1. Periodontal splinting involves immobilizing teeth using various appliances to help stabilize mobile teeth and distribute forces. 2. There are many types of splints including temporary, provisional, and permanent splints made of materials like wire, bands, acrylic, and composites. 3. Splinting has a variety of objectives like redistributing forces on teeth, preventing migration, and restoring function during periodontal treatment.

1. PERIODONTAL SPLINTING
DR. THASLIM FATHIMA N.
SECOND YEAR POSTGRADUATE
DEPARTMENT OF PERIODONTOLOGY

2. INTRODUCTION
The ultimate goal in successful management
of mobile teeth is to restore function and
comfort by establishing a stable occlusion
that promotes tooth retention and the
maintenance of periodontal health. MM.DD.20XX2

3. Definitions
A splint is a device used to immobilize the teeth, and it is
one of the oldest form of aids to periodontal therapy.
(Hallmen WW )
Any apparatus or device
employed to prevent motion
or displacement of fractured or
movable parts.
(Glickman1972)
An appliance for
immobilization or stabilization
of injured or diseased parts.
(AAP 1996)
In dentistry stabilization or
splinting commonly refers to
tying teeth together either
unilaterally or bilaterally to
convey increased stability to
the entire unit
Glossary of
Periodontal
Terms (1986)
An appliance designed to
stabilize mobile teeth.
3 MM.DD.20XX

4. HISTORY
Tooth splinting have been accomplished since
ancient civilizations to decrease tooth mobility,
to replace missing teeth & to improve form,
function, and esthetics.
4 MM.DD.20XX
A Phoenician mandible from 500BC and another Phoenician
prosthetic appliance was found from 400 BC in modern day
Lebanon that is comprised of two carved ivory teeth attached
to four natural teeth by gold wire.

5. MM.DD.20XX5
HISTORY
• Archeological excavations of the
Etruscan society (Eighth century BC
to the first century AD) have found
evidence of their use of wire ligation
and gold bands to stabilize teeth.
In the last 50 years, scientific
principles evolved to treat patients
with compromised dentitions.
• In early 1700s
Fauchard attempted
tooth ligation.
• Hirschfeld (1950) was one of the first
modern periodontal authors to advocate
ligation of periodontally diseased teeth
using either stainless steel wire or silk.
His technique was extracoronal and
involved only the anterior teeth.

6. WHEN TO SPLINT?
o Cohen and Chacker have noted, "When
large areas of attachment apparatus have
been destroyed, the artificial support
offered by temporary stabilization may allow
a new, healthy tooth-bone relationship to be
established.
o Therefore it would seem advisable that
when the treatment plan is being formulated
the need for stabilization be determined on
the basis of the nature and extent of the
destructive process present.
6 MM.DD.20XX

7. o Root planing, curettage, oral hygiene, and surgery
may cause teeth to tighten as inflammation is
resolved.
o Occlusal adjustment, periodontal orthodontics,
and restorative dentistry may alter occlusal
relationships and redirect forces, thereby reducing
traumatism.
o This may result in the teeth becoming firmer.
o Increasing the support of loose teeth may also
increase their firmness, the device used for such
treatment is the splint.
7 MM.DD.20XX

8. INCREASED TOOTH
MOBILITY.
INCREASED VERSUS INCREASING TOOTH MOBILITY:
8 MM.DD.20XX
• This process is the adaptation of the periodontium to occlusal forces
that may not necessarily be considered pathologic.
• In the absence of inflammation, mobile teeth with a complete and
healthy connective tissue attachment can be maintained.
• The radiographic appearance of a widened periodontal ligament
(PDL) space coupled with a clinical diagnosis of increased tooth
mobility may merely be manifestations of adaptive changes to
increased functional demand.
• Removal of the excess occlusal load through equilibration and
perhaps, conventional splint therapy can decrease and, often at
times, eliminates this tooth mobility.

9. INCREASING TOOTH
MOBILITY.
INCREASED VERSUS INCREASING TOOTH MOBILITY:
9 MM.DD.20XX
• This clinical condition is best managed by treating any localized
inflammation, performing an occlusal equilibration, and perhaps stabilizing
or splinting the affected mobile teeth.
• Those individuals diagnosed with increasing tooth mobility must first receive
periodontal therapy.
• Treatment should include an occlusal analysis and equilibration, if needed,
followed by a reevaluation for extraction or splinting of the affected teeth.

10. INDICATIONS FOR SPLINTING
(Belikova and Petrushanko, 2013;
LEMMERMAN 1976 :
As part of occlusal therapy
O As a prevention of tooth drifting
O As a replacement for missing teeth
O As a treatment of secondary occlusal
trauma
Restore patients’ masticatory function and comfort
•Stabilize teeth with increasing mobility that have not responded to occlusal
adjustment and periodontal treatment
•Facilitate periodontal instrumentation and occlusal adjustment of
extremely mobile teeth
• Prevent tipping or drifting of teeth and extrusion of unopposed teeth
• Stabilize teeth, when indicated, following orthodontic movement
• Create adequate occlusal stability when replacing missing teeth
• Stabilize teeth following acute trauma
10 MM.DD.20XX

11. Contraindications:
•
11 MM.DD.20XX
• Occlusal stability and optimal
periodontal conditions cannot be
obtained (Nyman and Lang, 1994)
• Poor oral hygiene
• Insufficient number of non-mobile teeth
to adequately stabilize mobile teeth
• Presence of occlusal interference
• High caries activity
• Overall poor prognosis
• Crowding and malaligned teeth that may
compromise the utility of splint

12. Clinical rationale for
splinting
(Friedman, 1953)
To control parafunctional or bruxing forces.
Stabilization of mobile teeth during surgical,
especially regenerative, therapy.
Friedman believed that unless splinted, mobile
teeth may not respond as well to reattachment
procedures
(Lindhe and Nyman, 1977).
The main objective and rationale of splinting and
occlusal adjustments are to control the progressive
tooth mobility.
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13. IDEAL SPLINT
13 MM.DD.20XX

14. OBJECTIVES OF
SPLINTING
 Rest is created for the supporting tissues giving them a favorable condition for repair of trauma.
 Reduction of mobility immediately and hopefully permanently. In particular jiggling movements
are reduced or eliminated.
 Redirection of forces - redirected in a more axial direction over all the teeth included in the
splint.
 Redistribution of forces - ensures that forces do not exceed the adaptive capacity.
Forces/received by one tooth are distributed to a number of teeth.
 Restoration of functional stability - functional occlusion stabilizes mobile abutment teeth.
MM.DD.20XX14

15. OBJECTIVES OF
SPLINTING
 To preserve arch integrity - restores proximal contacts, reducing food impaction & consequent
break down.
 To stabilize mobile teeth during surgical, especially during regenerative periodontal therapy.
 To prevent migration and over eruption.
 Psychologic well being - gives the patient comfort from mobile teeth a sense of well being.
 Masticatory function is improved.
 Discomfort and pain are eliminated.
MM.DD.20XX15

16. BIOMECHANICS
MM.DD.20XX17
A mobile individual tooth
is capable of being
loaded and moved in
several directions:
mesio-distally,
buccolingually and
Apically.
When the mobile tooth is
splinted, the splint tends
to redirect lateral forces
into more vertical forces,
which the tooth is better
able to resist
Limits amount of
force on a single
tooth
Aids in distribution of force

17. TYPES OF SPLINTS
• Splints, like bridges may be fixed, removable, or a combination of
both.
• They may be temporary, provisional, or permanent, according to the
type of material and duration of use.
• They may be internal or external, depending on whether tooth
preparation is required or not.

18. According to
the period of
stabilization
Temporary Stabilization:
worn for less than 6 months.
o Removable
o Occlusal Splint with wire
o Hawley appliance with arch wire
o Fixed
o Intracoronal
o Amalgam
o Amalgam & Wire
Amalgam , Wire & Resin
o Composite Resin & Wire
Permanent Splints: used
indefinitely
o Removable/Fixed
o Extra/Intracoronal
o Full/Partial veneer crowns
soldered together.
o Inlay/Onlay soldered together.
19 MM.DD.20XX
o Extracoronal
o Stainless steel wire with resins
o Wire & Resin with acid etching
o Enamel etching & composite resin
o Orthodontic soldered bands,
Brackets & Wire
Provisional splinting: to be
used for months up to several
years.
e.g. Acrylic splints, Metal band
etc.

19. 20 MM.DD.20XX
According to the type of material:
Bonded composite resin splint
Braided wire splint
A – Splints.

20. MM.DD.20XX21
Goldman, Cohen and Chacker
Classification
Temporary splints
A. Extra coronal type
Wire ligation
Orthodontic bands
Removable acrylic appliances
Removable cast appliances
Ultraviolet-light-polymerizing bonding materials
B. Intracoronal type
Wire and acrylic
Wire and amalgam
Wire, amalgam, and acrylic
Cast chrome-cobalt alloy bars with acrylic, or both.
Provisional splints
All acrylic
Adapted metal band and acrylic

21. MM.DD.20XX22
Ross, Weisgold and Wright
Classification
A. Temporary stabilization
Removable extra coronal splints
Fixed extra coronal splints
Intracoronal splints
Etched metal resin-bonded splints
B. Provisional stabilization
Acrylic splints
Metal-band-and-acrylic splints
C. Long-term stabilization
Removable splints
Fixed splints
Combination removable and fixed splints

22. TEMPORARY
STABILIZATION
Temporary stabilization is essentially a diagnostic procedure that, ideally, should be reversible in nature.
Temporary splints are used both until hypermobility is satisfactorily reduced or eliminated and the teeth can
function without the help of the splint or until the dentition clearly requires long term stabilization.
MM.DD.20XX23
INDICATIONS
For economic reasons or
When prognosis for all remaining teeth is extremely doubtful
or
When poor health seriously affects the longevity of the
dentition
When the patient cannot emotionally accept the lengthy
procedures of permanent fixation.

23. The functions of a temporary splint may be listed as follows:
• To protect mobile teeth from further injury by stabilizing them in a favorable
occlusal relationship.
• To distribute occlusal forces so that teeth that have lost periodontal support
are not further traumatized.
• To aid in determining whether teeth with a borderline prognosis will
respond to therapy.
MM.DD.20XX24

24. EXTRACORONAL
TYPES
• Unfortunately almost all the extracoronal forms of stabilization have certain inherent
disadvantages.
• They usually are a detriment to good oral physiotherapy because of their bulk, thus
interrupting proper coronal forms.
• It is often difficult to perform various surgical procedures in these areas because of the nature
of the appliance.
• The appliances frequently leave a great deal to be desired cosmetically.
MM.DD.20XX25

25. •
26 MM.DD.20XX
• Wire ligation is probably the most
commonly used type of stabilization.
• It is easy to construct and rather sturdy.
• However, one of its basic limitations is
that it can be utilized only where coronal
form permits.
• Because of this shortcoming it has its
greatest use in stabilizing the mandibular
incisors.
• Hirschfeld suggests a loop tied at the
cervical line on poorly contoured teeth
to prevent slippage of the main wire.
• After an interproximal tie is made,
connecting the buccal and lingual
segments of the mesh, tooth-colored,
self-curing acrylic is painted over the
wire to obtain a more pleasing aesthetic
result.
Wire ligation:

26. • This method may offer the advantage of greater stability while producing a splint that is thin in
a buccolingual direction and quite acceptable to the patient.
MM.DD.20XX27

27. MM.DD.20XX28

28. •
29 MM.DD.20XX
• Orthodontic bands tend to stabilize both
anterior and posterior teeth and
therefore have the advantage over wire
ligation in that they are not limiting.
• It is important to give proper attention
to the contours of the bands and to
check their relationship to the adjacent
gingival tissue.
• Often the contacts between the teeth
must be opened so that a band or bands
can be inserted.
• Again, acrylic may be placed over the
bands for cosmetic purposes. The bands
may be welded directly or indirectly.
• When the multiple bands are welded
together, it is necessary to have a
common path of insertion so that the
composite fit of the multiple bands is the
same as the fit of each individual band.
Orthodontic bands:

29. MM.DD.20XX30

30. MM.DD.20XX31

31. REMOVABLE ACRYLIC APPLIANCES:
• The clinician must be aware of the fact that when
he utilizes any form of acrylic appliance, the
dimensional instability of the material may cause
distortions to occur.
• It is imperative to check these appliances
frequently and to make any necessary adjustments.
• It is also vital to check the path of insertion of the
appliance, since the appliance must not be
traumatic as it goes to its final seat.
MM.DD.20XX32

32. Night guards can be constructed in many ways,
and they have a wide variety of uses like
treatment of bruxism and clenching.
The most common type of appliance is one that
covers the occlusal surfaces of the teeth. For
additional support the palate is often covered.
Another appliance frequently used is the
maxillary Hawley bite plane with a labial wire.
This appliance has an advantage in that the
posterior teeth are freed of occlusal contact in
all positions and excursions of the mandible.
It can be used only when there is an anterior
overbite so that the palatal bite plane can
disarticulate the posterior teeth.
ACRYLIC BITE GUARDS ( NIGHT GUARDS):
MM.DD.20XX33

33. • When there is no overbite a labial lip of acrylic over the maxillary anterior teeth will often
suffice.
MM.DD.20XX34

34. •
35 MM.DD.20XX
• The removable cast appliance is usually a
rigid casting either of gold or of chrome
cobalt, made to fit around the teeth.
• Friedman has suggested a useful
variation utilizing a double
continuous clasp casting.
• One end usually the anterior section, is
not joined but is left open so that the
casting can be sprung over the
undercuts and then ligated.
• The posterior end is continuous from the
buccal to the lingual surface and is distal
to the most posterior tooth.
• Another modification is an interlocking
attachment on the distal end so that the
appliance can be locked after being
sprung over the teeth.
• Obviously, with any form of removable
splint, it is only effective if the patient
wears the appliance.
REMOVABLE CAST APPLIANCES:

35. Extracoronal resin-bonded retainers, which can be fabricated to strengthen the overall
bond.
The splints are usually cast from metals, usually non noble alloys that can be electrolytically
or chemically etched.
This type of splint has greater inherent strength than a composite-resin splint created
intraorally.
Extra features such as grooves, pins and parallel preparations increase the retentive capacity
of these splints.
MM.DD.20XX36

36. • Newly developed laboratory-cured composite resins such as DiamondCrown (Biodent Inc.,
Mont-Saint-Hilaire, QC) claim improved diametric tensile strength and bonding capabilities.
• These materials may be considered for use in extracoronal applications.
• No long-term clinical data are available for these materials; however, they seem promising at
this time.
MM.DD.20XX37

37. MM.DD.20XX38

38. INTRACORONAL TYPES:
Internal temporary splints include
MM.DD.20XX39
• WIRE LIGATION,
• ACRYLIC,
• AMALGAM WITH AN EMBEDDED WIRE,
• COMPOSITE RESIN WITH OR WITHOUT EMBEDDED
WIRE
Internal temporary splints should be used
only when permanent splinting is to follow.
It is used on a provisional basis when tooth
prognosis is guarded.

39. INTRACORONAL SPLINT
Types
Discontinuous splint
Continous splint
MM.DD.20XX40

40. COMPOSITE & WIRE SPLINT
MM.DD.20XX41

41. Wire Ligation:
• The intracoronal type of temporary stabilization serves well for posterior
teeth, but has obvious disadvantages for the anterior segment.
• Because forces against the maxillary teeth are often generated in a labial
direction, there is often noted a movement of the teeth away from the
splinting mechanism.
MM.DD.20XX42

42. MM.DD.20XX43
Realizing this problem, one could prepare a
channel in these teeth on the labial, lingual,
and proximal surfaces, utilize a
circumferential wire ligation technique, and
retain this with acrylic.
A major disadvantage to this means of
stabilization is that the channels may prove
to be undercut areas if the teeth are
prepared for full crowns in the future.

43. WIRE AND ACRYLIC: ( A – SPLINT)
Obin and Arvins have described a technique of stabilization whereby wire (usually twisted in the
form of a braid) is fixed with acrylic into channels prepared in mobile teeth.
This approach can be utilized on the occlusal surfaces of posterior teeth and the lingual surfaces of
anterior teeth.
The technique offers advantages over the other forms of stabilization because there is greater
control over coronal forms, occlusion, embrasure areas, and aesthetics.
Unfortunately, because of the limited properties of self-curing acrylics, there is always the
possibility of caries or breakage.
MM.DD.20XX44

44. PROCEDURE-
o Acrylic internal temporary splints (A splints) require the preparation of a channel
approximately 3 mm wide and 2 mm deep in several teeth.
o The preparations should be slightly undercut for retention.
o The pulpal surfaces should be coated.
o A piece of platinized wire 22 to 16 gauge (0.64 to 1.3 mm in diameter) is placed in
the channel.
o Then self-cure acrylic is placed to fix the wire in the channel.
o Adjust the occlusion and polish the splint.
o This technique had been varied by Kessler by placing threaded pins incorporated
in the teeth along with wire and acrylic.
o This approach can be utilized more readily with anterior teeth.
o As its major disadvantage is the possibility of recurrent caries. MM.DD.20XX45

45. ACRYLIC SPLINT
ACRYLIC INTERNAL SPLINT
MM.DD.20XX46
• Fixed temporary bridges may be made of acrylic crowns and pontics and may also serve as
temporary splints.
• They are used when permanent fixed splints will ultimately replace them

46. AMALGAM SPLINT
• Similar to the A splint.
• It has less strength than that of cast gold. Its use is limited to the posterior teeth.
• PROCEDURE:
• Prior to the procedure a buccal, lingual and gingival matrix is fabricated in acrylic to control proximal
gingival contours.
• Prepare the teeth.
• Commercial steel matrix band cannot be used, make a matrix of self-cure acrylic. Condense the
amalgam in one unit.
• Two to five teeth may be splinted in this fashion.
• A wire may be used for reinforcement.
• Amalgam splints tend to fracture easily-DISADVANTAGE MM.DD.20XX47

47. The authors noted disadvantages, to this form of stabilization
(l) The confinement of the procedure to only posterior teeth and
(2) The possibility of fracture (usually at the narrow part of the isthmus).
A variation of this approach is to embed the wire in preexisting amalgam or gold restorations with acrylic.
o The acrylic and wire embedded in amalgam or the amalgam-and wire technique as described by Lloyd and
Baer appears to have the advantage over the wire-and-acrylic method.
o Langeland and Langeland, used acrylic monomer in experimentally prepared cavities of monkey teeth, and
have shown the penetration of the monomer into the dentinal tubules next to the cavity.
o Another advantage of the wire and acrylic embedded in amalgam is that a greater degree of mechanical
retention can be achieved. MM.DD.20XX48

48. WIRE AND AMALGAM SPLINT
MM.DD.20XX49

49. WIRE, AMALGAM, AND ACRYLIC:
• Trachtenberg has combined the wire-and-amalgam and the wire-and-acrylic techniques.
• This approach allows one to insert individual compound amalgam restorations and finish their
interproximal areas prior to insertion of the wire and acrylic.
• The author noted in an 18-month period of observation there had been no amalgam fractures or
recurrent caries.
MM.DD.20XX50

50. WIRE, AMALGAM, AND ACRYLIC:
MM.DD.20XX51

51. CAST CHROME-COBALT ALLOY BARS:
Because of the disadvantages and weaknesses of threaded wire, a number of clinicians have utilized
cast chrome-cobalt bars for reinforcement.
Baumhammers suggested condensing amalgam over a 14-gauge chrome-cobalt bar. He offered as an
advantage, increased strength of the splint but also noted that inherent to this technique were the
usual problems of amalgam deterioration.
Corn and Marks –they modified the approach where in a cast bar is fabricated on study casts prior to
its insertion. A channel is made in the teeth to be stabilized and chrome cobalt alloy bar cast. The bar
is then inserted with acrylic into grooves prepared in the natural dentition.
MM.DD.20XX52

52. CAST CHROME-COBALT ALLOY BARS:
MM.DD.20XX53

53. • This technique can be utilized both in the anterior & posterior parts of the mouth.
• The intracoronal type of temporary stabilization has served well for posterior teeth, but there are
obvious disadvantages for the anterior segment.
• Because forces against the maxillary teeth are often generated in a labial direction, there is often noted a
movement of the teeth away from the splinting mechanism.
MM.DD.20XX54

54. Combination splinting technique:
• Klassman and Zucker have described a combination wire-intracoronal splinting
technique where 0.010 soft ligature is imbedded in prepared channels of the anterior
teeth.
MM.DD.20XX55

55. SPLINTING TECHNIQUES FOR ANTERIOR TEETH:
• There are several variations of the intracoronal splints for anterior teeth.
• The indications for their use are the same as those for the posterior teeth.
• Kessler describes a variation that provides excellent stabilization, has adequate retention, requires
conservative removal of tooth structure, and yet in most patients preserves the original esthetics of
the teeth because the cavity preparation is limited to the lingual aspect of the tooth.
MM.DD.20XX56

56. • The position of the splint, marginal adaptation, and interproximal joints tend to create plaque
harbors, which lead to caries, calculus deposition, and inflammation.
• Thus maintenance needs are increased, and oral hygiene procedures are made more difficult.
• When only part of the occlusal surface is covered by the splint, occlusal contact may displace
individual teeth from the splint.
• Extensive gingival recession, root indentations, and furcations make tooth preparation more
difficult, and pulp involvement may result.
• Nevertheless, internal temporary splints have a definite place in periodontal treatment, provided
they are used in situations for which they are suited. MM.DD.20XX58

57. Sometimes proper interproximal contour and marginal adaptation can be ensured by the use of matrices.
The teeth to be splinted with composite resin are isolated with a rubber dam.
A narrow, beveled groove is placed circumferentially around each tooth.
This groove should be within the enamel and not exposing dentin. The teeth are pumice polished.
A 0.010 dead-soft single or double wire, polyester filament yarn or nylon monofilament line is placed in the
grooves, ligating the teeth with continuous figure-eight loops.
The enamel is then etched with a 37% phosphoric acid solution for 60 seconds, rinsed thoroughly, and dried.
Self-polymerizing or light polymerizing composite resin is then placed, cured, and polished.
MM.DD.20XX59

58. PROVISIONAL
SPLINTS:
MM.DD.20XX60
o Provisional restorations serve to stabilize a permanently mobile dentition from
the time of initial tooth preparation until the time the dentition is periodontally
stable enough for permanent restorations.
o As the name alone implies, the objective of a provisional splint is to absorb
occlusal forces and stabilize the teeth for a limited amount of time.
o Provisional splints can be useful adjuncts to many different types of treatment.
o The provisional splint is a restoration usually fabricated in acrylic as part of a
restorative dentistry program.
o With this form of stabilization it is imperative that the patient go on to a
permanent restorative program.

59. Provisional splints can either be placed externally or
internally.
(I) External splints typically are fabricated using
ligature wires,
night guards,
interim fixed prostheses, and
composite resin restorative materials.
(2) Internal splints, on the other hand, are fabricated using
composite resin restorative material with or without wire or
fiber inserts.
MM.DD.20XX61

60. MM.DD.20XX62
• Only after the interim restoration has been worn by the patient can the design and occlusal
form be evaluated.
• This evaluation should be made before deciding to proceed with the definitive restoration.
• Any design modifications can then be made in the definitive restoration.

61. MM.DD.20XX63
Amsterdam and Fox have described the use of
copper or gold bands fitted exactly to the
subgingival termination of prepared teeth and then
incorporated into self-curing acrylic.
ADAPTED METAL BANDS AND ACRYLIC:

62. MM.DD.20XX64
PERMANENT STABILIZATION
(PERMANENT SPLINTS) :
• Permanent splinting of teeth that have been treated periodontally is also referred to as
Periodontal prosthesis.
• Periodontal prosthesis may be defined as those restorative and prosthetic endeavors that are
indicated and essential in the total treatment of advanced periodontal disease.
• Permanent splinting is indicated whenever periodontal treatment does not reduce mobility to the
point at which the teeth can function without added support.
• Such devices serve to stabilize loose teeth, to redistribute occlusal forces, to reduce trauma and
to and in the repair of the periodontal tissues.
• Permanent splints are fabricated after periodontal treatment has been completed, when their use
will extend the functional lifetime of the teeth.
• Also used for retention of teeth following orthodontic procedures and to prevent eruption of
teeth without antagonists.

63. • Permanent splints may be classified as follows:
1.REMOVABLE -
EXTERNAL
A). Continuous clasp devices
B) Swing - lock devices
C). Overdenture (full or partial)
2. FIXED - INTERNAL
A). Full coverage, three-fourths
coverage crowns and inlays
B). Posts in root canals
C). Horizontal pin splints
3. CAST-METAL RESIN-BONDED
FIXED PARTIAL DENTURES
(MARYLAND SPLINTS)
4. COMBINED
A) Partial dentures and
splinted abutments
B). Removable—fixed splints
C). Full or partial dentures on
splinted roots
D). Fixed bridges incorporated
in partial dentures, seated
on posts or copings
5. ENDODONTIC POSTS.
MM.DD.20XX65

64. REMOVABLE – EXTERNAL :
SWING – LOCK DEVICES :
May be useful in situations in which fixed splinting is not possible or desirable.
For eg. In advanced age, in poor physical or mental status, or when the prognosis
is questionable, the dentist chooses to avoid full coverage.
The cosmetic disadvantages of labial continuous clasping can be overcome by use
of the swing –lock appliance, which tends to conceal the metal of the splint and
avoid torque.
MM.DD.20XX66

65. Over denture :
When few teeth with questionable prognosis remain, an over denture may
be used.
Advantage :
More favorable crown-root ratio and retention of alveolar bone around
roots.
Disadvantage :
Long-term use has high incidence of recurrent periodontal disease.
Patient must carry out adequate plaque control measures.
MM.DD.20XX67

66. Fixed-internal :
Fixed permanent devices may incorporate a series of soldered castings, such as crowns,
three – quarter crowns, telescope crowns, inlays, horizontal pin splints spin ledges.
Splint is cemented to place.
Full coverage is simple to perform (if recession is not extensive and teeth are parallel)
otherwise inlays or pin ledges may be more conserving of tooth structure and simpler to
use.
It is important that these splints be rigid
Ideally the teeth and splint should be reciprocally stabilized in all directions (i. e., mesial,
distal, vestibules and apical).
MM.DD.20XX68

67. Palatal bar :
A palatal bar connecting two fixed bridges in the upper molar and premolar areas is useful.
This palatal bar is secured to the bridges on both sides by means of precision attachments and
provides cross – arch splinting.
When all segments cannot be paralleled, Jeweler’s screws or internal attachments may be used to
combine segments of the splint.
Sectional splinting or splinted telescope crown copings also can overcome divergent parallelism.
It is comfortable and esthetic.
MM.DD.20XX69

68. Cast-metal resin bonded fixed partial denture
(Maryland splints) :
• These are used with intact or very slightly altered enamel surfaces.
• This type of fixed prosthesis is functional, esthetic, reversible and
economic.
• It consists of a metal frame bonded with resin to tooth enamel.
• Retention is enhanced by perforations or by slots.
• The enamel bond is fairly strong, however excessively mobile teeth
under a strong occlusal load can break loose from the metal framework.
MM.DD.20XX70

69. Combined Permanent Splints :
Despite the advantages inherent in fixed splinting, instances occur of periodontally weakened
dentitions, in which a combination of fixed splinting and partial dentures will best answer the
needs of the patient.
These instances are governed by the distribution of remaining teeth.
When partial dentures are used, the abutment teeth are best splinted where feasible, with clasps
and rests so placed that stabilization is afforded in all directions.
When the teeth are mobile, they may be jeopardized if the partial denture is completely dependent
on the abutments. In these cases stress breakers may be used.
When a few teeth remain, a partial denture partly supported by means of telescope crowns can be
used. The partial denture then serves as the splint.
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70. • Intracoronal methods are also available.
• Composite-resin restorations can be placed in adjoining teeth and cured to
eliminate any interproximal separation.
• These restorations can be further reinforced with metal wires, glass-
reinforced fibers or pins.
• If restoration of the mouth includes crowns, the crowns can be splinted to each
other by solder joints or precision attachments.
• The use of attachments affords the practitioner the ease of preparing
nonparallel abutments yet achieves a splinted result.
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71. MM.DD.20XX73

72. MM.DD.20XX74

73. PARTIAL DENTURE WITH SPLINTED ABUTMENTS
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74. FULL COVERAGE FIXED SPLINT
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75. FULL COVERAGE FIXED SPLINT
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76. DISADVANTAGES RELATED TO SPLINTING:
The knowledge required to prepare the dentition adequately to accept the splint is probably
more important than all other factors combined.
Difficulty of performing the extensive restorative procedure.
Many patients that require reconstruction also may require many months of initial
periodontal, orthodontic, and endodontic care.
By neglecting to carry such care, the clinician can expect failure, irrespective of excellence
in the restorative and technical phases.
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77. Cost:
Socio economic factors could deflect treatment away from the ideal.
Quality cannot be compromised on any part of the splint.
Each unit of the splint is like the link of a chain, and the splint is no better than its weakest
unit.
Technical Difficulty:
Unfortunately, few technicians are trained adequately to create a periodontal prosthetic
reconstruction that is truly biologically compatible with the stomatognathic system.
The achievement of excellent marginal adaptation, good contour, functional occlusion, and
esthetic acceptance by the patient usually is expected but is difficult and rarely attained in
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78. Repair and maintenance:
The repair of a single restoration is accomplished easily, because at worst, it can be redone.
The repair of one unit of an extensive splint, however, can be difficult and expensive, at best the
result is often a compromise.
Mechanical failures, such as porcelain fracture and solder joint separation, are more frequent in
multi unit splints than in smaller segments.
Cement wash outs can occur without showing any signs until the pulp has become involved and
endodontic problems are difficult to resolve.
Additional Tooth Reduction:
All the teeth in a rigidly splinted segment require composite draw, which requires additional tooth
reduction and pulpal damage is not uncommon.
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79. Plaque Removal:
• Well designed periodontal prosthetic splints, however, need not compromise plaque removal.
• They may complicate the conventional use of floss, but the use of floss usually is not indicated in plaque
control for patients with splints.
• Interdental brushes and wooden tooth picks are better suited to these patients because they are the only
adjunctive plaque-control aids that can effectively remove plaque from the proximal surface of roots,
where many concavities exist.
• Development of caries is an unavoidable risk.
• It requires excellent maintenance by the patient.
• Splints should never be used as a “shotgun” substitute for accuracy and precision in occlusal therapy of
the individual teeth
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80. SPLINTING AND PERIODONTAL REPAIR:
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• Many authors believed that mobile teeth may inhibit “periodontal repair.” Fixed splinting was
advocated believing that it would reduce the mobility of individual teeth during healing, but studies
have shown otherwise in the following manner.
• 1. Splinting of the teeth will not prevent or retard apical downgrowth of plaque (in fact, it will
increase) and associated attachment loss.
• 2. Splinting of mobile teeth before scaling and root planing (SRP), and elimination of potential
SRPinduced trauma to the mobile teeth did not have any adjunctive effect on healing (Alkan et al.,
2001).
• 3. Tooth mobility increases initially after surgery and subsequently decreases by 24 weeks to about
pre-surgical values. Splinting did not reduce the mobility of individual teeth and also did not have
any infl uence on bone and attachment level after osseous surgery (Kegel et al., 1979).
• 4. Splinting of mobile teeth did not have any effect on mobility reduction after initial therapy (Kegel
et al. 1979).
• 5. Attachment levels and bone levels were similar in splinted and non-splinted teeth following
osseous surgery (Gallers, 1979).

81. MM.DD.20XX83
Glickman et al. (1961) evaluated the effects
of splinting teeth in hyperocclusion using
five Rhesus monkeys.
The forces which applied to 1 tooth in a
splint were transmitted to all teeth within the
splint. The direction of the initial force was
maintained and comparable areas of the
splinted periodontium were affected.
The bifurcation and bifurcation areas were
most susceptible to excessive force. Forces
applied to non-splinted teeth were not
transmitted to adjacent teeth and force
sufficient to cause necrosis did not cause
pocketing.

82. MM.DD.20XX84
In a study to determine the effect of initial
preparation and occlusal adjustment on
tooth mobility, it was observed that for teeth
with initial mobility of greater than 0.2 mm
there was a decrease in tooth mobility up to
20% (Rateitschak, 1963).

83. RECENT TYPES
• Fiber reinforced resin
composite splint
• Titanium trauma splint
• Button bracket splint
• Bonded metal mesh splint
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86. CONCLUSION
• Based on the available data it could be observed that splinting can be considered as an
essential part of periodontal treatment to increase the longevity of periodontally
compromised teeth with advanced mobility.
• However, further research is still required to come to a definitive conclusion about the exact
role of splints, and patient selection criteria for splinting in periodontal treatment.
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87. REFERENCES
• Carranza’s clinical periodontology 10th edition.
•
• Lindhe 4th edition
• The Dental clinics of North America vol. 43 No. 1 Jan 1999
• Periodontal diseases By Saul Schluger
• Periodontal Therapy – Henry M. Goldman, D. Walter Cohen
• Periodontics in the tradition of Gottlieb and Orban – Daniel A. Grant
• To Splint or Not to Splint_ The Current Status of Periodontal Splinting Journal of the International
Academy of Periodontology 2016
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88. THANK YOU!
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