Splinting is one of the oldest forms of aids to periodontal therapy. By redistribution of forces on the affected teeth the splint minimizes the effects caused by loss of support. Splinting teeth to each other allows weakened teeth to be supported by neighbouring teeth. This presentation reviews the rationale, techniques, advantages and ill effects of stabilization of teeth by splinting as an aid to periodontal therapy. With the acceptance and clinical predictability of adhesive procedures, the use of conservative bonding techniques to splint teeth offers a useful alternative to more invasive restorative procedures. Loss of tooth-supporting structures results in tooth mobility. Increased tooth mobility adversely affects function, aesthetics, and the patient’s comfort. Splints are used to overcome all these problems. When faced with the dilemma of how to manage periodontally compromised teeth, splinting of mobile teeth to stronger adjacent teeth is a viable option. This prolongs the life expectancy of loose teeth, gives stability for the periodontium to reattach, and improves comfort, function and aesthetics.

1. DR. SHRADDHA KODE
SPLINTING – A HEALING THERAPY FOR
THE PERIODONTIUM

4. PATIENT:
“Some of my teeth are mobile”

5.  Dental splinting (Glossary of Prosthodontic Terms 1999):
The joining of two or more teeth in to a rigid unit by means of
fixed or removable restorations/ devices.
 Periodontal Splint (Glossary of Prosthodontic Terms):
Rigid or flexible device that maintains in position a displaced
or movable part, also used to keep in place and protect an
injured part.
WHAT IS SPLINTING?

6. HISTORY
Phoenician mandible from 500BC found
in modern day Lebanon which has two
carved ivory teeth attached to four
natural teeth by gold wire.
Obin and Arvin’s (1951) – Self curing
internal splint
Egyptians(3000 -2500 B.C.) show
similar gold wiring
Early 1700s-Fauchard attempted tooth
ligation

7. Wellensiek(1958), Shatzkin(1960) & Taatz(1964) – intra coronal
splints
Harrington (1957) – Modification of splint
by incorporating cemented stainless steel
wire
Most complete literature review on tooth stabilization was by
Lemmerman in 1976
Cross(1954) – Continuous amalgam
splints
PRESENT
Bondable
Fibre Splinting

8. OBJECTIVES
•To provide rest to the supporting tissues
•Redistribution of forces
•Redirection of forces
•Preservation of arch integrity
•Restoration of functional stability
•Psychological well being
•Promote healing
•Increase patient’s esthetics, comfort and function

9. SIMPLE
ECONOMIC
STABLE &
EFFICIENT
HYGIENIC
NON
IRRITATING
ESTHETIC
NOT
INTERFERING
WITH
TREATMENT
EASILY
CLEANSABLE
NOT
PROVOKING
IATROGENIC
DISEASE
IDEAL SPLINT (Simring & Thaller, 1956)

10. •Stabilise moderate to advanced tooth mobility
that cannot be treated by other means
•Stabilise teeth with increased tooth mobility
interfering with normal masticatory function
•Secondary occlusal trauma
•Prevent tipping or drifting of teeth
•Prevent extrusion of unopposed teeth
•Stabilization of mobile teeth during surgical especially regenerative
therapy (Serio 1999)
•Stabilise teeth following acute trauma
•Stabilise teeth following orthodontic movement
INDICATIONS

11. •When there is moderate to severe tooth mobility
in the presence of periodontal inflammation or
primary trauma (Nyman and Lang, 1994)
•Insufficient number of non-mobile teeth to adequately stabilise
mobile teeth
•Poor oral hygiene
•High caries activity
•Crowding and malaligned teeth that may compromise the utility of
splint
CONTRAINDICATIONS

12. ADVANTAGES DISADVANTAGES
Establish stability and comfort for
patients with occlusal trauma
Difficulty in maintaining oral
hygiene
Helps to accelerate healing
following acute trauma and
regenerative therapy
Leads to caries development
Allows remodelling of alveolar
bone and PDL for splinted teeth
Can destroy other teeth if the
forces are not distributed
properly
Distribute occlusal forces over a
wider area
Technical difficulty

13. PRINCIPLES OF SPLINTING
Inclusion of sufficient number of
healthy teeth
Splinting around the arch
Coronoplasty may be performed to
relieve traumatic occlusion

14. Splints should facilitate proper
plaque control
Splints should be esthetically
acceptable
Splints should not interfere with
occlusion

15. By Weisgold
CLASSIFICATION OF SPLINTS
Temporary splints
•<6 months
•To stabilise teeth
•during periodontal
treatment
•May or may not
lead to other types
of splinting
Provisional or
Semi- permanent splints
•Few months to as long
as several years
•For diagnostic purpose
•To see how teeth will
respond to treatment
•To see how missing
teeth may be replaced
Permanent splints
•used indefinitely
•Can be fixed or
removable

16. Modified classification by Ross, Weisgold and Wright
Temporary splints Provisional
splints
•Acrylic
splints
•Gold band
and acrylic
splints
Permanent
splints
Removable
Fixed
Combination
Extra-
coronal
Intra-
coronal
•Wire &
acrylic
•Wire &
amalgam
•Wire,acrylic
& amalgam
Removable
•Acrylic bite
guards
•Cast
removable
clasp
appliance
Fixed
•Wire & acrylic
splints
•Wire mesh &
acrylic splints
•Orthodontic
bands
soldered in
series

17. TRADITIONAL TECHNIQUES
TITANIUM TRAUMA SPLINT CAST METAL SPLINT
COMPOSITE WIRE SPLINT COMPOSITE INTERLOCKING SPLINT BAND-ARCH WIRE SPLINT

18. ADVANTAGES
Easy to use
Esthetically pleasing
Less incidences of fracture at
metal-resin interface
Acts as a stress bearing component
Increases toughness of material by
crack-deflecting mechanism
NEW ADVANCES
FIBRE-REINFORCED
MATERIALS

19. COMMERCIALLY AVAILABLE FIBRES
LENO WEAVE POLYETHYLENE FIBRES – RIBBOND
UNI-DIRECTIONAL PRE-IMPREGNATED GLASS FIBRES SPLINT-IT
OPEN WEAVE GLASS FIBRES – INTERLIG

20. Freshly drawn glass fibres
degrade on exposure to
moisture and humidity
Hence, they are coated
with resins for high
strengths and called pre-
impregnated
They dissipate stresses
and prevent crack
propagation when exposed
to multi-directional forces
COLD PLASMA TREATMENT
Hydrophobic hydrophilic state
CREATION OF A CHEMICAL BOND WITH RESIN AND FIBRE

21. •Leno weave cross-linked
and lock-stitched
polyethylene fibres
•Resistant to sliding and
shifting forces
•Ultrahigh tensile strength •THM RIBBOND – 0.18mm
thick
•Thinner than RIBBOND but
not better breaking
resistance
•Adapts closely to the teeth
•Final finish is esthetic and
smoother

22. PROCEDURE
Place wedges in the interdental spaces as
necessary, so that the spaces to be cleaned are
not filled with composite. If you are working
without wedges, be careful not to block these
spaces with composite.
Clean the teeth - All surfaces of the teeth to be
splinted are thoroughly polished with a slurry of
pumice and water using a rotating brush, rinsed
and dried with air.
Measure the fibre using periodontal probe or
dental floss and cut the fibre and saturate it
with bonding agent

23. Acid etching – 37% phosphoric acid is applied
to the interproximal and lingual surfaces to be
bonded with an applicator tip for 30seconds.
Rinse with water and dry. Lightly frosted
appearance can be seen.
A hand instrument is used to place a small amount
of composite onto the lingual surfaces (but not
cured)
Bonding agent is applied, lightly blown with air,
and cured to all etched surfaces

24. The bonded strip is then covered incrementally
with flowable composite, resulting in a smooth
surface
By using a gloved finger, the strip is pressed
into uncured composite and cured initially into
place
Finish and then evaluate the occlusion

25. TIPS
In posterior teeth, groove is placed on occlusal surface with
one abutment tooth on each side
In mandibular teeth, groove should be placed more apical.
Cingulum should act as a seat for placement of fibre
In maxillary teeth, groove should be placed at the incisal third
of the tooth surface
Good isolation should be achieved
Un-polymerised fibre areas should be well protected from light
source
Proper polishing should be done for a smooth finish

26. CONCLUSION
•Effective plaque control and professional caries
risk assessment is crucial for longevity of the splint
•By combining the chemical adhesive and esthetic
characteristics of composite resin with strength
enhancement of fibre reinforcing material, dentists
can provide patients with restorations and splints
that resist the load bearing forces of occlusion and
mastication

27. •Prichard 2nd edition
•Lindhe 5th edition
•Shailly et al; Splinting – A Healing Touch for an Ailing
•Periodontium; Journal of Oral Health Community Dentistry;
September 2012
•Edwin et al; Aspects in Effectiveness of Glass- and Polyethylene-
Fibre Reinforced Composite Resin in Periodontal Splinting;2016
•Davies et al; Occlusal considerations in Periodontics; British Dental
Journal, Volume 191, NO. 11, DECEMBER 8 2001 597
•Guillermo et al; A Review of the Clinical Management of Mobile
Teeth; The Journal of Contemporary Dental Practice, Volume 3, No.
4, November 15, 2002
•Rahul et al; To Splint or Not to Splint: The Current Status of
•Periodontal Splinting; Journal of the International Academy of
Periodontology · April 2016
REFERENCES