The periodontally compromised dentition offers many opportunities to debate the

efficacy of splinting. It frequently addresses the therapeutic goals of treatment,

including patient comfort with mastication and retention of teeth after orthodontic
intervention.

A continued increase in mobility can be devastating in the presence of a reduced

periodontium. In such situations, normal or physiologic forces can no longer be
tolerated and a change in the attachment apparatus occurs.':'

If the patient experiences the tooth mobility as disturbing, however the mobility
can be reduced only by splinting i.e. by joining the mobile / tooth teeth together
with other teeth in the jaw into a fixed unit – a SPLINT

A splint, according to the glossary of periodontic terms (1986) is an “an

appliance designed to stabilize mobile teeth”.

A splint can be fabricated in the form of composite fillings, fixed budges,

removal partial prosthesis etc.,

In clinical practice, the treatment of mobile anterior teeth seems to be one of the
most common and most challenging situations practitioners face. Splinting
stabilizes the teeth as a unit by including healthy teeth, and redirects the forces
from individual teeth to the new unit as a whole including the healthier teeth
results in a new increase in crown-root ratio and a net decrease in force to the
individual tooth, especially in a horizontal direction. Horizontal forces are believed
to be more traumatic than axial forces." The most important aspect of splint design
is to secure the teeth in all planes. Many times this principle necessitates cross arch
stabilization. This ensures tooth stability without increasing mobility and allows
the periodontal ligament of each to other to increase in surface area," thus
providing long-term retention."
The selection of the form of splinting will be affected by the problem at hand. It
has been suggested that splints be categorized by the length of time they will be
used

Classification of Splints

A temporary splint is used on a short-term basis to stabilize teeth during

periodontal therapy or after a traumatic episode.

A provisional splint is used for several months to several years for diagnostic
information. Provisional splints allow the clini cian t ime to observe the healing
response to treatment and to make changes based on patient response; this enables
the clinician to prop erly design a more permanent and biologically acceptable
form of stabilization.

A permanent splint is used indefinitely, Permanent splints are usually used in a

more reduced periodontium. In the periodontal patient, applicat ion of splints
frequently crosses the planned perimeters of use and may create several gray
zones. The etiology of mobility, the degree of mobility, esthetics, tooth contours,
tooth position, the coronal condition of the teeth, and embrasure morphology are
some of the factors to be considered in choosing the type of splint.

Splints of all three categories can be further subdivided into exrracoronal and
intracoronal forms.

Intracoronal Splints
lnrracoronal splints are the rnost commonly used type of splint. As the name
implies, rhe technique entails making a cavity preparation into rhc lingual, palatal,
or occlusal surface.

This preparation is used to increase strength and retention of the restorative

material. The preparation can be cont inuous (Fig 10-1) or discontinuous (Fig 10 -
2). The continuous splint is generally used in the mandibular segment because of
the relatively short mesiodistal dimension of mandibular incisors. The discon
tinuous splint is more commonly used in the maxillary segment.

The teeth must first he evaluated as stable abutments. If the canines are periodon
tally sound, it is not necessary to include additional teeth in the splint . If the
canines arc not pcriodotally sound, additional teeth should be added, or use of a
complete-coverage provisional splint should be considered.

1 . Teeth with a more reduced periodontium (Figs 10-3a and 1O·3b)

2. Dentition with a deep overbite

3. Teeth with very short roots or resorbed roots (Fig 10-4)

4. To evaluate potential abutment teeth

5. Teeth with root amputations and mobility

6. To avoid dislodgment during regenerative procedures

7. Posrorthodontics. especially in cases involving intrusions, extrusions, rotations,

pathologic migrations, or molar up righting
8. When teeth with advanced mobility cannot he treated any other way (eg, the:
patient has medical or financial problems)
Technique

Step 1. Evaluate occlusal contacts. This is especially important in maxillary

anterior teeth. Try to avoid centric occlusion and centric relation contacts to
minimize damage or breakage of material.

Step 2. Evaluate proximal contacts (fig IO-5a). lf possible try to design preparation
in the thickest part of the contact area. This will aid in strength, retention , and
comfort.
Step 3. Make cavity preparations with a No. 699 bur. Refine later with a No. 33;'<
bur. The depth of the preparation is 1.5 to 2.0 mm (Fig 1O-5b). For the continuous
splint , it is best to prepare one tooth at a time, beginning at one proximal surface
and ending at the other. At the distal end, it is best to stop one half to two thirds th
e width of the tooth, so as not to leave unsupported tooth structu re.

Step 4. Cut wire or mesh to match the cavity preparation and try in place (Fig IO-
5c). The wire thickness can vary from 0.01 H to 0.030 in diameter, depending on
the strength needed and the proximal contact width. Threaded wire is
recommended for increased surface area.

Step 5. Apply ctchant , dentin bonding agents, and adhesives according to their
manufacturers' specifications. Layer material and secure wire or mesh. Layering is
especially important, to ensure complete curing, if a light-cured material is used.

T he use of a rubber dam or wooden wedges is recommended to keep a dry field

and prevent excess material from blocking interproximal spaces or injuring tissue.

Step 6. All occlusal contacts are checked for prematurities. It is especially

important to check protrusive and lateral protrusive contacts. If left unchecked,
these forces will cause early failure of the splint. In teeth that have supererupted. it
may be necessary to perform odontoplasty so that the incisal edges provide evenly
distributed surfaces for posteriorr disocclusion in protrusive movements.

Step 7. Refine form and polish. All excess material should be removed, and
embrasures should be opened enough to allow routine hygieni c procedures (Fig
IO-5d).

As with all splints, the integrity of the splint and the patient's ability to perform
adequate ora l hygiene should be evaluated within a 4- to 6-week period.
The major advantage of intracoronal splinting is the ease with which it can be
done, without disruption of occlusal harmony or function. It is also more
comfortable, more esthetically pleasing, and less irr ita t ing to the gingival tissues

The disadvantages of inrraco ronal splinting are the risk of pulpal injury during
cavity preparation and the risk of caries if material breaks or loosens.

Extracoronal Splints

Extracoronal splints are usually temporary in nature, although, with today's

materials, they can be considered provisional or permanent sp lints. In contrast to
the intracoronal splint, this type of splint does not involve any tooth preparation.
Similar to the inrracoronal splints, extracoronal splints can be reinforced with wire
o r mesh if additional strength is needed. Use of extracoronal splints is usually
confined to anterior teeth.

Indications :
1. Anterior teeth with moderate mobility
2. Post orthodontic retention without mobility, especially where retainer
compliance is a concern (Figs 1O-6a to 10-6<:)
3. To provide stability in cases of acute trauma and allow for healing of the
periodontal ligament, remodelling of alveolar bone, maintenance of tooth position,
and comfort during function
4. Regenerative procedures, where mobility may temporarily increase
5. Endodontic-periodontic lesions
\
Technique

Step 1. Evaluate occlusal contacts. This technique is contraindicated in patients

with deep overbite or minimal posterior occlusion.

Step 2. Evaluate proximal contacts. This will indicate the amount of material that
can be flowed onto lingual surface without creating unsupported material or an
unsightly situation (Fig IO-h).

Sup3 . Try in wire or mesh. Tight adaptation of material is very important for
strength and thickness of material. Floss may be used to hold the material in place
while the wire or mesh is secured (rig IO-7b). If canines are included in a
continuous splint, it is usuall y necessary ro place a slight offset bend between the
lateral incisor and canine to compensate for the larger lingual dimension of the
canine (f'Ig 10-7c).

Step 4. Apply etchant,dentin bonding agent, and adhesives according to their

manufacturers' specifications. Layer material; if possible. flow a small amount of
material into the inter proximal areas to provide additional resistance to
dislodgment.

Step 5. Check occlusal contacts.

Step 6. Refine and polish (Fig lO ~7d ) .

Exrracoronal splints offer advantages over imracoronal splints: They require less
time because no tooth preparation is necessary, and are more reversible. The
disadvantage of extracoronal splints is initial compromise of phonetics and
comfort. They may also limit the patient's ability to perform oral hygiene.

Materials

The materials used in splint construction come in a variety of forms. The most
commonly used materials are resin composite, acrylic resin . and amalgam.

Resin composite is the most popular material used today in both exrracoronal and
intracoronal stabilization for several reasons: ease of application. strength.
Esthetics and relatively simple to repair. The biggest disadvantage to resin
composite is the bond strength. The newer materials are much st ronger hut must
sti ll be monitored for breakage, which can allow tooth to migrate or caries to form.

Acrylic resin is used primarily in the provisional type of stabilization. The main
advantages of acrylic resin are: esthetics and strength (especially with crossarch
design ).

T he disadvantages of acrylic resin arc that it is difficult to repair and stains easily,

Amalgam is rarely used today because it fractures mo re easily and is very difficult
to repair.
Conclusion

The value of splinting has been debated for decades. Most of the data about splinti
ng come from clinical observations rather than from scientific studies, but that does
not mean that these findings shou ld be discounted altogether.

Certainly Hcszar cr al " have demonstrated that non mobile teeth heal much better
than mobile teeth , and most clinicians treating advanced disease would agree (figs
10-8a to 1O-8e).

Splinting in any form , temporary, provisional, or permanent, provides the clin

ician with invaluable information during the course of treatment. At the same time,
splinting increases the patient's comfort and function. Splinting should be
considered, therefore, as part of an overall treatment plan in patients with
moderate-to -severe tooth mobility.

Splints

Leonard – Koecker (1785 – 1850) German born dentist who

practiced in Baltimore, published a article first about splinting for
stabilizing mobile teeth in a paper in 1821, Philadelphia Journal of
Medicine and physical sciences.

But later the controversies followed with the statements such as

‘Splinting should be discouraged because it looses the firm teeth’.

There is probably no area in dentistry in which treatment

procedures are more empirical than when splinting is used for
therapeutic purposes. As yet, no research has defined when a splint
should be used, the relative efficacy of the different types of splint,
or even if a splint is of benefit to the patient.

The theoretical basis for splinting has been described as

 To rest the supporting tissues in accord with the general

principle that rest promotes resolution of inflammation;
  To redistribute stress to a group of teeth, so that forces act
mainly in an axial direction and the force on any single tooth
does not exceed the adaptive capacity of its s upporting tissues;
 To prevent tipping, migration or over -eruption of teeth
following extraction and to stabilize proximal contacts of mobile
teeth and reduce food impaction into the embrasures.

Splints can be classified as either ‘temporary’ or ‘permanen t’

and as either ‘removable’ or ‘fixed’.

Temporary splints are employed for a limited period of time to

aid healing by limiting the mobility of a tooth or teeth and therefore
assisting in healing. Temporary splints may also be used as a
diagnostic measure to assist in the determination of prognosis of
questionable teeth. Ramfjord and Ash have classified splints into (i)
temporary (ii) diagnostic and (iii) permanent. Such splints have also
been grouped as either external or internal to the circumference of
the tooth.

External splints are placed outside the crown of the teeth (e.g.)
wire ligature splints; internal splints are fitted or attached inside the
circumference of the teeth, e.g. amalgam splints

or parallel gold inlay splints.

Temporary splints

These are usually used over a period of from 1 – 6 months. The

most frequently used temporary splint is a brass or stainless steel
wire ligature splint, stabilized with cold curing acrylic resin. This is an
excellent splint for anterior teeth and provides a high degree of
stability. It is acceptable from the aesthetic view point and if properly
constructed, the embrasures are protected from food impaction. This
type of splint has largely replaced welded orthodontic bands and wire
ligature splints without acrylic, which were commonly used in the
past. Direct bonding of composite material after acid etching is now
gradually replacing wire and acrylic splints due to ease of fabrication,
improved aesthetics and access for cleaning.

Practically all-removable temporary splints are modifications of

acrylic bite plates used as bite-freeing appliances. Splinting action is
gained by carrying the acrylic over onto either the labial surface of
anterior teeth or the buccal aspect of posterior teeth.

Indications for the use of temporary splints or bite -freeing

appliances

 Following loosening of teeth by trauma

  To prevent cuspal contact and interlocking in bruxists or
patients with temporomandibular joint pain -dysfunction
syndrome
 To stabilize teeth during surgical correc tive phase therapy of
advanced periodontitis
 For stabilization of teeth during comprehensive occlusal
reconstruction

Permanent splints

Permanent splints are constructed to provide stability for teeth

that have lost so much support that normal forces act as
hyperfunctional forces. Permanent splints are also used for retention
of teeth following orthodontic procedures.

 All gingival irritation by the splint must be avoided.

 Fixed splints must allow adequate access for oral hygiene.
 Abutment teeth must be chosen carefully to provide adequate
support and retention for the fixed restoration.

For technical, aesthetic and economic reasons, the minimal

numbers of teeth are usually included to provide the support needed
for the splint. This does not always lead to the most desirable type of
splint and the decision as to the number of teeth to be included is
often based on poorly defined clinical factors. Whenever feasible,
pin-ledge preparations or three-quarter crowns should be used for
fixed splints. The complete coverage type of preparation with
subgingival extension is the last choice from the viewpoint of
biological acceptability. Full coverage crowns should only be used
when unavoidable. Precision attachment connections between
various parts of a splint come next to fixed rigid splints in providing
stability and controlling the distribution of stress in a dentition.
Present day techniques frequently combine splinting with occlusal
reconstruction. Fixed retainers are preferable to removable
appliances with clasps. The use of the precision attachment brings
the forces closer to the axial center of the tooth when a removable
partial denture is necessary.

Even splinted teeth, which were not in occlusal contact, did not
escape injury, when only one member of the spl int was traumatized.
When one of the teeth in a splint is subjected to excessive occlusal
force, the remaining teeth share the load.

Nabers has reported that night-guard appliances can open

interproximal contacts between teeth, and Saturen has reported that
wire ligatures are an undesirable form of temporary splinting because
they induce active forces on the ligated teeth, causing them to be
moved into new positions.
 Extensive caries may develop under loose abutments and gross
sepsis may follow with minimal symptoms. It is therefore imperative
that all splints be inspected regularly.

Since splints have many disadvantages accompanying their obvious

stabilizing advantages, splinting of teeth should be restricted to the
minimum needed to achieve occlusal s tability and adequate
masticatory function. Splints should never be used as a substitute for
accuracy and exactness in occlusal therapy of the individual teeth.

SPLINTING

Definition-

It is an appliance to prevent periodontal tissue injury by immobilizing & stabilizing

the periodontal affected teeth so as to promote healthy environment around them.
Therefore periodontal splints are adjunct to periodontal therapy but they
themselves do not eradicate the pocket.

Prerequisites-

1) Periodontal pathology including the etiological factors must be eradicated

first before periodontal splint is applied.
 2) The occlusal adjustment must be given attention prior to construction of
splints.

3) Sufficient number of teeth must be included in construction of splints.

Normal ratio is 1:2.

4) Splints must be maintain in apposition in such a fashion as to cause no harm

to gingiva, tongue, cheek, lip & which will not interfere in occlusion.

5) A construction of splints must be decided in such a fashion that the teeth

splinted are covered around the arch.

6) Teeth which have extensively involved pathology with bone negative factor
in such a teeth splinting may cause harm therefore hopeless involved teeth
should not be included.

INDICATIONS:

1) Acutely traumatizing teeth.

2) Second degree of mobility cause by periodontal pathology.

3) Selected case of third degree mobility especially in anterior teeth of young

female patient.

4) To prevent pathologic migration of teeth as in cases of Juvenile

periodontitis.
 5) In cases of bruxism where parafunctional occlusal pressure require to be
relieved.

6) For stabilizing periodontally affected teeth which are in the arch, but which
are subjected to secondary traumatic occlusion.

CLASSIFICATION:

I] According to metal material used-

1. Metallic – stainless steel wire

Silver.

2. Non metallic – acrylic

Polymerizing resin restorative material.

3. Combination of both (wire & acrylic).

II] According to nature –

1. Temporary.

2. Permanent

III] Internal – intracoronal

External- around the teeth.

IV] Removal

Fixed

V] Endo-osseous implanting
Common splints used-

1) Interdental wire ligation-

a) For anterior teeth- Soft stainless steel wire thickness .oo7” to 0.01” in
diameter is used.

b) For posterior teeth-the splint is constructed through orthodontic bands which

have the metal of thickness 0.03” to 0.08”. usually these splints are given in
a teeth suffered acute trauma to teeth & first to second degree mobility due
to periodontal pathology.

2) Hawley’s Splint- is constructed through wire which is used in ligation in

labial bow of fashion to prevent pathologic migration of teeth in
cases of juvenile periodontitis.

3) Internal fixed metallic splints- Through restoration provide more stable &
desirable biomechanical action of splints because they can sustain occlusal
pressure in the axial direction thereby preventing development of lateral
forces, however, from frictional point of view they are usually not
constructed.

4) Acrylic & wire splints (Intracoronal) - Cavities are prepared on the lingual
side of the anterior teeth. Stainless steel wire is placed & cavities are filled
with acrylic.
 5) Acid etch Splint- After through preparation enamel surface area is etched
with acid gel for 2 minutes. Polymerized resin restorative material is placed
on prepared teeth & cured by light. Currently this technique is very widely
used.

6) Endo-osseous implants- After through removal of pathology, Root canal is

to be done& selected stainless steel wire or titanium insert is implanted
through root canal to the Bone. This is indicated in 3rd degree mobility of
anterior teeth in young patient.

7) Night guards- This non metallic acrylic cover splint given in cases of
Bruxism. Through this splint the occlusal surface of the partially made teeth
are covered by the acrylic splint layer to prevent periodontal injury & tooth
injury during the Para functional tooth movement at subconscious level
through clenching & grinding of teeth.

Principle involved in Splinting-

The fulcrum of tooth movement is placed in more favorable position through

stabilization of teeth, since the axis of rotation around the fulcrum is adjusted
favorably. The facial – lingual mobility of teeth is restricted thereby preventing
damage to periodontal structures. The forces balanced through the splint are to
prevent injury from lateral forces. It is essential that sufficient number of healthy
teeth should be splinted to immobilize teeth. The stability provided by the splint
attains reorganization of tissue.