The Guide to When and When Not

to Splint Restorations
By Greggory Kinzer on November 9, 2015 | comments  PRINT 
SHARE
 

There are a lot of clinical situations that arise that beg this question: Should the
teeth or  restorations  be splinted or not?
I’m not referring to cases in which there are missing teeth; of course these
situations require splinting. I am referring to situations that have all of the teeth
present. Although all of the different situations can’t be addressed in one
article, the following should help answer a few questions. 

These are general guidelines and in no way applicable to any and all clinical
situations. The question, once again, is should the teeth or restorations be
splinted or not?

Provisionals:  YES
Splinting provisionals provides a lot of benefits. It increases the strength and
retention of the provisionals and makes fabrication easier. The only time I
wouldn’t splint provisionals is prior to orthodontics where the teeth need to be
able to move independently. When restoring an arch of teeth, it is typically
easier to keep the provisionals in three segments (an anterior segment – cuspid-
to-cuspid –  and two posterior segments). (Click here for more on modifying
provisionals.)

Patient with bruxism or grinding:  NO

It has been stated that splinting restorations in these types of situations makes
the teeth stronger and more able to withstand the force. The reality is that
when teeth are splinted together, the entire system becomes more rigid.  If a
patient has significant signs of attrition, I want the teeth to be able to move
individually in response to the force. This “shock absorption” helps to prevent
fractured ceramic.  In addition, if there is a failure of an
individual restoration the more teeth that are splinted together, the more
difficult and costly the repair. If the restorations are kept as individual units, the
repair or replacement is much easier. (Click here for more about managing
bruxism.)
Fig 1. Initial presentation of a patient with a history of periodontal disease and
bone loss. The patient has been stable
periodontally for the past 5 years, but the teeth continue to splay facially due to
force and limited bony support despite
palatal bonding with a Ribbond palatal composite splint.

Mobile teeth:  YES
Splinting teeth that have mobility due to short roots from a history of periodontal
disease, roots that are short due to root resorption, or roots that are excessively
tapered can be beneficial. This is especially true if they can be splinted to a
tooth (teeth) that is not mobile as it will help create stability. Even splinting
multiple mobile teeth together can help create stability, especially if the teeth
that are splinted turn the corner of the arch. The reason splinting can help is
that all teeth are mobile in the same direction (buccal-lingual); however,
depending on where the teeth are positioned in the arch, their buccal-lingual
direction may be in different vectors.

Fig 2. The  restorative  plan was to restore the anteriors with full coverage
restorations and splint to the canines, which had no mobility.

Structurally compromised teeth:  YES

Splinting teeth that are structurally compromised (lack of adequate tooth
structure, short preps) is similar to double abutting multiple unit FPD
restorations for added structural stability. Although it must be said that if the
tooth is that structurally compromised, it might be advantageous to consider
removal of said tooth and replacement with an implant.

Fig 3. Prior to restorative treatment, the existing composite was removed and
the teeth were retracted orthodontically.

Implants:  DEPENDS
Implants already create a rigid system making the restorations more prone to
ceramic fracture, so the main reason to splint them would be stress distribution
(from horizontal forces) so that excessive load can be minimized on individual
implants or components.(Click here for the Spear Online course "Implants 101".)

My rule of splinting implants depends on multiple

factors.                            

External hex (Branemark-style) implants:  YES

The external hex on these implants provide little resistance or retention to the
abutments, so a lot of load is placed on the screw itself. In these situations,
splinting the implant restorations can be advantageous.  However, due to the
rigidness of the system and the tolerance in the fit of the components, trying to
well fitting restorations with passive fit in these types of situations can be
challenging.

Internal connection (platform switch) implants:  NO

Today’s implants area mainly designed with an internal connection utilizing a
platform-switch concept.  With this design, the screw gets very little load as
most of the forces are distributed in the internal connection. In these
situations, splinting the restorations is typically not as advantageous. If the
restorations are treated as single units and an individual restoration has a
 problem, repair and/or replacement of the restoration is much easier and less
costly.

Short implants:  YES
There are times when the length of implant that can be placed is limited due to
the local anatomy. In these situations it may be beneficial to splint the implant
restorations together to help biomechanically (Yang TC., Int J Prosthodont,
2011). However, it must be noted that if the length of the implant crown is 15
mm or greater, splinting the implants together did not help prevent prosthetic
failure regardless of the implant length (Nissan J.,  J Oral Maxillofac Surg,
2011). 
Implants and natural teeth:  NO
The literature is clear that it is not a good idea to splint implants and natural
teeth (Rangert B., Int J Oral Maxillofac Impl, 1991). When an implant and a
natural tooth are connected, the forces applied to one now affect the other. 
The amount of force transferred varies depending on the amount of mobility of
the natural tooth. Connecting teeth and implants never increases the load on
the tooth … only on the implant. The only time implants and natural teeth can
be connected without risk is in situations where the natural teeth provide no
support for the FPD.  In other words, ask yourself, “Would the restoration still
be structurally supported if the teeth were pontics?” If the answer is yes, then
the implants and natural teeth can be splinted (i.e. Can you splint implants in #7
and #10 to central incisors with a Grade II mobility? Imagine if the central
incisors were pontics … would an implant restoration from #7-10 be structurally
sound? YES!  In this situation, the natural teeth provide no structural support
for the restoration, but they do help make maintain the soft tissue architecture
and overall esthetics).

Fig 4. The definitive 6-unit splinted restoration at 10 years.