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ORIGINAL
CASE REPORT
ARTICLE

Management of tooth mobility in the periodontology

clinic: An overview and experience from a tertiary
healthcare setting
Clement Chinedu Azodo, Paul Erhabor1
Department of Periodontics, University of Benin, Department of Periodontics, University of Benin Teaching Hospital, Benin City, Edo, Nigeria
1

Address for correspondence:

Dr. Clement Chinedu Azodo,
Department of Periodontics, University of Benin Teaching Hospital, Room 21, 2nd Floor,
Prof. Ejide Dental Complex, P.M.B. 1111 Ugbowo, Benin City, Edo State, Nigeria.
E‑mail: clementazodo@yahoo.com

Access this article online

Website: www.ajmhs.org
DOI: 10.4103/2384-5589.183893
Quick Response Code:
ABSTRACT
Background: Tooth mobility, considered as the extent of horizontal and vertical tooth
displacement created by examiners force, is caused trauma and periodontal disease. It is
a common presenting complaint in periodontal clinic and may result in occlusal instability,
dietary restriction, masticatory disturbances, esthetic challenge, and impaired quality of life.
The treatment of tooth mobility involves a combination of treatment of the etiology usually by
nonsurgical and surgical periodontal treatment, occlusal adjustment, and splinting. This article
reviewed occlusal adjustment and splinting in the management of tooth mobility and reported
our experience in University of Benin Teaching Hospital, Benin City, Nigeria on tooth mobility
managed with 0.5 mm hard stainless steel wire reinforced composite splint. Results: Composite
splinting reinforced with 0.5 mm HSS wire facilitates healing of periodontally compromised teeth
with mobility after they have been treated with nonsurgical periodontal therapy and occlusal
adjustment. Conclusion: Splinting is a well-accepted integral part of holistic periodontal
treatment which results in morale boost, improved patient comfort, and oral functions.

Key words: Composite resin, hard stainless steel wire, occlusal adjustment, splint, tooth mobility

INTRODUCTION disruption of the periodontal tissues, widening of the

Periodontitis, which is an advanced form of periodontal
disease, causes destruction of both soft and hard tissue
components of the tooth supporting structures leading to
tooth mobility.[1] Tooth mobility is considered as the extent
of horizontal and vertical tooth displacement created by
examiners force. Assessment of tooth mobility is considered
as an integral part of periodontal assessment because it is
one of the important signs in the diagnosis of periodontal
diseases. Hence, the reduction of tooth mobility is one of
the prime objectives of periodontal therapy.
Tooth mobility is usually graded into Grade 1, 2, and 3 in
periodontal healthcare delivery using Miller tooth mobility
index because it has bearing on the choice of treatment and
prognosis prediction.[2] The mechanism through which
periodontitis cause tooth mobility include inflammatory
periodontal ligament, attachment loss, alveolar bone loss,
and occlusal trauma.[3] The occlusal trauma here is considered
as secondary occlusal trauma because the tissue destruction
occurs in the presence of normal occlusal forces on the mobile
tooth due to the weakened supporting tissues.[4] Branschofsky
et  al. reported that secondary trauma from occlusion is
frequently seen in periodontally compromised patients.[5]
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License, which allows others to remix, tweak, and build upon the
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Cite this article as: Azodo CC, Erhabor P. Management of tooth mobility in the
periodontology clinic: An overview and experience from a tertiary healthcare
setting. Afr J Med Health Sci 2016;15:50-7.

50 © 2016 African Journal of Medical and Health Sciences | Published by Wolters Kluwer - Medknow
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Azodo and Erhabor: Tooth mobility management in periodontology
Tooth mobility results in occlusal instability, masticatory
disturbances, and impaired quality of life.[1] The continued
movement of the mobile tooth during oral function further
damages the periodontium, accelerating the disease process
thereby leading to tooth loss.[6] The initial awareness of
tooth mobility in patients may be from tooth tenderness
experience on mastication followed by pain on sudden tooth
displacement when biting on hard foods or from inadvertent
trauma. The anterior labial or lateral tooth displacement
that results in fanning and elongation of clinical crown with
poor appearance is the esthetic challenge associated tooth
mobility. Individuals experiencing tooth mobility may resort
to unilateral mastication and dietary restriction as their
coping mechanisms.[6] Teeth cleaning is also difficult thereby
leading to the worsening of oral hygiene status by plaque
accumulation. These factors trigger a positive feedback
mechanism which will be truncated only if appropriate
treatment is rendered or the untreated tooth is lost [Figure 1].
Periodontal diseases have remained one of the major causes
of tooth loss in Nigeria and globally despite numerous
technological advances in prevention and management of oral
diseases. Tooth mobility is one of the terminal presentations of
periodontal disease before tooth loss. The adoption of proper
and adequate steps in the management of tooth mobility
will definitive help in increasing the longevity of the tooth
and preventing edentulism. The treatment of tooth mobility
involves a combination of treatment of the etiology usually
by nonsurgical and surgical periodontal treatment, occlusal
adjustment, and splinting. Although other causes of tooth
mobility exist; however, this review was limited to tooth
mobility due to periodontitis. This article reviewed occlusal
adjustment and splinting in the management of tooth mobility
and reported our experience in University of Benin Teaching
Figure 1: Effects of periodontitis associated tooth mobility with positive feedback
African Journal of Medical and Health Sciences / Jan-Jun 2016 / Vol 15 | Issue 1
Hospital, Benin City, Nigeria on tooth mobility managed with
0.5 mm hard stainless steel wire reinforced composite splint.
Treatment of tooth mobility
The treatment of periodontitis‑associated tooth mobility
may involve specific treatment for the stage of periodontitis,
occlusal therapy and splinting.[7,8] Splinting is not a substitute
for periodontal treatment as a real reduction in tooth
mobility occurs from healing that follows the treatment of
the periodontitis.[9,10] The treatment of the periodontitis usually
involves nonsurgical and surgical periodontal treatments but
sometimes may be limited to only the nonsurgical periodontal
treatment.[11] The treatment of the periodontitis and sometimes
occlusal adjustment is usually enough to strengthen the
supporting tissue and re‑establish function, especially in Miller
Grade 1 tooth mobility.[12] However, splinting is needed in cases
of Miller Grade 2 tooth mobility in addition to the treatment
of the periodontitis and occlusal adjustment. Splinting is
sometimes indicated in cases of Miller Grade 3 tooth mobility
where tooth extraction is not acceptable or contraindicated.
Although splinting provides some beneficial distribution of
occlusal forces that cause tooth mobility, occlusal adjustment
alleviate these occlusal forces by removing destructive contacts
and creating proper occlusal clearance.[13,14]
Occlusal adjustment
Occlusal adjustment also known as selective grinding is
the modification of the occluding surfaces of teeth through
grinding to create harmonious contact relationships between
the maxillary and mandibular teeth.[15] The aim of occlusal
adjustment is to establish and maintain stable occlusal
relationships and to restore an optimal occlusal function.[16] It is
known that proper occlusal management assists in maintaining
comfort during function and health of the natural dentition.[8]
Ramfjord and Ash[17] stated that occlusal therapy is required
to enhance occlusal stability at any stage of periodontitis but is
most often necessary in advanced periodontitis. The treatment
of occlusal discrepancies is considered an important factor in
the overall treatment of periodontal disease because it has been
reported to significantly reduce the progression of periodontal
disease.[18,19] Occlusal equilibration helps to offset persistent
impaired function, diminished comfort, or unacceptable
esthetics after inflammatory process has been controlled.
Report of statistically greater clinical periodontal attachment
gains when occlusal adjustment was included as a component
of periodontal therapy exists in the literature.[18] The indications
and contraindications for occlusal adjustment listed by The
1989 World Workshop in Periodontics[20] are as follows:
Indications for occlusal adjustment
• To reduce traumatic forces to teeth that exhibit:
(a) Increasing mobility or fremitus to encourage repair
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Azodo and Erhabor: Tooth mobility management in periodontology
within the periodontal attachment apparatus and
(b) discomfort during occlusal contact or function
• To achieve functional relationships and masticatory
efficiency in conjunction with restorative treatment,
orthodontic, orthognathic surgery, or jaw trauma when
indicated
• As adjunctive therapy that may reduce the damage from
parafunctional habits
• To reshape teeth contributing to soft tissue injury
• To adjust marginal ridge relationships and cusps that
are contributing to food impaction.
Contraindications to occlusal adjustment
• Occlusal adjustment without careful pretreatment study,
documentation, and patient education
• Prophylactic adjustment without evidence of the signs
and symptoms of occlusal trauma
• As the primary treatment of microbial‑induced
inflammatory periodontal disease
• Treatment of bruxism based on a patient history without
evidence of damage, pathosis, or pain
• When the emotional state of the patient precludes a
satisfactory result
• Instances of severe extrusion, mobility, or malpositioning
of teeth that would not respond to occlusal adjustment
alone.
Splinting
Splinting, which is a procedure by which a tooth resistance to
an applied force, is increased by joining it, to a neighboring
tooth or teeth, is a well‑accepted clinical treatment used
to control irreversible tooth mobility through mechanical
stabilization.[21] It has the advantage of stabilizing mobile
teeth by forming a firm unit, minimizing tooth mobility,
and greatly improving the occlusal function of the
teeth.[22] Splinting is considered an important component
of a periodontal treatment plan because of its ability to
provide coaptive stability to the teeth and greatly improve
the outcome and prognosis of teeth affected by periodontal
disease.[23] Splinting is valuable in ensuring the retention of
periodontally compromised tooth and positively affecting
the longevity.[24] Splinting is regarded as an integral part
of periodontal therapy because it is used to maintain
periodontally migrated teeth that have been repositioned
and also used before periodontal surgery to stabilize mobile
teeth during postsurgical healing as such stabilization
creates a more favorable environment for periodontal
repair.[25] Chalifoux[26] stated that splinting saves a significant
number of mobile teeth but requires a high degree of clinical
skill and diagnostic expertise. The success in splinting
therefore depends heavily on the ability of the clinician to
make an accurate diagnosis concerning the etiology of the
52 African Journal of Medical and Health Sciences / Jan-Jun 2016 / Vol 15 | Issue 1
functional disturbance. The technical elements in splinting
include achievement of marginal fit, contour, cleansibility,
occlusion and aesthetics, retention, and adequate thickness
or bulk of the splint and good solder joints.[27]
The overall objective of splinting is to create an environment
where the tooth movement can be contained within
physiological limits, thereby improving patient comfort and
the restoration of function.[24] Splinting is known to improve
patient’s comfort during mastication by evenly distributing the
masticatory and occlusal forces in the arch.[28,29] Zhang asserted
that splints help redirect force to other teeth when occluding
thereby protecting the mobile tooth, reducing traumatism, and
facilitating periodontal tissue repairing and regeneration.[22]
Vályi et al.[30] reported that the stabilization of mobile teeth
with splint allow the same healing like a nonmobile teeth.
Splinting has also been shown to promote healing following
periodontal surgery in localized aggressive periodontitis with
resultant significant bone gain.[31] Splinting boost the morale
of patients with tooth mobility by increasing their confidence
while eating and reducing the fear of tooth loss in them.
The rationale for splinting
The rationale for splinting which are mainly for protection
of tissue, restoration of physiologic occlusion, distribution
of force, ensuring functional comfort during mastication
are listed below.[32]
• To protect the investing structures of the teeth
• To protect the pulp
• To control forces and stress
• To establish physiologic occlusion
• To serve as an evaluating procedure
• To serve as anchorage and stabilizer in cases requiring
minor tooth movement
• To treat periodontal cases which required both restorative
and periodontal therapy to be executed simultaneously or
required immobilization or to maintain periodontal result
• To establish the prognosis of a questionable teeth as it
affects the final treatment plan
• To enhance stabilization in postacute trauma
• To prevent drifting in normal dentition during occlusal
therapy
• To provide functional comfort by preventing mobility
in disease dentition.
Indications for splinting
The main purposes of splinting are to provide rest where
wound healing is in process and permits function where
the tissues alone cannot perform adequately. Indications
for splinting include[17,25,28,33]:
• To maintain periodontally migrated teeth that have been
repositioned
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Azodo and Erhabor: Tooth mobility management in periodontology
• It is usually required in addition to occlusal adjustment
in moderate to severe periodontitis when trauma from
occlusion is progressive
• Moderate to advanced tooth mobility that cannot be
reduced by other means and which has not responded to
occlusal adjustment and periodontal therapy and when
there is interference with normal function and patient
comfort
• In cases where nonsurgical and surgical periodontal
procedures are difficult in the absence of tooth
stabilization. It facilitates treatment of extremely
mobile teeth by splinting them before periodontal
instrumentation and occlusal adjustment procedures
• Splinting is used to eliminate movements in the healing
area after periodontal surgery since micromovement of
the surgical site may inhibit repair to take place in the
healing area
• Tooth splinting may be indicated for individual mobile
teeth as well as for an entire dentition in cases where
extraction and implant therapy is not a viable alternative
• Prevention of teeth drifting after orthodontic treatment
or when a tooth is missing
• Prevention of mobility after acute trauma as in
subluxation and avulsion. von Arx [34] stated that
splinting of traumatized teeth is an important step
in the treatment of periodontally injured teeth and a
precondition of healing of the periodontal tissues and
also listed medicolegal reasons, patient comfort and
avoidance of additional trauma during periodontal
healing as other reasons for splinting in such situations.
Contraindications for splinting
• When the treatment of inflammatory periodontal disease
has not been addressed
• When occlusal adjustment to reduce trauma and/or
interferences has not been previously addressed
• When the sole objective of splinting is to reduce tooth
mobility whose etiology could be ascertained.[20]
Biomechanics of the splint
In periodontitis associated tooth mobility, occlusal forces,
lateral, mesiodistal, and intrusive forces play roles in further
tissues destruction as the forces are not directed on the long
axis of the tooth as the center of rotation of affected tooth
is altered.[35] Before splinting, tooth mobility reduction is
achieved by decreasing the occlusal forces through occlusal
adjustment. Splinting increases the total area of root resistance,
periodontal resistance, and the resistance to mesiodistal forces
by creating a multirooted unit and altering the center of
rotation of each tooth.[36] Splinting ensures better distribution
of force by directing the force over the splinted area that has
adequate periodontal support.[37] Consequent upon this,
African Journal of Medical and Health Sciences / Jan-Jun 2016 / Vol 15 | Issue 1
masticatory function would then be directed toward the
area of most convenient and efficient for function as a result
of conditioned reflex activity. between the abutments of the
splint are necessary to avoid tipping (lateral) forces on forceful
biting. Th e distribution of mesiodistal force is better when
two single rooted teeth are splinted together. In splinted areas,
intrusive forces are very well tolerated because the impact
of the force spread over a maximal number of principal
periodontal fibers. Splinting extends around the arch to
connect posterior and anterior segments or to engage teeth
in the opposite side of the arch so that anteroposterior forces
and faciolingual forces are counteracted to achieve a favorable
stabilization in the faciolingual and mesiodistal direction.[17]
Disadvantages of splinting
The primary disadvantage of splinting is that it compromises
plaque control by making oral hygiene access difficult thus
instructing the patient about enhanced measures for
oral hygiene after splinting is essential for the improved
longevity of the connected teeth.[38] This is based on the fact
that plaque accumulation at the splinted margins can lead
to gingival irritation and further periodontal breakdown in
a patient with already compromised periodontal support.
Syme and Fried[39] stated that periodontal and caries risk
assessment, periodontal debridement, and preventive
interventions during professional follow‑up are critical to
splint longevity. Other disadvantages of splinting included
loose or fractured crown, splint interference with phonetics,
normal interproximal wear, and mesial drift. Splinting is
known to cause further deterioration in periodontal health
if incorrectly performed. The following requirements
have been outlined to overcome such potential negative
consequences and achieve maximal positive outcome.[9]
Ideal splinting requirements
Splints will achieve the indicated purpose for the fabrication
and application when the ideal requirements listed below
are given due consideration.[9]
• It should incorporate as many firm teeth as is necessary to
reduce the extra load on individual teeth to a minimum
• It should hold the teeth rigid and not impose torsional
stresses on any incorporated teeth
• It should extend around the arch so that anteroposterior
forces and faciolingual forces are counteracted
• It should not interfere with the occlusion
• If possible, gross tooth disharmonies should be
eliminated before the application of the splint
• It should not irritate the pulp
• It should not irritate the soft tissues, gingiva, cheeks,
lips, or tongue
• It should be designed to be comfortable and easy to keep
clean for the patient
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Azodo and Erhabor: Tooth mobility management in periodontology
• Interdental embrasure spaces should not be blocked by
the splint
• It should be readily available, relatively inexpensive, and
medically acceptable
• Ease of fabrication and maintenance
• Capable of removal and insertion
• Esthetically acceptable.
Classification of splints
There are many techniques for splinting teeth. They can be
classified based on their purpose and duration of use, the
location of the splinted teeth in the jaw and the way of
fabrication.[33] Ferencz classified splints into short‑term
splints, provisional splints, and long‑term splints according
to their expected length of service.[40]
1. Splints are classified as metallic, nonmetallic, and
combination of metallic and nonmetallic type on the
basis of material.[41] Metallic types are usually made of
stainless steel, chrome cobalt, and cast metals, whereas
nonmetallic types are made of acrylic and composites
2. Splints are classified as fixed and removable on the basis
of way of fabrication[41]
3. Splints are classified as extra coronal and intracoronal
on the basis of the location of the splinted teeth in the
jaw[41]
a. Extracoronal splints: Here, stabilizing wire,
fiber‑reinforced ribbon, or similar stabilization
device is bonded to the outside of the teeth like a
fixed orthodontic retainer. Other examples include
tooth‑bonded plastic, night guard, and welded
bands
b. Intracoronal splints: Here, a slot is milled into the
affected teeth, and the stabilizing device is inserted
into the slot and bonded in place. This makes this
type of splint less visible with esthetic superiority.
Examples include inlays and nylon wire
4. Splints are classified as temporary, provisional, or
permanent on the basis of duration and purpose[41,42]
a. Temporary splints: Temporary splints are those
which are used less than 6 months during
periodontal treatment and may or may not lead
to other types of splinting. It is used to reduce
unfavorable occlusal forces for a limited time in
postacute trauma, in supportive measure in the
treatment of advanced periodontal disease, and
for anchorage in orthodontic therapy. Temporary
splints can be removable, fixed external, and fixed
internal types. Examples of removable temporary
splint are cast metal splint of Elbrecht, the acrylic
Hawley or other types of orthodontic appliance,
the bite guards or night guards. Examples of
fixed external types are  (1) Annealed 0.010 or
54 African Journal of Medical and Health Sciences / Jan-Jun 2016 / Vol 15 | Issue 1
0.012 inches stainless steel ligature wire, single
or double, bonded to the teeth facially, lingually,
and sometimes incisally.(2) The splint of wire
combined with acrylic.(3) Orthodontic bands
welded together (4) cast splints of gold or chrome
nickel alloy cemented to the teeth and the facial
and lingual parts tied together with ligature wire.
(5) The most popular temporary splint is the one
made with acid etch, self‑polymerizing resin, and
composite material.(6) Acrylic reinforced with the
orthodontic grid material or cast metal framework
Example of fixed internal type metal wires with
acrylic reinforced placed in interproximal box
preparation with mark retention to hold the teeth
together
b. Provisional splints: Provisional splints may be
used from several months to years for diagnostic
purposes, and usually lead to more permanent types
of stabilization. Amsterdam and Fox[43] defined
provisional splinting as the phase of restorative
therapy utilizing a biomechanical combination
of tooth dressing coverages and stabilization
of teeth on an immediate and temporary basis.
They are used in borderline cases in which the
final result of the periodontal treatment cannot
be predicted with certainty during the initial
treatment planning. They provide information
as to whether splinting will offer benefits before
planning comprehensive treatment. Examples
include ligature wires, nightguards, and interim
fixed prosthesis, composite resin splints (with or
without wire and fiber support)
c. Permanent splints: Permanent splints are worn
indefinitely and could be fixed or removable. They
are intended to increase functional stability and
improve esthetics on a long‑term basis. They are
usually placed only after completion of periodontal
therapy and achievement of occlusal stability.
Examples include Pin ledge type of abutment,
clasped supported partial denture.
CASE REPORTS
Case #1
A 24‑year‑old male undergraduate who is a Christian and
Urhobo by tribe. He presented with a complaint of a desire
to replace a missing tooth lost 6‑year ago. The missing tooth
was as a result of a head‑on collision, he sustained while
cutting his hair in a barbing saloon. There was associated
tooth mobility which patient noted was progressing. On
examination, the following were noted: The upper left
central incisor (21) and lower left lateral incisor (32) were
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Azodo and Erhabor: Tooth mobility management in periodontology
missing. There was Grade 3 mobility with supra‑eruption
of the two lower central incisors (31, 41), Simplified‑Oral
Hygiene Index (OHI‑S) was 4.7 with heavy calculus deposits
around the mobile teeth. There were gingival inflammation
and recession around the affected teeth with severe clinical
attachment loss. Treatment done were scaling of all the
quadrants, selective grinding of the lower central incisors,
and reinforced composite splint  [Figure  2]. At 3  months
postoperative review, the tooth mobility has reduced, and
there was radiographic evidence of minimal bone deposition.
Case #2
A 38‑year‑old female hairdresser who is a Christian
and Benin by tribe. She presented with a complaint of
mobile lower left central incisor  (31) of about 2  years
duration. The mobility was progressively increasing in
severity. There was no history of trauma to affected tooth,
but history of associated recession of the gingiva in the
lower anterior segment was obtained. On examination, the
following were noted: Grade  2 mobility of the lower left
central incisor  (31). OHI‑S was 1.3. There were gingival
inflammation and recession around the lower left central
incisor (31), lateral incisor (32), first premolar (34), lower
right central incisor (41), lateral (42), and first premolar (44)
with clinical attachment loss. Periapical radiograph reveals
horizontal bone loss with enlarged periodontal ligament
space of the lower left central incisor (31). An impression
of chronic periodontitis of the lower left central incisor (31)
was made. Treatment done were scaling of all the quadrants,
root planing, and selective grinding of the lower left central
incisor (31) with composite reinforced with 0.5 mm HSS
splint [Figure 3]. Oral hygiene instruction was given, and
patient was placed on doxycycline 100  mg 12 hourly for
14 days. On 3 months recall visit, mobility has reduced with
some level of alveolar bone deposition.
Case #3
A 30‑year‑old female legal practitioner who is a Christian and
Ibo by tribe. She presented with a complaint of mobile upper
right first molar (16), upper left first molar (26), lower left central
incisor (31), lateral incisor (32), first molar (36), lower right
central incisor (41), and first molar (46) of about 1 year duration.
Figure 2: Case #1
African Journal of Medical and Health Sciences / Jan-Jun 2016 / Vol 15 | Issue 1
The mobility started some 17 years ago but became worse a year
ago. There was a history of associated recession of the gingival
in the lower anterior segment. On examination, the following
was noted: Grade 1 mobility of the upper right first molar (16),
upper left first molar (26), lower left central incisor (31), first
molar (36), lower right central incisor (41), and first molar (46)
of about 1 year duration.; Grade 11 mobility of lower left lateral
incisor (32). OHI‑S was 0.4. There were gingival inflammation
and recession around the lower left central incisor (31), and
lower left lateral incisor (32) with clinical attachment loss. Full
blood count was done and revealed an essentially normal blood
profile. Orthopantomogram revealed bone loss. An impression
of localized aggressive periodontitis was made. Treatment
done was scaling of all the quadrants and root planing of the
affected teeth was done along with irrigation with tetracycline
solution. Patient was placed on 500 mg amoxicillin and 400 mg
of metronidazole both 8‑hourly for 10 days. On review, 3 weeks
later, mobility was still be present with no reduction. Selective
grinding of the lower left central incisor (31), lateral incisor
(32), lower right central incisor (41), and lateral incisor (42)
with composite reinforced with 0. 5 mm HSS splint was done
[Figure 4]. Oral hygiene instruction was given. Patient defaulted
on the follow‑up appointment. However, on 4 months recall
visit, mobility has reduced with some level of alveolar bone
deposition.
Case #4
A 37‑year‑old female trader who is a Christian and Benin
by tribe. She presented with a complaint of mobile upper
left central incisor  (21) of about 3  weeks duration. The
mobility is progressively increasing in intensity. Patients
ascribed the mobility to the trauma from intimate partner
violence. There is a history of associated supra‑eruption
of the affected tooth. On examination, the following were
noted: Grade 2 mobility of the 21. OHI‑S was 3.3. There
was gingival inflammation around the upper left central
incisor (21). Periapical radiograph reveals horizontal bone
loss with enlarged periodontal ligament space of the upper
left central incisor (21). Impression of chronic periodontitis
was made. TTreatment done were scaling of all the quadrants
root planing and selective grinding of the upper left central
incisor (21) with composite reinforced with 0.5 mm HSS
splint [Figure 5]. Oral hygiene instruction was given, and
patient was placed on doxycycline 100  mg 12 hourly for
14 days. Patient defaulted on the follow‑up appointment.
However, on 4  months recall visit, mobility has reduced
with some level of alveolar bone deposition.
DISCUSSION
Tooth mobility may arise in different patients from
different causes ranging from aggressive periodontitis,[5]
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Azodo and Erhabor: Tooth mobility management in periodontology
Figure 3: Case #2
Figure 4: Case #3
Figure 5: Case #4
chronic periodontitis, periodontitis associated with
systemic conditions, trauma, occlusal traumatism, and
complication of periodontal surgery. The management of
periodontitis associated tooth mobility necessitates the
administration of nonsurgical and surgical periodontal
treatment, occlusal adjustment, and splinting. The composite
splinting reinforced with 0.5 mm HSS wire utilized in the
cases reported is a fixed temporary extracoronal splint.
Mismanagement using splint alone without removal of
the underlying cause and subsequent healing often results
in tooth mobility manifesting again when the splint is
56
removed.[8] It is therefore crucial to raise clinician’s awareness
in the appropriate way of managing tooth mobility. In
the cases reported, the causes were chronic periodontitis
and aggressive periodontitis. It is important to properly
diagnose the cause of a particular patient’s tooth mobility
so as to know how to manage the patient. History taking
is necessary for proper diagnosis; however, incomplete
history given by the patient may misguide an unsuspecting
dentist, especially in cases of trauma. Dental examination
and intraoral radiography are usually helpful in confirming
the cause. In this report, nonsurgical periodontal treatment
and occlusal adjustment before splinting resulted in a good
clinical outcome. The bone deposition may be due resolution
of the inflammation, passive eruption following occlusal
adjustment and improved healing from the splinting.
CONCLUSION
Splinting is a well‑accepted integral part of holistic
periodontal treatment which results in morale boost,
improved patient comfort, and oral functions. Composite
splinting reinforced with 0.5  mm HSS wire may be used
to facilitate healing of periodontally compromised teeth
with mobility after they have been treated with nonsurgical
periodontal therapy and occlusal adjustment.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
REFERENCES
1. Dombret J, Marcos E. Tooth mobility and containment. Rev Belge Med
Dent (1984) 1989;44:98‑109.
2. Miller SC. Texbook of Periodontia. Philadelphia: Blakiston Company;
1938. p. 92.
3. Serio FG. Clinical rationale for tooth stabilization and splinting. Dent
Clin North Am 1999;43:1‑6, v.
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