DEPARTMENT OF

PERIODONTOLOGY

S.M.B.T DENTAL COLLEGE,

SANGAMNER.

TOPIC SPLINTING

BY-RUPALI BORADE
(1ST YEAR MDS)

INTRODUCTION
When teeth are seriously loosened by acute trauma or
periodontal disturbances, stabilization by splinting can
become a valuable adjunct before, during and after
corrective therapy.
A splint is a device used to immobilize the teeth, and it is
one of the oldest forms of aids to periodontal therapy.
Splinting however, doesnt cure the periodontal disease
but by redistribution of force on the affected teeth, the
splint minimizes the effects caused by the loss of support.
As an axially inclined force is the least traumatic,
splinting provides for this type of force by controlling
excessive mobility and thus, aids in the prevention of
further breakdown of a seriously weakened periodontium,
of tooth migration, and of subsequent bite collapse.
Splinting transforms several individual teeth with varying
degrees and patterns of mobility into a single functioning
unit similar to a multirooted tooth, thereby improving the
resistance of these forces and altering the area of
application and the direction of force
Looseness of teeth is the result of occlusal trauma
(occlusal bite; trauma injury) that can literally
damage the remaining periodontal structures of the teeth.
Occlusal trauma comes in two varieties:

 Primary occlusal trauma an excess force applied

to normal periodontal structures that is usually caused
by parafunctional forces (para beyond; function
normal range) such as clenching or grinding habits.
Secondary occlusal trauma normal biting forces
applied to a tooth that has lost significant bone
support or periodontal attachment.
A combination of both, in which excessive biting
forces are applied to weakened or reduced
periodontal structures (teeth that have lost bone due
to periodontal disease).
Loosening of teeth is mostly caused by secondary trauma,
as a result of bacterial plaque-induced periodontal disease.
The approach to treatment of loose teeth is both biologic
and mechanical.
-The biological approach involves treatment of the gum
disease that must be addressed first to provide an
environment in which the periodontal attachment can
heal.
-The mechanical approach involves modifying forces
applied to the teeth, treating the effects of the force on the
periodontal ligament (the attachment mechanism of the
teeth to the bone) and also by modifying the amount of
biting force generated by the jaw muscles and received by
the teeth during biting. This can be achieved in a number

of ways, depending upon the degree of looseness of the

teeth. The current methods:
Occlusal (Bite) Adjustment: First, the bite or occlusion
can be adjusted by minor reshaping of the biting surfaces
of the teeth so that they receive less force. This procedure
is known as occlusal adjustment by selective grinding and
requires knowledge and skill of how bites work and
function.
Splinting: If the teeth are very loose, they can be splinted
or joined together so that any biting force is distributed
among groups of teeth rather than individual loosened
teeth.
DEFINITIONS
SPLINT: A rigid or a flexible device that maintains in
position a displaced (or) a movable part also used to keep
in place and protect an injured part.
ACCORDING TO GLOSSARY OF PERIODONTICS
1936: A splint is an appliance designed to immobilize and
stabilize mobile teeth in their functional position.
ACCORDING TO GLOSSARY OF AAP 1996: A splint
has been defined as an appliance (or)device employed to
prevent motion (or) displacement of fractured (or)
movable part.

BIOLOGIC RATIONALE FOR SPLINTING

Rest:Active periodontitis, alone or combined with
parafunctional activity, can be complicated by
extrinsic and intrinsic factors, such as strategically
missing teeth, malocclusion, and short spindly roots.
Occlusal rest provided by splints therapy of one form
or another helps to eliminate or at least to neutralize
some of the adverse occlusal factors that compound
the effects of an already existing inflammatory
disease, such as periodontitis.In advanced
periodontitis pts with angular defects, occlusal
adjustment by selective grinding and splinting
occasionally may be required as part of initial or
presurgical therapy.
Redistribution of forces:Stabilization of weakened
teeth by splinting increases resistance to applied
forces. The redistribution of forces ensures that the
excessive force on a single tooth doesnt exceed the
adaptive capacity of the surrounding tissue and that
jiggling movement, which can contribute to further
bone loss in an existing periodontitis, are prevented.
Redirection of forces:Splinting effects a redirection
of force in a more axial direction over all the teeth
included in the splint.
Preservation of arch integrity: Splinting restores
proximal contact that have been disrupted by missing

and migrated teeth, makes the patient more

comfortable, and reduces the likelihood of food
impaction and consequent breakdown.
Restoration of functional stability: Splinting in
conjunction with replacement of missing teeth, if
necessary, not only restores a functional occlusion,
but stabilizes the remaining mobile abutment teeth
Psychologic wellbeing:Hypermobility can be
stabilized by splinting and restoration not only
improves function, but it also can restore a sense of
solid feeling dentitions as well as of comfort and
good looks.Many pts who require long term
stabilization by the extensive use of fixed
prosthodontics are concerned more with improved
functional qualities.
To protect the tooth supporting tissues.
To prevent the extrusion of unopposed teeth.
To bring into function the teeth that cant be used to
eat efficiently.

IDEAL REQUIREMENT OF SPLINTS;(Simmering

and Thaller 1956)

Simple design.
Economical.
Stable and efficient.
Hygienic

 Non-irritating to the soft tissues.

Aesthetically acceptable.
Should not provoke iatrogenic diseases.
INDICATIONS FOR SPLINTING
To stabilize moderate to severe tooth mobility that
cannot be reduced by occlusal adjustments for
periodontal therapy.
To stabilize teeth with increased tooth mobility that
interferes with normal masticatory procedure.
To stabilize teeth in secondary occlusal trauma.
To facilitate scaling and surgical procedures.
To stabilize teeth after orthodontic movement.
To stabilize teeth after acute dental trauma. E.g.
subluxation and avulsion etc.
Prevention of tooth drifting
TMJ dysfunction
Prevention of tooth wear
pre-restorative treatment (identification of retruded
contact position, RCP)
enhancing periodontal healing
Stabilization of mobile teeth during surgical
especially regenerative therapy. (Serio 1999)

Simring in 1952 described the theory and practice of

splinting in detail:
O He emphasized the importance of direction of forces
and the movement of teeth under occlusal loads, thus
rationalized the need for splinting as the safety
procedure to employ when a tooth must withstand a
forces beyond its individual physiologic limits.
O Simring stressed that splinting is indicated where the
traumatic effects of occlusion are intense and the
stimulating physiologic action of the occlusal forces
needs to be improved.
CONTRAINDICATION FOR SPLINTING
Moderate to severe tooth mobility in the presence of
periodontal inflammation (or)in case of primary
occlusal trauma.
Insufficient number of firm teeth to stabilize mobile
teeth.
In cases where prior occlusal adjustment has not been
done (or) occlusal interferences.
Patients with bad oral hygiene.
When the sole objective of splinting is to decrease
tooth mobility following the removal of splint.

ADVANTAGES OF SPLINTING:
May establish the final stability and comfort for
patient with occlusal trauma.
It helps to decrease mobility and occlusal healing
following acute trauma to the teeth.
It allows for remodelling of alveolar bone and
periodontal ligament for orthodontically splinted
teeth.
It helps in decreasing mobility following regenarative
therapy.
It distributes occlusal forces over a wide area.
DISADVANTAGE OF SPLINTING
HYGIENE:Accumulation of plaque at splinted
margins can lead to further periodontal breakdown in
a patient with already compromised periodontal
support.
MECHANICAL:The splint being rigid may act as a
lever with uneven distribution of forces. If one tooth
of the splint is in traumatic occlusion it can injure the
periodontium of all teeth within the splints.
BIOLOGICAL:Development of caries is an
unavoidable risk and thus it requires excellent
maintenance by the patient.

 DIFFICULTY OF PERFORMING THE

EXTENSIVE RESTORATIVE PROCEDUREThe
knowledgerequired to prepare the dentition
adequately to accept the phase of crown preparation
is probably more important than all other factors
combined.Many patients that require reconstruction
also may require many months of initial periodontal,
orthodontic, and endodontic care.
COST:Socioeconomic factors could deflect treatment
away from the ideal.Quality cannot be
compromised on any part of the splint.
TECHNICAL DIFFICULTY:The achievement of
excellent marginal adaptation, good contour,
functional occlusion and esthetic acceptance by the
patient usually is expected in single restoration (or) in
small segment bridges, but is difficult and rarely
attained in full arch splints.
REPAIR AND MAINTENANCE:Mechanical
failures, such as porcelain fracture and solder joint
separation, are more frequent in multiunit splints than
in smaller segments.Cements washouts can occur
without showing any signs until the pulp has become
involved.Endodontic cases are more difficult to
resolve.
ADDITIONAL TOOTH REDUCTION:All the
teeth in a rigidly splinted segment require composite

draw, which requires additional tooth reduction and

pulpal damage is not uncommon.
PLAQUE REMOVAL:Well-designed periodontal
prosthetic splints, however, need not compromise
plaque removal.Floss usually is not indicated in such
pts, interdental brushes and wooden toothpicks are
better suited for such pts because they are the only
adjunctive plaque control aids that can effectively
remove plaque from the proximal surfaces of roots
where many concavities exists.
CLASSIFICATION OF STABILIZATION BY
SPLINTING:
ACCORDING TO THE TYPE OF MATERIAL
USED:
i. Braided wire splints
ii. Bonded, Composite resin splints.
ACCORDING TO THE LOCATION ON THE
TOOTH:
A.
INTRACORONAL
i. Composite resin with wire
ii. Inlays
iii. Nylon wire.
B.
EXTRACORONAL
i. Night guard

ii. Welded band

iii. Tooth bonded plastic
ACCORDING TO THE PERIOD OF
STABILISATION (SCHUGLER et al ):
i. Temporary stabilization-worn for less than 6
months. Removable- Occlusal splint with wire,
hawley with splinting archwire.
Fixed- Intracoronal,extracoronal.
ii. Provisional stabilization-to be used for 6
-12months.eg- acrylic splints, metal bands.
iii. Permanent splints- used indefinitely
Removable/fixed.
extra/intracoronal.
full/partial veneer crown soldered together.
inlay/onlay soldered together.
GOLDMAN, COHEN AND CHACKER
CLASSIFICATION
I. TEMPORARY SPLINTS:
a. EXTRACORONAL TYPE
Wire ligation
Orthodontic bands
Removable acrylic appliances
Removable cast appliances
Ultraviolet light polymerizing bonding material.
b. INTRACORONAL TYPE

Wire and acrylic

Wire and amalgam
Wire, amalgam and acrylic
Cast chrome, cobalt alloy,brass with acrylic.
II. PROVISIONAL SPLINTS
All acrylic
Adapted metal bond and acrylic.
ROSS ,WEISGOLD AND WRIGHT
CLASSIFICATION:
1) TEMPORARY STABILIZATION:
Removable-extracoronal splints.
Fixed extracoronal splints.
Intracoronal splints.
Etched metal resin bonded splints
2)PROVISIONAL STAILIZATION:
Acrylic splints
Metal band and acrylic splints.
3)LONG TERM STABILIZATION:
Removable splints
Fixed splints
Combination of removable and fixed splints.
PERMANENT SPLINTS MAY BE CLASSIFIED
AS:
1) REMOVABLE EXTERNAL
Continuous clasp devices.

Swing-lock devices
Overdenture (full/partial)
2) FIXED INTERNAL
Full coverage, 3/4th coverage and crown and inlays
Post in root canals.
Horizontal pin splints
3) CAST METAL ,RESIN BONDED,FIXED
PARTIAL DENTURES.(MARYLAND SPLINTS)
4) COMBINED:
Partial dentures and splinted abutment
Removable and fixed splints.
Full/partial dentures on splinted roots.
Fixed bridges incorporated in partial dentures,
seated on parts or capings.
BASED ON THE EXTENT OF THE
PROSTHESIS:
Across the midline, fixed partial dentures splints can be
classified as;
Unilateral splints

Bilateral /cross arch splints

THEORETICAL AIMS
O Rest is created for the supporting tissues, permitting
repair of trauma.

O Mobility is reduced immediately and, it is hoped,

permanently. In particular, jiggling movements are
reduced or eliminated.
O Forces received by any one tooth are distributed to a
number of teeth
O Proximal contacts are stabilized, and food impaction
(but not retention) is prevented.
O Migration and overeruption are prevented
O Masticatory function may be improved
O Appearance may be improved
O Discomfort and pain are eliminated

PURPOSE OF SPLINTING:
It should incorporate as many firm teeth as is necessary to
reduce the extra load on the individual teeth to a
minimum.
It should hold the teeth rigid and not impose torsional
stresses on any incorporated teeth.
It should extend around the arch, so that the apicolabial
and faciolingual forces are counteracted.
It should be able to eliminate any mobility that may be
present.
PRIMARY PURPOSE OF SPLINTING;
STABILIZATION:
Primary purpose is to increase the resistance of tooth
against any force. When only 2 teeth for example are
splinted by a fixed bridge the splinted teeth become one
and act as a single unit against any force. The resistance
pattern of teeth against Mesial, Buccal, Distal and Lingual
vectors of force is increased because of
Root surface area of resistance is increased.
There is distribution of force pattern over a wider area.
REORIENTATION OF FORCE AND STRESS:
Since the resistance per unit area is increased the force are
rerouted/redirected, decreasing the potential damage to
the weakened teeth.

SECONDARY PURPOSE OF SPLINTING:

To improve the form and function.
To modify the occlusal contact patterns.
To adjust jaw relations.
To improve the masticatory efficiency.

GUIDELINES FOR PERIODONTAL SPLINTING:

1. All hopeless teeth should be extracted before
splinting.
2. Occlusal adjustment should be preceded by splinting.
After the forces of occlusion are redirected to make
the contact relation in the long axis of the tooth, the
splint will be in harmony with the corrected
occlusion. The exception of mobile teeth with a
compound care to facilitate a preliminary phase of
occlusal adjustment. The core is used for one visit
procedures.
3. Questionable teeth are included in the splint for a
period of upto 3 months. After this period the splint is
removed and the tooth (or)teeth and revaluated and a
definite prognosis is made.
4. If the splint includes only one firm tooth, the firm
teeth may loosen.
5. To counteract multidirectional occlusal forces the
splint should include teeth of different segments of
the arch.
6. Splinting in a straight line which resist the
mesiodistal tilting forces only by carrying the splint
around the curve of dental arch the multidirectional
occlusal forces are counteracted. This is called
splinting around the arch.

7. If there are no contraindications, the type of splint

should be esthetically acceptable.
8. The initial phase of periodontal therapy should be
rendered before temporary stabilization if there is no
immediate urgency of stabilization.
9. The appliance to be used for splinting depends upon
the required periodontal treatment. A non-rigid
appliance is necessary for the successful treatment of
any infrabony pocket than for a gingivectomy.
10. A preliminary determination must be made as to
whether permanent fixation is necessary. If it is
required in the permanent treatment plan and full
coverage is the method of choice, then the teeth
should be prepared and a provisional splint used after
the initial phase of periodontal therapy. If the
permanent fixation is not considered or if partial
coverage is to be used as permanent fixation then
periodontal treatment will be rendered in conjunction
with temporary stabilization.
11. The splint should not impinge upon (or)irritate
the gingiva, cheeks(or) tongue. It should not cause
food impaction (or) obliterate the housing of
interdental papillae.
12. The patient must be instructed to proper oral
hygiene procedure to prevent gingival irritation and
tooth decalcification.
13. The type of splint to be used depends upon the
amount of time the splint is to be used. Esthetics area

and spacing of teeth in the arch, the amount of

rigidity needed and oral physiological contour of the
teeth.
BASIC CONSIDERATION OF ANY SPLINT:
1. For most patients, splinting should be considered
only after the preliminary phase of periodontal
therapy has been completed, including the
elimination of all local factors contributing to
inflammation and occlusal adjustment by selective
grinding.
Exceptions are dentitions with so much mobility
that adequate occlusal adjustment is impossible, in
these circumstances the teeth should be stabilized
as early as possible, and then the occlusion can be
definitively adjusted.
2. The method of splinting is dictated by the cause
and degree of mobility the coronal condition of the
teeth to be incorporated in the splint, and
evaluation of the state of hypermobility, whether
temporary or permanent. If the coronal portions of
the teeth are in relatively good conditions, the
extracoronal method of splinting should be used.
3. The extent of splinting is dictated primarily by the
number of teeth involved and the degree of their
mobility. In all cases, a sufficient number of
nonmobile teeth should be included in the splint. If

all the teeth in a quadrant demonstrate

hypermobility splinting should be extensive
enough to include the support of anterior teeth and,
on occasion, teeth on the opposite side of the arch.
4. If, in case of occlusal traumatism associated with
severe bone loss, all the teeth demonstrate
hypermobility, cross arch splinting is beneficial,
because the pattern of mobility of mesiodistal
direction.
5. The method of splinting should neither impede
normal function nor frustrate the oral hygiene and
physiotherapeutic efforts of the patients. The splint
must not irritate the gingival tissues, and whenever
possible, it should be esthetically acceptable.
6. The patient must be informed that future restorative
measures are usually necessary when any form of
intra or circumcoronal splinting is used.

TEMPORARY STABILIZATION
REMOVABLE AND FIXED:
INDICATIONS FOR TEMPORARY
STABILIZATION:
1. To a splint that is used until stabilization is no longer
necessary for example,in cases of mobility caused by
orthodontic repositioning, accidental or surgical
trauma, or occlusal traumatism of a reversible nature.
2. As a phase in the therapy being undertaken to
determine whether hypermobility can be resolved by
conservative methods or whether mobility is caused
by loss of support sufficient to create permanent
hypermobility, by root resorption, or any extrinsic or
intrinsic precipitating factors.
3. When advanced periodontal disease dictates
permanent fixation by extensive restorative methods,
but this cannot be done either because of
economic reason because of prognosis for all
remaining teeth is extremely doubtful-because of
poor health seriously affects the longevity of the
dentition , or even the life of the patient or
because the patient cannot emotionally accept the
lengthy procedures of permanent fixation

EXTRACORONAL SPLINTS.
Wire Ligation-Hirschfield-loop tied at cervical line

Most common
Easy to construct; sturdy
may be retained for several months if they are
tightened and replaced periodically
Greatest use inmandibular incisors satisfactory means
of stabilizing anterior teeth.
Limitationonly where coronal form permits
Poor esthetic appearance
May perform minor tooth movements
Can cause gingival irritation due to plaque or food
accumulation
OCCLUSAL SPLINTS:

They are used not only for protecting the

dentition,muscles and temporomandibular joint from the
damaging effects of parafunctional activity, such as
bruxism.
During restorative therapy, they have other adjunctive
uses to relax the jaw muscles to help to locate the hinge
axis accurately, to record centric relation, and to test,
before undertaking complex restorative dentistry, the pts
tolerance of an increased vertical dimension.
These appliances can provide a reversible means of
resting the teeth and the muscles.
Many varietiesof occlusal splints are as follows:
-Maxillary and mandibular bite guard.
-Maxillary occlusal splint.
-Mandibular occlusal splint.
-Soft occlusal splint.
MAXILLARY OCCLUSAL SPLINT:
Uses:
Single maxillary occlusal splint are used more commonly
than any other splints.
For stabilization of mandibular anterior teeth that are
either relatively sound or protect extensively restored
dentition.

As a diagnostic splint in temporomandibular joint therapy.

In a modified way as a device to change the vertical or
horizontal relationship of the mandible to the maxilla
during treatment of meniscus deranged problems.
Basically there are two variations depending upon
whether all the mandibular teeth or just the anteriors
contact the splinting centric relation.
Both variations can be made whether heat processed or
auto polymerizing acrylic resin or they can be vaccum
forced.
Heat cured types are more durable, stronger, with less
porosity and are more expensive.
PROCEDURE:
On articulation the incisal pin should be allowed to open
or approx 1.5 -2 mm of clearance in molar region.
All contacting surfaces should have absolute freedom and
no interferences during excessive movements
The anterior segment should be inclined to allow
disarticulation of posterior teeth during any excursion.
A matrix of a stone cast of maxillary teeth is made with
resin sheet and methyl methacrylate resin.
Final adjustment of the splint is achieved by precise
occlusal contacts and must be completed intraorally.
MANDIBULAR OCCLUSAL SPLINT

Single mandibular splint referred to by SHORE as the

auto-polymerizing appliance.
DISADVANTAGES:
It interferes with lip positioning
Bruxism is commonly seen.
Tends to increase the mobility of the maxillary anterior
teeth.
SOFT OCCLUSAL SPLINTS:
Occlusal splint can be made of soft acrylic resin, latex
rubber or vinyl material.
Believed to act as shock absorber during bruxism.
They are used during sports activities.
ORTHODONTIC BANDS
1. Stabilize both anterior & posterior teeth
2. Attention to the contours of the bands
3. Contacts between teeth must be opened
4. Acrylic over the bands
5. Common path of insertion
REMOVABLE ACYRLIC APPLIANCE
1. Dimensional instability of material may cause
distortions.

2. Imperative to check these frequently & make

necessary adjustments.
3. Vital to check the path of insertion of appliance
Acrylic Bite Guards (Night Guards)
Treatment of bruxism and clenching
Covers occlusal surface of teeth (For additional support
palate is covered)
The double bite guards are preferable to the single
maxillary or mandibular occlusal splint for patients with
severe parafunctional activity that has resulted in severe
occlusal attrition or for patients with generalized
hypermobility that also involved the mandibular anterior
teeth.
Disadvantage:
Unaesthetic
Cant be worn at night as they impede the normal
functions.
PROCEDURE:
The accuracy of the fit depends upon mainly on the
quality of the impressions and working casts.
Alginate impressions or elastic impression materials can
be used.
Mount the impression casts on a semi-adjustable
articulator with the aid of a face-bow.

During waxing the wax must not extend gingivally

beyond the height of contour.
For added strength, stainless steel wire may be luted over
the occlusal surfaces of the posterior teeth and the lingual
surfaces of the anterior teeth.
After completion of waxing, flask the casts in regular
denture flasks, boil the wax out, and process the bite
guards in clear acrylic resin.
Carefully remove the processed bite guards and trim and
polish them.
Check the bite guard for retention and stability.
Polish the occlusal surfaces of the bite guard
MAXILLARY AND MANDIBULAR BITE GUARDS;
The double bite guards are preferable to the single
maxillary or mandibular occlusal splint for patients with
severe parafunctional activity that has resulted in severe
occlusal attrition or for patients with generalised
hypermobility that also involved the mandibular anterior
teeth.
Disadvantage:
Unaesthetic
Cant be worn at night as they impede the normal
functions
Removable Cast Appliances

Usually a rigid casting either of gold or of chrome cobalt

Friedmans variation double continuous clasp casting
One end is not joined but is left open so that the casting
can be sprung over the undercuts and then ligated. The
posterior end is continuous from the buccal to the lingual
surface. Another modification is interlocking attachment
on the distal end.
UV Light Polymerizing Bonding Materials
Polson &Billen
"Because the materials do not polymerize until they are
exposed to ultraviolet light, they provide prolonged
working times for placement, shaping, and contouring
over extensive areas of enamel
One popular kit NUVA SYSTEM(Caulk, Division
of Dentsplylnternational Inc. Milford, Delaware)
The composite resin splint can be strengthened by adding
wire,monofilament line,fiber glass or by using a fibre
meshwork to reinforce the material.
E.g.:RIBBOND,Ribbond Inc.,Seattle, WA
Extracoronal resin-bonded retainers can strengthen the
overall bonded situation.
The splints are usually cast from metals, usually
non noble alloys.
Greater inherent strength than composite-resin splint

Grooves, pins and parallel preparations increase retention

ADVANTAGES:
Such splints are cosmetic, fairly durable, and well
tolerated by the patient
DIS-ADVANTAGES:
They are not able to resist heavy interocclusal forces and
fractures often occur.
INTRACORONAL SPLINTS
Wire Ligation Serves well for posterior teeth
A channel is prepared on the labial, lingual and proximal
surfaces
Major disadvantage -channels may become undercuts in
case crowns are needed later
WIRE AND ACRYLIC RESIN SPLINT:
INDICATIONS:
Used for mandibular anterior teeth.
ADVANTAGES:
Stability

Esthetics
Acrylic / composite resin are used either with or without
direct bonding etchants. Direct bonding reduces the
undesirable tendencies for interproximal fracturing or
shaving of resins.
Alone it causes caries.
Bonding with enamel etchant can cause difficulty while
removing so, great care is required.
A splint was given by BERLINER AND KESSLEER.
USES:
1. Simple acid etched splint can be used that require no
ligation reinforcing, cavity preparation or pins.
2. Provisional or partial dentures, post extraction.
3. Multiple teeth can be splinted.
4. Periodontal splinting in conjunction with removable
partial denture.
5. Support for conventional fixed partial denture.
6. As a fixed orthodontic retainer.
7. To prevent supra eruption of opposing teeth.
AMALGUM AND STAINLESS STEEL SPLINTS:
It is similar to A-Splint but used in posterior teeth.
A series of mesio-occlusal- distal preparations are made
and then restored with amalgam that has a wire of

diameter of 0.05embedded in it at the time of

condensation.
DISADVANTAGES:
Frequent fracture of amalgam and pulp injury may occur
during preparation.
Band failure of one or more teeth within splint may occur.
ADVANTAGES:
More retention than temporary splints
Lasts longer
Neither it irritates gingival tissues nor does it impede
home care measures.
Economical
Simple to design
Can be readily removed by dentist
Stable
Wire, Resin, &Amalgam(Trachtenberg)
Embed the wire in preexisting amalgam with acrylic
Langeland et al tagged acrylic in experimentally prepared
cavities in monkeys
Cast Chrome-Cobalt Alloy Bars
Baumhammers
Condensed amalgam over a 14 gauge chrome-cobalt bar

Corn & Marks

Cast bar fabricated on study casts prior to insertion
A channel is made in the teeth to be stabilized; bar is
inserted with acrylic into grooves prepared
FIXED EXTRACORONAL SPLINTS NOT
REQUIRING CAVITY PREPARATION
USES:
Indicated in dentition with high probability that
hypermobility is only temporary and cant be resolved.
E.g.of hypermobility present/ arising after therapy:
1. Severe occlusal trauma with periodontal
disturbances.
2. Temporary hypermobility resulting from accidental
or surgical trauma.
3. Pt requiring bone reattachment procedure.
4. Pt requiring osseous correction.
5. Pts requiring combined periodontal and endodontic
therapy.
6. Pts requiring osseous correction.
7. Temporary stabilization by crown or pin splints
rather than full crown.
ETCHED METAL RESIN BONDED SPLINT
Commonly used in dentistry nowadays.

ADVANTAGES:
If technique of fabrication is carried out well than it can
result in splinting of seriously compromised teeth that
would otherwise be lost.
DISADVANTAGES:
Due to their bulkiness, they increase axial contour,
thereby correcting interdental embrasure and promoting
plaque and food deposition.
Itsunaesthetic.
Its difficult to maintain hygiene.
MODIFICATION
A Bracket wire rather than ligature wire is directly bonded
with acrylic resin to etched surface on facial aspects of
posteriors and anteriors teeth of same arch.
PROVISIONAL SPLINTING
Morton Amsterdam and Lewis Fox in 1959 defined that
the term provisional splinting as the phase of restorative
therapy utilizing a biomechanical combination of tooth
dressing coverages and stabilization of teeth on an
immediate and temporary basis.
May be used for monthsupto several years.
Usually fabricated in acrylic

Stabilize a mobile dentition from initial tooth preparation

to the time for permanent restorations.
Provide- Stability,Occlusal function,Good aesthetic result
All Acrylic
Most common
Can be fabricated chairside
Limitation -marginal adaptation
Adapted Metal Bands & Acrylic
Amsterdam & Fox-copper / gold bands fitted and
incorporated into acrylic
Fulfils all objectives-exact marginal fit (caries control &
pulp protection)
Frequent removal is possible added strength of metal
bands
PERMANENT SPLINTING
Swing-Lock Devices
Used in situations where fixed splinting is not possible or
desirable

Advanced age, poor physical / mental status, questionable

prognosis
Advantages -Conceals metal, avoids torque
Overdentures
Used where few teeth with questionable prognosis remain
Advantages -Favourable crown-root ratio, retention
of alveolar bone around roots
Disadvantage-Recurrent periodontal disease
FIXED SPLINTS
Full coverage- simple
Inlays -more conservative
Reciprocal stabilization in all directions
Palatal bar-cross arch stabilization
Advantages -comfortable, esthetic
Cast Metal Resin Bonded FPDs
Maryland splints-used with intact or very slightly altered
enamel surfaces
Advantages-functional, aesthetic, reversible, economic.
Not suitable for- excessively mobile teeth under strong
occlusal load

COMMON PROBLEMS
OVERCOUNTOURING:
Finished A splint must follow the same principles as cast
restoration and should allow for placement of
interproximal brushes.
ESTHETICS:
Enhanced by closing diastema, covering or replacing old
discolored restoration, covering discolored dentin/ enamel
and selectively recontouring.
WIRE STABILITY:
The more mobile the abutment or longer edentulous space
the stronger should be the wire.
ARCH STABILITY:
It should gain support in 2 or more planes.

SPLINT MAINTENANCE
1. A properly fabricated splint will be effective in
maintaining tooth stability, but maintaining oral
health is critical. Increased plaque retention and
difficult access to teeth may be challenges for
effective plaque control.
2. Adequate interdental plaque control must be
established, and this may involve the use of
interdental brushes, Super Floss or floss combined
with a floss threader.
3. Occasionally some patients may require special
instruments such as an end tuft brush or Sulca brush
to cleanse specific locations of the splint.
4. Personal plaque control, professional caries risk
assessment and periodontal maintenance is crucial to
the longevity of both the teeth and the splint.
5. Teeth with greater than percent attachment loss when
splinted and that are inflammation-free can be
maintained long term. At each recall visit, the
integrity and rigidity of the splint, bonding to the
teeth, mobility of the teeth and splint and presence of
caries and/or periodontal disease should be examined
and noted.