for dental students

3. CONTENTS
 Introduction
 History
 Rationale for splinting
 Biologic
 Clinical
 Correlation between Tooth Mobility and Occlusion
 Indications for Splinting
 Contraindications for Splinting
 Principles of Splinting
 Classification of splints

4.  Provisional splint
 Temporary splint
 Permanent splint
 Types of Splints
 Extracoronal splint
 Intracoronal splint
 Fiber reinforced splints
 Conclusion
 References

5. INTRODUCTION
 Trauma to the teeth can be transmitted to the
supporting structures, which get damaged. This can
cause mobility of the teeth.
 Such mobile teeth may require splinting for a
specified period of time till the supporting tissues
heals and the tooth becomes stable.

6. DEFINITION
 “The joining of two or more teeth into a rigid unit by
means of fixed or removable restorations or
devices.” (The Glossary of Prosthodontic Terms )
 Stabilization – it is an increase in the resistance to
applied force by providing reciprocal antagonisms
and increasing the effective tooth area. The force
may remain the same, but the resistance is
increased.

7. EARLY HISTORY OF SPLINTING
 Archeological excavations of the Etruscan society
(8th centuary to 1st centuary AD) have found
evidence of their use of wire ligation and gold
bands to stabilize teeth.
 In early 1700s Fauchard attempted tooth ligation.
Litch has written splinting techniques that date back
to early 1800s.

8.  Hirschfeld 1950 was one of the first modern authors
advocate ligation of periodontally advanced leisons.
 Ottolengui, in 1889, used gold wire to stabilize loose
teeth. In the 1900,s several authors described splinting
techniques that dated back to the 1800’s.

9.  Lloyd and Baer (1959) and Friedman (1960) also
advocated the continuous amalgam splint posterior
teeth. Elaborate matrices were required to confine
this amalgam for this technique, fractures were
common.
 Shatzkin (1960) expanded on Obin’s technique by
using stainless steel wires embedded in channels
cut in lingual aspect of anterior teeth and covered
with self curing acrylic resin.

10.  Alloy and Kato (1962) and later Liatukas (1976)
advocated reinforcing the amalgam splint technique
by embedding wires or silver root canal points into
the amalgam.

11. BIOLOGIC RATIONALE FOR SPLINTING
 Rest- Occlusal rest provided by splint therapy of
one form or another helps to eliminate or at least to
neutralize some of the adverse occlusal factors that
compounds the effect of an already existing
inflammatory disease, such as periodontitis.

12.  Re-distribution of forces-The re-distribution of
forces ensures that the excessive force on a single
tooth does not exceed the adaptive capacity of the
surrounding tissues and those jiggling movements
which can contribute to further bone loss in existing
periodontitis, are prevented.

13.  Re-direction of forces- It effects the re-direction of
forces in a more axial direction over-all the teeth
included in the splint.
 It prevents the tilting effect of the unfavourably
directed occlusal force.

14.  Preservation of arch integrity- it restores proximal
contacts that have been disrupted by missing and
migrated teeth and makes the patient more
comfortable.
 Restoration of functional stability – in
conjunction with replacement of missing teeth it
restores functional occlusion.

15.  Psychological well being

16. CLINICAL RATIONALE FOR SPLINTING
 Control of forces of parafunction or bruxing.
 Stabilization of mobile teeth for masticatory
discomfort.
 Stabilization of mobile teeth during surgical,
especially regenerative therapy.

17.  Cross arch stabilization of an intact tooth.

18.  Stabilization of periodontally compromised teeth
when the definitive treatment is not possible.
 Restoration of vertical dimension of occlusion in
case of posterior bite collapse, provisional splint
can be given followed by a permanent splint.

19.  Prevention of the eruption of an unopposed tooth.
 Restores psychological and physical well being of
the patient.
 Restore occlusal stability.
 Post-orthodontic retention usually given on lingual
aspect.

20. GENERAL CONSIDERATIONS FOR SPLINTING
 Phase I therapy
 Etiology of tooth mobility
 Degree of tooth mobility
 Sufficient number of stable teeth
 Cross arch splinting
 Not interfere with function.
 Esthetically acceptable

21. IDEAL SPLINT REQUIREMENTS
 It should be
 Simple
 Economic stable and efficient
 Hygienic
 Nonirritaing
 Not interfere with treatment esthetically acceptable
 Not provoke iatrogenic diseases.

22. PRINCIPLES OF SPLINTING
 The main objective of splinting is to decrease
movement three-dimensionally.
 This objective often can be met with the proper
placement of a cross-arch splint.
 Conversely, unilateral splints that do not cross the
midline tend to permit the affected teeth to rotate in
a faciolingual direction about a mesio-distal linear
axis.

23.  If splinting is to achieve any measure of success,
the center of rotation of the affected teeth must be
located in the remaining supporting bone.
 In this way, the affected teeth are able to resist
tooth movement. Otherwise, the prognosis for any
splint will be unfavorable if the occlusal or
masticatory forces exceed the resistance provided
by the splinted teeth.

24.  Thus, the ideal splint should reorient and redirect all
occlusal and functional forces along the long axis of
teeth, prevent tooth migration and extrusion, and
stabilize periodontally weakened teeth.

25. INDICATIONS
 When a patient presents with multiple teeth that
have become mobile as a direct result of gradual
alveolar bone loss, a reduced periodontium.
 When the patient presents with increased tooth
mobility accompanied by pain or discomfort in the
accompanied by pain or discomfort in the affected
teeth.

26.  Following loosening of accidental or surgical teeth by
trauma.
 To stabilize teeth in their new position after orthodontic
repositioning.
 As supportive measure to facilitate periodontal
therapeutic procedures for hypermobile teeth.
 To immobilize excessively mobile teeth so that patient
can chew more comfortably.
 To avoid moving of the teeth prior to or during
reconstructive procedures.

27. CONTRAINDICATIONS
 Splinting teeth is not recommended if occlusal stability
and optimal periodontal conditions cannot be obtained.
 Any tooth mobility present before treatment must be
reduced by means of occlusal equilibration combined
with periodontal therapy otherwise if the tooth involved
does not respond, it must be extracted prior to
proceeding from provisional restorations to definitive
treatment.

28. ADVANTAGES OF SPLINTING
 1. It allows the patient to chew comfortably.
 2. Mobile teeth become firm and patient can use
regular brush, inter-dental brush etc. without the
fear of knocking down teeth.

29.  3. As splinting is done in conjunction with other
periodontal therapy, such as scaling / curettage /
root planing / flap surgery etc, it also is an adjunct
to preservation of hard and soft tissue.
 4. Enhances patient self confidence.

30. DISADVANTAGES OF SPLINTING
 Difficulty in performing extensive restorative procedures.
 Cost- The cost of the splint can be a limiting factor to
ideal treatment.
 Technical difficulty- The achievement of margin
adaptation, contours, esthetic acceptance is technique
sensitive.
 Repair and maintenance- the repair can be difficult
expensive time consuming and still a compromise.

31.  Additional tooth reduction-all the teeth in the rigidly
splinted segment require composite draw, which requires
tooth reduction.
 Plaque removal becomes compromised and difficult oral
hygiene access with splints in mouth.
 Gingival irritation may result.
 Interference of the splint to normal interproximal wear
and mesial drift.
 Interference with patient’s comfort and phonetics.

32. CLASSIFICATION OF SPLINTS
 According to the period of stabilization:
 Temporary stabilization – worn for less than 6 months.
 Provisional stabilization – to be used for months to
several years, like acrylic splints and metal bands.
 Permanent splints – to be used indefinitely.

33. ACCORDING TO THE LOCATION ON THE TOOTH:
• Amalgam and wire
• Amalgam, wire and resin
• Composite, wire and resinIntracoronal
• Stainless steel wire and resins
• wire and resin with acid etching
• enamel etching and composite
resin
• ortho-soldered bands, bracket
and wire
Extracoronal

35. Removable
fixed

36. ACCORDING TO THE TYPE OF MATERIAL:
Wire splint
Composite bonded splint
Acrylic splint
Fiber-Reinforced Composite Resin
Titanium Trauma Splint(TTS)

37. TITANIUM TRAUMA SPLINT(TTS)

38. ROSS WEISGOLD AND WRIGHT CLASSIFICATION 1959:
• Removable extracoronal splint
• Fixed extracoronal splint
• Intracoronal splint
• Etched metal resin bonded splint
Temporary
stabilization
• Acrylic splint
• Metal band and acrylic splint
Provisional
stabilization
• Removable splint
• Fixed splint
• Combination removable and fixed splint.
Long term
stabilization

39.  Ramjford classified splint as
 Temporary,
 Diagnostic or Provisional,
 Permanent.

40. TEMPORARY STABILIZATION
 Done for a period of 6 months.
 Usually considered in cases of reversible nature.
 Where permanent treatment is required but for
reasons like:
 Cost
 Questionable prognosis
 Overall health of the patient
 Patient’s unacceptance

41. TEMPORARY SPLINT
 Required before during and after the periodontal
surgery.
 Cohen and Chacker- temporary stabilization may
allow a new healthy tooth bone relationship to be
established.

42. REMOVABLE EXTRACORONAL SPLINT
 Occlusal splints
 Maxillary and mandibular bite guard
 Maxillary occlusal splint
 Mandibular occlusal splint
 Soft occlusal splint

43.  Maxillary and mandibular bite guard

45.  Maxillary occlusal splint
Mandibular occlusal splint

46.  Soft occlusal splints

47.  Bite plates
 Short term use
 Covers most part of hard palate
 Retained by clasp or labial bow or a combination
 Flat or inclined plane present lingually.

48.  Hawley’s bite plate
Sved bite plate

49. FIXED EXTRA-CORONAL SPLINT
 Used in teeth with fair prognosis.
 Indications:
 When surgery is indicated.
 When combined perio-endo treatment is required
 Cost factor
 When permanent stabilization is not confirmed.

50.  Wire and acrylic splint

51.  Modifications such as use of bracket wire instead of
a ligature wire can be used.
 However this technique is not suitable for posterior
teeth as it can exaggerate the tooth contour and
promote plaque retetntion.

52. INTRACORONAL SPLINTS
 Amalgam and wire
 Resin and wire
 Pins and resins
 It is usually beneficial when the patient has to go for
a permanent splint.

54. ADVANTAGES
 More retentive than extracoronal temporary splint.
 Fixed .
 Does not interfere with personal oral hygiene
maintenance.
 Does not irritate soft tissue.
 Simple and cost effective.
 Simple to repair.
 Most variations are esthetics.

55. DISADVANTAGES
 Pulp injury.
 Not indicated for patients prone to caries.

56. Etched metal resin bonded splint

57. PROVISIONAL STABILIZATION
 The objective of a provisional splint is to absorb
occlusal forces and stabilize the teeth for a limited
amount of time.
 Provisional splints can either be placed externally or
internally. External splints typically are fabricated using
ligature wires, nightguards, interim fixed prostheses,
and composite resin restorative materials.

58. oInternal splints, on the other hand, are fabricated using
composite resin restorative material with or without wire or
fiber inserts. Most provisional splints are made using some
form of external support in their design.
oFull coverage acrylic provisional splinting
oAll acrylic type
oMetal band and acrylic type

59. LONG TERM SATBILIZATION
 Definitive splints are placed only after the
completion of periodontal therapy and once
occlusal stability has been achieved in order to
eliminate or prevent occlusal trauma, increase
functional stability, and improve esthetics on a long-
term basis.
 Periodontal prosthesis

61. RATIONALE OF SPLINTING IN TOOTH INJURY:
 Injured anterior teeth should be stabilized for less than three
weeks as it will allow periodontal fibers to repair rather than a
bony healing (may lead to ankylosis).
 Tooth luxation needs stabilization for 2 -3 wks.
 Tooth subluxation needs stabilization for 1 -2 wks.
 Tooth extrusion needs stabilization for 1 -2 wks.
 Root fracture needs a longer splinting time such as 1 -3
months, as this will allow the calcified tissue to heal.

62. Other Areas Of Application Of Splinting :
 Orthodontics - As a Retainer after orthodontic
therapy. As a space maintainer
 Implant Dentistry -- As a Maryland bridge using
stock denture teeth in anterior segment. -- For
reinforcing implant over denture.

63.  Simring in 1952 described the theory and practice of
splinting in detail.
 He emphasized the importance of direction of forces
and the movement of teeth under occlusal loads, thus
rationalized the need for splinting as the safety
procedure to employ when a tooth must withstand a
forces beyond its individual physiologic limits.

64.  Jens Waerhaug evaluated the justification for the
splinting in periodontal therapy as a protective
mechanism in the case of occlusal trauma.

65.  Lemmerman in 1976 reviewed the rationale for
splinting.
 He described the use of splinting as to device as to
reduced the mobility or stabilized an existing
mobility.

66.  Ferenez in 1991 reported that there is little rationale
for splinting teeth manifesting primary occlusal trauma.
 In the case of secondary occlusal trauma, the
periodontium is reduced and the teeth loose a lot of
support. The need for splinting thus is more obvious as
to achieve stabilization.

67.  Ferenez in 1991 also divided the splint into its
duration of use:
 Short term splint
 Provisional splints
 Long term splint.

68. RIBBOND

69. FIBER REINFORCED SPLINT

71. SPLINT MAINTENANCE
 Interdental devices
 Floss
 Interdental brushes

73. CONCLUSION
 The concept of tooth stabilization is not new the
field of dentistry and it serves its purpose well
enough till date. However, the problem of deciding
whether to splint or not to splint is becoming more
controversial with time.
 A smart decision by the clinician and patient
cooperation can give significant results from this
treatment modality and satisfy multiple treatment
objectives.

74. REFERNCES
 Shyam Padmanabhan, Venkateswara Allu Reddy . Inter-disciplinary
management of a patient with severely attrited teeth. 2010;14(3):190-
194.
 E. Griffin Cole. To Splint or Not To Splint:Treating Periodontally
Compromised Teeth by Improving Occlusion. Contemporary Esthetics
and Restorative Practice. May 2005
 Serio FG, Hawley CE. Periodontal trauma and mobility. Diagnosis and
treatment planning. Dent Clin North Am. 1999;43:37-44.
 Waerhaug J. Justification for splinting in periodontal therapy. J
Prosthet Dent. 1969;22:201-208.

75.  Galler C, Selipsky H, Phillips C, et al. The effect of splinting on tooth mobility. (2) After
osseous surgery. J Clin Periodontol. 1979;6:317-33
 Siegel SC, Driscoll CF, Feldman S. Tooth stabilization and splinting before and after
periodontal therapy with fixed partial dentures. Dent Clin North Am. 1999;43:45-76.
 Carranzas Clinical Periodontology 10th Edition.
 Pollack RP. Non-crown and bridge stabilization of severely mobile, periodontally
involved teeth. A 25-year perspective. Dent Clin North Am. 1999;43:77-103.
 Strassler HE, Haeri A, Gultz JP. New generation bonded reinforcing materials for
anterior periodontal tooth stabilization and splinting. Dent Clin North Am.
1999;43(1):105-126.
 Schluger: temporary, provisional and long term stabilization .
 Goldman: temporary stabilization and periodontal prosthesis.

76.  Bhaskar SW, Orban B. Experimental occlusal trauma. J Periodontol.
1955; 26:270-284.
 Kegel W, Selipsky H, Phillips C. The effect of splinting on tooth
mobility. I. During initial therapy. J Clin Periodontol. 1979;6:45-58.

77. CLASS III MHC GENES
 They encode, in addition to other products, various
secreted proteins that have immune functions, including
components of the complement system and molecules
involved in inflammation.
Thank u….