Periodontal splinting involves joining mobile teeth together to restrict their movement and distribute forces. It has been used for centuries to treat issues like tooth mobility. While splinting can help in specific situations, it also poses risks if not applied carefully. The clinician must consider factors like a patient's oral hygiene and ongoing periodontal disease monitoring when using splinting. Different types of splints include removable, fixed, hard acrylic and vacuum-formed options, each with advantages and disadvantages for the situation. Careful patient education is important when using splinting.
This document discusses various surgical techniques for preserving the interdental papilla during periodontal regeneration procedures. It describes the conventional papilla preservation flap technique introduced by Takei in 1985, as well as several modifications including the modified papilla preservation flap, simplified papilla preservation flap, interproximal tissue maintenance technique, and whale's tail technique. The advantages and disadvantages of each technique are summarized. A novel entire papilla preservation technique introduced in 2015 is also outlined, which aims to completely preserve the interdental papilla.
REFERENCES TAKEN FROM CARRANZA'S TEXTBOOK OF CLINICAL PERIODONTOLOGY AND LINDHE'S TEXTBOOK OF CLINICAL PERIODONTOLOGY AND IMPLANT DENTISTRY. CONTAINS ENOUGH AND MORE DETAILS OF THIS TOPIC FOR BDS STUDENTS.HOPE THIS PRESENTATION WILL HELP U GAIN SOME KNOWLEDGE ABOUT PERIODONTAL PLASTIC AND ESTHETIC DENTISTRY.
This document discusses genetics in relation to periodontitis. It provides background on genetic study designs like segregation analysis, twin studies, and linkage/association studies that are used to identify genes associated with periodontal diseases. Specific genes linked to aggressive periodontitis are mentioned, including mutations in the alkaline phosphatase, cathepsin C, and CD18/CD11 genes. Studies finding autosomal dominant and recessive inheritance of aggressive periodontitis in different populations are summarized. The role of HLA antigens and IL-1 gene polymorphisms in periodontitis susceptibility is also briefly covered.
This document discusses personalized periodontology and precision medicine approaches in periodontal treatment. It makes the following key points:
1. Precision or personalized medicine in periodontics uses biomarkers to predict periodontal disease susceptibility, determine optimal treatment, and enhance outcomes. This stratifies patients based on risk factors and biological markers.
2. Various genetic and inflammatory biomarkers can predict risk, diagnose disease severity, and monitor treatment effectiveness. Combinations of multiple biomarkers are more accurate than single biomarkers.
3. A study by Giannobile stratified over 5,000 patients by risk factors like smoking and diabetes to predict tooth loss outcomes over 16 years. High-risk patients had worse outcomes.
4. Personalized approaches show promise
Periodontal flaps can be classified based on bone exposure, flap placement, and papilla management. A full thickness flap reflects all soft tissue including periosteum to expose bone, while a partial thickness flap reflects only epithelium and connective tissue, leaving bone covered. Flaps can be placed in their original position (non-displaced) or moved to a new position (displaced). Conventional flaps split the papilla while papilla preservation flaps incorporate the entire papilla into one flap. Proper flap design and suturing are important to achieve desired outcomes and promote healing.
Emdogain is a gel containing enamel matrix proteins that has been shown to regenerate hard and soft tissues lost to periodontal disease. It works by attracting mesenchymal cells to the root surface, promoting attachment, proliferation, and differentiation which results in new cementum, bone, and periodontal ligament formation. Over 20 years of clinical studies involving over 2 million patients have demonstrated its effectiveness and safety in treating intra-bony and gingival recession defects.
This document discusses various surgical techniques for preserving the interdental papilla during periodontal regeneration procedures. It describes the conventional papilla preservation flap technique introduced by Takei in 1985, as well as several modifications including the modified papilla preservation flap, simplified papilla preservation flap, interproximal tissue maintenance technique, and whale's tail technique. The advantages and disadvantages of each technique are summarized. A novel entire papilla preservation technique introduced in 2015 is also outlined, which aims to completely preserve the interdental papilla.
REFERENCES TAKEN FROM CARRANZA'S TEXTBOOK OF CLINICAL PERIODONTOLOGY AND LINDHE'S TEXTBOOK OF CLINICAL PERIODONTOLOGY AND IMPLANT DENTISTRY. CONTAINS ENOUGH AND MORE DETAILS OF THIS TOPIC FOR BDS STUDENTS.HOPE THIS PRESENTATION WILL HELP U GAIN SOME KNOWLEDGE ABOUT PERIODONTAL PLASTIC AND ESTHETIC DENTISTRY.
This document discusses genetics in relation to periodontitis. It provides background on genetic study designs like segregation analysis, twin studies, and linkage/association studies that are used to identify genes associated with periodontal diseases. Specific genes linked to aggressive periodontitis are mentioned, including mutations in the alkaline phosphatase, cathepsin C, and CD18/CD11 genes. Studies finding autosomal dominant and recessive inheritance of aggressive periodontitis in different populations are summarized. The role of HLA antigens and IL-1 gene polymorphisms in periodontitis susceptibility is also briefly covered.
This document discusses personalized periodontology and precision medicine approaches in periodontal treatment. It makes the following key points:
1. Precision or personalized medicine in periodontics uses biomarkers to predict periodontal disease susceptibility, determine optimal treatment, and enhance outcomes. This stratifies patients based on risk factors and biological markers.
2. Various genetic and inflammatory biomarkers can predict risk, diagnose disease severity, and monitor treatment effectiveness. Combinations of multiple biomarkers are more accurate than single biomarkers.
3. A study by Giannobile stratified over 5,000 patients by risk factors like smoking and diabetes to predict tooth loss outcomes over 16 years. High-risk patients had worse outcomes.
4. Personalized approaches show promise
Periodontal flaps can be classified based on bone exposure, flap placement, and papilla management. A full thickness flap reflects all soft tissue including periosteum to expose bone, while a partial thickness flap reflects only epithelium and connective tissue, leaving bone covered. Flaps can be placed in their original position (non-displaced) or moved to a new position (displaced). Conventional flaps split the papilla while papilla preservation flaps incorporate the entire papilla into one flap. Proper flap design and suturing are important to achieve desired outcomes and promote healing.
Emdogain is a gel containing enamel matrix proteins that has been shown to regenerate hard and soft tissues lost to periodontal disease. It works by attracting mesenchymal cells to the root surface, promoting attachment, proliferation, and differentiation which results in new cementum, bone, and periodontal ligament formation. Over 20 years of clinical studies involving over 2 million patients have demonstrated its effectiveness and safety in treating intra-bony and gingival recession defects.
The document discusses root conditioning agents used in periodontal treatment. It focuses on citric acid, tetracycline, and fibronectin. Citric acid works by removing the smear layer and demineralizing the root surface, exposing collagen fibers to promote new attachment of fibroblasts. Tetracycline also demineralizes roots but requires higher concentrations and longer application times than citric acid. Fibronectin enhances new attachment by promoting cell proliferation and acting as a fibrin sealant during wound healing. While not fully proven in human studies, these agents provide benefits over scaling and root planing alone by detoxifying roots and enhancing new attachment.
The document discusses the Cumulative Interceptive Supportive Therapy (CIST) protocol for treating peri-implant mucositis and peri-implantitis. The CIST protocol is a 4-step approach using increasing levels of antibacterial treatment and potentially regenerative surgery. Step A involves plaque removal and patient education. Step B adds local antiseptics. Step C adds systemic or local antibiotics. Step D uses regenerative treatments like bone grafting or resective treatments like defect osteoplasty if previous steps fail to resolve bone loss. The document also mentions promising results using laser-assisted peri-implantitis treatment to remove pathogens.
This review covers the surgical and non-surgical management of
Gingival black triangles (GBTs).
This review also covers the aetiology and management of GBTs,
highlighting the importance of considering the options currently
available when treating a lost dental papilla.
1. Controversies exist in many areas of periodontology including disease diagnosis and classification, microbial aspects, pathogenesis, and various treatment modalities such as periodontal, implant, and mucogingival therapies.
2. Dogmas that were previously held as undisputed truths are now being challenged by new evidence, with debates around issues like the definition of biologic width, need for splinting, and thresholds for peri-implant disease diagnosis.
3. Mapping techniques can help explore controversies through non-controversial elements, literature analysis, review of opinions, networks of relationships, and chronologies to better understand disagreements.
Gingival enlargement refers to excessive overgrowth of gum tissue surrounding teeth. It has several potential causes including inflammation, medications, and certain medical conditions. Treatment involves first managing any inflammatory component, and then surgical procedures such as gingivectomy or gingivoplasty may be performed to reshape the gums. These procedures aim to eliminate pockets and establish a healthy gum contour, but can result in loss of gum tissue or recession. Crown lengthening is a related procedure to increase the amount of visible tooth structure and is used for restorative or aesthetic reasons. It may involve gingivectomy, osseous recontouring, or repositioning of gum tissue. Maintaining an adequate biologic width between restoration
Scaling and root planing (SRP) is a non-surgical treatment for periodontitis that aims to remove dental plaque and calculus from tooth surfaces. It involves scaling to remove deposits and root planing to smooth root surfaces. The goals are to eliminate periodontitis by removing irritants and restoring a healthy environment for tissue healing. The long-term effectiveness depends on factors like patient compliance, disease severity, and anatomical challenges. Overhanging restorations can interfere with cleaning and disturb the ecological balance, allowing disease-causing bacteria to proliferate.
Critical apprisal of 2018 classification of periodontal disease yasmin parvin ss
The document provides a critical appraisal of the 2018 classification of periodontal diseases. It summarizes the key changes from the previous 1999 classification. The 2017 workshop with 130 experts from around the world developed the new classification framework based on new evidence from various studies. The new classification addresses some of the drawbacks of the previous system by introducing concepts such as periodontal health, risk factors, staging and grading of periodontitis, and inclusion of peri-implant diseases. While it provides several improvements, some experts note that the new classification is complex and may be difficult to implement in daily clinical practice. Future efforts are needed to disseminate and explain the new classification system.
This document discusses various controversies in periodontal therapy. It covers debates around the need for surgical procedures versus non-surgical therapy, the effectiveness of different instrumentation techniques like ultrasonic scaling versus manual scaling, the role of root planing and its aggressiveness, the use of lasers versus mechanical debridement, and the role of local and systemic antimicrobials. It also discusses controversies around the role of trauma from occlusion in causing periodontal disease progression and gingival recession. While some studies have found associations, there is no clear consensus on many of these topics with evidence on both sides of the issues.
Impact of periodontal infection on systemic health By Dr Sachin RathodDr Sachin Rathod
The document discusses the relationship between periodontal disease and diabetes. It notes that periodontitis is associated with gram-negative bacteria in subgingival plaque. Diabetes can increase the risk of periodontitis by impairing the immune response and altering collagen metabolism. Persistent infection from periodontal pathogens may increase insulin resistance in diabetes. Treatment of periodontitis in diabetics through nonsurgical and antibiotic methods has been shown to improve glycemic control and periodontal health. Maintaining periodontal health is important for optimal management of diabetes.
This document provides an overview of periodontal dressings. It discusses the history of dressings from the early 20th century use of eugenol-containing dressings to the development of non-eugenol dressings. The ideal properties and types of dressings are described, including eugenol, non-eugenol, and those containing neither zinc oxide nor eugenol. Modifications to dressings through the addition of substances like chlorhexidine to improve antimicrobial activity are also summarized. The document concludes by stating that while dressings provide wound protection, mouthwashes are now preferred for their antimicrobial effects during healing.
Reconstructive periodontal therapy
Some of the slides may appear Blank/White/Black, those are the Videos that I added in the presentation.
Kindly Ignore those slides.
Full Mouth Disinfection (FMD) is a treatment approach that involves scaling and root planing of all teeth in one or two visits to eliminate periodontal pathogens. The goals of FMD are to prevent reinfection of treated sites by untreated sites or other oral niches harboring pathogens. FMD originally included scaling, root planing, chlorhexidine treatment, and prolonged chlorhexidine use. Over time, variations have been developed including replacing chlorhexidine, supplementing with antibiotics or probiotics, and combining with photodynamic therapy. FMD aims to provide more effective periodontal treatment than the standard approach of scaling and root planing in quadrants over multiple visits.
Surgical v/s Non surgical periodontal therapy Achi Joshi
Both surgical and nonsurgical therapy produced improvement in the periodontal health.
Treatment approach was based on the comfort level of the practitioner.
In the late 60’s and continuing into the 70’s and 80’s, many series of longitudinal studies were conducted, aimed to document the immediate and most importantly long term clinical results following several types of periodontal therapy.
This document provides an overview of periodontal flap surgery techniques. It defines a periodontal flap as incising the gingival tissues to control or eliminate periodontal disease by elevating the gingiva and oral mucosa from underlying tissues for improved accessibility and visibility of bone and roots. The document discusses the classification, indications, advantages, and types of incisions for various flap techniques used in pocket therapy, including modified Widman flap, undisplaced flap, apically displaced flap, and distal wedge procedure. Healing processes and outcomes for different flap techniques are also summarized.
This document discusses various suturing techniques used in periodontal flap surgery. It begins with an introduction on the purpose of suturing flaps, which is to maintain the flap in position until desired healing. Resorbable sutures are preferred for patient comfort and elimination of removal appointments. The document then describes different suturing techniques like horizontal mattress suture, continuous independent sling suture, anchor suture, closed anchor suture, and periosteal suture. It provides details on their specific uses and how to perform each technique. A variety of suture materials, both resorbable and non-resorbable, are also listed.
The modified papilla preservation technique aims to improve primary closure and membrane coverage in interproximal regenerative procedures by carefully preserving the papilla during incisions, coronally positioning the buccal flap, and using the papilla to cover an implanted membrane. In a study of 15 patients, this technique achieved primary closure in 93% of cases and maintained membrane coverage in 73% of cases until membrane removal at 6 weeks.
This document provides an overview of splinting as a treatment for stabilizing mobile teeth. It defines splinting and discusses the history, objectives, indications, contraindications, and principles of splinting. It describes different types of splints including temporary, provisional, and permanent splints. Temporary splints are used until mobility is reduced and can include wire ligation, bands, or removable acrylic appliances. The goal of splinting is to decrease tooth movement, distribute forces, and stabilize teeth during and after periodontal treatment.
The document discusses root conditioning agents used in periodontal treatment. It focuses on citric acid, tetracycline, and fibronectin. Citric acid works by removing the smear layer and demineralizing the root surface, exposing collagen fibers to promote new attachment of fibroblasts. Tetracycline also demineralizes roots but requires higher concentrations and longer application times than citric acid. Fibronectin enhances new attachment by promoting cell proliferation and acting as a fibrin sealant during wound healing. While not fully proven in human studies, these agents provide benefits over scaling and root planing alone by detoxifying roots and enhancing new attachment.
The document discusses the Cumulative Interceptive Supportive Therapy (CIST) protocol for treating peri-implant mucositis and peri-implantitis. The CIST protocol is a 4-step approach using increasing levels of antibacterial treatment and potentially regenerative surgery. Step A involves plaque removal and patient education. Step B adds local antiseptics. Step C adds systemic or local antibiotics. Step D uses regenerative treatments like bone grafting or resective treatments like defect osteoplasty if previous steps fail to resolve bone loss. The document also mentions promising results using laser-assisted peri-implantitis treatment to remove pathogens.
This review covers the surgical and non-surgical management of
Gingival black triangles (GBTs).
This review also covers the aetiology and management of GBTs,
highlighting the importance of considering the options currently
available when treating a lost dental papilla.
1. Controversies exist in many areas of periodontology including disease diagnosis and classification, microbial aspects, pathogenesis, and various treatment modalities such as periodontal, implant, and mucogingival therapies.
2. Dogmas that were previously held as undisputed truths are now being challenged by new evidence, with debates around issues like the definition of biologic width, need for splinting, and thresholds for peri-implant disease diagnosis.
3. Mapping techniques can help explore controversies through non-controversial elements, literature analysis, review of opinions, networks of relationships, and chronologies to better understand disagreements.
Gingival enlargement refers to excessive overgrowth of gum tissue surrounding teeth. It has several potential causes including inflammation, medications, and certain medical conditions. Treatment involves first managing any inflammatory component, and then surgical procedures such as gingivectomy or gingivoplasty may be performed to reshape the gums. These procedures aim to eliminate pockets and establish a healthy gum contour, but can result in loss of gum tissue or recession. Crown lengthening is a related procedure to increase the amount of visible tooth structure and is used for restorative or aesthetic reasons. It may involve gingivectomy, osseous recontouring, or repositioning of gum tissue. Maintaining an adequate biologic width between restoration
Scaling and root planing (SRP) is a non-surgical treatment for periodontitis that aims to remove dental plaque and calculus from tooth surfaces. It involves scaling to remove deposits and root planing to smooth root surfaces. The goals are to eliminate periodontitis by removing irritants and restoring a healthy environment for tissue healing. The long-term effectiveness depends on factors like patient compliance, disease severity, and anatomical challenges. Overhanging restorations can interfere with cleaning and disturb the ecological balance, allowing disease-causing bacteria to proliferate.
Critical apprisal of 2018 classification of periodontal disease yasmin parvin ss
The document provides a critical appraisal of the 2018 classification of periodontal diseases. It summarizes the key changes from the previous 1999 classification. The 2017 workshop with 130 experts from around the world developed the new classification framework based on new evidence from various studies. The new classification addresses some of the drawbacks of the previous system by introducing concepts such as periodontal health, risk factors, staging and grading of periodontitis, and inclusion of peri-implant diseases. While it provides several improvements, some experts note that the new classification is complex and may be difficult to implement in daily clinical practice. Future efforts are needed to disseminate and explain the new classification system.
This document discusses various controversies in periodontal therapy. It covers debates around the need for surgical procedures versus non-surgical therapy, the effectiveness of different instrumentation techniques like ultrasonic scaling versus manual scaling, the role of root planing and its aggressiveness, the use of lasers versus mechanical debridement, and the role of local and systemic antimicrobials. It also discusses controversies around the role of trauma from occlusion in causing periodontal disease progression and gingival recession. While some studies have found associations, there is no clear consensus on many of these topics with evidence on both sides of the issues.
Impact of periodontal infection on systemic health By Dr Sachin RathodDr Sachin Rathod
The document discusses the relationship between periodontal disease and diabetes. It notes that periodontitis is associated with gram-negative bacteria in subgingival plaque. Diabetes can increase the risk of periodontitis by impairing the immune response and altering collagen metabolism. Persistent infection from periodontal pathogens may increase insulin resistance in diabetes. Treatment of periodontitis in diabetics through nonsurgical and antibiotic methods has been shown to improve glycemic control and periodontal health. Maintaining periodontal health is important for optimal management of diabetes.
This document provides an overview of periodontal dressings. It discusses the history of dressings from the early 20th century use of eugenol-containing dressings to the development of non-eugenol dressings. The ideal properties and types of dressings are described, including eugenol, non-eugenol, and those containing neither zinc oxide nor eugenol. Modifications to dressings through the addition of substances like chlorhexidine to improve antimicrobial activity are also summarized. The document concludes by stating that while dressings provide wound protection, mouthwashes are now preferred for their antimicrobial effects during healing.
Reconstructive periodontal therapy
Some of the slides may appear Blank/White/Black, those are the Videos that I added in the presentation.
Kindly Ignore those slides.
Full Mouth Disinfection (FMD) is a treatment approach that involves scaling and root planing of all teeth in one or two visits to eliminate periodontal pathogens. The goals of FMD are to prevent reinfection of treated sites by untreated sites or other oral niches harboring pathogens. FMD originally included scaling, root planing, chlorhexidine treatment, and prolonged chlorhexidine use. Over time, variations have been developed including replacing chlorhexidine, supplementing with antibiotics or probiotics, and combining with photodynamic therapy. FMD aims to provide more effective periodontal treatment than the standard approach of scaling and root planing in quadrants over multiple visits.
Surgical v/s Non surgical periodontal therapy Achi Joshi
Both surgical and nonsurgical therapy produced improvement in the periodontal health.
Treatment approach was based on the comfort level of the practitioner.
In the late 60’s and continuing into the 70’s and 80’s, many series of longitudinal studies were conducted, aimed to document the immediate and most importantly long term clinical results following several types of periodontal therapy.
This document provides an overview of periodontal flap surgery techniques. It defines a periodontal flap as incising the gingival tissues to control or eliminate periodontal disease by elevating the gingiva and oral mucosa from underlying tissues for improved accessibility and visibility of bone and roots. The document discusses the classification, indications, advantages, and types of incisions for various flap techniques used in pocket therapy, including modified Widman flap, undisplaced flap, apically displaced flap, and distal wedge procedure. Healing processes and outcomes for different flap techniques are also summarized.
This document discusses various suturing techniques used in periodontal flap surgery. It begins with an introduction on the purpose of suturing flaps, which is to maintain the flap in position until desired healing. Resorbable sutures are preferred for patient comfort and elimination of removal appointments. The document then describes different suturing techniques like horizontal mattress suture, continuous independent sling suture, anchor suture, closed anchor suture, and periosteal suture. It provides details on their specific uses and how to perform each technique. A variety of suture materials, both resorbable and non-resorbable, are also listed.
The modified papilla preservation technique aims to improve primary closure and membrane coverage in interproximal regenerative procedures by carefully preserving the papilla during incisions, coronally positioning the buccal flap, and using the papilla to cover an implanted membrane. In a study of 15 patients, this technique achieved primary closure in 93% of cases and maintained membrane coverage in 73% of cases until membrane removal at 6 weeks.
This document provides an overview of splinting as a treatment for stabilizing mobile teeth. It defines splinting and discusses the history, objectives, indications, contraindications, and principles of splinting. It describes different types of splints including temporary, provisional, and permanent splints. Temporary splints are used until mobility is reduced and can include wire ligation, bands, or removable acrylic appliances. The goal of splinting is to decrease tooth movement, distribute forces, and stabilize teeth during and after periodontal treatment.
Splinting involves joining two or more teeth together to provide support and stabilization. It has been used in dentistry for thousands of years to treat injuries and mobility. Modern splinting uses various materials like wires, resins, and fibers placed intracoronally or extracoronally. Splints are indicated to stabilize mobile teeth from trauma, reduce forces during healing, or maintain arch integrity. They come in many forms like direct bonding splints, wire splints, night guards, and occlusal splints. The goal is to evenly distribute forces across multiple teeth while allowing function and hygiene.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
1. A periodontal splint is an appliance used to stabilize mobile teeth and promote healing. It prevents mobility during chewing and allows non-mobile teeth to heal faster.
2. Splints are classified based on the period of use, material type, and location on teeth. Common splints include direct bonding resins, intracoronal wires, and bite guards.
3. Principles of splinting include including healthy teeth, splinting around the arch, and ensuring proper plaque control and occlusion. Splints distribute forces and are indicated to stabilize mobility and trauma, but can hamper hygiene and unevenly distribute forces if not fabricated properly.
Preprosthetic surgery /certified fixed orthodontic courses by Indian dental a...Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable
The document discusses problem-based periodontal diagnosis and disease management. It defines key concepts such as health, disease, and the normal periodontium. The fundamental periodontal disease categories are gingivitis, periodontitis, and occlusal traumatism. Gingivitis involves gingival inflammation while periodontitis involves periodontal inflammation, attachment loss, and bone loss. Occlusal traumatism results from excessive force on teeth. Effective treatment requires classifying the disease based on these categories and identifying pertinent local and systemic etiological factors.
Pre prosthetic surgery /certified fixed orthodontic courses by Indian dental ...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Wiring techniques in maxillofacial surgerySyed Abuthagir
This document discusses various techniques for closed reduction of mandibular fractures including direct and indirect interdental wiring methods like Essig's, Gilmer's, and Risdon's wiring. It also covers arch bar fixation, circummandibular wiring, perialveolar wiring, and suspension wiring techniques like frontal suspension and circumzygomatic wiring. The advantages of closed reduction are that it is more conservative than surgery and can be used for medically compromised patients, but disadvantages include airway compromise, loss of function, decreased nutrition, and effects of prolonged intermaxillary fixation like joint adhesions and osteoporosis.
Dental veneers are custom shells made of tooth-colored materials that are bonded to the front of teeth to improve their color, shape, size or alignment, and can be made of either composite or porcelain; they are used to treat issues like discoloration, crooked teeth, gaps or cracks and improve the aesthetics and function of the smile. The document discusses the different types of veneers, their applications, benefits and risks, as well as the procedures for applying both composite and porcelain veneers.
The document discusses preprosthetic surgery procedures for modifying the oral anatomy to facilitate denture retention. It describes various ridge correction techniques like alveoloplasty and mylohyoid reduction. It also discusses ridge augmentation procedures for both the maxilla and mandible using autogenous bone grafts harvested from different sites or alloplastic grafts like hydroxyapatite. Complications of these surgical techniques are also outlined. The goal of these preprosthetic surgeries is to establish an optimal bony foundation with adequate height, width, and contour of the residual alveolar ridges to support dentures.
Dental veneers are thin shells that are bonded to the front of teeth to improve aesthetics or repair damage. There are three main types: conventional porcelain veneers, lumineers, and composite resin veneers. Conventional porcelain veneers require tooth structure removal and are fabricated from porcelain, providing very natural-looking results. Lumineers are extremely thin porcelain shells that can be bonded without tooth preparation. Composite resin veneers are made from dental composite but do not last as long as porcelain options. The document outlines the procedures for conventional porcelain veneers, including tooth preparation, temporaries, impressions, cementation, and finishing. Placement of lumineers is also described.
types and classification of dental implantsDesa Ghanavi
This document discusses types and classifications of dental implants. It describes 5 main classifications: 1) based on implant design, which includes blade, root form, subperiosteal, transosteal, and intramucosal implants; 2) based on attachment mechanism, which includes fibrointegration and osseointegration; 3) based on body design, including cylindrical, threaded, plateau, perforated, solid, and hollow implants; 4) based on surface, such as smooth, machined, textured, and coated surfaces; and 5) based on material, including metallic, ceramic, polymeric, and carbon implants. Key advantages of implants include maintaining bone height/width and improved stability, retention, and esthetics
This document discusses splinting of teeth. It defines splinting as joining two or more teeth into a rigid unit using fixed or removable restorations or devices. The document outlines various techniques for splinting teeth, such as extracoronal and intracoronal splinting using acid etch composite resin or wires. It discusses indications for splinting including stabilization of mobile or avulsed teeth. Ideal requirements for splints include immobilizing teeth, withstanding occlusal forces, and allowing for endodontic access if needed. The duration of splinting depends on the type of injury or treatment, ranging from 2-8 weeks generally.
Adjunctive role of Orthodontic Therapy in PeriodontologyNavneet Randhawa
This document summarizes the adjunctive role of orthodontic therapy in periodontology. Some key points:
- Orthodontic tooth movement can benefit adult patients by correcting tooth malposition that makes cleaning difficult and increases periodontal disease risk.
- Light, prolonged orthodontic forces can move teeth without damaging tissues if excellent oral hygiene is maintained. However, some tissue necrosis is unavoidable.
- Tooth movement through cortical bone can create dehiscences if the bone is not remodeled quickly enough in front of the tooth.
- Tooth movement into existing infrabony pockets or compromised bone areas does not further periodontal attachment loss if the area is first treated and hygiene is
This article discusses the clinical management of mobile teeth through splint therapy. It defines splinting and reviews the relationship between tooth mobility and occlusion. Increased tooth mobility may be managed through occlusal adjustment alone, while increasing mobility requires periodontal treatment followed by possible splinting or extraction. The article describes the indications for splinting, such as multiple mobile teeth from bone loss or increased mobility with pain. It also defines provisional and definitive splints and their purposes in stabilizing teeth temporarily or long-term. The goal of splint therapy is to restore function and comfort through a stable occlusion.
This document provides a summary of a case report from Periodontics of the Desert regarding the benefits of flap access in treating periodontal disease. Flap access allows for direct visualization of the root surface and access for calculus removal. It summarizes that flap access permits thorough debridement and smoothing of root surfaces, eliminating periodontal pockets and regenerating lost bone and soft tissue for improved periodontal health.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Splinting part i /certified fixed orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
This document discusses furcation involvement, which refers to the progression of periodontal disease between the roots of multi-rooted teeth. It first defines furcation involvement and notes that it presents challenges for diagnosis and treatment. It then discusses the etiology of furcation involvement, including plaque-associated inflammation and pulpo-periodontal disease. It also describes Glickman's classification system for the horizontal component of furcation involvement, including four grades based on the amount of interradicular bone loss present. The presence of furcation involvement can indicate advanced periodontitis and affect the prognosis for the affected tooth.
This document discusses the interface between endodontic and orthodontic treatment. It addresses several topics:
1) How orthodontic tooth movement can affect the pulp and cause inflammation, changes in blood flow, and neural responses. Teeth with mature roots or a history of trauma are more at risk.
2) How orthodontic forces can cause root resorption in a small number of patients, particularly of maxillary incisors. Resorption may be similar in root-filled and vital teeth.
3) That endodontically treated teeth can be moved orthodontically similarly to vital teeth, though replacement resorption or injury to tissues could prevent movement. Maintaining the apical seal
Periodontal changes in ortho treatment/certified fixed orthodontic courses by...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Dental trauma an overview of its influence on the management of orthodontic t...djoka
This document discusses the influence of dental trauma on orthodontic treatment. It provides an overview of factors orthodontists should consider when moving traumatized teeth, including the prevalence of dental trauma, assessment and diagnosis of trauma, and evidence on orthodontic tooth movement of vital and root canal treated teeth. It also discusses prevention of dental trauma, effects of orthodontic tooth movement on traumatized teeth like pulp vitality and root resorption, and recommendations for radiographic monitoring of traumatized teeth during orthodontic treatment.
This document discusses joint restorative orthodontic treatment and summarizes several situations where combined orthodontic and restorative treatment may be required, including uprighting tilted molars, managing peg laterals or other diminutive teeth, managing traumatized teeth before or during orthodontic treatment, treating periodontal patients, managing cleft lip and palate patients, and treating orthognathic patients. It also discusses the impact of endodontically treated teeth, the role of orthodontics in prosthodontic treatment, tooth surface loss, and modification of tooth color.
This document discusses aggressive periodontitis, including its definition, classification, clinical characteristics, diagnostic criteria, and treatment modalities. Aggressive periodontitis is defined as a rare, severe form of periodontitis characterized by early onset and familial aggregation. It can be localized or generalized. Treatment involves nonsurgical and surgical therapies like scaling and root planing as well as adjunctive systemic or local antibiotics. Maintaining frequent periodontal maintenance visits is important for long-term disease control.
Orthodontic Correction of Midline Diastema in Aggressive Periodontitis: A Cli...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Root Resection – A Dark Horse in Management Offurcation Involved Maxillary Mo...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This document discusses dental splints, including their definition, rationale, requirements, classifications, indications, and contraindications. It notes that splints are used to immobilize and stabilize mobile or loose teeth. They help reduce tooth mobility, distribute forces evenly, preserve arch integrity, and provide psychological benefits. Splints are classified based on duration, materials used, and location. They are indicated when tooth mobility impairs function or comfort, while contraindications include poor oral hygiene or insufficient firm teeth for stabilization. The document reviews different splint designs and their advantages of stabilizing teeth, but also notes disadvantages like hindering oral hygiene.
The document discusses the biomechanical implications of an edentulous or toothless state. It considers factors like modifications in areas of support between natural dentition and complete dentures, functional and parafunctional considerations, changes in facial height and the temporomandibular joint, and cosmetic changes and adaptive responses. Specifically, it compares the support mechanisms and forces involved for natural teeth versus complete dentures, noting things like reduced maximum bite forces for denture wearers. It also discusses changes that occur in the residual alveolar bone after tooth extraction and denture use, like progressive bone loss over time.
This document discusses the interrelationship between orthodontics and periodontics. It notes that orthodontic tooth movement can benefit periodontal patients by improving access for cleaning and potentially eliminating the need for osseous surgery in some cases of bone defects. However, it also acknowledges that orthodontic treatment can potentially cause harmful effects like gingival recession, root resorption, or reduced alveolar bone height if excessive forces are used. The document provides details on how different malocclusions and orthodontic appliances can influence plaque accumulation and periodontal health. It emphasizes the importance of a multidisciplinary approach between orthodontists and periodontists to properly treat patients with periodontal and orthodontic needs.
An overdenture is a removable dental prosthesis that covers and rests on one or more remaining natural teeth, tooth roots, or dental implants. Overdentures help preserve remaining alveolar bone and maintain vertical dimension of occlusion. They provide better retention, stability, and proprioception compared to conventional dentures. Overdentures can be tooth-supported, implant-supported, or a combination of both. They require meticulous oral hygiene to prevent caries and periodontal disease.
This document discusses trauma from occlusion (TFO), which refers to pathologic alterations or adaptive changes in the periodontium resulting from excessive occlusal forces. It covers the historical understanding of TFO, definitions, classifications, clinical features, and the periodontal response and adaptation to excessive forces. It also examines Glickman's concept of co-destruction between TFO and plaque-associated periodontal disease. The document provides details on injury, repair, remodeling processes in the periodontium in response to TFO.
This document discusses splinting of traumatized teeth. It defines splints and their requirements, and describes how splinting influences dental tissues. Different types of splints are described, including composite and wire splints, fibre splints, and titanium trauma splints. Guidelines are provided for splint indications, contraindications, application steps, and recommendations for splint type and duration depending on the specific dental trauma. Factors such as injury classification, healing timeframes, and risk of ankylosis are considered for splint removal timing.
This document provides an overview of the management of dental traumatic injuries in paediatric patients. It discusses the classification, aetiology, epidemiology, clinical evaluation and treatment protocols for various injuries. Key points include:
- Dental trauma is common in children aged 2-4 and 7-10 years old, often due to falls or collisions.
- Injuries range from enamel fractures to luxations and avulsions and are classified systems like Andreasen.
- Clinical evaluation involves medical history, extraoral/intraoral exams, sensitivity tests, and radiographs to diagnose the injury.
- Treatment depends on the injury but may include allowing re-eruption, extraction, or restoration with composite for fractures.
Similar to 63668245 dental-update-periodontal-splinting-in-general-dental-practice (20)
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Our backs are like superheroes, holding us up and helping us move around. But sometimes, even superheroes can get hurt. That’s where slip discs come in.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
1. P E R I O D O N T I CPSE R I O D O N T I C S
Periodontal Splinting in General
Dental Practice
SOPHIE J. WATKINS AND KENNETH W. HEMMINGS
(drifting) of periodontally involved
Abstract: Splinting periodontally involved teeth is a technique that has been in use for teeth.
centuries. This article gives a brief history and review of the literature concerning periodontal
splinting and outlines the rationale and indications for the correct application of periodontal
splinting in modern dental practice. The common types of splint and clinical techniques A variety of factors can contribute to
involved are described, addressing some of the clinical problems. tooth mobility, including trauma;
periapical or periodontal inflammation,
Dent Update 2000; 27: 278-285 decreased periodontal support and
pathologically increased occlusal load.
Clinical Relevance: Although periodontal splinting can be a useful tool in specific These clinical entities have been
situations, it can be inappropriately applied and may create some technical difficulties in
clinical management. It is therefore important that the clinician is well aware of the potential
described as primary or secondary
hazards involved in carrying out this type of treatment. The importance of careful periodontal occlusal trauma (Table 1).3 Most
monitoring and maintenance following splinting cannot be overstressed, because ongoing commonly, mobility of teeth is caused
disease can be masked and access for hygiene compromised around periodontally involved by loss of support as a result of
teeth. periodontal disease, although it is
important to be aware that more than
one factor may be involved (Figure 1).
Diagnosis and clinical management
D ental splinting involves joining the
crowns of two or more teeth by
more or less rigid means; so that their
indicated that the appliance had been
placed on a living patient and is thus
one of the earliest known dental
should take this into account.
When patients present with
periodontal disease and mobile teeth,
relative movement is restricted and the prostheses, dated at around 2500 BC. efforts should be directed at resolving
forces applied to one of the splinted Tooth transplantation has been the periodontal disease before
teeth are transmitted to the root systems described as early as the ninth century considering occlusal management if the
of all the linked teeth.1 This article will AD, and ligatures of silk, gold and silver teeth are to be preserved. In the absence
concentrate on the use of splints in were used in the tenth and eleventh of periodontal disease the most likely
periodontal disease. centuries by the Spanish physician cause of tooth mobility is primary
Splinting has been used as a form of Albucasis. Splinting loose teeth occlusal trauma and therefore
dental treatment for centuries, and is one remained a popular treatment for periodontal treatment would be
of the earliest known examples of mobility well into the twentieth century, inappropriate. Rare causes of tooth
dentistry: excavations of Egyptian and was used as an integral part of mobility – such as abnormal root
remains at Gizeh in the early 1900s periodontal treatment planning by many morphology, iatrogenically shortened
included a wire ligature around the clinicians.2 roots following apical surgery, excessive
cervical margins of lower left second Splinting is still used in a wide variety loading during orthodontic movement,
and third molar teeth, the roots of the of clinical situations: root resorption or intrabony pathology –
third molar having been resorbed. should not be forgotten.
Calculus around both the teeth and wire q traumatic injuries to teeth; In the past it has been thought that
q TMJ dysfunction; mobility adversely affects periodontal
q prevention of toothwear; destruction and healing. Fleszar, as
Sophie J.Watkins, BDS, FDS (Rest Dent) RCPS,
q permanent post-orthodontic recently as 1980,4 found that decreased
MSc, Senior Registrar in Restorative Dentistry, retention; mobility did in fact improve the
and Kenneth W. Hemmings, BDS, MSc, MRD q pre-restorative treatment response of affected teeth to periodontal
RCS, FDS RCS, Consultant in Restorative (identification of retruded contact therapy. The temptation has been in the
Dentistry, Department of Conservative Dentistry, position, RCP); past to ‘treat’ periodontally involved
Eastman Dental Hospital, London.
q excessive movement or migration teeth by early splinting. However, the
278 Dental Update – July/August 2000
2. P E R I O D O N T I C S
Definition The lesion that develops in the periodontium as a result of excessive occlusal teeth to less mobile teeth by splinting
forces during functional and parafunctional activities. lies in the fact that this results in a more
favourable distribution of the forces
Primary The effect of abnormal occlusal forces on periodontal tissues in the absence of
inflammation. A physiological adaptation of the periodontium results in acting on the teeth concerned, thus
mobility with no periodontal pocketing and radiographically a widened protecting those with reduced
periodontal ligament. periodontal support.
Secondary The effect of occlusal forces on teeth where the periodontium is already Indications for splinting are:
weakened by inflammation, giving rise to more complex breakdown of the
periodontal structures. q drifting;
Table 1. Occlusal trauma.3 q improving comfort and function;
q enhancing periodontal healing.
lack of correlation between mobility or stable jaw relationships with stable Drifting
occlusal trauma and periodontal disease/ simultaneous multiple interocclusal Drifting teeth are a common problem in
healing has been demonstrated by many contacts and smooth excursive patients with periodontally diseased
authors.5-10 It is now widely accepted movements unimpaired by occlusal teeth, and may result from normal forces
that the resolution of inflammation is the interferences’, and is described in detail acting on teeth with compromised
most important factor in the treatment of by Wise.14 It may involve the adjustment periodontal support which can no longer
chronic periodontitis. Although trauma of multiple tooth surfaces to achieve an withstand these forces.15 If the patient is
from occlusion may modify the ‘ideal occlusion’ and is therefore a concerned about appearance following
progression of existing periodontitis,11 it significant undertaking and is not drifting, after the disease has been
does not initiate or aggravate recommended to the inexperienced controlled the teeth can be repositioned
gingivitis.12 Kantor, Polson and Zander13 practitioner. A trial adjustment on study orthodontically. The result is, however,
showed that alveolar bone is regenerated casts may confirm that the procedure is inherently unstable and splinting is
after removal of both inflammation and not excessively destructive of tooth generally advisable to prevent relapse.
traumatic factors. tissue and the aims of the adjustment are Indeed, the position of drifted teeth that
attainable (Figure 2). are not treated orthodontically can be
prevented from worsening by the
CLINICAL MANAGEMENT provision of a splint.
The options for the clinical management Extraction Similarly, adverse tooth movements
of mobile teeth include: It is important to be able to recognize such as over-eruption or tilting can be
whether a tooth is conservable or not prevented by splinting.16 Splinting in
q no treatment; and to consider whether retaining a this situation can be provided by a fixed
q occlusal adjustment; certain tooth may be harmful to or removable prosthesis and, although
q extraction; neighbouring teeth. If this is the case, this may not be the primary function of
q splinting. extraction is the best course of action. the prosthesis, it should be taken into
account whilst designing the appliance.
It is important to stress that, if a fixed
SPLINTING splint or a removable appliance is
No Treatment The scientific basis for joining mobile provided, this may have an adverse
If the clinician considers the situation
unlikely to deteriorate, this option may
be acceptable to many patients. a b
However, regular review is
recommended.
Occlusal Adjustment
If an occlusal aetiological factor has
been positively identified, occlusal
adjustment may be indicated. Localized
adjustment to a few teeth is relatively Figure 1. Radiographs demonstrating occlusal trauma. (a) Root treated upper first molar
straightforward. Occlusal equilibration bridge abutment presented with distal and furcation pocketing of 6–7 mm. There was also
has been described as ‘planned distal caries. (b) Following root resection the pocketing was reduced to 4 mm, but mobility
alteration of occlusal surfaces to provide increased with widening of the periodontal ligament on the remaining (mesial) root.
Dental Update – July/August 2000 279
3. P E R I O D O N T I C S
but increase accumulation of plaque
a b around the abutment teeth. Fixed splints
may compromise the ability of patients
to use interdental cleaning aids.
Therefore, care must be taken in
designing and making splints with good
physiological contour to allow easy
patient maintenance. Patients need
regular instruction on oral hygiene and
Figure 2. Trial occlusal adjustment on study casts. (a) The casts mounted in the retruded axis encouragement to maintain high levels
position demonstrate a large non-working side interference between /7 and /8 in right lateral of plaque control.
excursion (arrowed). (b) Trial adjustment of the casts. The occlusal surfaces of the casts are
painted before performing the trial adjustment. In this way it is possible to assess the necessary Periodontal Monitoring
removal of tooth tissue, allowing the operator to assess how destructive this would be before
carrying out the procedure clinically. In this case, extensive tooth reduction would be required to Fixed splinting of teeth prevents clinical
eliminate the interference, making it too destructive to carry out clinically without recourse to assessment and reduces patient
crowns or onlays. awareness of increasing tooth mobility.
Occasionally, if patients are lost from
regular review, they may perceive a
problem only when gross periodontal
effect on the patient’s ability to maintain periodontal ligament (rigid splinting of destruction has occurred and the whole
good oral hygiene. Unless excellent root or alveolar fractures is still splint is mobile. These potential
plaque control is maintained, the recommended17). Rarely, mobile teeth complications should be stressed to
periodontal condition may not be stable undergoing periodontal surgery require patients. Effective recall systems should
and could result in breakdown. temporary splinting until initial healing be in place and regular clinical and
Furthermore, a fixed splint may mask is complete. However, questions should radiographic review carried out.
this deterioration: an added danger of be raised concerning the prognosis of
which the operator must be aware. such teeth and the advisability of Dental Caries
Meticulous monitoring and maintenance surgery. The advantages of splinting If plaque control is inadequate in
is therefore essential. have been contested; Renggli et al.18–20 combination with dietary factors, fixed
showed no difference in mobility before or removable splints may encourage
and after wearing a splint. Indeed, many dental caries in a susceptible patient.
Comfort and Function authors have found that increased Cementation failure of fixed splints
Mobile teeth can be very distressing to mobility/occlusal trauma may not be may go unnoticed until gross dental
the patient and may often be the detrimental to the health of the caries is observed. Prevention in the form
presenting complaint. Extreme mobility remaining supporting tissues.19,20 of fluoride supplements, diet counselling
can interfere with speaking and eating. It and regular prophylaxis are therefore
must be stressed that active disease important, as well as regular review with
should be controlled as far as possible Disadvantages of Splinting careful inspection of margins allowing
and the patient capable of maintaining a early maintenance if required.
good standard of oral hygiene before Plaque Control
further treatment is considered. Removable splints allow the patient to Maintenance of Splints
Although a reduction in inflammation practise normal plaque control measures Biological failure of splints is usually
may result in a decrease in mobility to
acceptable levels, in the presence of
severe periodontal involvement this may
not be complete and mobility may still a b
constitute a significant problem. In such
cases, splinting may be the only way of
resolving the situation.
Periodontal Healing
Post-trauma splinting of luxated or
subluxated teeth, allowing some
physiological loading of the teeth, is Figure 3. (a) Deep overbite causing trauma to the labial gingivae of the lower incisors. (b) A
soft splint fitted over the maxillary teeth protects the gingivae.
beneficial to the healing of the
280 Dental Update – July/August 2000
4. P E R I O D O N T I C S
Hard Acrylic Occlusal Splint: Occlusal
a b splints can be useful in the diagnosis of
occlusal trauma in periodontal patients
and for retention of drifting teeth
(Figure 4).
There are many descriptions of
occlusal splints in the literature. The
term covers full coverage, partial
coverage and repositioning appliances,
Figure 4. Hard maxillary occlusal splint. (a) Facial view. (b) Palatal view, showing the occlusal and are used in diagnostic and
scheme adjusted to provide even contacts around the arch in the retruded axis position (black therapeutic procedures as outlined
marks) and anterior guidance with immediate posterior disclusion in excursions (red marks). below:
q TMJ dysfunction;
q prevention of toothwear;
the result of dental caries, progressive progressive drifting despite treatment. q to facilitate restorative procedures
periodontal disease or endodontic In borderline cases, where the by establishing a stable retruded
complications. All restorations have a outcome of treatment cannot be contact position;
finite lifespan and will eventually wear predicted, a provisional splint may be q assessment of patient tolerance to
out unless more significant mechanical provided. an increase in occlusal vertical
failure occurs first. The very nature of Describing appliances as ‘permanent’ dimension;
splinting means that splints are large is a relative term because it must be q stabilization of tooth position.
and expensive prostheses. If prompt remembered that all restorations will fail
attention is not given to a mechanical in time. It is a term that can be Partial-coverage splints are not
failure there is a significant risk of misunderstood by patients and should be recommended for long-term use. There
mobile teeth drifting away from the used with caution. is a significant risk of over-eruption of
splint. Repositioning or replacement of unopposed teeth, which leads to
such teeth will complicate maintenance. Removable Splints disruption of the occlusal plane in one or
A biological and financial cost/benefit The use of removable splints is simple, both arches and is difficult to rectify.
analysis of splinting teeth should be reversible and inexpensive. The We therefore favour a full-coverage
carried out and compared with other splinting of teeth may be less rigid in maxillary hard acrylic occlusal splint
treatment options before confirming the removable splinting than using fixed providing even contacts in the retruded
most appropriate treatment. alternatives, but they have the axis position, and anterior guidance in
advantage of facilitating oral hygiene.19 protrusive and lateral excursions. In
They are usually the most appropriate patients with Angles class III occlusal
Types of Splint splints for use in emergencies and relationship, it is often easier to
Splints used in clinical practice can be diagnostic procedures. construct one for the mandibular arch.
categorized as either removable or fixed. Vacuum-formed Splints: These This type of appliance is more time-
The descriptive terms temporary or appliances are temporary or provisional consuming to construct than the vacuum-
provisional refer to the durability of the in nature. They are most useful in formed acrylic splint as mounted study
appliance or the intended use. reducing the symptoms in traumatic casts are required for laboratory
occlusions when incisal edges of
Temporary/Permanent/Provisional anterior teeth occlude directly on the
Temporary splints can be defined as a gingivae or palate (Figure 3). These
splint intended for short or medium-term splints are also useful in the diagnosis of
use, which may or may not be replaced TMJ dysfunction, when symptoms are
by a permanent appliance. They may be usually alleviated by the use of a splint.
used to stabilize the mobile teeth during In parafunctional patients the splints
surgery. Examples of temporary splints will show early deterioration and will
include acrylic and wire splints21 and often perforate on the occlusal surface.
vacuum-formed splints, which are The splint is usually best tolerated in
described later. the upper arch. The alginate impression
Permanent splints, such as linked is cast in the laboratory and a vacuum-
Figure 5. Removable orthodontic retainer with
restorations, may be used for teeth that formed polythene splint of 2–3 mm in acrylic on the labial bow, adapted to the labial
cannot maintain stability after treatment, thickness is made. Minimal adjustments surfaces of the teeth. This improves control over
or teeth with increasing mobility or are made for patient comfort. the tooth position during the retention phase.
282 Dental Update – July/August 2000
5. P E R I O D O N T I C S
advantageous (Figure 6). A new
a b technique, using flexible ceramic
bonding fibre ribbon or cords such as
GlasSpan or Ribbond (Sigma Dental
Systems, Heideland 22, Germany)
instead of wire to reinforce the
composite resin gives a more aesthetic
and useful alternative (Figure 6). Where
a palatal appliance is provided, it is of
obvious importance to ensure that the
c Figure 6. (a) Twistflex® (Wildcat® Wire bulk of the splint does not interfere with
GAC International Inc. Central Islip, NY inter-occlusal contacts or with guidance.
11722-1402, USA) orthodontic retainer, Resin-Bonded Splints: Laboratory-
passively adapted to the palatal surfaces and fabricated splints may offer a more
bonded to the teeth using composite resin.
long-term solution to the chairside-
(b) GlasSpan® (Exton, PA, USA) flexible
ceramic fibre can be used as an alternative prepared splints described above. They
to wire for reinforcing the composite resin are less bulky and can be placed in most
splint (c) Finished result. situations, allowing greater occlusal
control. Rochette originally described a
perforated resin-bonded splint (Figure
7) in 1973.26 The technique was adapted
construction. The use of a facebow Orthodontic Retainer: Drifted and refined for tooth replacement. The
recording and a semi-adjustable periodontally involved teeth can be basic laboratory and chairside
articulator considerably reduces repositioned orthodontically. Long-term procedures are now commonly used and
chairside adjustment of the splint.3 If retention is necessary to prevent relapse. well known.27–29
this is not possible, the RCP jaw Removable orthodontic retainers (Figure Today, a non-perforated framework
registration must be at the correct 5) can be used in long-term retention, (Figure 8) is recommended for use with
occlusal vertical dimension (2–3 mm but are associated with periodontal modern Bis-GMA (e.g. Panavia 21) or
increase) and adjustment of the splint inflammation unless plaque control is 4-META cements (e.g. Superbond
in excursions will be necessary. exemplary. They are unaesthetic, but C&B ). Retention should be optimized
A well made splint can be retained by may be acceptable for night wear. by providing maximum coverage of the
a friction fit. Additional retention can available enamel, but tooth preparation
be provided by ball-ended clasps or Fixed Splints should be kept to a minimum. Parallel
Adams cribs as direct retainers, usually Composite/Acrylic and Wire: This guide planes also allow accurate
on the first molars. Long-term occlusal temporary or semi-permanent splint is insertion and increase the bonding area
stability of the splint requires several fabricated using a chairside, or direct, by removing undercut areas – and as a
adjustments as mandibular technique. It is reversible, and relatively result can increase retention. Proximal
repositioning occurs. Good service strong, stable and aesthetic. The grooves and parallel walls do involve
would be considered to be 2–3 years of operative technique for making this type extensive tooth preparation (which is
use. In a bruxist patient, more frequent of splint has been widely described21–24 not usually necessary in most situations
replacement will be required as a result and there are many variations. The in the authors’ opinion). In the
of wear or fracture of the acrylic. technique involves adapting a wire, periodontal patient with anterior
mesh or other former to the teeth to be
splinted and covering it with composite
resin etched to the enamel. The wire
may be twisted around the teeth as a
ligature or adapted to the palatal
surfaces of the teeth, as long as it is
passive in order to avoid orthodontic
movement. Rosenberg described a
variation using orthodontic grid material
and acrylic.25 Using composite resin
alone to link the teeth is likely to lead to
early failure at contact points, as the
Figure 7. Perforated resin-bonded splint, as material is brittle.23 A linking wire Figure 8. Resin-retained splint with a non-
described by Rochette.26 provides flexibility and is therefore perforated framework.
Dental Update – July/August 2000 283
6. P E R I O D O N T I C S
for resin-bonded splinting also apply to
a b conventional crown and bridgework. In
addition, it is often difficult to obtain
perfect impressions of multiple tooth
preparations within a single impression.
The use of a pick-up procedure allows
the dies of multiple abutment teeth to
be located on a single working cast,
and allows the opportunity to overcome
Figure 9. (a) Periodontally involved teeth may cause problems during impression taking due to the problems of excessive tooth
their mobility and the large embrasure spaces, which may cause difficulty in removing the mobility if transfer copings (e.g. acrylic
impression. (b) A temporary splint made of pink acrylic resin Triad visible light cure reline bonnets) are linked passively before
material (Dentsply International Inc., York, PA, USA) is adapted to the labial surfaces of the taking a locating impression (Figure
teeth to stabilize them, and soft wax is placed in the embrasure spaces and undercuts to
prevent the impression material engaging deep undercuts. 11).
It is wise to verify the accuracy of the
working casts before committing your
technician to extensive laboratory
localized or generalized recession, it consuming to prepare and therefore work. This can be simply achieved by
can be difficult to mask interproximal costly in chairside and laboratory time. using a bite fork lined with compound
metal connectors. For splint rigidity, it Parallel and non-undercut preparations and refined with temporary cement.
is rarely wise to reduce connector of multiple teeth are demanding and are The indentations created by the teeth
height below 3 mm. Composite resin destructive of tooth tissue, and should correspond to those on the
additions can be used to cover movement of the abutments during working cast (Figure 12).
unsightly metal. cementation can lead to poorly fitting In common with any extensive
Practical points: margins and failure (Figure 10a). restorative dentistry, maintenance is of
Telescopic crowns, or the use of paramount importance. It must be
q Impression taking and cementation copings and a superstructure, can remembered that splinting teeth can
of restorations can be problematic provide a useful alternative (Figure often delay the presentation of
when teeth are mobile. Temporary 10b,c). Maintenance and tooth loss can mechanical and biological failures.
splinting of teeth and the use of a more easily be accommodated than Late diagnosis of dental caries,
low-viscosity impression material with conventional splinting, but cementation failure and further
can be useful in overcoming some aesthetics and periodontal health can periodontal breakdown may result in
of these problems. Composite be compromised due to increased bulk difficult maintenance, if not
resin, acrylic (Figure 9a) or of the superstructure. catastrophic failure. Patients require
impression compound can be The practical points mentioned above effective recall, careful review and
useful temporary splinting
materials.
q Interdental spacing often needs
blocking out with soft wax to a b
prevent impression material
engaging deep undercuts. This
facilitates removal of the
impression, and not the teeth
(Figure 9b)!
q All luting cements perform best in
thin section, thereby increasing the
longevity of the restoration. Great
care must be exercised to ensure c
teeth are held intimately in contact Figure 10. Linked crowns (a) can be
with the splint during cementation. difficult to cement due to independent
movement of the abutment teeth leading to
Splinted Conventional Crown and poor marginal fit and failure. Gold copings
(b) with telescopic crowns (c) facilitate
Bridgework access for maintenance of abutment teeth
Splinted crowns still have a place when splinted crowns are used.
where the teeth are heavily restored.
However, these splints are time-
284 Dental Update – July/August 2000
7. P E R I O D O N T I C S
crown and bridge procedures. Holland: Dental equilibrium between forces acting on a tooth
Center for Postgraduate Courses, 1985; p.25. and the resistance of the supporting tissues).
4. Fleszar TJ, Knowles JW, Morrison EC, Burgett Angle Orthod 1978; 48: 175–186.
FG, Nissle RR, Ramfjord SP. Tooth mobility and 16. Love WD, Adams RL. Tooth movement into
periodontal therapy. J Clin Periodontol 1980; 7: edentulous areas. J Prosthet Dent 1971; 25: 271–
495–505. 278.
5. Ericsson I, Lindhe J. Lack of significance of 17. Andreasen JO, Andreasen FM. Textbook and
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Figure 11. Acrylic resin Duralay® (Reliance occlusion, co-destructive factors in chronic 19. Renggli HH, Schweizer H. Splinting of teeth with
Dental Mfg. Co., Worth, Illinois, USA) bonnets periodontal disease. J Periodontol 1963; 34: 5– removable bridges. Biological effects. J Clin
are placed over the teeth and passively linked 10. Periodontol 1974; 1: 43–46.
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to one another during impression taking. (Slide The effect of occlusal forces on healing with fixed bridges: biological effect. J Oral Rehabil
courtesy of Mr Alex Gow, Specialist Registrar in following mucogingival surgery. J Periodontol 1984; 11: 535–537.
Restorative Dentistry, Eastman Dental Hospital.) 1966; 37: 319–325. 21. Clark JW, Weatherford TW, Mand WV. Wire
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from occlusion on reduced but healthy 371–375.
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prompt intervention to preserve what 1976; 3: 110–122. composite resin intracoronal splinting: Rationale
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CONCLUSIONS 3(2): 81–93. Am Dent Assoc 1974; 89: 1137–1141.
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The value of splints in periodontal progressive tooth mobility on destructive periodontally involved teeth. Br J Orthodont 1990;
therapy has been called into question in periodontitis in the dog. J Clin Periodontol 1978; 17: 29–32.
5: 213–225. 25. Rosenberg S. A new method for stabilization of
the last decade, but may be indicated in 12. Svanberg G. Influence of trauma from the periodontally involved teeth. J Periodontol 1980;
some circumstances. It is important to occlusion on the periodontium of dogs with 51: 469–473.
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with thorough maintenance following 15. Proffitt W. Equilibrium theory revisited. Factors 29. Tay WM. Resin bonded bridges. 1. Materials and
splinting. In this context, it is important influencing the position of teeth (i.e. methods. Dent Update 1988; 15: 10–14.
to ensure that the patient is aware of
the potential pitfalls in order to
safeguard compliance with continued
monitoring and maintenance. a b
The indications for splinting are
usually limited to improving patient
comfort and controlling tooth
movement in teeth with periodontal
health but reduced support. Clinical
techniques have been developed to help
the practitioner provide such treatment
or consider referral to a specialist.
c
Figure 12. A facebow bitefork, refined with
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