International Journal of Applied Dental Sciences 2019; 5(4): 315-319 

ISSN Print: 2394-7489

ISSN Online: 2394-7497
IJADS 2019; 5(4): 315-319 Periodontal splinting: A review before planning a splint
© 2019 IJADS
www.oraljournal.com
Received: 17-08-2019 Dr. P Bhuvaneswari, Dr. Gowri T, Dr. Ram Kumar GD and Dr. Vanitha
Accepted: 20-09-2019
M
Dr. P Bhuvaneswari
The Tamil Nadu Dr. M.G.R
Abstract
Medical University, Tamil Nadu The treatment of periodontitis-associated tooth mobility may involve specific treatment for the different
Government Dental College & stages of periodontitis starting from simple occlusal therapy, splinting, non surgical phase therapy till
Hospital, Chennai, Tamil Nadu, surgical phase therapy. The treatment of the periodontitis usually involves nonsurgical and surgical
India periodontal treatments but sometimes may be limited to only the nonsurgical periodontal treatment.
Splinting plays dual role both as primary therapeutic measure as well as adjuvant in stabilizing the teeth
Dr. Gowri T for future surgical therapy. Chalifoux stated that splinting saves a significant number of mobile teeth but
The Tamil Nadu Dr. M.G.R requires a high degree of clinical skill and diagnostic expertise. This article discusses the overview of
Medical University, Tamil Nadu history of periodontal splinting, biomechanics, classifications, objectives, indication, contraindication,
Government Dental College & principles and various materials used for splinting.
Hospital, Chennai, Tamil Nadu,
India
Keywords: Appliances, appliance, splinting, stabilization, tooth mobility
Dr. Ram Kumar GD
The Tamil Nadu Dr. M.G.R Introduction
Medical University, Tamil Nadu Periodontitis is the inflammatory disease of periodontium progressing to destruction of soft &
Government Dental College & hard tissue in the oral cavity. It is caused by certain bacteria and by local factors progressing
Hospital, Chennai, Tamil Nadu, from gingivitis to periodontitis and leading to the morbidity and loss of the tooth. Progressive
India
attachment loss around the involved teeth eventually results in increased mobility. Mobility
Dr. Vanitha M can interfere with function. In certain conditions, it is required to strengthen the supporting
The Tamil Nadu Dr. M.G.R tissues reduces mobility and re-establish the function. Nyman and Lang (1994) have
Medical University, Tamil Nadu distinguished between increased tooth mobility due to compromised bone level which may be
Government Dental College & stable following treatment like splinting and increasing tooth mobility indicative of an unstable
Hospital, Chennai, Tamil Nadu,
India periodontium requiring periodontal management to control inflammation.

Definition
Splint: A splint is any device which joins two or more teeth in order to provide support and to
reduce mobility.
According to Glossary of Periodontics Term 1986 a splint is “an appliance designed to
stabilize a mobile tooth”.
According to AAP (1996) a splint has been defined “as an apparatus, appliance, or device
employed to prevent motion or displacement of fractured or mobile parts”.
The Glossary of Prosthodontic Term defines a splint “as a rigid or flexible device that
maintains in position a displaced or movable part; also used to keep in place & protect the
injured part”.

Splinting: A splinting is the stabilization of loose teeth by mechanical means with the
intention of promoting repair.

Periodontal Splint: A periodontal splint is an appliance used for maintaining or stabilizing or

Corresponding Author: immobilizing mobile teeth in their functional and physiological positions.
Dr. P Bhuvaneswari
The Tamil Nadu Dr. M.G.R Evolution of splinting
Medical University, Tamil Nadu
Government Dental College &
Early evidence of human desire to splint weakened teeth can be seen in archaeological
Hospital, Chennai, Tamil Nadu, findings.
India

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1. A phoenix mandible from 500 B.C. demonstrated,

loosened and periodontally compromised anterior teeth
bound together by gold wire.
2. Findings from digging of Egyptians show similar gold
wiring.
3. The history of splinted dental prosthesis progressed to
using silver wire followed later by appliances of gold
wire or ribbon to support loose teeth.
4. Obin & Arvins (1951) advocated the use of self curing
internal splint to achieve temporary stabilization.
5. Harrington (1957) modified the splint by incorporating a
cemented stainless steel wire.
6. Wellensiek (1958), Shatzkin (1960) & Taatz (1964)
presented approaches to the anterior intra-coronal splints.
7. Cross (1954) suggested the use of a continuous amalgam
Fig 2: (M) indicates mesiodistal force, dotted line (m) indicates axis
splint for fixation of mobile post teeth. between teeth, (B) indicates buccolingual, dotted line (b) indicates an
8. L’yod & Baer (1959) & later on Ward & Weinberg axis which runs through both teeth.
(1961) developed new techniques using a plastic matrix
or using wire reinforcement. Classification
Temporary splint: A splint which exist only for a limited
In 1993 Alvarez concluded that traumatized tooth to be period of time-not a permanent splint.
splinted to avoid constant movement that causes damage for
the re-organization of periodontal ligament. Provisional splint: A provisional splint can be fabricated for
He also stated that situation with the present situation which can be changed later may or may
1. Fractured tooth or bone requires splinting for 6-8 weeks not to a permanent splint.
2. With no fracture of tooth or bone may require splinting
for 2-3 weeks. Goldman, Cohen & Checker Classification
Temporary splints
In 2000, Trope et al. indicated avulsed tooth requires semi- (1) Extra-coronal type
rigid splint of 7-10 days.  Wire ligation
 Orthodontic bands
Biomechanics  Removable acrylic appliances
1. A loose tooth splinted to adjacent firm teeth will be
 Removable cast appliances
stabilized.
 Ultraviolet-light-polymerizing bonding materials
2. When it includes many teeth, adjacent quadrants should
be splinted.
3. Teeth tends to loosen bucco-lingually and yet remain (2) Intra coronal type
firm mesio-distally.  Wire & acrylic
4. “Cross-Arch Stabilization” reduces mobility to the “least  Wire & amalgam
common denominator.”  Wire, amalgam & acrylic
5. Splinting should include at least two groups so that they  Cast chrome- cobalt alloy bars with acrylic, or both
will reciprocally stabilize their “mobility” by their “point
of firmness”. Provisional splint
6. Teeth are immobilized and occlusal force are distributed  All acrylic
over a broader area.  Adapted metal band and acrylic
7. The splint may serve as an “orthopedic brace” which
permits the retention of loose teeth in useful functions. Ross, Weisgold and Wright Classification
(1) Temporary stabilization
 Removable extra coronal splints
 Fixed extra coronal splints
 Intra-coronal splints
 Etched metal resin-bonded splints

(2) Provisional stabilization

 Acrylic splints
 Metal-band-and-acrylic splints

(3) Long term stabilization

 Removable splints
 Fixed splints
 Combination removable and fixed splints

Grant, Stem and Listgarten Classification

(1) Removable (external)
Fig 1: (P) and (L) are labiolingual forces: (1) and (2) indicate axis
 Continuous clasp devices
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 Swing-lock devices (4) Combined

 Over dentures (full or partial)  Partial dentures and splinted abutments.
 Removable fixed splints
(2) Fixed (internal)  Full or partial dentures on splinted roots
 Full coverage, three-fourths coverage and inlays  Fixed bridges incorporated in partial dentures seated on
 Posts in root canals posts or copings
 Horizontal pin splints
Others
(3) Cast metal resin bonded fixed partial denture (Maryland  Arch bar splint
splints)  Orthodontic wire and bracket splint

Fig 3: Resin Bonded Splint Fig 4: Intra-Coronal Splint

Fig 5: Wire & Composite Splint Fig 6: Etched Metal Splint

Fig 7: Maryland Bridge Fig 8: Intracoronal Pins & Posts

Fig 9: Partial Dentures Fig 10: Swing-Lock Dentures

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Fig 11: Soft/Flexible Splint Fig 12: Composite Splint

Objectives Principles of splinting

 To provide rest, reduce mobility, redirection of forces,  Inclusion of sufficient area of healthy teeth. Healthy teeth
redistribution of forces and restoration of functional included in the splint should have double the area of root
stability. surface than the mobile teeth to be splinted.
 To promote healing of underlying periodontal tissues by  If one tooth included in the splint is in a traumatic
removing occlusal trauma. occlusion, the periodontal tissue of the remaining teeth
 To promote patient comfort & function. may also be injured. So coronoplasty to be performed in
 Redirection of occlusal forces to all teeth included in the most of the cases.
splint. This ensures that forces are within the adaptive  It should be fabricated in such a way as to facilitate
capacity of periodontium. proper plaque control.
 To preserve the arch integrity splinting restores proximal  Should not interfere with occlusion.
contacts reducing food impaction at proximal area.  Esthetically acceptable.
 To promote psychological well being.  To avoid forces from lip, cheek and tongue.
 To aid in effective surgical procedure.
Material used for splinting
Indications 1. Ligature wire -Stainless steel wire, brass wire
1. To protect mobile teeth and to promote healing. 2. Night guards-Heat polymerized poly-methyl methacrylate
2. To distribute occlusal forces to the teeth which lost 3. Welded stainless steel band splints
periodontal support and not traumatized. 4. Castable splints-stainless steel or gold or acrylic
3. To prevent extrusion of unopposed teeth. 5. Amalgam splint
4. To facilitate effective prophylaxis and surgical 6. Pin & screw continuous clasp splint
procedures. 7. Monofilament nylon composite splint
5. To preserve normal masticatory function. 8. Wire composite splint
6. To prevent occlusal forces. 9. composite or fiber reinforced composite as internal splint
7. To stabilize teeth after trauma, subluxation and avulsion. a) Reinforced with metal wires
8. To stabilize teeth after orthodontic movements. b) Glass reinforced fibers or pin. (Brazilay,2000) (not
recommended)
Contraindications
1. Severe tooth mobility. Discussion
2. Insufficient number of firm teeth. Splinting of the teeth will not prevent or retard apical down-
3. Patient with very poor oral hygiene. growth of plaque and associated attachment loss. In fact splint
4. A tooth on which occlusal trauma has been reduced. act as a challenge for OHI compared to the same thing for that
5. Teeth with severe inflammation and pathology. patient.
It was also observed that the areas of root bifurcation and
Advantages trifurcation are more susceptible to excess occlusal forces.
 Alveolus remodeling of alveolar bone and periodontal In a study to determine the effect of initial preparation and
ligament for orthodontically moved tooth or teeth. occlusal adjustment on tooth mobility, it was observed that for
 Provides healing of supporting structures. teeth with initial mobility of greater than 0.2 mm there was a
 Fine stability and comfort for patient will be provided. decrease in tooth mobility up to 20%.
 Facilitates surgical procedures by keeping the tooth Splinting of mobile teeth doesn’t have any effect on mobility
immobile. reduction after initial therapy.
 Distributes occlusal forces on a wide area. The effect of rigid splinting on anterior teeth following
extrusion of teeth by 3 mm and their replacement back into
Disadvantages the socket, the investigators did not observe any significant
difference between the splinted and non-splinted teeth in
 Accumulation of plaque can lead to further periodontal
maintenance. terms of periodontal ligament width or stress or strain values.
Results of the study showed that rigid splinting of luxated
 Requires excellent OHI maintenance.
teeth did not improve the mechanical properties of the
 If one tooth in the splint is in traumatic occlusion, it can
periodontal ligament during healing.
injure the periodontium of all other teeth included in the
The use of a metal primer on stainless steel wires either
splint.
separately or in combination with sandblasting had lower
 Development of caries is an amenable risk.
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wire-composite interface bond strength than sandblasting current status of periodontal splinting. JICP. 2016;
alone, while no surface treatment on the wire had the least 18(6):45-56.
bond strength for both the light and chemically activated 9. Giordano R. Fiber reinforced composite resin systems.
composite resins. General Dentistry. 2000; 48:244-249.
Dental splinting is frequently needed following traumatic
injuries to stabilize subluxated, luxated, avulsed and root-
fractured teeth. The prognosis is determined by the type of
injury rather than factors associated with splinting. Duration
of splinting is not recommended to be more than 10 days.
Significantly less tooth mobility with direct composite splint
compared to all other splints and no differences between
nylon-composite and wire composite splints were observed.
The nylon and SS or NT wires up to 0.016” (0.4 mm)
diameter are significantly more flexible than direct composite
splints and thus may be better suited for the splinting and
management of traumatized teeth.
According to Lindae, when progressive bone loss with normal
width of periodontal ligament is noticed, two of one sequalae
can happen, either tooth mobility that does not interfere with
patient’s comfort or tooth mobility that interferes with
patient’s comfort.
In condition with tooth mobility that interferes for regular
functions, splinting is required to reduce or fix the mobility.
Under these conditions, a provisional splint followed by a
fixed splint is advisable for long term results of the
periodontally compromised mobile teeth.
The provisional splint may be unilateral or bilateral depending
on the number of mobile teeth involved. The time period
requires 6 months for monitoring abutment teeth.

Conclusion
In advanced periodontal disease, tissue destruction reaches the
level of extraction of one or more teeth. In such conditions,
remaining teeth available for Periodontal treatment can be
immobilized that fulfils the major objective of stabilizing
hypermobile teeth as well as replacing the missing teeth
amidst mobile teeth.
The choice of splint varies widely from simple composite
splint to removable cast partial prosthesis. Later on review
when no increase in mobility of the previously assigned
provisional bridge or abutment teeth is noticed, the permanent
splint such as metal bridge or PFM bridge may be included.
The time period for retaining the periodontal splinting may
vary from other types of traumatic splinting or orthodontic
splinting. Thus the choice of splint, time period for splinting
and material of splinting requires the collective knowledge
about the biomechanics of splinting related to the patient’s
existing periodontal condition.

References
1. Kamath S, Bhavasar NV. Periodontal splints A Boon or a
Bane? JISP, 21-25.
2. Current concepts in Periodontics. B.R.R. Varma & R.P.
Nayak, 309-311.
3. The Practice of Periodontia. Sidney Sorrin. 340-358.
4. Clinical Periodontology. 1st edition Glickman, 922-926.
5. Carranza Clinical Periodontology. Newmann MG, Takei
HH Klokkevold PR, Carranza FA. 11th edition. 1065.
6. Clinical Decisions in Periodontology. Walter B. Hall,
131-132.
7. Barzilay I. Splinting teeth- a review of methodology and
clinical case reports Journal of the Canadian Dental
Association. 2000; 66:440-443.
8. Kathariya R, Devanoorkar A, Golani R, Bansal N,
Vallakatla V, Bhat MYS. To splint or not to splint: the
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