Splinting

Splinting:

It is defined as the joining of two or more teeth with a rigid unit by means of fixed or removable restorations.

Splint :

It is defined as an appliance used for immobilization of injured or diseased parts.

Requirements of an Ideal Splint:

1. It should allow direct application in the mouth without delay due to laboratory procedures.
2. It should not traumatize the tooth during application.
3. It should immobilize the injured tooth in a normal position.
4. It should provide adequate fixation throughout the entire period of immobilization.
5. It should neither damage the gingiva nor predispose to caries.
6. It should not interfere with occlusion.
7. It should not interfere with endodontic treatment.
8. It should fulfill aesthetic demands.

What are the different Types of Splints:

1. Fixed Splints
2. Removable Splints

What are the Objectives Of Splinting:

1. It provides rest .
2. For redirection of forces : Forces of occlusion are redirected in a more axial direction over all the teeth included in the splint .
3. For redistribution of forces: Redistribution ensures that forces do not exceed adaptive capacity .
4. To preserve arch integrity: Splinting restores proximal contacts reducing food impaction & consequent breakdown .
5. Restoration of functional stability: Restores a functional occlusion , stabilizes the mobile teeth & increases masticatory comfort .
6. Psychological wellbeing: Gives the patient comfort from mobile teeth thereby giving him the sense of well being .

Indications:

1. It is used in the treatment of dentoalveolar & mandibular fractures .
2. It stabilizes moderate to advanced tooth mobility that cannot be reduced by other means .
3. It stabilizes teeth after acute dental trauma .Ex: Subluxation .

Contraindications:

1. Insufficient number of firm or sufficiently firm teeth to stabilize mobile teeth .
2. Prior occlusal adjustment cannot be done on teeth with occlusal trauma or occlusal interference .
3. Patients who don’t maintain good oral hygiene.

There are 2 types of Dental Splints:

1. Fixed Dental Splints
2. Removable Dental Splints

These are divided into types based on their property of allowing movement to the Dental Structures. These are used to immobilize the Oral structures to aid in the healing process.

Fixed Dental Splints:

Fixed Dental Splints are further divided into  types:

1. Sectional acrylic cap splint
2. Vacuum / pressure formed splints
3. Interdental Wiring
4. Arch Bar

Sectional Acrylic Cap Splint:

Synonyms:  stout’s or ribbon splint.

Uses:

• Immobilization of dentoalveolar structures
• Mandibular fractures.

Advantages:

• Simplicity of the appliance
• Little lab equipment is required for its construction.

Sectional Acrylic Cap Splint

Procedure Of Splinting Using Sectional Acrylic Cap Splint:

• It consists of acrylic band or flange.
• Undercuts need not be eliminated.
• By embracing the crown and more especially the interdental spaces excellent retention is obtained.
• 1cm in diameter is situated on the buccal aspect of splint.
• If displacement is present then obtain a working model, correcting this my dividing the model to wire connectors are adapted.
• From half round1.25 mm diameter of stainless steel wire around the distal aspect and then splint is fabricated in wax.
• Wire ends are left long in order to obtain retention.
• An essential component of this splint is the formation of wax button approximately 1cm in diameter is situated on the buccal aspect of splint.
• The model with wax splint is then invested making sure that the wire inserts are secured in the plaster matrix.
• Following separation of two halves the flask, the wax is boiled out and the plaster surface painted with cold mould seal.
• If splint is urgently requires then cold cure acrylic is used.
• When processed, splint is removed from plaster, trimmed and polished.
• Splint is sectioned vertically retaining the button, longitudinally along any edentulous spaces.
• Allows splint to be opened out and sprung into position on the model.
• Fixation into the mouth is obtained by passing a soft stainless steel wire around the vertically divided button and through holes drilled horizontally through any edentulous areas.
• This will firmly adapt the splint into all the retaining sites to obtain adequate stability and immobilization.

Vacuum / pressure formed splints

Uses:

• Fixation of dentoalveolar fractures.

Advantages:

• Method of construction is extremely simple and not time taking.
• Highly plasticised polymeric material in sheet form can be used.

Two basic techniques:

1. Vacuum forming (suck down)
2. Pressure forming ( blow down).

Procedure Of splinting Using Vacuum / Pressure formed Splints:

1. Impression of both arches are taken and working models are prepared.
2. Displaced teeth should be ligated together in order to restore the original arch form.
3. Gingival margins around the teeth are trimmed.
4. Large tooth undercuts should be blocked out with plaster to provide a common path.
5. With both methods of adapting the splint material it is advisable to trim the edges of the base of the model to the full depth of sulcus
6. The working model is placed on top plate of machine and a suitable shaped dry sheet of appropriate material is located and clapped beneath the heating section.
7. Following cooling the splint is carefully eased from the model and the gingival margins are trimmed.
8. The contoured splint is fitted back to the working model to check the relationship of the edges of splint o the gingival margin and occlusion with the opposing model.

Interdental Wiring:

• Thin soft stainless tell wires are used for this type of fixation.
• It is important that the ligatures are applied to several adjacent teeth on both sides of traumatized area to achieve sufficient stabilization.

Interdental wiring:

• For additional stability cold cure acrylic can be placed around the interdental ligatures.
• The stabilization properties of this ligature are limited due to lack of rigidity especially when the wires become to stretch.
• So interdental wiring should be limited to fixation of a single traumatized tooth.

Arch Bars:

Arch Bars

• Metal bars fitted to the dental arch and ligated to the individual teeth are commonly used
• Most often a semi-circular soft metal bar is manually shaped to fit the dental arch
• This is used for immobilization of avulsed and partially displaced tooth

Disadvantage:

• The correct positioning of traumatized teeth is often not obtained because of difficulties in exact adaptation of the dental arch.

Removable Splints:

Occlusal splints : They are used in temporomandibular disorder patients. They are Divided into 2 groups

1. Auto-repositioning
2. Anterior – repositioning

Auto-repositioning :

It is mostly used to treat muscle problems & eliminate tmj pain .

This splint allows full arch dental contact with the condyles in more posterior retruded position .

This also allows the patient to seek a comfortable muscle & joint position without excessive influence of occlusion.

Anterior –repositioning :

• Used for temporary relief in rare cases  & long term cure for anterior disc displacement .
• In this case the anterior position is determined by protrusion of mandible necessary to produce proper disc & condyle relationships .
• These are  usually worn 24 hours a day for several months .
• These splints are generally effective in producing permanent reduction  of disc displacement

SVED Splints:

• It is a removable appliance fabricated in acrylic .
• It is constructed such that the acrylic extends over the occlusal / incisal surface of the tooth thereby fixing & stabilizing it .