Periodontal splinting of mobile teeth
With advanced periodontal disease the bone around the teeth gradually resorbs and the gums recede, as a result of which the teeth become increasingly more mobile. Treatment of periodontitis begins with scaling and the purging of pockets. If a great extent of tooth mobility is detected, a treatment known as periodontal splinting will be necessary. Periodontal splinting is a dental intervention that secures the mobile teeth to one another and the neighbouring stable teeth with a glass fibre line and tooth-coloured liquid filling material. The teeth bound together move around less, resist masticatory forces better and are aesthetically more appealing. In certain cases, bone resorption is so advanced that the root of the teeth is no longer in the bone, but we can help preserve the “lost” tooth temporarily by attaching it to neighbouring teeth by periodontal splinting. This only works as a provisional solution until such time as the permanent tooth restoration is ready. Periodontal splinting is only a complementary treatment. Being a symptomatic, temporary treatment of chronic tooth mobility resulting from bone loss, it does not eliminate the cause of periodontal disease.
The application of periodontal splints:
- The support of teeth is compromised and the teeth become loose as a result of bone decay induced by periodontal disease. Periodontal splinting stabilises chronically mobile teeth, increasing thereby the periodontium’s readiness to heal and the preservability of the teeth.
- The preservation of severely mobile teeth slated for removal due to severe bone loss for the duration of the periodontal treatment:
- for aesthetic reasons,
- to use them in the fabrication of a long term provisional tooth replacement,
- to preserve occlusal height,
- to decrease the load incurred by salvageable teeth.
- The remounting of removed teeth into the dental arch by splinting (cementing) for aesthetic reasons, can be used solely as a temporary solution in the following instances:
- Decreasing tooth mobility enhances the efficacy of periodontal surgeries, especially regenerative surgeries.
- Fixing sutures in case of gum plastic surgeries
Types of periodontal splints by duration of use:
- Provisional splints: used during periodontal treatment and removed once the stability of the teeth is restored.
- Long-term provisional splints: can be used for several months or even 1 to 2 years
- Permanent splints: in the event of severe periodontal decay/periodontitis teeth can only be preserved by permanently splinting the teeth together. For the most part, it is associated with the irreversible filing of teeth.
Types of periodontal splints by their structure and material:
- Splints made with aesthetic filling material, cementing the teeth together.
- Splints made with aesthetic filling and a glass fibre or metal thread serving for reinforcement. More often than not, a small groove needs to be drilled into the surface of the teeth (for retention).
- Acrylate (plastic) splints fabricated by the dentist at the chairside.
- Acrylate splints milled in the dental laboratory (e.g. poly-methyl-acrylate PMMA provisional bridge milled with the CAD/CAM procedure). This procedure is associated with the irreversible filing of teeth which are given permanent replacement teeth once the periodontal treatment is over. PMMA provisional bridge designed for six upper anterior teeth on the master cast and in the mouth
- In case of teeth splinted with metal ceramic or zirconia bridges replacement teeth are fabricated in the dental laboratory based on the impressions taken by the dentist of the permanently filed-down abutment teeth.
- Retention or splinting performed with the use of orthodontic brackets.
The cleaning of fixed tooth restorations – crowns, bridges
The selection of the periodontal splint is always subject to the periodontologist’s discretion depending on the case at hand. For the most part, we tend to begin with the least drastic interventions, as a result of which corrections may be necessary due to the incidental breakage of the splints. Periodontal splints reinforcing or substituting extensive arches are vulnerable and susceptible to breakage, in which case they only need to be re-fabricated. This does not qualify as a warranty issue since the overloading of mobile teeth at certain points and correct occlusion are unpredictable. Periodontal splints are made at all times by filling up interdental spaces and as such they expressly promote plaque build-up and successful treatment is therefore only guaranteed with patients with impeccable oral hygiene. Splinting is not aesthetically appealing as the material filling up the interdental spaces by no means match the aesthetics of natural teeth and the pink gums (papillae) in between.
Periodontal splints are not in contact with the gum edge, so interdental spaces can be cleaned with interdental brushes or Super floss underneath the splint, doing which will, more often than not, require further training in oral hygiene, including the selection of the right tools and instruction on their use.
The cleaning of teeth splinted together with crowns with Super floss
Regular professional tartar removal and dental check-ups are essential in the fight against periodontal disease, as are timely diagnosis and intervention, since the spread of the process to bone tissues brings about irreversible damage. Treatment consists in the prevention of the progress of the disease and the inactivation of inflammation by means of various techniques of cleaning, or in more severe cases, with surgical intervention. A periodontal splint implies an already advanced state of periodontal disease.
The interdental brush and its use