Case Report Int J Clin Prev Dent 2015;11(2):125-128ㆍhttp://dx.doi.org/10.15236/ijcpd.2015.11.2.

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ISSN (Print) 1738-8546ㆍISSN (Online) 2287-6197

Stabilizing Periodontally Compromized Teeth with Poly-

ethylene Fibre Splint: A Case Report
Ruchi Singla1, Rahul Grover2
1
Dr HSJ Institute of Dental Science and Hospital, Panjab University, Chandigarh, 2Sudha Rustagi College of Dental Sciences
and Research, Faridabad, India

The aim of this article is to present a case of splinting periodontally compromised mandibular right anterior teeth with poly-
ethylene fibre reinforced composite splint-ribbond. A 34-year-old male with Grade II mobile mandibular right anterior teeth
splinted with ribbond. Different materials have been successfully used for splinting which include–composite, wire and com-
posite and fibre reinforced splints. In order to fulfill both the periodontal and restorative needs, ribbons and fibers were de-
veloped that could be reinforced with composite resin to form thin-but-strong splints. These splints are more stable and du-
rable than the approaches of splinting used in the past.

Keywords: polyethylene, ribbond, splints, tooth mobility

Introduction Different materials have been successfully used for splinting

A splint has been defined as an apparatus, appliance, or de-
vice employed to prevent movement or displacement of frac-
tured or movable parts [1]. In dentistry, splinting or tooth stabili-
zation usually refers to joining teeth together either unilaterally
or bilaterally, to transmit increased stability to the entire
restoration. Typically, a splint is indicated due to a single tooth
or multiple teeth having mobility. However, the reasons to stabi-
lize periodontally compromised teeth include decreased patient
discomfort, increased occlusal and masticatory function, and
improved prognosis of mobile teeth [2].
Corresponding author Ruchi Singla
Dr HSJ Institute of Dental Science and Hospital, Punjab
University, Vidya Path, Sector 25, Chandigarh, 160014,
India. Tel: +91-9915772837, Fax: +91-1722693987, E-mail:
dr.ruchisingla@gmail.com
Received November 4, 2013, Revised June 18, 2015,
Accepted June 30, 2015
which include–composite, wire and composite and fibre re-
inforced splints. In order to fulfill both the periodontal and re-
storative needs, ribbons and fibers were developed that could
be reinforced with composite resin to form thin-but-strong
splints. Both glass and polyethylene fibers have been in-
troduced for this purpose. Glass fibers are treated with a silane
chemical coupling agent to allow bondability to dental resins
while polyethylene fibers are chemically treated with surface
etching called plasma treatment to enhance their chemical
bondability. Without this treatment, there would be no surface
wetting of resin and bonding between the two substrates [3].
Studies have demonstrated that fiber reinforcement increases
the flexural strength and flexural modulus of composite resins
[4].
One problem with the fiber reinforcement materials that have
been available is their inherent thickness when embedded with-
in composite resin in a splint. To overcome this problem, a lock
stitched cross-linked weave of thinner strands of polyethylene
®
fibers, Ribbond (Ribbond Inc., Seattle, WA, USA) THM Rein-
forcement Ribbona was introduced. The thinner material still

Copyright ⓒ 2015. Korean Academy of Preventive Dentistry. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/
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International Journal of Clinical Preventive Dentistry

incorporated the ease of use of the original ribbon’s lock stitch rinsed with an air-water spray for 10 seconds and gently dried.
weave. Unlike braided fiber weaves that had a tendency to un- A dental adhesive (Adper Single Bond 2; 3M, Saint Paul, MN,
ravel and not hold their dimensional shape once they were cut USA) was applied to the etched surfaces including the inter-
to the desired length needed, the new material does not unravel proximal surfaces using a disposable brush.
and is dimensionally constant when embedded within compo- A medium viscosity hybrid composite resin was dispensed
site materials. The special fiber network of this material allows onto the facial surfaces of all the interproximal areas of the teeth
efficient transfer of forces acting on itself [5,6]. to be splinted. The facial surfaces were shaped and then
This case report describes the splinting of periodontally com- light-cured for 20 seconds. The purpose of the facial composite
promised mandibular right anteriors with ribbond. resin was to seal the interproximal areas against recurrent caries,
o
to provide a 180 wrap of composite resin to each of the splinted
Case Report teeth, and to stabilize the teeth to prevent movement when the
composite resin and ribbon are placed onto the lingual surface.
This facial extension of composite resin functions as a cross-
1. Material and method
splint for each tooth to prevent tooth movement and breakage
A 34-year-old male patient was presented with a chief com- of the final splint. The composite resin was then placed onto the
plaint of mobile lower anterior teeth. On examination there was lingual surface.
Grade II mobility in the mandibular incisors with no occlusal The ribbond was placed into the composite resin starting
discrepancy noted (Figure 1). Patient followed phase I therapy from the canine and pushed into the composite resin (Figure 4).
for two months, but did not showed any improvement so it was
decided to splint the involved teeth.
Teeth were cleaned and isolated with rubber dam (Figure 2).
To minimize the bulk of completed splint, a definite tooth prepa-
ration into the lingual surfaces of mandibular right central in-
cisor, lateral incisor and canine, was done using 330 bur to a
depth of 0.5 mm. A 2 mm wide ribbond of desired length was
cut. The cut ribbon was impregnated with adhesive resin. The
ribbon was then blotted to remove excess resin using a napkin.
The ribbon should be only lightly wetted with adhesive resin.
The ribbon was put aside and covered to block any light until
it could be embedded in the composite resin on the teeth.
The teeth were etched for 30 seconds with a 32% phosphoric
acid gel etchant (Uni- Etch®; BISCO Inc., Schaumburg, IL,
USA) (Figure 3). The etchant was kept away from all exposed
roots, to avoid increasing tooth sensitivity. The teeth were Figure 2. Isolated mandibular right anterior teeth with rubber dam.

Figure 1. Preoperative view. Figure 3. Acid etching.

126 Vol. 11, No. 2, June 2015


Figure 4. Placement of ribbond.
Cotton pliers and burnisher can be used to adapt and embed the
ribbon into the composite resin. Excess composite was removed
and the lingual surfaces were then light-cured for 60 seconds
for each tooth. The rubber dam is removed. The composite resin
is shaped, finished and polished to remove excess bulk of re-
storative material and achieve an esthetic result.
2. Results
Different materials have been successfully used for splinting
which include–composite, wire and composite and fibre re-
inforced splints. In order to fulfill both the periodontal and re-
storative needs, ribbons and fibers were developed that could
be reinforced with composite resin to form thin-but-strong
splints.
Discussion
Tooth mobility has been described as an important clinical
parameter in predicting prognosis [7,8]. For this reason and for
patient comfort, splinting has been the recommended therapy
to stabilize teeth. In the past, direct stabilization and splinting
of teeth using an adhesive technique required the use of wires,
pins, or mesh grids. These materials could only mechanically
lock around the resin restorative. Because of this there was the
potential of creating shear planes and stress concentrations that
would lead to fracture of the composite and premature failure.
With the introduction of bondable, polyethylene woven rib-
bons, many of the problems with older types of reinforcement
were solved [9].
Ribbond is a reinforced ribbon made of ultrahigh molecular
weight polyethylene fiber that has an ultrahigh modulus. It is
Ruchi Singla and Rahul Grover：Polyethylene Fibre Splint
treated with cold gas plasma to enhance its adhesion to synthetic
restorative materials, including chemically cured or light-cured
composite resins. The special fiber network of this material al-
lows efficient transfer of forces acting on it. It is relatively easy
to use and technique is fast as no laboratory work is needed. Its
translucency makes it an excellent esthetic material, and it can
be cured with light-cured composites [10].
This article has described a technique for splinting mobile
mandibular anterior teeth. By combining the chemical, adhe-
sive, and aesthetic characteristics of composite resin with the
strength of a thin, plasma-treated, high-elastic-modulus re-
inforcing ribbon, dentists can provide patients with splints that
will effectively resist the forces of occlusion and mastication.
These restorations will be more durable than the approaches to
splinting teeth that have been used in the past.
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