Splinting of periodontally involved teeth: indications and contraindications.
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The effect of splinting upon periodontal and pulpal healing after autotransplantation of teeth with complete and incomplete root formation was studied in 16 green Vervet monkeys (Cercopithecus aethiops). 2 maxillary incisors were extracted in each monkey and autotransplanted to the contralateral socket. One of these teeth was stabilized with an acrylic splint for either 2 or 6 weeks, while the other incisor was non-splinted. The animals were sacrificed 8 weeks after autotransplantation and the autotransplanted teeth were examined histologically. The following histologic parameters were registered for each tooth: surface resorption, inflammatory resorption, replacement resorption (ankylosis), downgrowth of pocket epithelium, periapical inflammatory changes and extent of pulp necrosis. The histometric analysis demonstrated that splinting increased the extent of pulp necrosis and inflammatory root resorption compared to non-splinting. Furthermore, the extent of normal periodontium was decreased among the splinted teeth, when compared to the non-splinted teeth. It is concluded that splinting not only failed to improve healing but apparently exerted a harmful effect upon periodontal and pulpal healing after autotransplantation.
A technique has been described whereby a heat-processed provisional splint was fabricated with the factors of esthetics and long-term serviceability being of prime importance. Additional advantages of the use of a well-adapted provisional restoration in a periodontal prosthesis are as follows: (1) They facilitate periodontal treatment by allowing total visibility and access to surgical sites when the splint is removed. (2) The splinting effect may enhance healing and periodontal-ligament reattachment by stabilizing mobile abutments. (3) The patient's ability to render adequate home care for a fixed prosthetic restoration may be evaluated and reinforced before making case restorations. (4) The patient's cooperation is assured during an extended period of restorative care when an esthetic, comfortable, provisional splint is provided.
In the present study, 139 periodontally compromised patients received a complete periodontal treatment; in 104 cases this was followed by orthodontic treatment. At the end of the entire therapy, a total of 150 Maryland restorations (69 resin-bonded fixed partial dentures and 81 resin-bonded splints) was placed and then followed for a period of up to 10 years (mean 6.7 y). Thirteen fixed partial dentures and 16 splints failed during the observation period; the 10-year cumulative survival rate from lifetable analysis was 76.2% (70.6% for fixed partial dentures and 80.7% for splints).
Shortcomings of techniques presently available for the stabilization of periodontally-involved teeth following orthodontic therapy are discussed. The rationale for rigid fixation of such teeth is questioned in the light of modern concepts of tooth mobility. An inexpensive technique of tooth stabilization based on wire and composite resin is described. The technique permits fixation allowing for individual periodontal adjustment, yet with minimal interference with tooth structure and the occlusion.
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The patient described in this case report required removal of several mandibular incisor teeth because of severe periodontal disease. She demanded an immediate replacement for these teeth, but, because of the periodontal conditions, it was not possible to use conventional approaches to fulfill her request. The decision was made to fabricate an immediate indirect-direct, reinforced, bonded composite resin periodontal prosthesis. The patient's extracted mandibular central incisors were used as pontic replacements. The procedure was expedient, inexpensive, and conservative, and the results were esthetic.
The usefulness of splinting of severely loosened teeth in advanced periodontitis has been discussed extensively, both positively and negatively. Retention of patients own teeth through the aid of this simple and inexpensive resin composite splint provides a satisfactory solution for many affected patients. The fabrication and placement techniques for splints for the anterior and posterior regions are described, as are additional indications for such splints, which are fabricated from resin composite and glass fiber bundles. Such splinting can be provided even for severely loosened, periodontally diseased teeth without danger of intraoperative tooth loss. Long-term retention of such teeth can be ensured only through a risk-oriented postoperative program of oral hygiene and regular examination of the splint.