Splints/ dentistry dental implants

SPLINTS IN PERIODONTICSSPLINTS IN PERIODONTICS
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com
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CONTENTSCONTENTS
 IntroductionIntroduction
 DefinitionsDefinitions
 SplintSplint
 StabilizationStabilization
 Rationale for stabilizationRationale for stabilization
 Biologic reasons for splintingBiologic reasons for splinting
 Ideal requirements of a splintIdeal requirements of a splint
 Basic consideration before construction of any splintsBasic consideration before construction of any splints
 Mode of actionMode of action
 Classification of splintsClassification of splints
 Packs and splintsPacks and splints
 Disadvantages of splintingDisadvantages of splinting
 Maintenance of splintsMaintenance of splints
 conclusionconclusion
 ReferencesReferences

IntroductionIntroduction
 Periodontal diseases are characterized by subgingival plaque
formation, gingival inflammation, loss of connective tissue
attachment and loss of alveolar bone.
 As a result of the progressive loss of attachment tissue, the
teeth involved in the disease process eventually exhibit
increased tooth mobility.
 Thus the reduction of mobility is an important objective of
periodontal therapy.

 Root planning, curettage, oral hygiene and surgery may cause
teeth to tighten as inflammation is resolved. However a
transient increase in mobility may occur immediately after
surgery.
 Occlusal adjustment, periodontal orthodontics and restorative
dentistry may alter occlusal relationships and redirect forces,
there by reducing traumatism. This may result in the teeth
becoming firmer.
 Increasing the support of loose teeth may also increase their
firmness, the device used for such treatment is the “SPLINT”.

 Splint may be used to maintain periodontally migrated teeth
that have been repositioned.
 It may also be used prior to surgery where splinting is
considered necessary to stabilize mobile teeth during post
surgical healing.
 Dental splints have been used since the 8th century B.C. thus,
while hardly a recent innovation splinting is still generally
regarded as an integral part of periodontal therapy.
 Splinting creates a multi-rooted unit, increasing the total area
of root resistance. The center of rotation of each tooth is so
altered as to afford greater resistance to mesiodistal forces.

 Splinting is commonly performed on the assumption that it
will create a more favorable environment for periodontal
repair.
 Etruscans from the 8th
century B.C. to the 1st
century A.D.
utilized wire ligation and small gold rings and bands to
stabilize mobile teeth.
 Fauchard in 1723 ligated and banded teeth to stabilize them.

DEFINITIONSDEFINITIONS
SPLINT:SPLINT:
 Splint is defined as an any apparatus, appliance device
employed to prevent motion or displacement of fractured or
movable parts (Francis G. Serio).
 Grant defined splint is an any appliance that joins two or
more teeth to provide support.
 According to Macphee and Cowley – Splint is a rigid
flexible appliance used to stabilize and protect an injured part.

 Manson and Eley defined splint is a device for supporting
weakened tissues. It serves two purposes
1. Provides rest where wound healing is in process
2. Permits function where the tissues alone cannot perform
adequately .
 Splint is an appliance for immobilization or stabilization of
injured or diseased parts (Keith Lemmerman).
 Page and Schluger defined splint is a device used to
immobilize teeth and it is one of the oldest forms of aids to
periodontal therapy
 Clark, Weatherford and Mann defined splint is an appliance
to stabilize or immobilize an injured or diseased part.www.indiandentalacademy.comwww.indiandentalacademy.com

STABILIZATION (SPLINTING):-STABILIZATION (SPLINTING):-
 Stabilization or splinting commonly refers to tying teeth
together either unilaterally or bilaterally, to convey increased
stability to the entire unit. (Francis G. Serio)
 Jenkins defined stabilization or splinting is the procedure
by which a tooth’s resistance to an applied force is increased
by joining it to a neighbouring tooth or teeth.
 According to Keith Lemmerman – Stabilization of a tooth is
an increase in resistance to applied force by providing
reciprocal antagonisms and increasing the effective root area.
The force may remain the same, but the resistance is
increased. www.indiandentalacademy.comwww.indiandentalacademy.com

 Dawson defines splinting as “the joining together teeth into
a rigid unit by means of fixed or removable restorations or
devices.
 Splinting is defined as the “joining of two or more teeth into
a rigid unite by means of fixed or removable restorations or
devices”. (Sharon C. Seigel, Carl F. Driscoll and Sylvan
Feldman)

RATIONALE FOR STABILIZATION:RATIONALE FOR STABILIZATION:
 The benefits of splinting teeth are based on clinicalThe benefits of splinting teeth are based on clinical
impression rather than on scientific studies. Clinicians haveimpression rather than on scientific studies. Clinicians have
used both fixed and removable splints to restore occlusalused both fixed and removable splints to restore occlusal
stability effectively.stability effectively.
I. Splinting the normal periodontiumI. Splinting the normal periodontium
 Prevention of mobility.Prevention of mobility.
 Prevention of drifting.Prevention of drifting.
II. Splinting the diseased periodontiumII. Splinting the diseased periodontium
 Prevention of mobility.Prevention of mobility.
 To allow repair during periodontal treatmentTo allow repair during periodontal treatment
 Prevention of Trauma from occlusionPrevention of Trauma from occlusion
 Prevention of drifting.Prevention of drifting.

 I. Splinting the normal periodontiumI. Splinting the normal periodontium:_:_
This includes cases where, a clinical point of view, theThis includes cases where, a clinical point of view, the
periodontium isperiodontium is healthyhealthy..
 A. Prevention of mobility:-
 The increased tooth mobility is detrimental, and if allowed toThe increased tooth mobility is detrimental, and if allowed to
continue, could cause other damage. The dividing linecontinue, could cause other damage. The dividing line
between normal mobility and mobility that should be treatedbetween normal mobility and mobility that should be treated
widely.widely.
 B.B. Prevention of driftingPrevention of drifting:-:-
 The rationale for stabilization here is that drifting of teethThe rationale for stabilization here is that drifting of teeth
can lead to or enhance the potential for the development ofcan lead to or enhance the potential for the development of
periodontal problems.periodontal problems. www.indiandentalacademy.comwww.indiandentalacademy.com

eg ::eg :: Replacement of missing teethReplacement of missing teeth::
 Hirschfeld 1937. The classic case used as an illustration was theHirschfeld 1937. The classic case used as an illustration was the
early loss of the mandibular first molar. Failure to replace it resultedearly loss of the mandibular first molar. Failure to replace it resulted
inin
mesial drifting of the mandibular 2nd and 3rd molars,mesial drifting of the mandibular 2nd and 3rd molars,
distal drifting of the mandibular premolars, extrusion ofdistal drifting of the mandibular premolars, extrusion of
the maxillary first molar,the maxillary first molar,
marginal ridge discrepancies, open contacts, increasedmarginal ridge discrepancies, open contacts, increased
plaque retention pocket formation and developmentplaque retention pocket formation and development
occlusion interferences.occlusion interferences.
Replacement of four missing 1st molars has beenReplacement of four missing 1st molars has been
shown to result in a 50% increase in masticatoryshown to result in a 50% increase in masticatory
efficiency.efficiency.

 II.II. Splinting the diseased periodontiumSplinting the diseased periodontium:-:-
 A)A) Prevention of mobility:-Prevention of mobility:-
 Splinting for functional reasonsSplinting for functional reasons:- The rationale in this case is:- The rationale in this case is
to splint where increased mobility makes function difficult orto splint where increased mobility makes function difficult or
impossible.impossible.
 Stern and Clark stated that one of the rationales forStern and Clark stated that one of the rationales for
stabilization is to decrease mobility and that one of its benefitsstabilization is to decrease mobility and that one of its benefits
was an increase in function for the patient.was an increase in function for the patient.
 Simring reported that temporary stabilization may be done toSimring reported that temporary stabilization may be done to
“increase the morale” of patients with multiple mobile teeth.“increase the morale” of patients with multiple mobile teeth.

To allow repair during periodontal treatmentTo allow repair during periodontal treatment
 The rationale is that mobility may either cause orThe rationale is that mobility may either cause or
accelerate the progression of periodontal disease, or theaccelerate the progression of periodontal disease, or the
very least inhibit tissue repair.very least inhibit tissue repair.
 HirschfieldHirschfield advocated that the use of stabilization 1 to 2advocated that the use of stabilization 1 to 2
years post-treatment in anterior teeth with residualyears post-treatment in anterior teeth with residual
mobility to encourage the consolidation of supportingmobility to encourage the consolidation of supporting
structures.structures.
 FriedmanFriedman believed that unless splinted, mobile teethbelieved that unless splinted, mobile teeth
may not respond as well to reattachment procedures.may not respond as well to reattachment procedures.

 CrossCross stated that in the absence of infection, mobilitystated that in the absence of infection, mobility
will inhibit repair and therefore splinting indicated..will inhibit repair and therefore splinting indicated..
 WardWard considered “pathologic movement” to be anconsidered “pathologic movement” to be an
etiologic factor in periodontal disease and advocatedetiologic factor in periodontal disease and advocated
temporary splinting to prevent it.temporary splinting to prevent it.
 AmsterdamAmsterdam and others have stated that splinting wasand others have stated that splinting was
also indicted following hemisection or root resectionalso indicted following hemisection or root resection
procedures to allow better healing.procedures to allow better healing.

 B.B. Prevention of drifting:-Prevention of drifting:-
 Replacement of missing teeth:-Replacement of missing teeth:-
This is basically the same as in normal periodontium withThis is basically the same as in normal periodontium with
increased function as a secondary benefit.increased function as a secondary benefit.
 Post orthodontics:-Post orthodontics:-
Splints used as retainers after orthodontic therapy in theSplints used as retainers after orthodontic therapy in the
periodontic patient..periodontic patient..

BIOLOGIC REASONS FOR SPLINTING:BIOLOGIC REASONS FOR SPLINTING:
1.1. RESTREST
 Occlusal rest provided by splint therapy of one form or
another helps to eliminate or atleast to neutralize some of the
adverse occlusal factors that compound the effects of an
already existing inflammatory disease, such as periodontitis.
 Many involved teeth are hypermobile because of a widened
periodontal space, and one of the main objectives of splinting
is to reestablish a narrow ligament space.

2.2. REDISTRIBUTION OF FORCESREDISTRIBUTION OF FORCES:-:-
 The stabilization of weakened teeth by splinting increasesThe stabilization of weakened teeth by splinting increases
resistance to applied forces.resistance to applied forces.
 The redistribution of forces ensures that the excessive forceThe redistribution of forces ensures that the excessive force
on a single tooth does not exceed the adaptive capacity of theon a single tooth does not exceed the adaptive capacity of the
surrounding tissue and that jiggling movements which cansurrounding tissue and that jiggling movements which can
contribute to further bone loss in an existing periodontitis arecontribute to further bone loss in an existing periodontitis are
prevented .prevented .

3.3. REDIRECTION OF FORCES:-REDIRECTION OF FORCES:-
 Splinting effects a redirection of force in a more axial directionSplinting effects a redirection of force in a more axial direction
over all the teeth included in the splint.over all the teeth included in the splint.
 Hypothetically, occlusal force on a mesially tilted molar will haveHypothetically, occlusal force on a mesially tilted molar will have
a mesial vector and an apical vector, but no vector along the longa mesial vector and an apical vector, but no vector along the long
axis of the tooth.axis of the tooth.
 Splinting such teeth prevents the tilting affect of the unfavourablySplinting such teeth prevents the tilting affect of the unfavourably
directed occlusal force.directed occlusal force.

4)4) PRESERVATION OF ARCH INTEGRITYPRESERVATION OF ARCH INTEGRITY:-:-
 Splinting restores proximal contacts that have been disruptedSplinting restores proximal contacts that have been disrupted
by missing and migrated teeth & makes the patient moreby missing and migrated teeth & makes the patient more
comfortable and reduces the likely hood of food impaction andcomfortable and reduces the likely hood of food impaction and
consequent breakdown.consequent breakdown.
5)5) RESTORATION OF FUNCTIONAL STABILITYRESTORATION OF FUNCTIONAL STABILITY:-:-
 Splinting in conjunction with replacement of missing teethSplinting in conjunction with replacement of missing teeth, if, if
necessary,necessary, not only restores a functional occlusionnot only restores a functional occlusion, but, but
stabilizes the remaining mobile abutment teethstabilizes the remaining mobile abutment teeth..

6)6) To prevent tipping, migration, or overeruption of teethTo prevent tipping, migration, or overeruption of teeth
following extraction and to stabilize proximal contacts offollowing extraction and to stabilize proximal contacts of
mobile teeth and reduce food impaction into the embrasures.mobile teeth and reduce food impaction into the embrasures.
7)7) Masticatory function may be improved.Masticatory function may be improved.
8)8) Discomfort and pain are eliminated.Discomfort and pain are eliminated.
9)9) Appearance may be improved.Appearance may be improved.
10)10) PSYCHOLOGICAL WELL-BEINGPSYCHOLOGICAL WELL-BEING:-:-
 Hyper mobility can become so severe that patients becomeHyper mobility can become so severe that patients become
fearful of losing teeth.fearful of losing teeth.
 Stabilization by splinting and restoration not only improvesStabilization by splinting and restoration not only improves
function, but it also can restore a sense of a solid-feelingfunction, but it also can restore a sense of a solid-feeling
dentition as well as of comfort and good looks.dentition as well as of comfort and good looks.

 The attainment of comfort and good looks as a basis forThe attainment of comfort and good looks as a basis for
splinting cannot be disregarded; however splinting must not besplinting cannot be disregarded; however splinting must not be
misused as a cosmetic procedure.misused as a cosmetic procedure.
 Many patients who require long-term stabilization by theMany patients who require long-term stabilization by the
extensive use of fixed prosthodontics are concerned more withextensive use of fixed prosthodontics are concerned more with
the cosmetic benefits that might result form such treatmentthe cosmetic benefits that might result form such treatment
than with improved functional qualities.than with improved functional qualities.
 The use of an expensive, irreversible procedure must not basedThe use of an expensive, irreversible procedure must not based
solely on a patient’s cosmetic demands.solely on a patient’s cosmetic demands.
 Often patients concerned with cosmetic results remainOften patients concerned with cosmetic results remain
dissatisfied despite the best efforts to restore their dentitions.dissatisfied despite the best efforts to restore their dentitions.

IDEAL REQUIREMENTS OF A SPLINT:IDEAL REQUIREMENTS OF A SPLINT:
1.1. Simple.Simple.
2.2. EconomicEconomic
3.3. Stable and efficientStable and efficient
4.4. Esthetically acceptableEsthetically acceptable
5.5. It should incorporate as many firm teeth as is necessary toIt should incorporate as many firm teeth as is necessary to
reduce the extra load on individual teeth to a minimum.reduce the extra load on individual teeth to a minimum.
6.6. It should hold the teeth rigid and not impose torsional stressesIt should hold the teeth rigid and not impose torsional stresses
on any incorporated teeth.on any incorporated teeth.www.indiandentalacademy.comwww.indiandentalacademy.com

7.7. It should extend around the arch, so that antero-posterior forces andIt should extend around the arch, so that antero-posterior forces and
facio lingual forces are counteracted.facio lingual forces are counteracted.
8. It should not interfere with the occlusion. If possible gross tooth8. It should not interfere with the occlusion. If possible gross tooth
disharmonies should be eliminated before the application of thedisharmonies should be eliminated before the application of the
splint.splint.
9.9. It should be designed so that it can be kept clean interdentalIt should be designed so that it can be kept clean interdental
embrassure spaces should not be blocked by the splint.embrassure spaces should not be blocked by the splint.
10.10. It should not irritate the pulp, soft tissues, gingiva, cheeks, lips orIt should not irritate the pulp, soft tissues, gingiva, cheeks, lips or
tongue.tongue.
11.11. It should not impair or disturb the phonetic pattern of the patient.It should not impair or disturb the phonetic pattern of the patient.
12.12. It should not provoke iatrogenic disease.It should not provoke iatrogenic disease.

BASIC CONSIDERATION BEFORE CONSTRUCTION OFBASIC CONSIDERATION BEFORE CONSTRUCTION OF
ANY SPLINT:ANY SPLINT:
1.1. For most patients, splinting should be considered only after theFor most patients, splinting should be considered only after the
preliminary phase of periodontalpreliminary phase of periodontal therapy has been completed,therapy has been completed,
including theincluding the elimination of all local factors contributing toelimination of all local factors contributing to
inflammationinflammation andand occlusal adjustmentocclusal adjustment by selective grinding.by selective grinding.
- Exceptions are dentitions with so much mobility that adequate- Exceptions are dentitions with so much mobility that adequate
occlusal adjustment is impossible.occlusal adjustment is impossible.
-In these circumstances the teeth should be stabilized as early as-In these circumstances the teeth should be stabilized as early as
possible, and then the occlusion can be definitely adjusted.possible, and then the occlusion can be definitely adjusted.

2.2. TheThe method of splintingmethod of splinting is dictated by theis dictated by the cause and degree ofcause and degree of
mobilitymobility,, whether,, whether temporarytemporary oror permanent.permanent.
If theIf the coronal portionscoronal portions of the teeth are inof the teeth are in relatively goodrelatively good
condition, thecondition, the extra coronalextra coronal method of splinting should bemethod of splinting should be
used.used.
If, however, the teeth obviouslyIf, however, the teeth obviously requirerequire extensive restorativeextensive restorative
therapytherapy, as well as periodontal therapy, a form of, as well as periodontal therapy, a form of intracoronalintracoronal
splintingsplinting is justified and preferable.is justified and preferable.

3.3. TheThe extent of splintingextent of splinting is dictated primarily by the number ofis dictated primarily by the number of
teeth involved and the degree of their mobility.teeth involved and the degree of their mobility.
In all cases, a sufficient number of non mobile teeth should beIn all cases, a sufficient number of non mobile teeth should be
included in the splint.included in the splint.
If all the teeth in a quadrant demonstrate hypermobility,If all the teeth in a quadrant demonstrate hypermobility,
splinting should be extensive enough to include the support ofsplinting should be extensive enough to include the support of
anterior teeth and, on occasion, teeth on the opposite side ofanterior teeth and, on occasion, teeth on the opposite side of
the arch.the arch.
For the same reason, the support of posterior teeth is oftenFor the same reason, the support of posterior teeth is often
necessary when anterior segments are mobile.necessary when anterior segments are mobile.

4.4. If, in a case of occlusal traumatism associated with severeIf, in a case of occlusal traumatism associated with severe
bone loss, all the teeth demonstrate hypermobility,bone loss, all the teeth demonstrate hypermobility, corss-archcorss-arch
splinting is beneficialsplinting is beneficial, because the pattern of mobility of, because the pattern of mobility of
some teeth is in a buccolingual direction and of others is in asome teeth is in a buccolingual direction and of others is in a
mesiodistal direction. (with splinting, a group of single rootedmesiodistal direction. (with splinting, a group of single rooted
teeth in effect becomes a multirooted unitteeth in effect becomes a multirooted unit.)
5.5. The method of splinting should neither impede normalThe method of splinting should neither impede normal
functions nor frustrate the oral hygiene and physiotherapeuticfunctions nor frustrate the oral hygiene and physiotherapeutic
efforts of the patient.efforts of the patient.
The splint must not irritate the gingival tissues, andThe splint must not irritate the gingival tissues, and
whenever possible it should be esthetically acceptable.whenever possible it should be esthetically acceptable.

 The patient must be informed that future restorative measuresThe patient must be informed that future restorative measures
are usually necessary when any form of intra orare usually necessary when any form of intra or
circumcoronal splinting is used.circumcoronal splinting is used.

MODE OF ACTIONMODE OF ACTION::
 Loose teeth splinted to adjacent firm teeth may become stabilized.Loose teeth splinted to adjacent firm teeth may become stabilized.
When many teeth are loose, adjacent sextants should be included inWhen many teeth are loose, adjacent sextants should be included in
the splint.the splint.
 Teeth tend to loosen buccolingually yet may remain firmTeeth tend to loosen buccolingually yet may remain firm
mesiodistally. Adjacent sextants therefore have complimentarymesiodistally. Adjacent sextants therefore have complimentary
strengths.strengths.
 Cross-arch splinting reduces mobility to the least commonCross-arch splinting reduces mobility to the least common
denominator. Teeth are thus immobilized and occlusal forces aredenominator. Teeth are thus immobilized and occlusal forces are
better distributed.better distributed.
 Traumatism is minimized, repair is enhanced, and teeth mayTraumatism is minimized, repair is enhanced, and teeth may
become firm again. Even when teeth do not tighten, the splintbecome firm again. Even when teeth do not tighten, the splint
serves as an orthopedic brace that permits useful function of looseserves as an orthopedic brace that permits useful function of loose
teeth.teeth.

CLASSIFICATION OF SPLINTSCLASSIFICATION OF SPLINTS
 Splints can be classified as eitherSplints can be classified as either ‘temporary’‘temporary’ or ‘or ‘permanent’permanent’
and asand as ‘removable’‘removable’ oror ‘fixed’.‘fixed’.
 RAMFJORD & ASHRAMFJORD & ASH have classified splints into:have classified splints into:
1.1. TemporaryTemporary
2.2. Diagnostic or provisionalDiagnostic or provisional
3.3. PermanentPermanent
 Such splints have also been grouped as eitherSuch splints have also been grouped as either EXTERNALEXTERNAL
oror INTERNALINTERNAL to the circumference of the tooth.to the circumference of the tooth.

 TEMPORARY SPLINTS:-TEMPORARY SPLINTS:- This is used on a short term basis,This is used on a short term basis,
usually less than 6 months, and is oftenusually less than 6 months, and is often advocated to stabilizeadvocated to stabilize
teethteeth during periodontal therapy or after a traumatic episodeduring periodontal therapy or after a traumatic episode..
 PROVISIONAL SPLINTS:-PROVISIONAL SPLINTS:- (Diagnostic):- This is used for(Diagnostic):- This is used for
several months to several years forseveral months to several years for diagnostic informationdiagnostic information..
Provisional splints allow the clinicianProvisional splints allow the clinician to observe the healingto observe the healing
response to treatment and to make changes based on patientresponse to treatment and to make changes based on patient
response to treatmentresponse to treatment, this enables the clinician to properly, this enables the clinician to properly
design a more permanent and biologically acceptable form ofdesign a more permanent and biologically acceptable form of
stabilization & better treatment.stabilization & better treatment.
 PERMANENT SPLINTS:_PERMANENT SPLINTS:_ This is used indefinitely. TheseThis is used indefinitely. These
are usually used in a more reduced periodontium.are usually used in a more reduced periodontium.

Intra coronal splints (Internal Splints):-Intra coronal splints (Internal Splints):-
 These are the most commonly used type of splint.These are the most commonly used type of splint.
 This type of splint involves cavity preparation.This type of splint involves cavity preparation.
 This preparation is used to increase the strength and retentionThis preparation is used to increase the strength and retention
of the restoration material.of the restoration material.
 The preparation may be continuous or discontinuous.The preparation may be continuous or discontinuous.
 The continuous type is used in the mandibular segmentThe continuous type is used in the mandibular segment
because of relatively short mesiodistal dimension ofbecause of relatively short mesiodistal dimension of
mandibular incisors. The discontinuous splint is used inmandibular incisors. The discontinuous splint is used in
maxillary segment.maxillary segment.

INDICATIONS OF INTERNAL SPLINTS :-INDICATIONS OF INTERNAL SPLINTS :-
1.1. Teeth with a more reduced periodontium.Teeth with a more reduced periodontium.
2.2. Dentition with a deep overbite.Dentition with a deep overbite.
3.3. Teeth with very short roots or resorbed roots.Teeth with very short roots or resorbed roots.
4.4. To evaluate potential abutment teeth.To evaluate potential abutment teeth.
5.5. Teeth with root amputations and mobility.Teeth with root amputations and mobility.
6.6. To avoid dislodgement during regenerative procedures.To avoid dislodgement during regenerative procedures.
7.7. Post orthodontics, specially in cases involving intrusions,Post orthodontics, specially in cases involving intrusions,
extrusions, rotations, pathologic migrations, or molar uprighting.extrusions, rotations, pathologic migrations, or molar uprighting.
8.8. When teeth advanced mobility cannot be treated any other way.When teeth advanced mobility cannot be treated any other way.

EXTRACORONAL SPLINTS (EXTERNAL SPLINTS):-EXTRACORONAL SPLINTS (EXTERNAL SPLINTS):-
 These are usually temporary in nature. & this type of splint does not involve anyThese are usually temporary in nature. & this type of splint does not involve any
tooth preparation.tooth preparation.
 These can be reinforced with wire or mesh if additional strength is needed.These can be reinforced with wire or mesh if additional strength is needed.
 Use of extra coronal splints is usually confined to anterior teeth.Use of extra coronal splints is usually confined to anterior teeth.
Indications:-Indications:-
 Anterior teeth with moderate mobility.Anterior teeth with moderate mobility.
 Post orthodontic retention without mobility, especially where retainer compliancePost orthodontic retention without mobility, especially where retainer compliance
is a concern.is a concern.
 To provide stability in cases of acute trauma and allow for healing of theTo provide stability in cases of acute trauma and allow for healing of the
periodontal ligament, remodeling of alveolar bone, maintenance of tooth position,periodontal ligament, remodeling of alveolar bone, maintenance of tooth position,
and comfort during function.and comfort during function.
 Regenerative procedures, where mobility may temporarily increase.Regenerative procedures, where mobility may temporarily increase.
 Endodontic – periodontic lesions.Endodontic – periodontic lesions.www.indiandentalacademy.comwww.indiandentalacademy.com

CLASSIFICATIONCLASSIFICATION
TEMPORARY SPLINTSTEMPORARY SPLINTS
 i)i) EXTRACORONALEXTRACORONAL --
1.1. Wire ligature – acrylic splintWire ligature – acrylic splint
2.2. Splints of enamel bonding materialSplints of enamel bonding material
3.3. Welded bands (Orthodontic bands)Welded bands (Orthodontic bands)
4.4. Continuous claspsContinuous clasps
5.5. Removable acrylic splintsRemovable acrylic splints
A) Occlusal splintsA) Occlusal splints
- Bite guards- Bite guards
- Maxillary occlusal splint- Maxillary occlusal splint
- Mandibular occlusal splint- Mandibular occlusal splint
- Soft occlusal splint- Soft occlusal splint
B) Bite platesB) Bite plates
- Hawley biteplate- Hawley biteplate
- Sved biteplate- Sved biteplate www.indiandentalacademy.comwww.indiandentalacademy.com

 ii)ii) INTRA CORONALINTRA CORONAL
1) Wire acrylic splint (‘A’splint)1) Wire acrylic splint (‘A’splint)
2) Wire composite resin splint2) Wire composite resin splint
3) Amalgam splint3) Amalgam splint
4) Acrylic full crowns4) Acrylic full crowns
5) Combined amalgam – wire – acrylic splint5) Combined amalgam – wire – acrylic splint
 PROVISIONAL SPLINTINGPROVISIONAL SPLINTING
1) Metal – Band – and acrylic type1) Metal – Band – and acrylic type
2) All – Acrylic type2) All – Acrylic type

 PERMANENT SPLINTINGPERMANENT SPLINTING
1.1. Removable – ExternalRemovable – External
 Continuous clasp devicesContinuous clasp devices
 Swing lock devicesSwing lock devices
 Over denture (full or partial)Over denture (full or partial)
2.2. Fixed – internalFixed – internal
 Full coverage, 3/4th coverage crowns and inlaysFull coverage, 3/4th coverage crowns and inlays
 Posts in root canalsPosts in root canals
 Horizontal pin splintsHorizontal pin splints
3.3. Cast-metal-resin-bonded fixed partial denturesCast-metal-resin-bonded fixed partial dentures
 Maryland splintsMaryland splints

4.4. CombinedCombined
 Partial dentures and splinted abutmentsPartial dentures and splinted abutments
 Removable – Fixed splintsRemovable – Fixed splints
 Full or partial dentures on splinted rootsFull or partial dentures on splinted roots
 Fixed bridges incorporated in partial denturesFixed bridges incorporated in partial dentures
seated on posts or copingsseated on posts or copings..
5.5. Endodontics

I.I. TEMPORARY STABILIZATION:TEMPORARY STABILIZATION:
 Temporary splinting is the joining of two or more teeth, to increaseTemporary splinting is the joining of two or more teeth, to increase
resistance to an applied force.resistance to an applied force.
 Temporary splinting should be considered as part of the initialTemporary splinting should be considered as part of the initial
preparation of the tissues, and should thus be done prior topreparation of the tissues, and should thus be done prior to
periodontal surgery.periodontal surgery.
 Temporary splints are employed for a limited period of time to aidTemporary splints are employed for a limited period of time to aid
healing by limiting the mobility of a tooth or teeth and thereforehealing by limiting the mobility of a tooth or teeth and therefore
assisting in healing.assisting in healing.
 Temporary splints may also be used as a diagnostic measure toTemporary splints may also be used as a diagnostic measure to
assist in the determination of prognosis of questionable teeth.assist in the determination of prognosis of questionable teeth.

INDICATIONS OF TEMPORARY SPLINTS:-INDICATIONS OF TEMPORARY SPLINTS:-
 These are used either until hypermobility is satisfactorilyThese are used either until hypermobility is satisfactorily
reduced or eliminated and the teeth can function without thereduced or eliminated and the teeth can function without the
help of the splint or until the dentition clearly requireshelp of the splint or until the dentition clearly requires
longterm stabilization.longterm stabilization.
 These are used until stabilization is no longer necessary ,These are used until stabilization is no longer necessary ,
for example, in cases of mobility caused by orthodonticfor example, in cases of mobility caused by orthodontic
repositioning accidental or surgical trauma, or occlusalrepositioning accidental or surgical trauma, or occlusal
traumatism, all of a reversible nature.traumatism, all of a reversible nature.
 These are used in the therapy being undertaken to determineThese are used in the therapy being undertaken to determine
whether hypermobility can be resolved by conservativewhether hypermobility can be resolved by conservative
methods or whether the mobility is caused by loss of supportmethods or whether the mobility is caused by loss of support
sufficient to create permanent hypermobility, by rootsufficient to create permanent hypermobility, by root
resorption or any extrinsic or intrinsic precipitating factors.resorption or any extrinsic or intrinsic precipitating factors.www.indiandentalacademy.comwww.indiandentalacademy.com

 In advanced periodontal diseases when the permanent fixationIn advanced periodontal diseases when the permanent fixation
cannot be done either because of economic reasons, poorcannot be done either because of economic reasons, poor
prognosis for all remaining teeth, poor health which affects theprognosis for all remaining teeth, poor health which affects the
longevity of the dentition, or even the life of the patient.longevity of the dentition, or even the life of the patient.
 In patients who cannot emotionally accept the lengthy proceduresIn patients who cannot emotionally accept the lengthy procedures
of permanent fixation.of permanent fixation.
 In cases of infrabony defects treated with heterografts andIn cases of infrabony defects treated with heterografts and
autografts.autografts.
 In cases of stabilizing the hemisectinoed teeth.In cases of stabilizing the hemisectinoed teeth.
 These can be used as a diagnostic and to evaluate the prognosisThese can be used as a diagnostic and to evaluate the prognosis
before instituting extensive permanent splinting.before instituting extensive permanent splinting.
 To improve the morale of the patient with mobile teeth.To improve the morale of the patient with mobile teeth.

FUNCTIONS OF TEMPORARY SPLINTING:-FUNCTIONS OF TEMPORARY SPLINTING:-
 Protection of traumatized teeth from further injury.Protection of traumatized teeth from further injury.
 Distribution of occlusal forces on teeth that have lost periodontalDistribution of occlusal forces on teeth that have lost periodontal
support.support.
 Retention of orthodontically moved teeth.Retention of orthodontically moved teeth.
 Aiding in the determination of whether teeth with borderlineAiding in the determination of whether teeth with borderline
prognosis will respond to therapy.prognosis will respond to therapy.
 Immobilization of loose teeth to facilitate occlusal adjustmentImmobilization of loose teeth to facilitate occlusal adjustment
procedures.procedures.
 To prevent pathologic migration.To prevent pathologic migration.
Temporary splints have been further classified into extracoronal, intracoronalTemporary splints have been further classified into extracoronal, intracoronal..

EXTRA CORONAL SPLINTS:EXTRA CORONAL SPLINTS:
1)1) LIGATURE SPLINTS:-LIGATURE SPLINTS:-
The most common and easiest method. In some case onlyThe most common and easiest method. In some case only
wire is used, but the acrylic resin offers the advantage ofwire is used, but the acrylic resin offers the advantage of
increased stable and improved esthetics, especially whereincreased stable and improved esthetics, especially where
diastema are present.diastema are present.
WIRE LIGATURE ACRYLIC SPLINTS:-
Indications:-
1) Short – term stabilization of anterior teeth.1) Short – term stabilization of anterior teeth.
2) Mobile anterior teeth not suitable for bonding or A-splint.2) Mobile anterior teeth not suitable for bonding or A-splint.
3) May be indicated when a questionable prognosis for a tooth3) May be indicated when a questionable prognosis for a tooth
or teeth persists past the active treatment phase.or teeth persists past the active treatment phase.www.indiandentalacademy.comwww.indiandentalacademy.com

 Advantages:-Advantages:-
 Non invasive and reversible.Non invasive and reversible.
 Ease of insertion,Ease of insertion,
adjustment, removal andadjustment, removal and
replacement.replacement.
 Simple, inexpensive.Simple, inexpensive.
 Can be done in one sitting inCan be done in one sitting in
a short-period of time.a short-period of time.
 Not requiring any alterationNot requiring any alteration
of crown.of crown.
 Disadvantages:-Disadvantages:-
 Non rigid.Non rigid.
 Not usable for posteriorNot usable for posterior
teeth or anterior teethteeth or anterior teeth
tapered toward incisal edge.tapered toward incisal edge.
 Can act as an orthodonticCan act as an orthodontic
appliance.appliance.
 Wires may stretch or breakWires may stretch or break
if improperly tightened.if improperly tightened.
 Collects plaque moreCollects plaque more
rapidly.rapidly.
 Plaque control becomesPlaque control becomes
more difficult.more difficult.
Advantage & Disadvantage Of Wire Ligature Acrylic Splints

Procedure :Procedure :
1.1. Dead-soft stainless steel wire 0.007 to 0.010 inch thick is used.Dead-soft stainless steel wire 0.007 to 0.010 inch thick is used.
Brass or silk ligatures are not as desirable.Brass or silk ligatures are not as desirable.
2.2. Double a 12-inch length for use as an arch wire, and bend itDouble a 12-inch length for use as an arch wire, and bend it
about the six anterior teeth.about the six anterior teeth.
3.3. Position it apical to the contact points and incisal to the cingula,Position it apical to the contact points and incisal to the cingula,
then loosely twist one end. Provide for edentulous spaces bythen loosely twist one end. Provide for edentulous spaces by
twisting the buccal and lingual strands of the arch wire together.twisting the buccal and lingual strands of the arch wire together.
4.4. Place single, hairpin bent wires interdentally around the archPlace single, hairpin bent wires interdentally around the arch
wires and below the contact point.wires and below the contact point.
Tighten them by twisting clockwise with a needle holder orTighten them by twisting clockwise with a needle holder or
Howe pliers.Howe pliers.
The interdental strands should not be so tight that they bring theThe interdental strands should not be so tight that they bring the
arch wires into contact or produce tooth movement.arch wires into contact or produce tooth movement.www.indiandentalacademy.comwww.indiandentalacademy.com

5.5. To properly distribute force tighten the last interdental ligatureTo properly distribute force tighten the last interdental ligature
after all the other interdental ligatures and the arch wire have beenafter all the other interdental ligatures and the arch wire have been
tightenedtightened
6.6. Clip the ends of the wires short (2-3 mm) and bend them into theClip the ends of the wires short (2-3 mm) and bend them into the
interdental space to minimize catching food and to preventinterdental space to minimize catching food and to prevent
injuring soft tissues.injuring soft tissues.
7.7. When the wires are properly positioned, both splint and teeth areWhen the wires are properly positioned, both splint and teeth are
held fast.held fast.
8.8. The slippage can be controlled by additional cervical loops.The slippage can be controlled by additional cervical loops.
9.9. Check the occlusion for interferences before dismissing theCheck the occlusion for interferences before dismissing the
patient. Instruct the patient in oral hygiene procedures around thepatient. Instruct the patient in oral hygiene procedures around the
splinted teeth.splinted teeth.
10.10. Self-care acrylic or composite acid etch resin may be placed overSelf-care acrylic or composite acid etch resin may be placed over
the wires. This will improve esthetics, reduce irritation and tend tothe wires. This will improve esthetics, reduce irritation and tend to
prevent displacement.prevent displacement. www.indiandentalacademy.comwww.indiandentalacademy.com

INTRA CORONAL SPLINTS:-INTRA CORONAL SPLINTS:-
 1)1) Wire Acrylic splintsWire Acrylic splints (‘A’ Splints)(‘A’ Splints)
 TheThe ‘A’‘A’ splint was first popularized by Berliner. Itsplint was first popularized by Berliner. It
consists of a preparation, or series of preparations, through theconsists of a preparation, or series of preparations, through the
lingual surfaces of anterior teeth.lingual surfaces of anterior teeth.
 The preparation are filled with acrylic and sometimesThe preparation are filled with acrylic and sometimes
‘reinforced’‘reinforced’ with wire. Although thewith wire. Although the ‘A’‘A’ splint can be used insplint can be used in
posterior teeth, it is most commonly used in anterior teeth.posterior teeth, it is most commonly used in anterior teeth.

 2)2) Wire and composite reins:-Wire and composite reins:-
 The restorative properties of composite materials areThe restorative properties of composite materials are
different and superior to those of acrylic resins.different and superior to those of acrylic resins.
 Composites have better strength, better dimensionalComposites have better strength, better dimensional
stability and a sealing effect when used with enamel etching.stability and a sealing effect when used with enamel etching.
 These splints are used commonly for anterior teeth.These splints are used commonly for anterior teeth.

 3)3) Amalgam splints:-Amalgam splints:-
 Advantages:-Advantages:-
 Simple.Simple.
 Inexpensive.Inexpensive.
 Time saving.Time saving.
 Effective device for posterior teeth.Effective device for posterior teeth.
 Does not require parallelism in preparations.Does not require parallelism in preparations.
 Adequate margins are easy to obtain.Adequate margins are easy to obtain.
 Good oral hygiene can be maintained.Good oral hygiene can be maintained.
 It is of an advantage in an amalgam preparation to effectIt is of an advantage in an amalgam preparation to effect
undercuts for retention. These undercuts resist apicalundercuts for retention. These undercuts resist apical
displacement of the tooth from the splint.displacement of the tooth from the splint.

 Disadvantages:-Disadvantages:-
 Limited to posterior teeth.Limited to posterior teeth.
 Amalgam splints tend to fracture more easily.Amalgam splints tend to fracture more easily.
 A technique has been devised in which contiguous mesial-A technique has been devised in which contiguous mesial-
occlusal-distal preparations in adjoining teeth can be preparedocclusal-distal preparations in adjoining teeth can be prepared
and a continuous amalgam filling can be replaced successfullyand a continuous amalgam filling can be replaced successfully
with relative case. This is termed the “Amalgam splint”.with relative case. This is termed the “Amalgam splint”.

4) Acrylic Full Crowns:-4) Acrylic Full Crowns:-
 Fixed temporary bridgesFixed temporary bridges may be made of acrylic crowns andmay be made of acrylic crowns and
pontics and may also serve as temporary splints. They arepontics and may also serve as temporary splints. They are
used when permanent fixed splints will ultimately replaceused when permanent fixed splints will ultimately replace
them.them.
Many ways exist to make acrylic splints.Many ways exist to make acrylic splints.
 One simple method employs duplicates of the patients studyOne simple method employs duplicates of the patients study
models. The temporary acrylic splint is then made on themodels. The temporary acrylic splint is then made on the
models of the prepared teeth.models of the prepared teeth.
 Another method was a pressure molded splint. Either isAnother method was a pressure molded splint. Either is
rebased in the mouth after the teeth are prepared.rebased in the mouth after the teeth are prepared.

 5) Combined Amalgam – wire – Acrylic splint5) Combined Amalgam – wire – Acrylic splint::
 To overcome the drawbacks of an amalgam splint theTo overcome the drawbacks of an amalgam splint the
combined Amalgam –wire-Acrylic splint has beencombined Amalgam –wire-Acrylic splint has been
developed.developed.

II.II. Provisional splinting:Provisional splinting:
 The provisional splint not only serves as a transitionalThe provisional splint not only serves as a transitional
fixed appliance to protect the prepared teeth until the finalfixed appliance to protect the prepared teeth until the final
restorations are inserted, but also serves several otherrestorations are inserted, but also serves several other
important functions that are most necessary if periodontalimportant functions that are most necessary if periodontal
prosthetic therapy is to be successful.prosthetic therapy is to be successful.
 Provisional restorations play a key role in theProvisional restorations play a key role in the
management of patients who require both periodontal therapymanagement of patients who require both periodontal therapy
and restorative dentistry.and restorative dentistry.
 Provisional restorations serve toProvisional restorations serve to stabilize a permanentlystabilize a permanently
mobile dentition form the time of initial tooth preparation untilmobile dentition form the time of initial tooth preparation until
the time the dentition is periodontally stable enough forthe time the dentition is periodontally stable enough for
permanent restorations.permanent restorations.www.indiandentalacademy.comwww.indiandentalacademy.com

Advantages:-Advantages:-
 Reduces the pathologic mobility.Reduces the pathologic mobility.
 Protects the dental pulp from irritation following toothProtects the dental pulp from irritation following tooth
preparation.preparation.
 It also affords the opportunity to determine the correct esthetic,It also affords the opportunity to determine the correct esthetic,
phonetic and functional occlusal qualities necessary for eachphonetic and functional occlusal qualities necessary for each
individual patient.individual patient.
 The operator can proceed with confidence, knowing that theThe operator can proceed with confidence, knowing that the
above qualities can be attained in the final reconstruction.above qualities can be attained in the final reconstruction.
 If a tooth included in the splint requires extraction it can beIf a tooth included in the splint requires extraction it can be
separated from the splint extracted, and the acrylic crown filledseparated from the splint extracted, and the acrylic crown filled
in with self curing acrylic.in with self curing acrylic.
 Additional teeth can be crowned and added to the existing splintAdditional teeth can be crowned and added to the existing splint
if additional support becomes necessary.if additional support becomes necessary.
 It can be placed any time after the initial periodontal therapy isIt can be placed any time after the initial periodontal therapy is
complete.complete.

III.III. PERMANENT SPLINTING:-PERMANENT SPLINTING:- (PERIODONTAL(PERIODONTAL
PROSTHESIS)PROSTHESIS)
 Introduction:-Introduction:-
 Permanent splinting is employed during complex andPermanent splinting is employed during complex and
rehabilitation where abutments are highly mobile or where a fewrehabilitation where abutments are highly mobile or where a few
abutments must support the entire prosthesis, particularly whenabutments must support the entire prosthesis, particularly when
such abutment teeth have minimal periodontal support but havesuch abutment teeth have minimal periodontal support but have
been successfully treated periodontally.been successfully treated periodontally.
 Splinting may also be necessary in cases of intractableSplinting may also be necessary in cases of intractable
parafunctions. If such teeth are not splinted, the danger ofparafunctions. If such teeth are not splinted, the danger of
progressively increasing tooth mobility exists (Nyman and Lindheprogressively increasing tooth mobility exists (Nyman and Lindhe
1979).1979).

 Complete dental treatment includes periodontal and restorativeComplete dental treatment includes periodontal and restorative
aspects, which are extensively interrelated successful treatmentaspects, which are extensively interrelated successful treatment
most often requires both types of therapy.most often requires both types of therapy.
 Permanent splinting is indicated whenever periodontal treatmentPermanent splinting is indicated whenever periodontal treatment
does not reduce mobility to the point at which the teeth candoes not reduce mobility to the point at which the teeth can
function without added support. Such devices serve to stabilizefunction without added support. Such devices serve to stabilize
loose teeth, to redistribute occlusal forces, to reduce traumatism,loose teeth, to redistribute occlusal forces, to reduce traumatism,
and to aid in the repair of the periodontal tissues.and to aid in the repair of the periodontal tissues.
 Permanent splints are fabricated after periodontal treatment hasPermanent splints are fabricated after periodontal treatment has
been completed, when their use will extend the functional life timebeen completed, when their use will extend the functional life time
of the teeth.of the teeth.

 Objectives:-Objectives:-
 The major objective of periodontal prosthetics is to restore theThe major objective of periodontal prosthetics is to restore the
dentition to a state of health in which it can safely resist thedentition to a state of health in which it can safely resist the
stresses of normal functions and also be better equipped tostresses of normal functions and also be better equipped to
resist parafunctional forces.resist parafunctional forces.
 The other objectives of periodontal prosthesis are to replaceThe other objectives of periodontal prosthesis are to replace
missing teeth to enhance the patient’s cosmetic appearancemissing teeth to enhance the patient’s cosmetic appearance
and to improve phonetics.and to improve phonetics.
 Ideally these objectives must be reached so that the proceduresIdeally these objectives must be reached so that the procedures
involved are biologically compatible with the hard and softinvolved are biologically compatible with the hard and soft
tissues of the mouth and so that the results will optimallytissues of the mouth and so that the results will optimally
afford protection to the periodontium against furtherafford protection to the periodontium against further
deterioration of its supporting qualities.deterioration of its supporting qualities.

PACKS AND SPLINTS:PACKS AND SPLINTS:
 Nonspecific inflammation of the gingival tissue mayNonspecific inflammation of the gingival tissue may
prove slow to resolve during hygiene phase therapy inspite ofprove slow to resolve during hygiene phase therapy inspite of
thorough scaling and polishing and an adequate standard ofthorough scaling and polishing and an adequate standard of
patient selfcare. Resolution of inflammation may be expeditedpatient selfcare. Resolution of inflammation may be expedited
by the use of a periodontal pack.by the use of a periodontal pack.
 Following scaling and polishing of the teeth, the role ofFollowing scaling and polishing of the teeth, the role of
pack is to protect the swollen tissues from trauma of normalpack is to protect the swollen tissues from trauma of normal
function and the pack should remain in position for periodsfunction and the pack should remain in position for periods
upto seven days.upto seven days.
 The dressing should be positioned, by packing eachThe dressing should be positioned, by packing each
embrassures firmly, to obtain retention and by placing a stripembrassures firmly, to obtain retention and by placing a strip
of pack across the whole field, which becomes bonded to theof pack across the whole field, which becomes bonded to the
packed embrasures.packed embrasures.

 The pack has the advantage that it has considerable powers ofThe pack has the advantage that it has considerable powers of
retention when properly positioned. It is relatively inert withretention when properly positioned. It is relatively inert with
respect to the soft tissues, and it is easy to remove cleanly.respect to the soft tissues, and it is easy to remove cleanly.
 There is an increasing tendency to replace the use of pressureThere is an increasing tendency to replace the use of pressure
packs with chemotherapeutic plaque control agents such as 0.2packs with chemotherapeutic plaque control agents such as 0.2
percent chlorhexidine mouth washes.percent chlorhexidine mouth washes.

DISADVANTAGES OF SPLINTSDISADVANTAGES OF SPLINTS ::
 1.1. Technical difficulty:_Technical difficulty:_ Unfortunately, few techniques areUnfortunately, few techniques are
trained adequately to create a periodontal prosthetictrained adequately to create a periodontal prosthetic
reconstruction that is truly biologically compatible with thereconstruction that is truly biologically compatible with the
stomatognathic system.stomatognathic system.
 The achievement of excellent marginal adaptation, goodThe achievement of excellent marginal adaptation, good
contour, functional occlusion, and esthetic acceptance by thecontour, functional occlusion, and esthetic acceptance by the
patient usually is expected in single restorations or in smallpatient usually is expected in single restorations or in small
segment bridges, but is difficult and rarely attained in full archsegment bridges, but is difficult and rarely attained in full arch
splints.splints.

 2.2. CostCost:-:- Socio-economic factors could deflect treatment awaySocio-economic factors could deflect treatment away
from the ideal. Quality cannot be compromised on any part offrom the ideal. Quality cannot be compromised on any part of
the splint. Each unit of the splint is like a link of a chain, andthe splint. Each unit of the splint is like a link of a chain, and
the splint is no better than its weakest chain.the splint is no better than its weakest chain.
 3.3. Plaque removalPlaque removal:-:- Difficult plaque removal is a criticismDifficult plaque removal is a criticism
often used by periodontists, well-designed periodontaloften used by periodontists, well-designed periodontal
prosthetic splints, however need not compromise plaqueprosthetic splints, however need not compromise plaque
removal. They may interfere with patient selfcare, and the selfremoval. They may interfere with patient selfcare, and the self
cleaning action of teeth and gingival tissues. This is of greatcleaning action of teeth and gingival tissues. This is of great
importance in a patient with a high susceptibility toimportance in a patient with a high susceptibility to
periodontitis.periodontitis.
 4.4. Increased occlusal forcesIncreased occlusal forces:-:- Glickman, Stein and SmulowGlickman, Stein and Smulow
reported the influences of increased occlusal forces on thereported the influences of increased occlusal forces on the
periodontium of monkeys both when the teeth were splintedperiodontium of monkeys both when the teeth were splinted
and when they were not.and when they were not.

 5.5. Faulty contacts and contoursFaulty contacts and contours:-:- Nabers reported thatNabers reported that
night-guard appliances can open interproximal contactsnight-guard appliances can open interproximal contacts
between teeth and Saturn reported that wire ligatures inducebetween teeth and Saturn reported that wire ligatures induce
active forces on the ligated teeth, causing them to be movedactive forces on the ligated teeth, causing them to be moved
into new positions.into new positions.
 6.6. CariesCaries :-:- Extensive caries may be developed under looseExtensive caries may be developed under loose
abutments and gross sepsis may follow with minimalabutments and gross sepsis may follow with minimal
symptoms.symptoms.
 7.7. Additional tooth reductionAdditional tooth reduction:-:- All the teeth in a rigidityAll the teeth in a rigidity
splinted segment require composite draw, which requiressplinted segment require composite draw, which requires
addition tooth reduction and pulpal damage is not uncommon.addition tooth reduction and pulpal damage is not uncommon.

8.8. Repair and maintenanceRepair and maintenance :-:-
The repair of, one unit of an extensive splint, howeverThe repair of, one unit of an extensive splint, however
can be difficult and expensive, at best the result is often acan be difficult and expensive, at best the result is often a
compromise mechanical failures, such as porcelain fracturecompromise mechanical failures, such as porcelain fracture
and solder joint separation, are more frequent in multiunitand solder joint separation, are more frequent in multiunit
splints than in smaller segments.splints than in smaller segments.
Cement washouts can occur without showing any signsCement washouts can occur without showing any signs
until the pulp has become involved.until the pulp has become involved.
Endodontic problems are difficult to resolve.Endodontic problems are difficult to resolve.

MAINTAINING THE ORAL HEALTH OF SPLINTEDMAINTAINING THE ORAL HEALTH OF SPLINTED
TEETH:TEETH:
 Maintaining oral health in and around fixed splints poses aMaintaining oral health in and around fixed splints poses a
significant challenge to the patient and the dental practitionersignificant challenge to the patient and the dental practitioner
because access to teeth and visibility for plaque control andbecause access to teeth and visibility for plaque control and
periodontal maintenance techniques require extra skill andperiodontal maintenance techniques require extra skill and
effort.effort.
 Effective personal plaque control, professional caries riskEffective personal plaque control, professional caries risk
assessment, and periodontal maintenance are crucial to theassessment, and periodontal maintenance are crucial to the
longevity of the splint and health of the splinted teeth.longevity of the splint and health of the splinted teeth.

 Patient and provider roles in therapy:-Patient and provider roles in therapy:-
Both the dental provider and the patient contribute to theBoth the dental provider and the patient contribute to the
success and longevity of the dental splint and to the health ofsuccess and longevity of the dental splint and to the health of
the supporting soft and hard tissues. During the fabrication andthe supporting soft and hard tissues. During the fabrication and
placement of the splint, the dental provider must be consciousplacement of the splint, the dental provider must be conscious
of access and visibility factors that facilitate effective patientof access and visibility factors that facilitate effective patient
oral hygiene procedures.oral hygiene procedures.
 Access:_Access:_
To facilitate adequate access for cleaning, a splint mustTo facilitate adequate access for cleaning, a splint must
be placed with open gingival embrasures and be properlybe placed with open gingival embrasures and be properly
contoured with no overhanging margins. Posteriorly placedcontoured with no overhanging margins. Posteriorly placed
splints pose additional patient access challenges.splints pose additional patient access challenges.

 Visibility:_Visibility:_
visibility issues also influence effectiveness of patientvisibility issues also influence effectiveness of patient
self care. If gaps between restoration materials and toothself care. If gaps between restoration materials and tooth
surfaces exist, bacterial plaque retention may occur.surfaces exist, bacterial plaque retention may occur.
Patients must be able to discriminate between restorationPatients must be able to discriminate between restoration
natural tooth surface, plaque, and calcified tooth depositsnatural tooth surface, plaque, and calcified tooth deposits
while practicing self-care.while practicing self-care.
After splint placement, the oral health care provider mustAfter splint placement, the oral health care provider must
deliver extensive home care instruction to the patient. Thedeliver extensive home care instruction to the patient. The
patient then must assume responsibility for plaque control andpatient then must assume responsibility for plaque control and
the adoption of any other suggested preventive measures.the adoption of any other suggested preventive measures.

 Manual plaque control devices:-Manual plaque control devices:-
Selection and recommendation of mechanical plaqueSelection and recommendation of mechanical plaque
control devices depend on the type of splint, spacingcontrol devices depend on the type of splint, spacing
surrounding splints, personal preferences, and dexterity of thesurrounding splints, personal preferences, and dexterity of the
patient.patient.
 Interdental plaque control:-Interdental plaque control:-
Increased bacterial plaque retention occurs in areasIncreased bacterial plaque retention occurs in areas
surroundings splints where other anatomic changes, includingsurroundings splints where other anatomic changes, including
loss of gingival attachment, papilla, bone and teeth, presenceloss of gingival attachment, papilla, bone and teeth, presence
of malpositioned teeth and tooth movement, are common.of malpositioned teeth and tooth movement, are common.
Specifically designed devices are required for accessingSpecifically designed devices are required for accessing
interproximal splinted surfaces.interproximal splinted surfaces.
A variety of floss and brush devices can be used to accessA variety of floss and brush devices can be used to access
these surfaces.these surfaces.

 Mechanical plaque control devices:-Mechanical plaque control devices:-
 For most patients, the choice between mechanical plaqueFor most patients, the choice between mechanical plaque
control devices and manual devices is a matter of personalcontrol devices and manual devices is a matter of personal
preference.preference.
 Mechanical devices tend to be easier to use comparedMechanical devices tend to be easier to use compared
with manual devices because the powered motion is built inwith manual devices because the powered motion is built in
and the patient need only place the device next to aand the patient need only place the device next to a
surrounding splinted structure to ensure effective plaquesurrounding splinted structure to ensure effective plaque
removal.removal.
 Powered tooth brushes, traditional mechanical toothPowered tooth brushes, traditional mechanical tooth
brushes, sonic ultrasonic tooth brushes, and poweredbrushes, sonic ultrasonic tooth brushes, and powered
interdental devices are used as mechanical plaque controlinterdental devices are used as mechanical plaque control
devices.devices.

 Oral irrigating devices:-Oral irrigating devices:-
 Oral irrigation can be an important part of selfcare for patientsOral irrigation can be an important part of selfcare for patients
who cannot control their gingivitis with only brushing andwho cannot control their gingivitis with only brushing and
interproximal cleaning.interproximal cleaning.
 Oral irrigation is an adjunctive therapy, not a replacement forOral irrigation is an adjunctive therapy, not a replacement for
brushing and interproximal plaque removal.brushing and interproximal plaque removal.
 Oral irrigators are most effective when patients adhere toOral irrigators are most effective when patients adhere to
stringent instructions for use.stringent instructions for use.
 Oral irrigators may be used after brushing and flossing toOral irrigators may be used after brushing and flossing to
deliver antimicrobial agents.deliver antimicrobial agents.
 Patients should be provided with instructions for careful use ofPatients should be provided with instructions for careful use of
home oral irrigating devices.home oral irrigating devices.

 Periodontal Health challenges:Periodontal Health challenges:
 Bacterial plaque is the primary cause of periodontalBacterial plaque is the primary cause of periodontal
disease. Daily plaque removal, especially in interproximaldisease. Daily plaque removal, especially in interproximal
areas, has been reported to help prevent periodontalareas, has been reported to help prevent periodontal
breakdown and is considered to be an essential component ofbreakdown and is considered to be an essential component of
oral hygiene.oral hygiene.
 Another important aspect in the prevention of periodontalAnother important aspect in the prevention of periodontal
disease is routine professional care. Because periodontaldisease is routine professional care. Because periodontal
health must be monitored after splint placement, frequenthealth must be monitored after splint placement, frequent
evaluation by the oral health care provider is warranted.evaluation by the oral health care provider is warranted.
 Regularly scheduled periodontal debridement also is essential.Regularly scheduled periodontal debridement also is essential.

 Professional periodonatal debridementProfessional periodonatal debridement:-:-
 Periodontal health can be best maintained by frequentPeriodontal health can be best maintained by frequent
maintenance visits and careful subgingival and supramarginalmaintenance visits and careful subgingival and supramarginal
debridement of hard and soft tissues surrounding the splint.debridement of hard and soft tissues surrounding the splint.
 Advances in hand instruments, such as the after five Graceys andAdvances in hand instruments, such as the after five Graceys and
Mini-Five Graceys curets provide increased adaptability in theMini-Five Graceys curets provide increased adaptability in the
periodontal patient.periodontal patient.
 The use of air and magnification may aid in visibility duringThe use of air and magnification may aid in visibility during
instrumentation. These clinical aids are of particular importanceinstrumentation. These clinical aids are of particular importance
during periodontal debridement of splinted teeth, where the splintduring periodontal debridement of splinted teeth, where the splint
material often blends with surrounding natural tooth surfaces.material often blends with surrounding natural tooth surfaces.

 Ultrasonic and sonic scalers are not recommended on or nearUltrasonic and sonic scalers are not recommended on or near
restorative splinting materials.restorative splinting materials.
 Air polishing and high abrasives also are contraindicated andAir polishing and high abrasives also are contraindicated and
are detrimental to the integrity of the splinted material.are detrimental to the integrity of the splinted material.
 Post splint periodontal maintenance and frequent assessmentPost splint periodontal maintenance and frequent assessment
of specific clinical parameters promote continued periodontalof specific clinical parameters promote continued periodontal
health.health.

Periodontal status:-Periodontal status:-
 Composite reins, exhibiting superior esthetics, often are theComposite reins, exhibiting superior esthetics, often are the
preferred restorative material in splint fabrication.preferred restorative material in splint fabrication.
 Marginal adaptation difficulties of composite resin restorationsMarginal adaptation difficulties of composite resin restorations
combined with ineffective plaque control, however, cancombined with ineffective plaque control, however, can
exacerbate gingival inflammation adjacent to these materials,exacerbate gingival inflammation adjacent to these materials,
thus increasing periodontal disease risk in susceptiblethus increasing periodontal disease risk in susceptible
individuals.individuals.
 Progression of periodontal disease is one cause of splint failure.Progression of periodontal disease is one cause of splint failure.
 Initial patient follow-up should occur 2 weeks after splintInitial patient follow-up should occur 2 weeks after splint
placement. Follow-up assessment is recommended to evaluateplacement. Follow-up assessment is recommended to evaluate
patient home care compliance and effectiveness and to evaluatepatient home care compliance and effectiveness and to evaluate
gingival health status surroundings the splint.gingival health status surroundings the splint.
 www.indiandentalacademy.comwww.indiandentalacademy.com

 Professional periodontal evaluation of splinted teeth isProfessional periodontal evaluation of splinted teeth is
recommended at 3-month intervals.recommended at 3-month intervals.
 Bleeding on probing, pocket depths, and presence or absence ofBleeding on probing, pocket depths, and presence or absence of
gingival inflammation are periodontal parameters to note whengingival inflammation are periodontal parameters to note when
evaluating supportive soft tissues surrounding splinted teethevaluating supportive soft tissues surrounding splinted teeth
comparative radiographic evaluation of alveolar bone levels alsocomparative radiographic evaluation of alveolar bone levels also
should be performed at appropriate intervals.should be performed at appropriate intervals.
 Occlusal interferences and parafunctional occlusal habits mustOcclusal interferences and parafunctional occlusal habits must
also be addressed as part of the periodontal evaluation becausealso be addressed as part of the periodontal evaluation because
they can contribute splint failure.they can contribute splint failure.

 Challengers to caries prevention:Challengers to caries prevention:
 Chemical adhesives and composite resins are commonlyChemical adhesives and composite resins are commonly
used to splint teeth together. The roughness of the compositeused to splint teeth together. The roughness of the composite
resin surfaces attracts plaque and debris, however, and canresin surfaces attracts plaque and debris, however, and can
increase the caries risk to the surrounding supportive splintedincrease the caries risk to the surrounding supportive splinted
structures.structures.
 A high number of composite resin are replaced because ofA high number of composite resin are replaced because of
recurrent caries. Both composite resin restorations andrecurrent caries. Both composite resin restorations and
composite resin splints require close examination atcomposite resin splints require close examination at
maintenance visits because of the potential for breakdown andmaintenance visits because of the potential for breakdown and
marginal leakage.marginal leakage.
 Caries risk assessment is required for long-term retention ofCaries risk assessment is required for long-term retention of
splinted teeth. Caries risk factors may include splint fracture,splinted teeth. Caries risk factors may include splint fracture,
marginal leakage and poor plaque control.marginal leakage and poor plaque control.www.indiandentalacademy.comwww.indiandentalacademy.com

 Recurrent decay may occur in the presence of fracturedRecurrent decay may occur in the presence of fractured
splints, and poor plaque control can contribute tosplints, and poor plaque control can contribute to
decalcification of splinted teeth.decalcification of splinted teeth.
 Neutral sodium fluoride preparations are preferred becauseNeutral sodium fluoride preparations are preferred because
they do not cause unsightly staining as stannous fluoridethey do not cause unsightly staining as stannous fluoride
preparations may, and they do not cause the etching effect onpreparations may, and they do not cause the etching effect on
composite and porcelain restorative materials that acidulatedcomposite and porcelain restorative materials that acidulated
phosphate fluoride.phosphate fluoride.
 A risk oriented post operative program consists of effectiveA risk oriented post operative program consists of effective
plaque control, fluoride applications, and frequent evaluationplaque control, fluoride applications, and frequent evaluation
of splint integrity through radiographic and clinicalof splint integrity through radiographic and clinical
examinations.examinations.

ConclusionConclusion
 With the combination of clinical skill, appropriate dentalWith the combination of clinical skill, appropriate dental
material selection, good communication and comprehensivematerial selection, good communication and comprehensive
health education, both providers and patients can benefit fromhealth education, both providers and patients can benefit from
esthetic, functional and healthy dental splints.esthetic, functional and healthy dental splints.
““ The dentist of the future should seek his rewards more inThe dentist of the future should seek his rewards more in
the teeth he has saved from the ravages of dental diseasesthe teeth he has saved from the ravages of dental diseases
than in the prostheses he makes it he fails with thethan in the prostheses he makes it he fails with the
prevention .”prevention .”

ReferencesReferences
 J P 1980;51;469-472( A new method for stabilization ofJ P 1980;51;469-472( A new method for stabilization of
periodontally involved teeth.)periodontally involved teeth.)
 JADA 1980;101;926-929( Cast metal resin bonding)JADA 1980;101;926-929( Cast metal resin bonding)
 DCNA;1964;213-219( The amalgam splint)DCNA;1964;213-219( The amalgam splint)
 DCNA ; 1969; 213-227( Principles & technique of theDCNA ; 1969; 213-227( Principles & technique of the
stabilization of loose teeth.stabilization of loose teeth.
 DCNA; 1999( Tooth splinting and stabilization)DCNA; 1999( Tooth splinting and stabilization)
 Text books of GRANT , CARRANZA & ROSE.Text books of GRANT , CARRANZA & ROSE.

TEMPORARY SPLINTSTEMPORARY SPLINTS
EXTRACORONAL.EXTRACORONAL.

2)2) SPLINTS OF ENAMEL-BONDING MATERIAL:-SPLINTS OF ENAMEL-BONDING MATERIAL:-
A simple method of external temporary splinting tooth-bondingA simple method of external temporary splinting tooth-bonding
material:material:
 Self polymerized,Self polymerized,
 Ultraviolet polymerized andUltraviolet polymerized and
 White light polymerized composite rein.White light polymerized composite rein.
ADVANTAGES:ADVANTAGES:
 Esthetic.Esthetic.
 Noninvasive and reversible.Noninvasive and reversible.
 May be reinforced with wire or plastic mesh.May be reinforced with wire or plastic mesh.
 Does not irritate the gingiva.Does not irritate the gingiva.
 Local anesthesia is not needed.Local anesthesia is not needed.

DISADVANTAGESDISADVANTAGES (( splints of enamel-bonding materialsplints of enamel-bonding material::
 Depends for strength on bond to enamel and bulk ofDepends for strength on bond to enamel and bulk of
material.material.
 No mechanical retention.No mechanical retention.
 Requires meticulous polishing of teeth immediately prior toRequires meticulous polishing of teeth immediately prior to
etching.etching.
 Dry field is imperative.Dry field is imperative.
 Caries hazard exists if seepage occurs.Caries hazard exists if seepage occurs.
 Plaque control becomes more difficult.Plaque control becomes more difficult.

Indication & Contraindication Splints Of Enamel-bonding Material:-Indication & Contraindication Splints Of Enamel-bonding Material:-
 INDICATIONINDICATION
 Mobile anterior teeth when esthetics is important.Mobile anterior teeth when esthetics is important.
 Temporary mobility due to trauma.Temporary mobility due to trauma.
 Need for long term stabilization is unlikely.Need for long term stabilization is unlikely.
 CONTRAINDICATIONS:CONTRAINDICATIONS:
 teeth subjected to severe stress.teeth subjected to severe stress.
 Posterior teeth.Posterior teeth.

a)a) Self-polymerized resin bonding materialsSelf-polymerized resin bonding materials:_:_
1.1. The teeth selected for splinting are polished with pumice prior toThe teeth selected for splinting are polished with pumice prior to
their isolation under a rubber dam.their isolation under a rubber dam.
2.2. After isolation the teeth are dried with a stream of air. The etchantAfter isolation the teeth are dried with a stream of air. The etchant
is then place on the labial, lingual and proximal surfaces of theis then place on the labial, lingual and proximal surfaces of the
teeth with a cotton pellet. After 2 minutes, the teeth are thoroughlyteeth with a cotton pellet. After 2 minutes, the teeth are thoroughly
rinsed off with water and allow them to dry.rinsed off with water and allow them to dry.
3.3. Following the etching procedure, the enamel has a dull chalkyFollowing the etching procedure, the enamel has a dull chalky
appearance. If this is not achieved, re-etching is necessary.appearance. If this is not achieved, re-etching is necessary.
4.4. To facilitate the later trimming of the polymerized resin, one orTo facilitate the later trimming of the polymerized resin, one or
more wooden interdental stimulators are placed interproximally tomore wooden interdental stimulators are placed interproximally to
fill the embrassure spaces and thereby limit the flow of the resin.fill the embrassure spaces and thereby limit the flow of the resin.www.indiandentalacademy.comwww.indiandentalacademy.com

5.5. Mix the appropriate proportions of the powder and liquid, the resinMix the appropriate proportions of the powder and liquid, the resin
is placed in a continuous layer on the facial surfaces of the teeth.is placed in a continuous layer on the facial surfaces of the teeth.
6.6. The material is compressed on the labial surfaces and into theThe material is compressed on the labial surfaces and into the
interproximal areas with a celluloid matrix strip which is held ininterproximal areas with a celluloid matrix strip which is held in
place during the initial setting period of 3 minutes.place during the initial setting period of 3 minutes.
7.7. The procedure is now repeated on the lingual surfaces. A thin,The procedure is now repeated on the lingual surfaces. A thin,
continuous layer of polymerized rein now covers the labial andcontinuous layer of polymerized rein now covers the labial and
lingual surfaces of the teeth, and forms an interproximal bridgelingual surfaces of the teeth, and forms an interproximal bridge
above and below the contact areas.above and below the contact areas.
8.8. After 10 minutes have elapsed, during which time the earlyAfter 10 minutes have elapsed, during which time the early
adhesive bonds mature, the material is trimmed and polished.adhesive bonds mature, the material is trimmed and polished.
9.9. The occlusion must be checked and adjusted as necessary toThe occlusion must be checked and adjusted as necessary to
relieve prematurities resulting from excess resin.relieve prematurities resulting from excess resin.www.indiandentalacademy.comwww.indiandentalacademy.com

b)b) Ultraviolet –light polymerized bonding materials:_Ultraviolet –light polymerized bonding materials:_
 The procedure is same as for self-polymerized bondingThe procedure is same as for self-polymerized bonding
materials but only the difference is the type of polymerization.materials but only the difference is the type of polymerization.
This type of bonding materials need ultraviolet-light forThis type of bonding materials need ultraviolet-light for
polymerization.polymerization.
ADVANTAGES :-ADVANTAGES :-
 Rigid and durable.Rigid and durable.
 No destruction of tooth structure.No destruction of tooth structure.
 Esthetically acceptable.Esthetically acceptable.
 Well tolerated by patients.Well tolerated by patients.
 They do not polymerize until they are exposed to ultra-violetThey do not polymerize until they are exposed to ultra-violet
light, they provide prolonged workinglight, they provide prolonged working times for placement,times for placement,
shaping and contouring over extensive areas of enamel.shaping and contouring over extensive areas of enamel.

3)3) Welded band splints:-Welded band splints:- (Orthodontic bands):(Orthodontic bands):
Advantages:_Advantages:_
 Provides rigidity, oralProvides rigidity, oral
hygiene is maintained.hygiene is maintained.
 Useful for stabilization ofUseful for stabilization of
posterior teeth.posterior teeth.
 At any time additional teethAt any time additional teeth
may be incorporated into themay be incorporated into the
splint.splint.
 Can be used as a provisionalCan be used as a provisional
splint.splint.
 Proper positioning of bandsProper positioning of bands
allow the use of nightallow the use of night
guards or bite planes.guards or bite planes.
Disadvantages:Disadvantages:
 Construction is tedious.Construction is tedious.
 Time consuming.Time consuming.

 Procedure:Procedure:
Herein is described a technique for the fabrication of aHerein is described a technique for the fabrication of a
wire band splint which blends the advantages of wire ligationwire band splint which blends the advantages of wire ligation
with its means of tension adjustment and orthodontic bandswith its means of tension adjustment and orthodontic bands
which may be placed on teeth without cutting into enamel orwhich may be placed on teeth without cutting into enamel or
gold crowns.gold crowns.
1.1. Select the prefabricated stainless steel bands which fit theSelect the prefabricated stainless steel bands which fit the
teeth snugly. The band pushing instrument can be used forteeth snugly. The band pushing instrument can be used for
proper setting of band.proper setting of band.
2.2. It must come to rest with the occlusal edge of the band at orIt must come to rest with the occlusal edge of the band at or
slightly below the marginal ridge.slightly below the marginal ridge.
3.3. The gingival edge of the bands should not touch the gingiva.The gingival edge of the bands should not touch the gingiva.www.indiandentalacademy.comwww.indiandentalacademy.com

4.4. If the interproximal contacts are too tight the adjacent toothIf the interproximal contacts are too tight the adjacent tooth
surfaces can be lightly stripped with sandpaper strips orsurfaces can be lightly stripped with sandpaper strips or
separating wires are placed for a period of 2-3 days.separating wires are placed for a period of 2-3 days.
5.5. Once the bands are placed on the teeth, they are scored withOnce the bands are placed on the teeth, they are scored with
sharp instrument at mesial and distal angles at a level midwaysharp instrument at mesial and distal angles at a level midway
between the occlusal and gingival edges of the band.between the occlusal and gingival edges of the band.
6.6. On the lingual surface of each band a mark is made which isOn the lingual surface of each band a mark is made which is
centered occluso gingivally and mesiodistatlly. The bands arecentered occluso gingivally and mesiodistatlly. The bands are
removed using band removing pliers without causing anyremoved using band removing pliers without causing any
distortion.distortion.
7.7. Preformed loops can now be spot welded to the bands at thePreformed loops can now be spot welded to the bands at the
locations previously marked.locations previously marked.
8.8. After welding, all rough edges are smoothed with free stonesAfter welding, all rough edges are smoothed with free stones
and rubber wheels.and rubber wheels. www.indiandentalacademy.comwww.indiandentalacademy.com

9.9. The finished bands are reseated the teeth and the margins areThe finished bands are reseated the teeth and the margins are
burnished down.burnished down.
10.10. The bands are removed, lined with Znpo4 cement and reseated onThe bands are removed, lined with Znpo4 cement and reseated on
the dried teeth.the dried teeth.
11.11. Once the cement has set, excess is removed.Once the cement has set, excess is removed.
12.12. The banded teeth are now ligated together with wire in a mannerThe banded teeth are now ligated together with wire in a manner
similar to that used to wire anterior teeth.similar to that used to wire anterior teeth.
13.13. The main wire is (0.018) is threaded through all the buccal lingualThe main wire is (0.018) is threaded through all the buccal lingual
loops. Where spacing exists between teeth, the wire is givenloops. Where spacing exists between teeth, the wire is given
sufficient twists to take up the space. The main wire is indentedsufficient twists to take up the space. The main wire is indented
interproximally with a plastic instrument and then interproximalinterproximally with a plastic instrument and then interproximal
wires are placed.wires are placed.
14.14. The final step is to tighten the main wire and tuck itThe final step is to tighten the main wire and tuck it
interproximally.interproximally. www.indiandentalacademy.comwww.indiandentalacademy.com

4)4) CONTINUOUS CLASPS:_CONTINUOUS CLASPS:_
(Removable Cast Continuous Clasp Appliances)(Removable Cast Continuous Clasp Appliances)
ADVANTAGES:-ADVANTAGES:-
 Rigid and strong.Rigid and strong.
 Non invasive.Non invasive.
 Usable on posterior teeth.Usable on posterior teeth.
 Removable by patient forRemovable by patient for
cleaning.cleaning.
 Pontics may be added when everPontics may be added when ever
extractions become necessary.extractions become necessary.
 Economic way of controllingEconomic way of controlling
hypermobility.hypermobility.
 They can be removed for socialThey can be removed for social
engagements.engagements.
 They may also be used at nightThey may also be used at night
only.only.
DISADVANTAGESDISADVANTAGES:-:-
 Unaesthetic.Unaesthetic.
 Caries risk.Caries risk.
 Laboratory procedure required.Laboratory procedure required.
 They may impede speech.They may impede speech.
 Removable splints generallyRemovable splints generally
donot contribute to a permanentdonot contribute to a permanent
decrease in mobility.decrease in mobility.

Indication & Contraindication Of Continuous Clasps:_Indication & Contraindication Of Continuous Clasps:_
INDICATIONS:-INDICATIONS:-
 Mobile teeth any where inMobile teeth any where in
either arch if esthetics is noteither arch if esthetics is not
a serious concern.a serious concern.
 Need for inexpensiveNeed for inexpensive
replacement of missingreplacement of missing
teeth when hopeless teethteeth when hopeless teeth
are extracted.are extracted.
CONTRINDICATIONS:-CONTRINDICATIONS:-
 When esthetics areWhen esthetics are
important.important.
 Poor patient cooperation inPoor patient cooperation in
plaque control.plaque control.

 The removable cast continuous clasp appliances can be seatedThe removable cast continuous clasp appliances can be seated
and removed in the fashion of a partial denture or they can beand removed in the fashion of a partial denture or they can be
ligated to place.ligated to place.
 Using them as freely removable appliances is advantageous,Using them as freely removable appliances is advantageous,
since adequate oral hygiene is possible.since adequate oral hygiene is possible.
 It rests at the height of contour and the cingulum of anteriorIt rests at the height of contour and the cingulum of anterior
teeth and at the buccal and lingual surfaces of posterior teeth.teeth and at the buccal and lingual surfaces of posterior teeth.
 The appliance is rigid and does not enter undercuts as does aThe appliance is rigid and does not enter undercuts as does a
partial denture clasp. Retention is achieved by frictional grippartial denture clasp. Retention is achieved by frictional grip
on the broad areas of tooth surface contacted.on the broad areas of tooth surface contacted.

5. REMOVABLE ACRYLIC APPLIANCES:_5. REMOVABLE ACRYLIC APPLIANCES:_
 The clinician must be aware of the fact that when utilizes any formThe clinician must be aware of the fact that when utilizes any form
of acrylic appliance, the dimensional instability of the materialof acrylic appliance, the dimensional instability of the material
may cause distortions to occur. It is imperative to check thesemay cause distortions to occur. It is imperative to check these
appliances frequently and to make any necessary adjustments.appliances frequently and to make any necessary adjustments.
 i)i) Occlusal splints:-Occlusal splints:-
 Maxillary and mandibular bite guardMaxillary and mandibular bite guard
 Maxillary occlusal splint.Maxillary occlusal splint.
 Mandibular occlusal splint.Mandibular occlusal splint.
 Soft occusal splint.Soft occusal splint.
 ii)ii) Bite plates:-Bite plates:-
 Hawley bite plate.Hawley bite plate.
 Sved bite plate.Sved bite plate.

I)I) OCCULSAL SPLINTS:_OCCULSAL SPLINTS:_
 USES:-USES:-
1) These are not only used for stabilizing the mobile teeth but also1) These are not only used for stabilizing the mobile teeth but also
for protecting the dentition , muscles and TMJ from the damagingfor protecting the dentition , muscles and TMJ from the damaging
effects of parafunctional activity, such as bruxism.effects of parafunctional activity, such as bruxism.
2) During orthodontic therapy the variations of occlusal splints are2) During orthodontic therapy the variations of occlusal splints are
used for treating the simple types of tooth movement, and for theused for treating the simple types of tooth movement, and for the
retention of the teeth after the teeth have been moved.retention of the teeth after the teeth have been moved.
3) Myospasm can be reduced.3) Myospasm can be reduced.
4) Can be used during the treatment of problems related to the TMJ.4) Can be used during the treatment of problems related to the TMJ.
5) Economical to construct.5) Economical to construct.

A)A) MAXILLARY AND MANDIBULAR BITE GUARDSMAXILLARY AND MANDIBULAR BITE GUARDS (NIGHT(NIGHT
GUARDSGUARDS))
ADVANTAGES:_ADVANTAGES:_
 Non invasiveNon invasive
 Protects teeth from stresses ofProtects teeth from stresses of
clenching and grinding habitsclenching and grinding habits
(Para functional activities)(Para functional activities)
 Provides smooth, had, flatProvides smooth, had, flat
occlusal surface for groupocclusal surface for group
function during tooth grinding.function during tooth grinding.
 Able to withstand severeAble to withstand severe
occlusal stress.occlusal stress.
 Occlusal surface may beOcclusal surface may be
adjusted as desired.adjusted as desired.
DISADVANTAGES:_DISADVANTAGES:_
 Some patients are unable toSome patients are unable to
tolerate guards because oftolerate guards because of
gagging, encroachment ongagging, encroachment on
free way space or inabilityfree way space or inability
to sleep with a foreignto sleep with a foreign
object in mouth.object in mouth.

INDICATION & CONTRAINDICATION OF THE NIGHT GURDINDICATION & CONTRAINDICATION OF THE NIGHT GURD
INDICATIONS:_INDICATIONS:_
 Presence of tooth clenchingPresence of tooth clenching
or grinding habit (bruxism).or grinding habit (bruxism).
 When retainer is neededWhen retainer is needed
following orthodonticfollowing orthodontic
therapy.therapy.
 Prevention of extrusion of aPrevention of extrusion of a
tooth when the opposingtooth when the opposing
tooth is missing and difficulttooth is missing and difficult
to replace (Eg:- missingto replace (Eg:- missing
mandibular second molar)mandibular second molar)
CONTRAINDICATIONS:CONTRAINDICATIONS:
 Allergy to methacrylateAllergy to methacrylate
resins.resins.
 Patient refuses to wearPatient refuses to wear
appliances.appliances.

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