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PRESENTED BY: POOJA BHASALE

CONTENTS
Definitions Early History Objectives Indications Contraindications Rationale Principles Ideal Splint Classifications Temporary Splints Provisional Splints Permanent Splints Effects of Splinting Disadvantages Conclusion

J Contemp Dent Pract Nov 2002; (3) 4: 10-22

J Contemp Dent Pract Nov 2002; (3) 4: 10-22

J Contemp Dent Pract Nov 2002; (3) 4: 10-22

J Contemp Dent Pract Nov 2002; (3) 4: 10-22

J Contemp Dent Pract Nov 2002; (3) 4: 10-22

TOOTH MOBILITY
Increased tooth mobility, determined clinically, is expressed in terms of amplitude of displacement of the crown of the tooth. The mobility (= movability) of a tooth in a horizontal direction is closely dependent on the height of the surrounding supporting bone, the width of the periodontal ligament, and the shape and number of roots present
Periodontology 2000, Vol 4, 1994, 15-22

The mechanism of tooth mobility was studied in detail by Mhlemann (1954, 1960) By means of the Periodontometer a small force (45 kg (100 pounds)) is applied to the crown of a tooth The resistance of the tooth-supporting structures against displacement of the root is low in the initial phase of force application and the crown is moved only 5/10010/100 mm. This movement of the tooth was called initial tooth mobility (ITM) by Mhlemann (1954) and is the result of an intra-alveolar displacement
Clinical Periodontology and Implant Dentistry- Lindhe, 5th Edition

Initial displacement of the root (ITM) corresponds to a reorientation of the periodontal membrane fibers into a position of functional readiness towards tensile strength. When a larger force (225 kg (500 pounds)) is applied to the crown, the fiber bundles on the tension side cannot offer sufficient resistance to further root displacement.
Clinical Periodontology and Implant Dentistry- Lindhe, 5th Edition

The additional displacement of the crown that is observed in secondary tooth mobility (STM) is allowed by distortion and compression of the periodontium in the pressure side.

Furthermore, tooth mobility seems to vary during the course of the day; the lowest value is found in the evening and the largest in the morning.
Clinical Periodontology and Implant Dentistry- Lindhe, 5th Edition

Two basic factors determine the degree of tooth mobility: (in non inflammed periodontal tissue) The height of the supporting tissues The width of the periodontal ligament

Periodontology 2000, Vol 4, 1994, 15-22

Normal periodontiurn with normal height of supporting bone prior to the application of traumatic forces. B. Loss of crestal bone resulting from the application of jiggling forces. Observe that no loss of connective tissue attachment has occurred. C. Following discontinuation of the traumatic forces, crestal bone regrowth has occurred. Photomicrographs courtesy of Kantor et al. J Periodont

Tooth mobility can be reduced by occlusal adjustment and/or splinting teeth.

Increased mobility of a tooth Increased width of the periodontal ligament. Normal height of alveolar bone Increased mobility of a tooth Increased width of the periodontal ligament Reduced height of the alveolar bone Increased mobility of a tooth Reduced height of the alveolar bone Patients chewing ability or Normal width of the function disturbed periodontal ligament

Occlusal Adjustment

Occlusal Adjustment Splinting

Splinting

Progressive (increasing) mobility of a tooth (teeth)

Gradually increasing width of the reduced periodontal ligament

Cross arch splinting

QUALITIES OF AN IDEAL SPLINT


(Baruch etal 2001)

Should be simple, economical, stable and efficient Non irritating to the surrounding tissues Esthetically acceptable and biologically compatible Not provoke iatrogenic disease Not cause entrapment of food Should not impair phonetics Rigid and durable

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.
PROVISIONAL SPLINTS may be used from several months to years for diagnostic purposes, and usually lead to more permanent types of stabilization.

PERMANENT SPLINTS are worn indefinitely and may be either removable or fixed.

TEMPORARY SPLINTING
They are intended for use for a short term and may or may not be replaced by a permanent appliance They may be used to stabilize the mobile tooth during surgery. Essentially they aid in determining whether teeth with a borderline prognosis will respond to therapy

TEMPORARY SPLINTING
Examples are: wire splints , acrylic and wire splints , Vacuum formed splints

2.UV Light Polymerizing Bonding Materials


Polson & Billen "Because the materials do not polymerize until they are exposed to ultraviolet light, they provide prolonged working times for placement, shaping, and contouring over extensive areas of enamel One popular kit NUVA SYSTEM (Caulk, Division of Dentsply lnternational Inc. Milford, Delaware)

3.Acrylic Bite Guards (Night Guards)


These are vacuum formed acrylic splints Treatment of bruxism and clenching Most common covers occlusal surface of teeth For additional support palate is covered

REMOVABLE PARTIAL DENTURE


Rudd and O'Leary (1966) determined that a specially designed removable partial denture using multiple parallel guiding planes and bracing clasps with a rigid major connector could be used as a removable splint to stabilize periodontally weakened teeth

A cross-arch design of a fixed bridge significantly reduces the lever effect of the occlusal forces. Hence, the stability of the entire bridge is assured and the mobility of the individual teeth before bridge installation is no longer a pertinent problem

Glickman et al. (1961) studied the effects of splinting teeth in hyperocclusion using 5 Rhesus monkeys. The authors observed that forces applied to 1 tooth in a splint were transmitted to all teeth within the splint. The direction of the initial force was maintained and comparable areas of the splinted periodontium were affected. The bifurcation and trifurcation areas were most susceptible to excessive force.

EFFECTS OF SPLINTING

Forces applied to non-splinted teeth were not transmitted to adjacent teeth and force sufficient to cause necrosis did not cause pocketing.
PERIODONTAL LITERATURE REVIEW

Mandel and Viidik (1989) used Vervet monkeys to study the effects of rigidly splinting anterior teeth that had been extruded 3 mm and replaced into the socket.

Two weeks after post-extrusive healing, no significant differences were found between splinted and nonsplinted teeth in terms of periodontal ligament (PDL) width or stress and strain values of the PDL. Within 2 weeks, the injured PDLs had regained 50 to 60% of the shear and strain values noted in non-injured teeth.
Rigid splinting of the luxated teeth did not improve the mechanical properties of the PDL during healing.
PERIODONTAL LITERATURE REVIEW

Renggli et al. (1984) studied the use of telescoping bridges placed 3 to 4 months after surgical therapy that could be removed by the patient on a daily basis for access to hygiene.
The authors noted that the telescoping bridges reduced mobility during an initial 4-week period when they were not removed and for an additional 6 weeks, when the bridges were removed daily.

The mobility of non-splinted control teeth was also reduced at the 4- and 10-week periods.
The reductions in mobility were not significantly different among the 2 groups. The authors suggest that the reductions in mobility may have been due to the establishment of a harmonious occlusion and not necessarily due to splinting.
PERIODONTAL LITERATURE REVIEW

Kegel et al. (1979) studied posterior tooth mobility


following scaling and root planing, occlusal adjustment, and oral hygiene education in splinted and unsplinted teeth utilizing 7 patients in a split-mouth design. No significant difference between splinted and nonsplinted segments with regard to tooth mobility, gingival bleeding attachment level, or radiographic bone scores. Teeth that were initially more mobile received no significant benefit from splinting when compared to initially less mobile teeth.

Galler et al. (1979) used a similar design to study the effects of splinting upon mobility during osseous surgery. Postoperative mobility seemed more dependent upon preoperative mobility than on the treatment method. Splinting had no effect on attachment level or alveolar bone height.

It has been shown that long-term rigid splinting following external trauma results in a higher incidence of dentoalveolar ankylosis than with a short-term, less rigid fixation (Andreasen 1975).

Clinical Periodontology and Implant Dentistry- Lindhe, 5th Edition

In a study by Klienfelder and Ludwig(2002) they concluded that reduced periodontal tissue support does not seem to limit bite force with maximal strength in natural dentition as measured by a device that opens the bite by 4mm.
Maximal biting forces at 4mm bite opening are increased when molar teeth are included in a posterior splint.
J Periodontol 2002 Vol 73

DISADVANTAGES
Gingival irritation Difficult oral hygiene access Interference of splint to normal interproximal wear and mesial drifting Crown becoming loose or fractured Interferences with phonetics.

CONCLUSION
It is generally accepted that tooth mobility is an important clinical parameter in predicting periodontal prognosis of the teeth The main reason to stabilize the periodontally compromised dentition with splinting is to decrease patient discomfort, increase occulusal and masticatory function and improve the prognosis of the teeth Further regenerative procedures using bone graft and membrane have greater predictability if mobility is eliminated.

Regardless of the type of splint design, material and method of fabrication, it must provide good access to oral hygiene, rigid fixation and good force distribution.

REFERENCES
Carranzas Clinical Periodontology- 9th , 10th Edition. Clinical Periodontology and Implant DentistryLindhe, 5th Edition Periodontology 2000, Vol 4, 1994, 15-22 J Contemp Dent Pract Nov 2002; (3) 4: 10-22 Chapter 11 Periodontal Literature reviews. J Prosthet Dent 2000; 84: 210-214 JOP 2002 VOL 73