Essential Guide to Dental Splinting

Splinting
Copyright ©2021 Periowiki.com

Contents
-Introduction
- History
-Definitions
- Aims & Principles
-Ideal requisites for a dental splint
-Indications & Contraindications
- Advantages & Disadvantages
- Classification

- Selective grinding versus splinting
-Splinting – related studies
- Oral hygiene devices for splint maintenance
- Splinting of traumatized teeth
- Conclusion
- References

Introduction
Periodontal disease results in destruction of the attachment apparatus
causing uneven distribution of occlusal forces resulting in additional
damage to the alveolar bone.
Occlusal adjustment, periodontal and restorative dentistry may alter
occlusal relationship and redirect forces thereby reducing traumatism.
This may result in teeth becoming firmer. Increasing the support of the
tooth may also increase their firmness; the device used for such
treatment is the Splint.

History
The first documented splinting of teeth for the treatment of jaw bone
fractures took place in Egypt in the 16th century B.C.
Hippocrates, (born 460 B.C.) used the occlusal relationship of the teeth
for the assessment of mandibular deviations and used gold wires and
linen threads to splint teeth.
Intermaxillary fixation (IMF) used for the immobilization of jaw bone
fractures was first described in a handwritten manuscript in the 14th
century A.D. but was forgotten until its revival at in the end of the 19th
century.
I. Jaw bone fracture immobilization:

9
II. Teeth splinting :
History
A Phoenician mandible from 500BC found in modern day Lebanon
which has two carved ivory teeth attached to four natural teeth by
gold wire.
Findings from digging of Egyptians (3000 -2500 B.C.) show similar
gold wiring.
Albucasis, a Spanish physician who lived in the 10th and 11th centuries
used gold, silver or silken ligatures for the fixation of loosened teeth.
The first description of an arch bar splint, a bent metal arch ligated to the
teeth, was provided by a London dentist, Hamtnond, in 1871.

Definitions
'The definition of a dental splint as introduced by the American Association
of Endodontics (1984) is:
‘A rigid or flexible device or compound used to support, protect or
immobilize teeth that have been loosened, replanted, fractured or
subjected to certain endodontic surgical procedures‘.
The Glossary of Prosthodontic terms defines Splinting (1999) as:
1) A rigid or flexible device that maintains in position a displaced or
movable part; also used to keep in place and protect an injured part.
2) A rigid or flexible material used to protect, immobilize or resist motion
in a part.

According to Glossary of periodontal terms (2001):
SPLINT: Any apparatus, appliance, or device employed to prevent
motion or displacement of fractured or movable parts.
DENTAL SPLINT: An appliance designed to immobilize and
stabilize loose teeth.
Esther M. Wilkins (8th edition):
Dental splint : designed to immobilise and stabilise teeth in the same
arch.
Grant (6th edition):
Splint is an appliance that joins one or more teeth to provide support
Definitions

Aims of splinting
Rest is created for the
supporting tissues,
permitting repair of trauma
Mobility is reduced
immediately & it is hoped,
permanently. In particular
jiggling movements are
reduced of eliminated
Forces received by any one
tooth are redistributed to a
number of teeth
Provisional contacts are
stabilized and food
impaction (but not
retention) is prevented
Migration and over-
eruption are prevented

Masticatory function may be improved
Discomfort and pain are eliminated
Appearance may be improved
Aims of splinting

Biologic rationale for splinting
1)Rest
2)Redistribution of forces
3)Redirection of forces
4)Preservation of arch integrity
5) Restoration of functional stability
6) Psychologic well being

Principles of splinting
Polygonal design for splints to obtain
cross- arch stabilization

Ideal requisites of a dental splint
It should
incorporate as
many firm teeth as
necessary to reduce
the extra-load on
individual teeth to
a minimum
It should hold
the teeth rigid
and not impose
torsional stresses
on any
incorporated
teeth
It should extend
around the arch,
so that antero-
posterior forces &
faciolingual forces
are counteracted
It should not
interfere with the
occlusion.

Should not
irritate the
pulp
Should not
irritate the soft
tissues, gingiva,
cheeks, lips or
tongue
Interdental
embrasure
spaces should
not be blocked
by the splint
Ideal requisites of a dental splint

Indications of splinting
Tarnow and Fletcher 1986
- To stabilize moderate to advanced tooth mobility that cannot be
reduced by other means that has not responded to occlusal
adjustment and periodontal therapy.
-Stabilize teeth in secondary occlusal trauma.
-Stabilize teeth after orthodontic movement.
-Stabilize teeth with increased tooth mobility, which interfere with
normal masticatory function.

-Stabilize teeth after acute dental trauma i.e., subluxation,
avulsion etc.
- Facilitates scaling and surgical procedures.
-Prevent tipping and drifting of teeth.
-Prevent extrusion of unopposed teeth
- Cross- arch stabilization
- Control bruxism
- In case of vertical bite collapse, restore the vertical dimension
of occlusion
Indications of splinting

Intracoronal splint specific indications
1) Dentition with deep overbite
2) Teeth with very short roots or resorbed roots
3) To evaluate potential abutment teeth
4) Teeth with root amputations & mobility

Contraindications of splinting
Moderate to severe tooth mobility in the presence of periodontal
inflammation
Insufficient number of firm teeth to stabilize mobile teeth
Patient not maintaining oral hygiene
Prior occlusal adjustment not done on teeth with occlusal trauma or
occlusal interferences

Advantages
May establish final
stability and comfort
for patient with
occlusal trauma
Helpful to decrease
mobility and accelerate
healing following
acute trauma to the
teeth
Allows remodelling of
alveolar bone and
periodontal ligament
for orthodontically,
splinted teeth
Helping in decreasing
mobility favouring
regenerative therapy
Distributes occlusal
forces over a wide area

Disadvantages
Hygienic
Accumulation of
plaque at the
splinted margins
can lead to
further
periodontal
breakdown in a
patient with
already
compromised
periodontal
support
Mechanical
Splint being rigid
may act as a lever
with uneven
distribution of
forces.
If one tooth of the
splint is in
traumatic
occlusion, it can
injure the
periodontium of all
the teeth within
the splint
Biological
Development of
caries is an
unavoidable risk
and thus,
requires
excellent
maintenance by
the patient

Classification of splints
Ramfjord and Ash (1966) :
1.Temporary
2.Diagnostic
3.Permanent
(I)

Ross, Weisgold & Wright (1986):
A) Temporary stabilization :
I. Removable extra coronal splints (occlusal splints, bite plate)
II. Fixed extra coronal splints
III. Intracoronal splints
IV. Etched metal resin bonded splints.
B) Provisional stabilization:
I Acrylic splints
II. Metal band and acrylic splints.
C) Long term stabilization:
I. Removable splints
II. Fixed splints
III. Combination removable and fixed splints
(II)

Goldman, Cohen and Cracker classification
(III)
Temporary Provisional
Extracoronal Intracoronal
1. Wire ligation
2. Orthodontic bands
3. Removable acrylic
appliances
4. Removable cast
appliances
5. UV light
polymerizing
bonding materials
1. Wire and acrylic
2.Wire and amalgam
3.Wire, amalgam and
acrylic
4.Cast chrome-cobalt
alloy bars with acrylic
1. All acrylic
2.Adapted metal
band and acrylic

ca
According to type of material A- splint, Braided wire splint, composite
resin splint, amalgam splints.
According to the location on the tooth Intracoronal – Composite resin with wire,
inlays, nylon wire
Extracoronal – Night guard, welded band,
tooth – bonded plastic
According to the period of stabilization (Schulger et al )
1. Temporary (used < 6 months) Removable – Occlusal splint with wire,
Hawley with splinting arch wire
Fixed – Intracoronal, extracoronal
2. Provisional (6 to 12 months) Acrylic splints, Metal band
3. Permanent (used indefinitely) Removable/fixed
Intraoral /extraoral
Full/partial veneer crown soldered together
Inlay/onlay soldered together
(IV)

ca
(V)
Grant, Stem and Listgarten Classification
(1) Removable (external)
-Continuous clasp devices
-Swing lock devices
-Over dentures (full or partial)
(2)Fixed (internal)
-Full coverage, 3/4th coverage &
inlays
-Posts in root canals
-Horizontal pin splints
(3) Cast metal resin bonded fixed
partial denture (Maryland splints)
(4) Combined
-partial dentures & splinted
abutments
-Removable fixed splints
-Full or partial dentures on
splinted roots
-Fixed bridges incorporated in
partial dentures seated on posts
or copings

i
Temporary splints

Ligature splints
Useful only for
anterior teeth
Dead soft
stainless steel wire
(0.007 to 0.010 inch
thick is used
Can be retained for
several months if
they are tightened
and replaced
periodically

Splints of enamel bonding material
Self
polymerized
UV light
polymerized
White light
polymerized
composite
resins
Fiber glass since 1989
Metal based wire splint

Cingulum rests prepared
Extracoronal composite-resin-based splint
Splint fabrication
Splint bonded

Resin bonded metal retainer
•A non- noble metal is usually used because of the strength of its bonding to Metabond &
its high strength in thin section.
•It is electrolytically or chemically etched, air abraded & cemented with Metabond.
•It has greater inherent strength than a composite-resin splint created intraorally.
•Grooves, pins & parallel preparations increase its retentive capacity.

Welded band splints
- Useful for posterior teeth :
-A strip of stainless steel 0.003 to 0.005 inch thick to
the tooth in form of a band
- Preformed bands can also be used
- Modification : welded band + wire splint
- Avoid accidental minor tooth movements

Continuous clasp
May be made of
acrylic, gold or cast
stainless steel
2 types:
- Ligated or
- Used in a fashion like
a partial denture
Not esthetic and may
impede speech
More elaborate
continuous clasps can
be ueed as permanent
splinting devices
Care to avoid irritating
sharp edges and
occlusal interferences

Night guards
Stabilizes
mobile teeth
Most often
made for the
maxilla
Prevent
damage to
the
periodontium
Deep overbite or
exaggerated curve of
spee instead of night
guard, bite plane
(Hawley retainer) is
prescribed as an
alternative
Hawley retainer

Acrylic splints (A splints)
Requires the preparation of a channel
approximately 3mm wide and 2mm deep in
several teeth
Preparation should be slightly undercut for
retention
Pulpal surfaces should be coated with a
protectant
22 to 16 guage – 0.64 to 1.3 diameter
platinized knurled wire is placed in the
channel
Self cure acrylic is used to fix the wire in the
channel

Composite splints
A narrow
beveled groove
is placed
circumferentially
around each
tooth
Groove should
within the
enamel without
exposing the
dentin
0.010 dead soft single or
double wire , polyester
filament yarn or nylon
monofilament line is
placed in the groove
Etching – 37% phosphoric
acid for 60 secs,
Self- polymerising or light
polymerising composite
resin is then placed, cured
and polished

Amalgam splints
Similar to
A splint
Two to
five teeth
may be
splinted
Tend to
fracture
easily
Use limited
to posterior
teeth
A connecting
bar or wire
may be used
for
reinforcement

Wire, amalgam and acrylic splints
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

Acrylic full crowns
Methods of
preparation
Duplicates of
patient’s
study models
Pressure
molding
splint
Disadvantages :
1) Breakage and wears off with time
2) May irritate the gingiva
1) May permit caries
Cast
occlusals &
Metal
copings are
preferred

Kegel W, Selipsky H, Phillips C. (1979) - Assessed if intracoronal wire-and-
acrylic splint aided in the reduction of posterior tooth mobility Chronic
periodontitis patients during initial therapy and concluded that, the reduction
in the mobility of teeth splinted during the entire therapy period did not differ
from the reduction observed in the unsplinted segments. The reduction in
tooth mobility observed in both the splinted and unsplinted segments over the
17-week period can be attributed to the improved occlusal relationships and
reduction in inflammation.
Galler C, Selipsky H, Phillips C, Ammons WF Jr (1979) - Assessed if fixed
intraoral wire and acrylic splints had advantages with respect to tooth
mobility, bone level and attachment level over unsplinted teeth following
osseous surgery. They concluded that, the splinted and unsplinted segments
reacted similarly throughout the study; splinting did not significantly reduce
the mobility of individual teeth. Pre- and postsurgical bone and gingival
attachment levels were also similar for the splinted and unsplinted segments.

Splinting related studies
Study Results
P. Preethe Paddmanabhan, S.C.
Chandrasekaran, V. Ramya,
Manisundar (2012)
Splinting if well placed and
maintained under patients
compliance, and on removal helps to
reduce mobility and gives stability.
The advantage of stainless steel metal
wire bonded with composite splinting
is it quick and easy to adapt and
removal of the splint is easy, good
vertical flexibility & controls tooth
mobility.
The advantage of fiber reinforced
composite splinting is that
aesthetically pleasing, low level of
fracture frequency. More superior
than any other type of splinting.

Study Result
Sekhar LC, Koganti VP, Shankar
BR, Gopinath A (2011)
Splint had a promising and beneficial
effects on anterior teeth exhibiting
Grade I to Grade II degrees of mobility.
Splinting is recommended as an
adjunct to periodontal surgery in the
treatment of hypermobile teeth,
especially in cases where patient
discomfort is a prominent factor.
Also Ribbond Ribbon reinforced with
composite resin was an excellent
material for application, patient
comfort, resistance to fracture,
biocompatable and esthetic
acceptability as compared to stainless
steel wire with composite.

Authors Groups Results
Schulz A, Hilgers RD,
Niedermeier (2000)
Aim : to evaluate the
effect of splinting teeth
on the results of
periodontal
reconstructive surgery
using a specific
carbonate bone
replacement graft (BRG)
material.
Pre- splint
group
Post splint
group
Non- splint
group
The less favourable improvement
in periodontal function of
postsplint or nonsplint teeth
seemed to be due to the loss of
BRG material caused by tooth
mobility. These results indicate
that an undisturbed wound healing
process using BRG together with
tooth stability is beneficial to
overall clinical success.

Machtei and Schallhorn (1999)- recommended that
very mobile teeth be splinted prior to GTR in class II
furcation defects.
Trejo and Weltman (2004) - recommended the splinting
of hypermobile teeth to improve patient comfort during
post-therapeutic healing.

Severely mobile teeth, if in health, can be retained almost
indefinitely.” Pollack (1999)
“Used correctly, periodontal splinting can greatly improve the
comfort, prognosis & outcome for a patient with serious
periodontal disease. But used incorrectly, splinting can cause
further deterioration in periodontal health.” Mosedale(2007)
“Splinting is not a substitute for periodontal treatment.”
Rada(1999)

Provisional splints

Characteristic features
1) 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.
2) Provides stability, occlusal function and a good esthetic result.
3) Allows the dentist to determine the optimum esthetic and functional
design to be incorporated into the future permanent splint.
4) Allows flexibility in case of future tooth loss.
5) Can be placed any time after initial periodontal therapy is complete.
6) If the splint is seated using temporary cement, it can be removed
during periodontal treatment, thus facilitating access to the root
surfaces.

All acrylic provisional splint
-Most common form of provisional splint
- Fabricated from:
1) Premade shell or
2) Directly done at chair side
- Limitation – marginal adaptation

Adapted metal bands with acrylic
-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.
-This technique fulfills all the objectives of a provisional restoration in that
an exact marginal fit is achieved for caries-control and pulpal protection.
-Also, protective sub-gingival and supragingival coronal forms are more
easily obtained, thus helping to achieve and maintain the health of the
gingival tissue.
-Because of the added strength of the metal bands, frequent removal of the
splints for various operative procedures (that is, impressions, coping
transfers, assemblages) will not cause the splints to warp or the margins to
become distorted. Copyright ©2021 Periowiki.com

Permanent splints

Objectives
- Permanent splints are fabricated after periodontal treatment
has been completed, when their use will extend the functional
lifetime of teeth.
- It is indicated whenever periodontal treatment does not reduce
mobility to the point at which the teeth can function without
added support.
- These devices serve to : -
(i) Stabilize loose teeth
(ii) Redistribute occlusal forces
(iii)Reduce traumatism
(iv)Aid in the repair of the periodontal tissues

Swing lock appliance
Useful in situations in which fixed splinting is not possible or desirable:
Eg: In advanced age, in poor physical or mental status, or when prognosis is
questionable, or when dentist chooses to avoid full coverage.
Overcome the disadvantage of labial continuous clasping

Overdenture
-Few teeth with questionable prognoses remain, an overdenture may be
used.
- Teeth are treated endodontically, then are shortened close to the gums
and fitted with a round nonanatomic gold dome, which may incorporate
retention device.
- A full or partial denture is then constructed over these remaining
abutments.
Advantages Disadvantages
Favourable crown root ratio &
retention of alveolar bone around roots.
Long term use :-
- High incidence of recurrent periodontal
disease
- Prosthetic or endodontic failure

Resin Bonded Fixed Partial dentures
Introduced by
Rochette (1973) –
for splinting
periodontally
compromised
mandibular anterior
teeth.
90% survival rate over 5 years with greater success rate
reported in maxilla than in the mandible
RBFPD
Cast metal
Rochette
appliance
Maryland
appliance
Fiber
reinforced
composite
Full coverage
(extracoronal)
Partial coverage
(intracoronal)

Maryland appliance

Fixed permanent internal splints
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).

A removable telescopic splinting technique
Case
Hsien –Yang
Chung &
Ching -Ming
Hung 2006

Periodontally compromised dentition and fibre-reinforced
composite therapy
Case
Step 1

composite therapy
Case
Step 2
Step 3

composite therapy
Case
Step 3
Step 4

Glass fibers + polymer resin gel matrix

Combined permanent splints
Partial dentures &
splinted abutments
Removable- fixed
splints
Full or partial
dentures on splinted
roots
Fixed bridges
incorporated in partial
dentures seated on
post or copings

Combined permanent splints

Treatment for increased tooth mobility
• Increased mobility of a
tooth with increased
width of PDL but normal
height of the alveolar
bone.
Situation
I
• Increased mobility of a
tooth + increased width
of PDL & reduced height
of the alveolar bone
Situation
II

• Increased mobility +
reduced alveolar bone
height + normal width of
PDL
Situation
III
• Progressive mobility of the
tooth as result of gradually
increasing width of the
reduced PDL
Situation
IV
Treatment for increased tooth mobility

Selective grinding versus splinting

Techniques for splinting traumatized teeth
Titanium trauma splint
Wire composite splint
Resin splint bonded

Oral hygiene devices for splint maintenance

Mangla C, Kaur S (2018)

Type Trade name Material details

Unidirectional Eg Prepreg Unidirectional fibers oriented in multiaxial plane stitched
Type Trade name Material details

Conclusion
Tooth splinting proves to be beneficial in several clinical
situations but, the overall objective is to create an environment
where tooth movement can be contained within physiologic
limits while restoring function and patient comfort.
Splinting teeth to each other allows weakened teeth to gain
support from neighbouring ones.
When used to connect periodontally compromised teeth,
splinting can increase patient comfort during chewing.

However, splinting makes oral hygiene procedures difficult.
Therefore, to ensure the longevity of the connected teeth,
special attention must be given to instructing the patient
about enhanced measures for oral hygiene after placement
of the splint.
Conclusion

References
-Periodontics in the tradition of Gottlieb and Orban 6th edition
Grant et al chapter - 47 splinting and stabilization
-Clinical periodontology and Implant dentistry 5th edition
Jan Lindhe
Chapter 51 : Tooth supported Fixed partial dentures
(Jan Lindhe & Sture Nyman)
- Periodontal therapy : Clinical approaches & evidence of success :
volume 1
Myron Nevins

-Critical decisions in periodontology 4th edition : Hall 2008
- Comparison of a new dental trauma splint device (TTS) with three
commonly used splinting techniques . von Arx T, Filippi A, Lussi A.
Dent Traumatol 2001; 17: 266–274.
- A removable telescopic splinting technique - cases report
HSIEN-YANG CHUNG 1,2 CHUNG-MING HUNG
J Dent Sci 2006‧Vol 1‧No 3
-A Review of the Clinical Management of Mobile Teeth Citation:
Bernal G, Carvajal JC, Muñoz-Viveros CA.
J Contemp Dent Pract 2002 November;(3)4:010-022.

- United we stand - periodontal splints : a brief insight A review
Dharamthok S , Kolte A, Kher V
INDIAN JOURNAL OF DENTAL RESEARCH AND REVIEW APR-SEPT 2011
-Tooth Splinting using Fiber Reinforced Composite & Metal –A
comparison - A report
P Preethe Paddmanabhan, S.C. Chandrasekaran, V. Ramya,
ManisundarI
Indian Journal of Multidisciplinary Dentistry, Vol. 2, Issue 4, August-
October 2012
-Periodontally compromised dentition and fibre-reinforced
composite therapy Ian E Shuman
Dentistry 1 August 2002

- Regeneration of Class II Furcation Defects: Determinants of Increased
Success . Arthur Belém NOVAES Jr. Daniela Bazan PALIOTO
Patrícia Freitas de ANDRADE Julie Teresa MARCHESAN
Braz Dent J (2005) 16(2): 87-97.
- Splinting – A Healing Touch for an Ailing Periodontium
Mahijeet Singh Puri, Harpreet Singh Grover, Anil Gupta, Navgeet Puri,
Shailly Luthra
J Oral Health Comm Dent 2012;6(3)145-148.
- Splinting teeth – A review of methodology and clinical case reports
Izchak Barzilay
J Can Dent Assoc 2000; 66: 440-3.

-Hsien –Yang Chung & Ching -Ming Hung. A removable telescopic splinting technique –
cases report. J Dent Sci 2006;1(3):146-152.
-Dr. P Bhuvaneswari, Dr. Gowri T, Dr. Ram Kumar GD and Dr. Vanitha M . Periodontal
splinting: A review before planning a splint. International Journal of Applied Dental
Sciences 2019; 5(4): 315-319.
-Mangla C, Kaur S. Splinting- A Dilemma in Periodontal Therapy. Int J Res Health Allied
Sci 2018;4(3):76-82.
-Periowiki.com holds copyright of this power point presentation only.
Photographs, flowcharts credit – google, textbooks and journal
articles (details mentioned in the ppt).

Essential Guide to Dental Splinting

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Essential Guide to Dental Splinting