A boon or A bane..???

SPLINTING

BY VIGNESH PRABHU.T C.R.I

WHAT IS SPLINT..???It is defined as rigid or flexible device that

maintains in position of a displaced or movable part , also used to keep in place

and protect an injured part.

Splinting in dentistry ..??“the joining of 2 or more teeth into a

rigid unit by means of fixed or removable restorations or devices.

History..!!! A 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.

Harrington(1957) modified the splint by incorporating cemented stainless steel wire.

Ward & Weinberg (1961) – developed new techniques using a plastic matrix or using wire reinforcement.

Splints have thus come a far way to INTRACORONAL BONDABLE FIBER SPLINTING of the present.

Should reduce movement 3 dimensionally

Centre of rotation of the affected teeth must be located in the remaining supporting bone.

No inflammation

Minimum one third of bone support remaining.

Should allow for oral hygiene methods

Should not irritate soft tissues.

principles

objectives

To provide rest

For redirection of forces

For redistribution of forces

To preserve arch integrity

CONTINUE…

Restore of functional stability

Psychological well being

To stabilize mobile teeth during surgery , especially during regenerative therapy

To prevent the eruption of unopposed teeth

Indications To stabilize moderate to advance tooth mobility, that

cannot be reduced by other means that has not responded to occlusal adjustment and periodontal therapy.

Stabilize teeth in secondary occlusal trauma

Stabilize teeth with increased mobility which interfere with normal masticatory function

Facilitate scaling and surgical procedures.

Prevent tipping & drifting of teeth.

Prevent extrusion of unopposed teeth.

Stabilize teeth after acute dental trauma i.e. .sub luxation , avulsion.etc.

CONTRA INDICATIONS

Moderate to severe tooth mobility in the presence of periodontal inflammation & or primary occlusal trauma

Insufficient number of firm/ sufficient firm teeth to stabilize mobile teeth.

Prior occlusal adjustment has not been done on teeth with occlusal trauma or interferences.

Patient not maintaining oral hygiene.

When the sole objective of splinting is to decrease tooth mobility following the removal of splint.

classification

According to the period of stabilization

According to the type of material

According to the location on the tooth

ACCORDING TO THE PERIOD OF STABILIZATION

Temporary stabilization (worn for less than 6 months)

Removable fixed

• Occlusal splint with wire• Hawley with splinting arch wire

Intra coronal Extra coronal

• Ss wire with resins• Wire & resin with & acid etching• Enamel etching & composite

resin• Ortho soldered bands• Brackets& wire

• Amalgam • Amalgam & wire

• Amalgam , wire, resin• Composite, resin, wire

PROVISIONAL STABILZATION

• To be used for months up to several years e.g. acrylic splints, metal band

• permanent splints ; used definitely

Removable / fixed • Extra / Intra coronal• Full / Partial veneer crowns

soldered together• Inlay / Onlay soldered together

ACCORDING TO THE TYPE OF MATERIAL

• Bonded composite resin button splint.

• Braided wire splint.

• A- SPLINTS

ACCORDING TO THE LOCATION ON THE TOOTH

Intra coronal Extra coronal

• Tooth bonded plastic• Night guard• Welded bands

• Composite resin with wire• Inlays

• Nylon wire

COMMONLY USED SPLINTS

• Splinting for anterior teeth

• Splinting of posterior teeth

Direct bonding system

Intra coronal wire

Acrylic wire resin splint

Intra coronal amalgam wire splints

Bite guard

Rigid occlusal splint

Composite splint

Splinting of anterior teeth

Splintee Tooth that needs support

Splinters Adjacent teeth that provide support.

Direct bonding system

Acid etching Bonding agent

Composite curing

INTRA CORONAL WIRE SPLINT Slot preparation Ss wire adapted into the slot

Sealed with resin

VARIATION OF THE “A” SPLINT

A 1mm deep M / D box is prepared parallel to the long axis of tooth

SnF/CA(OH)2 varnish is applies & threaded pin is then placed.

Ss is wire is adapted around the pin .

SPLINTING FOR POSTERIOR TEETH

INTRA CORONAL AMALGAM WIRE SPLINTS

BITE(NIGHT) GUARD

Bruxism with occlusal wear

Primary or secondary occlusal traumatism.

Anterior open bite with trauma.

Impinging over bite with periodontal involvement.

Following orthodontic treatment.( as retainer).

RIGID OCCLUSAL SPLINT

Head & neck pain as a result of muscle spasm is usually treated with maxillary occlusal splint.

Rigid & covers all occlusal surfaces.

Designed such that all opposing teeth contact the splint in centric

relations.

FIBER REINFORCED SPLINTING

Fibre reinforced splinting

PROCEDURECoronoplasty Acid etching

Flowable composite

It have good flexural strength and do not require mechanical

retention.

Faster & easier technique.

Superior in all properties compared to all other

splinters.

Composite curing

Post operative

Strength

• May establish final stability & comfort for patient with occlusal trauma.

• Helpful to decrease mobility and accelerate healing following acute trauma to the teeth.

• Allows remodelling of alveolar bone and PDL for orthodontically , splinted teeth.

• Helpful in decreasing mobility favouring regenerative therapy.

• Distributes occlusal forces over a wider area.

Weakness

Hygienic

Mechanical

Biological

REFRENCES

World workshop 1989 iii -4

Lemmerman k; rationale for stabilization JP 1976; 47 (7) : 405 – 411.

Trochtchberg delhi : combined amalgam – wire acrylic splint jp 198: 39 : 255 – 259/

Singer B : intracoronal aesthetic splinting comp. 1996: 17 (5) : 459- 48.

Leib et al : occlusal bite splint comp .1996: 17 (11) : 1081 -1090.

The periodontics syallabus 2nd ed 82- 85.

Doubts???

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