges in Partial Dentures

70. Swing-Lock Devices
Used in situations where fixed splinting is not possible or desirable
Advanced age, poor physical / mental status, questionable prognosis
Advantages – Conceals metal, avoids torque

71. Overdentures
Used where few teeth with questionable prognosis remain
Advantages – Favorable crown-root ratio, retention of alveolar bone around roots
Disadvantage – Recurrent periodontal disease

72. FIXED SPLINTS
Full coverage - simple
Inlays – more conservative
Reciprocal stabilization in all directions
Palatal bar – cross arch stabilization
Advantages – comfortable, esthetic

73. Cast Metal Resin Bonded FPDs
Maryland splints
Used with intact or very slightly altered enamel surfaces
Advantages – functional, esthetic, reversible, economic
Not suitable for – excessively mobile teeth under strong occlusal load

76. I. UNILATERAL SPLINTING
II. BILATRAL / CROSS-ARCH SPLINTING

77. BILATRAL / CROSS-ARCH SPLINTING
A. CONTINUOUS SPLINTS
B. SEGMENT SPLINTS
1. Non Rigid Connectors
2. Soldered Joints
3. Locking Rod And Tube
4. Coping Connector

78.  NON-RIGID CONNECTOR
SOLDERLESS JOINT 

79.  LOCKING ROD & TUBE
COPING CONNECTOR 

80. COMMONLY USED SPLINTS
For Anterior Teeth For Posterior Teeth
1. Wire Ligatures
2. Direct Bonding Systems
3. A-Splint
4. Variation of A-Splint
5. New Generation Bonded
Reinforcing Materials with
Composites
1. Intracoronal Amalgam
Wire Splints
2. A-Splints
3. Bite Guards
4. Rigid Occlusal Splints
5. Composite Splints – for
Severe Bruxism

81. J Can Dent Assoc 2000; 66: 440-443

82. J Can Dent Assoc 2000; 66: 440-443

83. Dental Traumatology 2006; 22: 345-349

84. J Prosthet Dent 2000; 84: 210-214

85. DISADVANTAGES OF SPLINTING
HYGIENIC
MECHANICAL
BIOLOGICAL

86. CONCLUSION
 Composite resin splints with fiber reinforcement
 BOON or BANE

87. REFERENCES
1. PERIODONTAL THERAPY – Henry M. Goldman & D.
Walter Cohen, 6th Ed
2. PERIODONTICS IN THE TRADITION OF GOTTLIEB
AND ORBAN – Grant, Stern & Listgarten, 6th Ed
3. PERIODONTAL DISEASES – Schluger, Youdelis, Page, &
Johnson, 2nd Ed
4. Periodontology 2000, Vol 4, 1994, 15-22

88. REFERENCES
5. Compendium Aug 2001, Vol 22, No. 8, 610-620
6. J Can Dent Assoc 2000; 66: 440-443
7. J Contemp Dent Pract Nov 2002; (3) 4: 10-22
8. DCNA, Vol 43, No. 1, 1999
9. BDJ, Vol 191, No.10, Dec 8, 2001
10. Dental Traumatology 2006; 22: 345-349
11. J Prosthet Dent 2000; 84: 210-214