Splints In Periodontal Therapy
Question 1. Write short note on splints.
Or
Write short note on periodontal splints.
Answer. Splint is defined as an appliance used for immobilization of injured or diseased parts.
A periodontal splint is an appliance used for maintaining or stabilizing mobile teeth in their functional position.
Classification of Periodontal Splints
- According to the period of stabilization
- Temporary stabilization: Worn for less than 6 months.
- Removable: Occlusal splint with wire and Hawley with splinting arch wire
- Fixed: Intracoronal and extracoronal
- Provisional stabilization: Worn for 6 to 12 months. For example, Acrylic splints and metal bands
- Permanent splints: Used indefinitely
- Removable/Fixed
- Extra/Intracoronal
- Full/Partial veneer crown soldered together
- Inlay/Onlay soldered together
- Temporary stabilization: Worn for less than 6 months.
Periodontal Splinting Material
Read And Learn More: Periodontics Question And Answers
- According to the type of material
- A-splints
- Bonded, composite resin button splint
- Braided wire splint.
- According to the location on the tooth
Intracoronal
-
- Composite resin with wire
- Inlays
- Nylon wire.
Extraoral
-
- Tooth-bonded plastic
- Night guard
- Welded bands.
Periodontal Splinting Material
Ideal Requirements of Periodontal Splint
- It is easy to prepare.
- It should be economical
- It should be rigid, durable and stable
- It should be easily removed and replaced
- It should be self-cleansing in design and is easily maintained by homecare procedure.
- It should be aesthetically acceptable and is well-adapted in its fit.
- It is non irritating to adjacent dental or gingival tissues.
Objectives of Splinting
- To provide rest: Occlusal rest provided by splinting therapy in one form or another helps in elimination of some adverse occlusal forces.
- For redirection of forces: Splinting helps to redirect forces in a more axial direction.
- For redistribution of forces: Splinting provide stabilization and enhances resistance to applied force.
- To preserve arch integrity: Splinting restores proximal contacts, reducing food impaction and consequent break down.
- Restoration of functional stability restores a functional occlusion, stabilizes mobile teeth and increases masticatory comfort.
- Psychological well-being: Splinting provides comfort to patient from mobile teeth and improves sense of well-being
- To stabilize mobile teeth during surgical procedure mainly regenerative therapy.
- To protect tooth supporting tissues during healing period following surgery or after an accident.
- To prevent extrusion of an unopposed teeth.
- To bring in function to the teeth which is not used to eat efficiently.
Periodontal Splints Indications
- To stabilize moderate to advanced tooth mobility which is unable to decrease by occlusal adjustment or periodontal therapy.
- To stabilize teeth in secondary occlusal trauma.
- To stabilize teeth with increased tooth mobility, which interferes with normal masticatory function.
- To make scaling and surgical procedures easy to conduct.
- To stabilize teeth after the orthodontic movement.
- To stabilize teeth after acute dental trauma, i.e. subluxation, avulsion, etc.
Periodontal Splinting Material
Periodontal Splints Contraindications
- In moderate to severe tooth mobility associated with periodontal inflammation and/or primary occlusal trauma.
- Inadequate number of firm teeth in order to stabilize mobile teeth.
- Unable to perform prior occlusal adjustment on teeth with occlusal trauma or occlusal interferences.
- Patient with poor oral hygiene.
- When the sole objective of splinting is to decrease, tooth mobility following the removal of the splint.
Periodontal Splints Advantages
- It helps to achieve final stability and comfort for patient with the history of occlusal trauma.
- Useful to reduce tooth mobility and enhance healing following acute trauma to the teeth.
- Orthodontically splinted teeth permit remodeling of alveolar bone and periodontal ligament.
- Useful in reducing mobility and favoring regenerative therapy.
- Distributes occlusal forces over a wide area.
Periodontal Splints Disadvantages
- Hygienic: Poor oral hygiene favors accumulation of plaque at the splinted margins which can further damage periodontal apparatus in a patient with poor periodontal support.
- Mechanical: Rigid nature of the splint makes it to act as lever with uneven distribution of forces. This can injure the periodontium of all teeth within the splint when one tooth of the splint gets traumatic occlusion.
- Biological: Development of caries is an unavoidable risk and thus, requires excellent maintenance by the patient.
Question 2. Write short note on tooth mobility.
Answer. All the teeth consist of slight degree of physiologic mobility which vary for different teeth and during different times of the day.
- Tooth mobility is highest in the morning and progressively decreases. Increase in tooth mobility in morning is attributed to slight extrusion of tooth due to limited occlusal contact during sleep. While later on this reduces by chewing and swallowing forces, which intrude tooth in the socket.
- The above variation is less marked in people with healthy periodontium as compared to bruxers and clenchers.
- Single rooted tooth shows less mobility as compared to multirooted teeth.
- Mobility in tooth is in the horizontal direction although some axial mobility also occur.
Periodontal Splinting Material
Etiology of Tooth Mobility
Following are the causes of tooth mobility:
- Loss of tooth support (Bone loss): Amount of mobility depends on the severity and distribution of bone loss at individual root surfaces, the length and shape of the roots, and the root size compared with that of the crown. Tooth with short, tapered roots is more likely to loosen than one with bulbous roots with the same amount of bone loss.
- Trauma from occlusion: It is produced by excessive occlusal forces or incurred because of abnormal occlusal habits, i.e. bruxism and clenching, is common cause of tooth mobility. Mobility is also increased due to hypofunction. Mobility caused by trauma from occlusion occurs initially as a result of resorption of the cortical layer of bone, leading to reduced fiber support, and later as an adaptation phenomenon resulting in a widened periodontal space.
- Due to extension of inflammation: As inflammation extends from gingiva or from periapex in periodontal ligament produces changes which causes tooth mobility.
- Periodontal surgery: It increases tooth mobility for short period.
- In pregnancy: Tooth mobility is increased in pregnancy and is associated with the menstrual cycle or the use of contraceptives. Mobility occurs in patients with or without periodontal disease, because of physicochemical changes in periodontal tissues.
- Pathologic processes of jaws: Pathological processes of the jaws that destroy the alveolar bone or the roots of the teeth can also result in mobility. Such processes include osteomyelitis and tumors of the jaws.
Stages of Tooth Mobility
- In initial stages, the tooth moves within the confines of the periodontal ligament. This is associated with viscoelastic distortion of periodontal ligament and redistribution of periodontal fluids, interbundle content in fibers.
- Secondary stages occur gradually and entail elastic deformation of alveolar bone in response to increased horizontal forces.
Checking of Tooth Mobility
As a general rule, mobility is graded clinically by simple method, i.e. tooth is held firmly between the handles of two metallic instruments or by one metallic instrument and one finger, and an effort is made to move the tooth in all directions. Abnormal mobility occur faciolingually.
Grading of Tooth Mobility
Tooth mobility is graded according to ease and extent of tooth movement
- Normal mobility
- Grade 1: Slightly more than normal
- Grade 2: Moderately more than normal
- Grade 3: Severe mobility faciolingually and mesiodistally, combined with vertical displacement.
Question 3. Write short note on splinting in periodontal therapy.
Answer. A periodontal splint is an appliance used for maintaining or stabilizing mobile teeth in their functional position.
Principles of Periodontal Splinting
- Before proceeding for the splinting, following principles should be considered:
- Only after the completion of elimination of all local factors which contribute to inflammation, the splinting should be considered.
- Occlusal adjustment should be done before splinting except when the remaining teeth are so mobile that they have to be stabilized to facilitate occlusal correction.
- There should be sufficient number of non mobile teeth should be included in a splint.
- Support of posterior teeth is necessary when anterior segments are mobile.
- If in case of occlusal trauma associated with severe bone loss, all the teeth demonstrate hypermobility, cross arch splinting is beneficial as the pattern of mobility of some teeth is in a buccolingual direction and others in a mesiodistal direction. With splinting, a group of single rooted teeth in effect becomes multirooted teeth.
- Splinting should not impede normal functions like phonetics, mastication or oral hygiene maintenance of the patient.
- Splinting should not irritate the gingival tissues.
- Splinting should be aesthetically acceptable.
Types Of Splinting In Dentistry
Procedure of Periodontal Splinting
- The most common splint and simple to fabricate are the wire and acrylic splint.
- Take a soft stainless steel wire of around 0.24 mm diameter, loop the wire around all the teeth to be included in splint, and its ends are loosely twisted. Loop should be positioned just apical to the contact points.
- Inter – dental wires of around 0.2 mm diameter should be cut to about 2 inches in length. Insert the wire between the teeth from lingual side and twist the ends until tight around the loop wire.
- As all of the inter dental wires have been placed, tighten the loop wire finally making sure that it should be just below the contact points. Cut ends of the wires leaving 2 to 3 mm which should be tucked between the teeth.
- Dry the area and a thin mix of quick set acrylic runs over the wire. Take care to ensure that the wire is evenly covered. Provide the acrylic a half round contour as it is run on.
- As acrylic become set, it should be trimmed so that the embrasures become free from acrylic at cervical margins, check the bite. Polish the acrylic so that it is easy to keep clean.
Question 4. Define and classify periodontal splints.
Answer. A periodontal splint is an appliance used for maintaining or stabilizing mobile teeth in their functional position.
Types Of Splinting In Dentistry
Classification of Periodontal Splints
According to the Period of Stabilization
- Temporary stabilization: Worn for less than 6 months
- Removable: Occlusal splint with wire and Hawley with splinting arch wire
- Fixed: Intracoronal and extracoronal
- Provisional stabilization: Worn for 6 to 12 months. E.g. Acrylic splints and metal bands
- Permanent splints: Used indefinitely
- Removable/Fixed
- Extra/Intracoronal
- Full/Partial veneer crown soldered together
- Inlay/Onlay soldered together
According to the Type of Material
- A-splints
- Bonded, composite resin button splint
- Braided wire splint.
According to the Location on the Tooth
Intracoronal
- Composite resin with wire
- Inlays
- Nylon wire.
Extraoral
- Tooth-bonded plastic
- Night guard
- Welded bands.
Ross, Weisgold and Wright Classification
- Temporary stabilization
- Extracoronal splints
- Removable
- Fixed
- Intracoronal splints
- Provisional stabilization
- Acrylic splints
- Metal—band and acrylic splints
- Permanent/Long-term stabilization
- Removable splints
- Fixed splints
- Combination of removable and fixed splints.
Question 5. Write short note on causes of tooth mobility.
Answer. Following are the causes of tooth mobility:
- Loss of tooth support (Bone loss): Amount of mobility depends on the severity and distribution of bone loss at individual root surfaces, the length and shape of the roots, and the root size compared with that of the crown. Tooth with short, tapered roots is more likely to loosen than one with bulbous roots with the same amount of bone loss.
- Trauma from occlusion: It is produced by excessive occlusal forces or incurred because of abnormal occlusal habits, i.e. bruxism and clenching, is a common cause of tooth mobility. Mobility is also increased due to hypofunction. Mobility caused by trauma from occlusion occurs initially as a result of resorption of the cortical layer of bone, leading to reduced fiber support, and later as an adaptation phenomenon resulting in a widened periodontal space.
- Due to extension of inflammation: As inflammation extends from gingiva or from periapex in periodontal ligament produces changes which causes tooth mobility.
Types Of Splinting In Dentistry
- Periodontal surgery: It increases tooth mobility for short period.
- In pregnancy: Tooth mobility is increased during pregnancy and is associated with the menstrual cycle or the use of contraceptives. Mobility occurs in patients with or without periodontal disease, because of physicochemical changes in periodontal tissues.
- Pathologic processes of jaws: Pathological processes of the jaws that destroy the alveolar bone or the roots of the teeth can also result in mobility. Such processes include osteomyelitis and tumors of the jaws.
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