Discuss the indication, guiding

principle and procedure for

reinforced composite splinting.

Dr Ogieriakhi Esther
Department of periodontology
24/02/2017
 outline
• Introduction
• Definitions
• classification of splint.
• Aim of splinting
• Indication
• Guiding principle
• Procedure
• Conclusion
• Reference
 Introduction
• Periodontal diseases and dental trauma may
result in tooth mobility. Therefore stability
through splinting is important to prevent
further mobility, tooth loss, patient discomfort
and occlusal trauma.
 Definition
• Splint is an apparatus, appliance or device
employed to prevent motion or displacement
of fractured or movable part.
• In general, splinting is the act of fastening or
confining, supporting or bracing a displaced or
movable part.
• In dentistry, splinting designates tying
together or uniting two or more teeth in order
to gain occlusal stability.
 Classification of splint

• Splints can be classified as follows

Based on duration and purpose;

• Temporary splint;are those which are used less than 6 months during
periodontal treatment.Example include composite splint,wire and acrylic
splint,eyelet wire.
• Provisional splints;may be used from several months to years.eg acrylic
splint.
• Permanent splint;are splints worn indefinitely and could be fixed or
removable.eg amalgam splint,chrome cobalt splint.

Base on type of material use for splinting;

• Bonded,
• composite resin button splint
• Braided wire splint
Based on location on the tooth; include
• Intracoronal splint
• Extracoronal splint

Based on the position of the teeth to be splinted;

includes
• Splint for anterior teeth eg
• Direct bonding system using acid etch techniques
and light cured resin.
• Intracoronal wire and acrylic wire resin splint.

Splint on posterior teeth; include

• Composite splint
• Rigid occlusal splint
• Bite-guard
• Intracoronal amalgam wire splint
 Aims of splinting
Include
• To protect the tooth supporting tissues during
healing period after an accident or following
surgery, especially regenerative therapy.
• To give psychological well being. splinting
gives the patient comfort from mobile teeth
thereby giving sense of well being.
• To prevent the supra-eruption of unopposed
teeth.
• To bring about redirection of forces. The forces of
occlusion are redirected in a more axial direction
over all the teeth included in the splint.
• To bring about redistribution of forces.
Redistribution ensures that forces do not exceed
the adaptive capacity.
• To preserve arch integrity. Splinting restores
proximal contacts reducing food impaction and
consequent breakdown.
 INDICATIONS
• Following periodontal osseous surgery
• A tooth with grade 3 mobility with greater
than 1/3 of bony support on the root length.
• In cases with mobility that cannot be
eliminated by selective coronoplasty alone,
splinting should be considered as an adjunct
• A grade 2 mobility with occlusal interference
• To immobilize excessively mobile teeth so that
the patient can chew more comfortably
• Progressive mobility with radiographic
evidence of bone loss.
• To stabilize teeth in their new position after
orthodontic movement.
• Secondary occlusal trauma.
 Guiding principle
• Oral hygiene status of patient.
• Extent of tooth/teeth coverage.
• Present state of occlusal harmonies in the
patient.
 Procedure for composite reinforced
splinting
• Before commencement of this procedure,
• patient should be counselled.
• Scaling and polishing and OHI should be done
if possible.
• Composite reinforce resin can be use in the
splinting of mobile teeth especially for
anterior teeth. Here a ribbon with stronger
composite fiber is used.
 Other materials for reinforced
composite splinting.
• 0.002 inch stainless steel wire on anterior
teeth
• 0,005 inch stainless steel band for posterior
teeth.
Armamentarium Used
 A groove (0.5 – 0.75 mm. deep and 3 mm. wide –
which are the dimensions of the splint material) was
prepared on the lingual surface between the incisal and
middle 1/3rd region.
The area was isolated with cotton roll
to prevent contamination from saliva.
Etchant and bonding agent was
applied.
Flowable composite of Shade of the
teeth is applied
Ribbond fiber material is cut according
to the required length and placed
lingually.
The composite is light cured.
Splint after initial placement
The cured splint is completely covered with another layer of composite and
cured. Finishing and polishing is done with rubber cups.
 advantages
• Safe and Biocompatible
• Unsurpassed Fracture Toughness
• Superior Ease of Use and Manageability
• Does Not Unravel, Fall Apart or Rebound
• Indefinite Shelf Life
• lt is aesthetically pleasing
• lt enhances resistance to further periodontal
breakdown.
• lt improves the healing response
 conclusion
• Splinting of perodontally involved teeth
should not be the sole method of obtaining
tooth/teeth stability. lt is therefore imperative
that occlusal stability and control of excessive
occlusal forces be obtained first.
 Reference
• 1. Tarnow DP, Fletcher P. Splinting of periodontally involved teeth: indications and
contraindications. NY State Dent J. 1986;52:24-25.
• 2. Serio FG, Hawley CE. Periodontal trauma and mobility. Diagnosis and treatment
planning. Dent Clin North Am. 1999;43:37-44.
• 3. Waerhaug J. Justification for splinting in periodontal therapy. J Prosthet Dent. 1969;22:201-
208.
• 4. Bhaskar SW, Orban B. Experimental occlusal trauma. J Periodontol. 1955;26:270-284.
• 5. Ramfjord SP, Kohler CA. Periodontal reaction to functional occlusal stress. J Periodontol.
1959;30:95-112.
• 6. Kegel W, Selipsky H, Phillips C. The effect of splinting on tooth mobility. I. During initial
therapy. J Clin Periodontol. 1979;6:45-58.
• 7. Galler C, Selipsky H, Phillips C, et al. The effect of splinting on tooth mobility. (2) After
osseous surgery. J Clin Periodontol. 1979;6:317-333.
• 8. Laudenbach KW, Stoller N, Laster L. The effects of periodontal surgery on horizontal tooth
mobility. J Dent Res. 1977;56(special issue). Abstract 596.
• 9. Scharer P. die stegkonstruktion als vesteigungemittel im vestgebiss (“The Construction of
Periodontal Splints”) [thesis]. Zurich, Switzerland: University of Zurich; 1961.
• THANK YOU