12 February 2020

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Are splints in periodontal therapy still a dilemma?

Edoardo Mancuso

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Clinical management of periodontally compromised teeth with advanced mobility remains an arduous challenge to the dentists.
Splints are being used to overcome these problems.
However, the value of splinting has been debated for a long time and most of the benefits of the splinting have been reported mostly from clinical observations than from scientific evaluations. According to the glossary of prosthodontic terms, a splint is defined as “a rigid or flexible device that maintains in position a displaced or movable part.”

Splinting the teeth to each other allows distribution of forces from mobile teeth to their immobile neighbours, thereby gaining support from the stronger teeth. This might prolongs the life expectancy of the loose elements, giving stability for the periodontium to reattach, and improves comfort, function and aesthetics. In an interesting review published on the International Journal of Research in Health and Allied Sciences in the late 2018, Professor Mangla et al. explore the different type of splints present on the market and their clinical indications.  

The review cite as indications for the splinting the following:
1) Stabilize moderate to advanced tooth mobility that cannot be reduced by other means and that has not responded to occlusal adjustment and periodontal therapy.
2) Stabilize teeth in secondary occlusal trauma.
3) Stabilize teeth after orthodontic movement.
4) Stabilize teeth after acute dental trauma i.e. subluxation, avulsion.
5) Prevent extrusion of unopposed teeth. Is specified that regarding the first of the indications listed, in the absence of periodontal disease, the most likely cause of tooth mobility is primary occlusal trauma.

In these cases increase in mobility may be reduced by occlusal adjustment alone by eliminating the occlusal interferences. In cases where occlusal adjustment will not be able to reduce the tooth mobility, reduction of mobility can only be achieved by using a splint. Splinting in such situations is only indicated if the mobility disturbs the patient’s masticatory function or chewing comfort or aesthetics. In a study to determine the effect of initial preparation and occlusal adjustment on tooth mobility, it was observed that for teeth with initial mobility greater than 0.2 mm there was a decrease in tooth mobility up to 20%.   

Depending on the duration of use, splints are classified as temporary, provisional or permanent and may be either fixed or removable. And according to the location on the tooth splints could be classified as intracoronal and extracoronal. There have been considerable advancements in the materials used for splinting, resulting in fewer ill effects, but still, the simplest and more efficient way to connect teeth to each other is the classic bonding method, using a composite resin to rigidly connect the teeth to each other. The mechanical properties of the composite resin splint should be improved by adding metal wires, fibers or by using a fiber meshwork.
A variety of reinforcement fibers are available for use with composite: Open weave glass fiber, woven polyethylene, glass fiber ribbon.
The challenge to place a thin but strong composite-based splint has been met with the introduction of a high strength, bondable, biocompatible, aesthetic and easily manipulated color neutral fiber that can be embedded in the resin structure. The added advantage is that this fiber also binds chemically with resin structure.

The article concludes suggesting that when facing with the dilemma of how to manage periodontally compromised teeth, splinting of mobile teeth to stronger adjacent teeth is a viable option. This prolongs the life expectancy of loose teeth, gives stability for the periodontium to reattach, and improves comfort, function and aesthetics. A suitable treatment option for periodontally compromised teeth with poor prognosis can also be to retain the teeth for a longer time by using splints, until a more definitive treatment is planned for the patient. Everyday more splints are becoming an integral part of periodontal therapy and maintenance, however, it should be noted that splinting itself will not eliminate the cause of tooth mobility. They are only an aid in stabilizing the mobile tooth, and mobility may revert once the splints have been removed. Hence, splinting is an essential adjunct but only in addition to cause-related therapy in the treatment of mobile teeth.  

(Photocredit: Dr. Edoardo Mancuso, Dr. Massimo Fuzzi)

For additional information: Splinting- a dilemma in periodontal therapy