2. CONTENTS
Introduction
Definition
Historical Highlights
Objectives Of Splinting
Factors Governing Use Of Splint
Indications And Contraindications
Advantages And Disadvantages
Principles Of Splinting
Biomechanics
Ideal Splint Characterstics
3. Principles Of Splinting
Biomechanics
Ideal Splint Characterstics
Classification Of Splints
Duration Of Splinting
Influence Of Splinting In Dental Tissues
Splint Removal
Splinting And Oral Hygiene
Caries Prevention In Splinted Teeth
Summary
Conclusion
4. INTRODUCTION
The ultimate goal in management of
mobile teeth4–
To restore function and comfort by
establishing a stable occlusion.
The clinical management of mobile teeth
can be a perplexing problem.
In some cases, mobile teeth are
retained because patients decline
multidisciplinary treatment that
might otherwise also include
strategic extractions.
5. Some mobile teeth can be treated
through occlusal equilibration alone
(primary occlusal trauma) whereas
mobile teeth with a compromised
periodontium can be stabilized with the
aid of provisional and/or definitive
splinting (secondary occlusal trauma).
Tooth splinting have been
accomplished since ancient
civilizations to decrease tooth
mobility and to improve form,
function and esthetics.
Still splinting remains one of the poorly
understood and controversial areas of
dental therapy.
6. DEFINITION
• SPLINT: A SPLINT HAS BEEN DEFINED AS “AN
APPARATUS USED TO SUPPORT, PROTECT OR
IMMOBILIZE TEETH THAT HAVE BEEN LOOSENED,
REPLANTED, FRACTURED OR SUBJECTED TO CERTAIN
ENDODONTIC SURGICAL PROCEDURES” 6.
7.
8.
9. HOW SHOULD AN IDEAL SPLINT
BE5
Be easily accessible
Be applied directly intraorally, using materials available in
the dental practice
Ensure adequate fixation of a tooth, preventing its
accidental ingestion or inhalation.
Protect from any further trauma during the healing period
10. Allow for physiological tooth mobility to promote the healing
of the PDL
Not impair oral hygiene and speech
Not traumatize oral soft tissues
Not interfere with occlusal movements
Be easy to remove, without causing permanent damage to the
dental hard tissues
Be comfortable and aesthetic.
11. OBJECTIVES OF SPLINTING6
REST - for the supporting tissues giving them favorable time
for repair of trauma.
REDIRECTION OF FORCES –redirect forces in a more
axial direction over all the teeth included in the splint.
REDISTRIBUTION OF FORCES- i.e ensures that the
forces does not exceed the adaptive capacity.
RESTORATION OF FUNCTIONAL STABILITY-
functional occlusion stabilizes mobile abutment teeth.
12. To PRESERVE arch integrity.
To STABILIZE mobile teeth during surgical, especially
regenerative therapy and stabilization of dislocated and
fractured teeth and alveolar bone fragments.
FIXATION of teeth and fragments in their original
anatomical position.
Prevention of accidental INGESTION AND
INHALATION as well as protection of impaired teeth
13. PREVENTION OF MIGRATION AND SUPRAERUPTION of
unopposed teeth.
MASTICATORY function is improved.
Splinting during or following periodontal therapy is useful in
controlling the effects of secondary trauma from occlusion.
The main objective and rationale of splinting and occlusal
adjustments are to CONTROL the progressive tooth mobility.
PSYCHOLOGICAL WELL BEING gives the patient comfort
from mobile teeth a sense of wellbeing.
14. FACTORS THAT GOVERN THE USE
PERIODONTAL SPLINT7
Include a sufficient number of firm teeth in the splint.
The splint should not impinge upon gingiva, irritate the other
parts of oral mucous membrane or create a functional
disharmony.
The splint should not interfere with oral hygiene
15. The splint should be simple and esthetically acceptable.
Their construction should entail a minimum loss of tooth
structure.
Meticulous care by patient should be emphasized.
16. INDICATIONS
To protect mobile teeth , to promote
healing.
To distribute occlusal forces to the teeth
which lost periodontal support .
To prevent extrusion of unopposed teeth.
To facilitate surgical procedures.
17. To preserve normal masticatory function.
To stabilize teeth after trauma, subluxation and
avulsion.
To stabilize teeth after orthodontic movements.
To protect teeth from secondary trauma from
occlusion
18. CONTRAINDICATIONS
Occlusal stability and optimal
periodontal conditions cannot be
obtained
Poor oral hygiene
Insufficient number of non-mobile teeth
to adequately stabilize mobile teeth
Presence of occlusal interference
19. High caries activity .
Overall poor prognosis.
Crowding and malaligned teeth that may compromise the utility.
Teeth with severe inflammation and pathology
20. ADVANTAGES
Alveolus remodeling of alveolar bone and
periodontal ligament for orthodontically
moved teeth.
Provides healing of supporting structures.
Fine stability and comfort for patient will
be provided.
Facilitates surgical procedures by keeping
the tooth immobile. Distributes occlusal
forces on a wide area.
21. DISADVANTAGES
Accumulation of plaque can lead to
further periodontal maintenance.
Requires excellent oral hygiene
maintenance.
If one tooth in the splint is in traumatic
occlusion, it can injure the periodontium
of all other teeth included in the splint.
Development of caries is an amenable
risk.
22.
23.
24. 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.
25.
26. DURATION OF SPLINTING5
• Since the research revealed that long-term splinting could
lead to adverse outcomes, such as replacement resorption
and ankyloses.
• It is recommended that the duration of splinting should be as
short as possible.
• The current International Association of Dental
Traumatology (IADT) and the American Association of
Endodontists guidelines for splinting are following-
29. splints
Temporary Splints Provisional Splints Permanent Splints
Acc to the period
of stabilization
WEISGOLD CLASSIFIED SPLINTS AS
TEMPORARY , PROVISIONAL AND
PERMANENT6-
31. GOLDMAN COHEN AND CHECKER
CLASSIFICATION
Splints
Temporary
Extracoronal-Wire
ligation
Orthodontic bands
Removable acrylic
appliance
Removable cast
appliance
UV light polymerising
bonding materials
Intracoronal-
Wire and Acrylic
Wire and amalgam
Wire,Amalgam and
acrylic
Cast chrome cobalt
alloy bars with
acrylic or both
Provisional
All acrylic
Adapted metal band
32. Splints are categorized as 1,2,3,11 -
• Rigid splints
• Nonrigid/semirigid/flexible splints
This categorization of splints is based on the possibility of the
physiological mobility of the tooth .
33. RIGID SPLINTS :-
suture splints
arch bar splints
acrylic splints
composite splints
SUTURE SPLINT-
It is the simplest form used as temporary splinting of traumatized
deciduous teeth or partially erupted permanent teeth in a situation
where the child is difficult to manage.
34. Soft wire and surgical thread can be used as materials for this type
of splint
35.
36. ARCH BAR SPLINTS
These are ready-made metal bars with hooks onto which the
wire is woven which fixes the metal brackets to the teeth
The bars are placed right up against the gums which cause
irritation, and they are therefore impractical for everyday use.
37.
38. ACRYLIC SPLINTS
They are indicated in cases of luxation of a tooth in combination
with a fracture of the alveolar bone. the best-known splint of this
type is the Pfeiffer splint.
This splint may be made in two ways:
Direct method
Indirect method
40. INDIRECT METHOD
This method differs from the previous one in how it is executed
first an impression is taken of the jaw in alginate.
various models are created in the laboratory.
on the basis of the models, a splint is created in wax so that the
cervical part of the crown of the tooth remains uncovered.
the wax model is exchanged for acrylic.
the splint is cemented in the same way as in the previous method.
41.
42. COMPOSITE SPLINTS
Only composite materials are used to make this kind of splint . The
technique is very simple because it consists of working with composite
material in the classical way:
Conditioning of the enamel of the injured and neighboring teeth
Application of the adhesive and composite material with polymerization
43. In conclusion, all tested splints appeared to maintain
physiologic vertical and horizontal tooth mobility.
However, the latter was critically reduced in RS splints.
45. ORTHODONTIC BRACKETS
• For this type of splint, orthodontic brackets and orthodontic wire
are needed. The brackets are placed in the middle third of the
labial surface of the tooth. They are connected by orthodontic
wire, 0.016 mm in diameter, which is passively adapted.
46. • It is indicated in a few clinical conditions like:
Severely malpositioned teeth which makes the placement of wire-
composite splint difficult.
In case of intrusive luxation, where repositioning of the tooth is
to done
47. Conclusion-The results suggested that stainless steel or cobalt-
chromium, square or round wires should be used for construction of
a dental splint.
48. • WIRE -COMPOSITE SPLINTS
The splint that is used most often in everyday practice is a wire-
composite splint .
To make it, any composite material and orthodontic wire, 0.3–
0.4 mm in diameter, are needed. It is indicated in all cases of
traumatic injuries .
.
49.
50.
51. • FIBRE REINFORCED SPLINTS
• These types of splint include
Fishing line
Glass-ionomer fiber
Ribbond splint
Kevlar fiber
Fishing line and glass-ionomer fiber are used in the same way as
in a wire-composite splint.
52. • RIBBOND SPLINTS
This type of splint relies on the use of special polyethylene
fibers, ribbond fibers, and composite materials .
In dental traumatology, ribbond fiber splints are fixed extra-
coronaly. They are used intracoronarily in cases of
periodontitis, where it is necessary to create cavities in the
teeth to place the fiber.
53. RIBBOND SPLINT
Clean the surface of tooth
Determine the length of Ribbond tape
Cut the ribbond tape using special scissors
The tape is impregnated with bonding agent or fissure
sealant material
Injured tooth and neighboring tooth conditioned with
phosphoric acid
54. • Wash the acid off with water, and dry.
• Apply the adhesive on the conditioned surface of the teeth.
• Apply the flowable composite material to the tooth and then the
ribbond tape, which is pressed into the composite applied and
smoothed
• Excess composite material is removed. Each tooth is then light
cured for 30–40 s.
• Using a drill, we remove the excess composite material and polish
the surface of the composite.
55. KEVLAR FIBER
Kevlar fiber, poly- paraphenylene terephthalamide, is a
synthetic, organic fiber of exceptional strength (five times
stronger than metal).
As well as being used to make bulletproof vests and in the
aero-industry, it is used in dental traumatology as a means of
immobilizing teeth .
It has the identical features, therapeutic effect, and manner of
application as ribbond splints.
56.
57.
58.
59. TITANIUM TRAUMA SPLINTS
A TTS is a more recent splint, made from pure titanium, only 0.2 mm in
thickness, which makes it significantly easier to apply to the tooth.
It is fixed to the tooth in the same way as a wire-composite splint. The
weakness of this splint system is that it is very expensive in comparison
with a wire-composite splint.
60. Conclusion-flexible or semirigid splints such as the titanium
trauma splint and wire-composite splint are appropriate
for splinting teeth with dislocation injuries and root
fractures, whereas rigid splints such as composite splint
and the titanium ring splint can be used to treat alveolar
process fracture.
61. MANAGEMENT OF DENTAL
TRAUMA13
SUBLUXATION
Tt-Non rigid splint for 7-14
days if necessary for comfort
An injury to the tooth
supporting structures resulting
in increased mobility , but
without displacement of the
tooth.
64. INTRUSION
Displacement of the tooth
into the alveolar bone
Tt-Spontaneous repositioning and
follow-up for 2-4 weeks. If
eruption has not begun
orthodontic or surgical
repositioning.
(if dislocation of tooth>7mm)-
apply flexible splint for 4 weeks
65.
66.
67. AVULSIO
N
The tooth is completely displaced out
of the socket.Clinically the socket is
found empty or filled with coagulum.
Tt-
Mature apex/open apex
Extraoral time<60 min-Flexible splint for
2 weeks
Extraoral time>60 min-Flexible splint for
4 weeks
68. In this study, replantation of a maxillary
incisor was done with an extended extraoral
period following a traumatic avulsion.
Conclusion-A 12 month, 18 month and a 5 year follow-up clinical examination
revealed the patient to be asymptomatic, and the tooth was functional.
69.
70.
71. ROOT
FRACTURES
A fracture confined to the root
of the tooth involving
cementum,dentin,and the pulp.
Tt-Stabilize with flexible splint
for 4 weeks
75. Influence of splinting in dental tissues7
Influence upon gingiva
• May lead to invasion of bacteria due to loss of some epithelial
attachment.
Influence upon periodontal healing
• Experimental studies demonstrated --optimal periodontal healing (ie.
With minimal ankylosis)
76. Influence on pulp healing
• In humans, splinting of auto transplanted teeth for only one
week (with a suture splint) has been found to improve pulpal
healing as compared to rigid splinting for four weeks.
Enamel changes after splinting
• The staining of the labial enamel takes place because of acid
etching
77. SPLINT REMOVAL
.
Various techniques are employed for removing the remnant
composite material used for retaining the splints from the enamel
surface.
They are hand instruments like scalers and pliers, burs, abrasive
discs, rubber wheels and cups.
78. SPLINTING AND ORAL HYGIENE
Splinting makes oral hygiene procedures difficult.
Special attention must be given to instructing the
patient about enhanced measures for oral hygiene
after placement of the splint prosthesis.
Effective personal plaque control, professional
caries risk assessment, and periodontal
maintenance
79. CARIES PREVENTION IN SPLINTED
TEETH6
The roughness of the composite resin surfaces
attracts plaque and debris, can increase caries risk
to the surrounding supportive splinted structures.
Composite resin restorations and composite resin
splints require close examination at maintenance
visit
82. CONCLUSION
• Splints offer numerous therapeutic advantages ranging from
increased periodontal resistance to occlusal relationship correction.
• Regardless of the type of splint design,material and method of
fabrication,it must provide good access to oral hygiene, fixation and
also elimination of occlusal trauma by providing force distribution
and resistance to occlusal overload.
• Splinting may thus serve as a boon,improving the health of the
periodontium,thereby decreasing tooth mobility,but may become a
bane if used incorrectly and not managed properly.
83. BIBLIOGRAPHY
1. Cohen’s pathways of the pulp-11th edition
2. Grossman’s Endodontic practice-13th edition
3. Textbook of Endodontics-Nisha garg-4th edition
4. Splints in Dentistry- A Contemporary Review. Acta Scientific Dental Sciences (ISSN: 2581-
4893) Volume 6 Issue 2 February 2022
5. Sobczak-Zagalska H, Emerich K. Best Splinting Methods in Case of Dental Injury–A
Literature Review. Journal of Clinical Pediatric Dentistry. 2020 Jan 1;44(2):71-8.
6. Tooth Splinting : An Update-By Dr. Sajili Mittal and Dr.Shailesh Jain
7. Recent Advances In Splinting In Dentistry -Ruchi Gupta , Anil K Tomer , S. Parvathi Jayan
8. Gupta S, Sharma A, Dang N. Suture splint: an alternative for luxation injuries of teeth in
pediatric patients--a case report. The Journal of clinical pediatric dentistry. 1997 Jan 1;22(1):19-
21.
9. Goswami M, Eranhikkal A. Management of traumatic dental injuries using different types of
splints: a case series. International Journal of Clinical Pediatric Dentistry. 2020 Mar;13(2):199.
10. Von Arx T, Filippi A, Lussi A. Comparison of a new dental trauma splint device (TTS) with
three commonly used splinting techniques. Dental Traumatology. 2001 Dec;17(6):266-74.
11. The Basics Of Splinting In Dentoalveolar Traumatology Written By-Naida
Hadziabdi.cSubmitted: 07 February 2019 Reviewed: 14 June 2019 Published: 15
January 2020
84. 12. Prevost J, Louis JP, Vadot J, Granjon Y. A Study Of Forces Originating From Orthodontic
Appliances For Splinting Of Teeth. Dental Traumatology. 1994 Aug;10(4):179-84.
13. Management And Treatment Of Dental Trauma Dr. John W Pawluk, DDS
Endodontist Naperville - Oakbrook Terrace
14. Tuloglu N, Bayrak S, Tunc ES. Different clinical applications of bondable reinforcement
ribbond in pediatric dentistry. European journal of dentistry. 2009 Oct;3(04):329-34.
15. Berthold C, Thaler A, Petschelt A. Rigidity of commonly used dental trauma splints. Dental
Traumatology. 2009 Jun;25(3):248-55.
16. Şermet Elbay Ü, Elbay M, Kaya E, Sinanoglu A. Management of an intruded tooth and
adjacent tooth showing external resorption as a late complication of dental injury: three-year
follow-up. Case reports in dentistry. 2015 Feb 23;2015.
85. 17. Kubasad G, Ghivari S, Garg K. Replantation Of An Avulsed Tooth
With An Extended Extra Oral Period. Indian Journal Of Dental Research.
2012 Nov 1;23(6):822-5.
18. Sisodia N, Manjunath Mk. Conservative Management Of Horizontal
Root Fracture–a Case Series. Journal Of Clinical And Diagnostic
Research: JCDR. 2015 Aug;9(8):zd04.
19. Cehreli Zc, Lakshmipathy M, Yazici R. Effect Of Different Splint
Removal Techniques On The Surface Roughness Of Human Enamel: A
Three‐dimensional Optical Profilometry Analysis. Dental Traumatology.
2008 Apr;24(2):177-82.
(that promotes tooth retention and the maintenance of periodontium and temporomandibular joint health)
especially if the underlying causes for that mobility have not been properly diagnosed.
Early dental splinting methods can be traced back to ancient civilizations such as Egyptians,greeks and romans,they used materials like gold wire ,silk thread and even cqatgut to stabilize teeth,In 18th and 19th century wire ligatures and dental braces made of gold and platinum became more common
the 20th century witnessed significant advancements in dental splinting techniques. The introduction of new materials such as stainless steel, composite resins, allowed for more effective and aesthetic splints. . Fiber-reinforced composite materials gained popularity for their strength and aesthetics.
Splints are indicated to
Its contraindicated if
However, evidence-based appraisal of injured teeth concluded that the splinting duration was not a significant factor when related to healing outcomes
Temporary splints-Used on a short term basis ,usually less than 6 months,usually as an interim measure until a more definitive treatment can be provided
Provisional splint-used for longer period of time from several months to as long as several years,to see how teeth will respond to treatment,usually leads to more permanent form of stabilization.
Permanent splint-to be used indefinitely,essential in treatment of advanced periodontal disease
Thus, a Rigid splint does not permit any physiological mobility of the tooth and thereby creates the conditions for complications in the sense of ankylosis.
In the case of a Nonrigid or Semirigid splint, the physiological functional mobility of the traumatized tooth is possible, which is more favorable for the healing of the periodontal ligament (pdl), and thereby the risk of ankylosis of the tooth root is reduced.
. it is a temporary splint because it is retained only for 3 to 4 days until the child becomes more receptive to a definitive treatment
a suture is placed over the incisal edge from palatal gingiva to the labial gingiva.it prevents the tooth from extruding. but the biggest disadvantage of this splint is that sometimes the incisal edge has to be grooved to hold the suture material in position
This is one of the case report published in journal of clinical pediatric dentistry where in suture and bonded resin splint was performed on laterally luxated maxillary central incisor and avulsed lateral incisor.The splint was removed after one week and sufficient periodontal and gingival healing was observed
This is one of the case report published in jour of cli ped dentistry in which -A 10-year-old boy reported , with a history of trauma due to fall during playing. Intraoral examination revealed Ellis class V fracture of 21 but was not detached from the gingiva. Ellis class II fracture of 11 was present. Clinical and radiographic examination of maxillofacial region was done and no fractured segments were noted. The treatment plan was to reposition the tooth using arch bar fixation .Splinting was removed after 3 weeks and the patient was asymptomatic and the tooth were planned for composite restorations.
Creating a Pfeiffer splint using the direct technique: (A) blending the acrylic, (B) pouring the blended acrylic onto the sterile gauze, (C) cutting the edges of the gauze onto which the acrylic was poured, (D) the rectangular-shaped gauze, (E) adjusting the splint over the vestibular and palatal surface of the tooth, (F) the inside of the splint, (G) verification of the splint in central occlusion, (H) removing the splint for processing, (I) creating space for the cement, (J) processing-cutting the edges of the splint, (K) phosphate cement, (L) the final appearance of the splint with the cement inside, (M) cementing the splint,
The weakness of a composite splint is its tendency to split due to the action of interdental occlusal forces. It also may irritate the surrounding gums if it is placed very close to them.
This study compared four dental trauma splints in 10 Switzerland volunteers. The evaluated splints included a wire-composite splint (WCS), a button-bracket splint (BS), a resin splint (RS), and a new device (TTSΩTitanium Trauma Splint) specifically developed for splinting traumatized teeth.
.
The advantage of immobilization using an orthodontic splint is the possibility of synchronizing the movement of the teeth, which is particularly important in cases of intrusion. The weakness is the irritation of the lips, which can be avoided by applying wax
This is one of the article published in endodontic dental traumatology in which….The mean force developed by nickel-titanium wires (14.27 x 10(-2) N) was significantly greater (p < 0.05) than the mean force developed by stainless steel and cobalt-chromium wires. Moreover, the mean force developed by rectangular wires (12.07 x 10(-2) N) was significantly greater (p < 0.05) than the mean force developed by square and round wires. The results suggested that stainless steel or cobalt-chromium, square or round wires should be used for construction of a dental splint.
Contraindications for the use of a wire and composite splint are when the teeth have artificial crowns and large fillings or in the teeth with exceptionally small crowns
The technique for making one is quite simple:
Orthodontic wire of the selected length is shaped directly in the patient’s mouth to cover 2–3 teeth on each side of the injured tooth.
The labial surface is conditioned using orthophosphoric acid.
After rinsing and drying, they are coated with the bonding substance and light cured for about 10 s.
The composite material is placed over the tooth and over that wire is positioned.
Light curing should first be performed on the healthy teeth on one side; then the tooth should be repositioned, followed by light curing (polymerization); and then the wire should be light cured on the healthy teeth on the other side.
This is one of the case series published in int journal of pediatric dentistry ..A 12-year-old boy reported with a history of fall while playing. On examination, lacerations were present on chin and lips (Fig. 1). Both the maxillary central incisors had Ellis class VII fracture without root fracture. Along with this, fracture of crown of 21 was also noted. Under local anesthesia, teeth were repositioned. Splint was applied with the help of stainless steel wire and composite resin material for 3 weeks (Fig. 2). Root canal treatment was started in 21. After 3 weeks, patient was examined clinically and radiographically. Eventually, the splint was removed. Occlusion was normal and soft tissues were healed properly.
This case report demonstrates usage of Ribbond as a space maintainer, a fixed partial denture with a natural tooth pontic, and a splint material in children. Ribbond can be used as an alternative to conventional treatment in pediatric dentistry.
It is available in 52 and 100 mm lengths. It is designed in the form of a rhomboid mesh, which makes it easier to be fixed and makes it flexible in all dimensions
The size of the rhomboid opening, 1.8 × 2.8 mm, reduces the quantity of composite material used to fix it to the surface of the tooth, making it easier to remove the splint.
This study evaluated the rigidity of various commonly used splints in vitro. evaluated composite splints, wire-composite splints, a titanium trauma splint, a titanium ring splint, a bracket splint, and 2 Schuchardt splints.
In surgical repositioning
In this case report, 11-year-old male patient with complete intrusion of the permanent maxillary left lateral incisor, associated with the adjacent central tooth presenting external resorption, treated by immediate surgical repositioning and root canal treatment with a favorable prognosis. After long-term (3-year) clinical and radiographic follow-up, the teeth appeared normal and the patient was pleased with the outcome.
The recall radiograph showed no evidence of renewed periradicular breakdown and apical root resorption
It is assumed that slight mobility in the initial healing period activates resorption of initially formed ankyloses sites.
and can be easily removed by careful polishing.
In an experimental study conducted to assess the surface roughness of enamel after employing various methods to remove the material, it was noted that Soflex discs and 16-blade tungsten carbide bur cause least damage to the enamel
2.Therefore, to ensure the longevity of the connected teeth,
3. are crucial to the longevity of the splint and health of the splinted teeth.
3.
because of the potential for breakdown and marginal leakage through radiograph and clinical examinations
