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Extension of
inflammation from
Loss of tooth support the gingival or from Periodontal surgery
the periapex into the
PDL
Tooth mobility
Pathologic process Trauma from
increases in
of the jaw occlusion
pregnancy
TRAUMA FROM OCCLUSION
Depending • Acute
upon the
duration of • Chronic
occurrence
Depending • Primary
upon the • Secondary
etiology
ACUTE TFO
CHRONIC TFO
O It is more common and is of greater
clinical significance.
O It is due to gradual changes in occlusion
produced by tooth wear, drifting
movement, extrusion of teeth combined
with parafunctional habits such as bruxism
and clenching, rather than as a sequelae
of acute TFO
O It leads to increased tooth mobility.
PRIMARY TFO
O In the case of primary occlusal trauma, the
periodontium is intact and not reduced,
thus the drifting of the teeth is due to an
excessive, continuous force resulting from
an occlusal disharmony.
Clinical
Periodontometer
measurements
O 0- Normal mobility
O Grade I- Slightly more than normal
O Grade II- Moderately more than normal
O Grade III- Severe mobility faciolingually and /
or mesiodistally combined with vertical
displacement.
O LINDHE 1997
Muhlemann in 1957
PERIOTEST
A new method for determining tooth
mobility was invented by Schulte
and co-workers in 1987 and 1992.
when the Periotest (Siemens,
Germany) system was introduced.
Stabilization of
mobile teeth during Stabilize teeth
Prevent extrusion of
surgical especially following orthodontic
unopposed teeth
regenerative movement
therapy. (Serio 1999)
Ascertain whether
occlusal therapy will
be effective or not
CONTRA-INDICATIONS
not provoke
iatrogenic economic
disease
Limits amount of
force on a single
Aids in distribution of force
tooth
A mobile individual tooth
When the mobile tooth is
is capable of being
splinted, the splint tends
loaded and moved in
to redirect lateral forces
several directions:
into more vertical forces,
mesio-distally,
which the tooth is better
buccolingually and
able to resist
apical
UNILATERAL AND
BILATERAL SPLINTS
CLASSIFICATION
RAMFJORD’S CLASSIFICATION (1979)
TEMPORARY:
(2-6 months)
Fixed external type
e.g. Ligature wire, orthodontic bands.
Removable- RPD, Night guards, removable acrylic splints
PROVISIONAL :
8-12 months, diagnostic, used in borderline cases where the outcome of treatment cannot be
predicted. eg. Temporary external splints.
PERMANENT:
a) Fixed- Full crowns, pin ledge type of abutment retainers.
b) Semirigid
c) Removable- Telescopic crowns, clasp supported partial denture.
Grant, Stern and Listgarten(1988)
TEMPORARY:
Extracoronal (External)-Ligature splint, Enamel bonding
material, welded bond splints, night guards
As a supportive
Following accidental measure to facilitate
loosening of teeth by periodontal therapeutic
trauma procedures for
hypermobile teeth
To avoid dislodging of
For anchorage and
teeth prior to and
temporary retention in
during reconstruction
orthodontic therapy
procedures
CHOICE OF SPLINTS
the
severity of
mobility
the stage
the
of
anticipated
treatment
outcome
involved
LIGATURE SPLINTS
FABRICATION
O Ligatures are a
satisfactory means of O Poor esthetic
stabilizing anterior appearance
teeth.
O May perform minor
O Although ligation is a
form of temporary tooth movements
splinting, ligatures O Can cause gingival
may be retained for
several months if they irritation due to plaque
are tightened and or food accumulation.
replaced periodically.
A study measured the forces originated from stainless steel
wires when used for splinting. The results demonstrated that
square or round stainless- steel wires exerted lower forces
compared to rectangular or nickel-titanium wires. The study
also showed that the construction of a truly neutral arch was
difficult, and therefore the authors concluded that only dentists
experienced in the handling of orthodontic appliances should
use such materials for dental trauma splints.
O DIS-ADVANTAGES:
USES:
Treatment of post acute trauma to prevent mobility
Progressive
TFO following
occlusal
adjustment, Continuous
expressed as
soreness of the migration or
teeth to pressure tipping of teeth
on percussion
during and after
function
Radiographic evidence of
ongoing resorption of the
alveolar bone several
months after occlusal
adjustment
Indications for splinting the patient with advanced
periodontal disease using fixed cast
restorations were described by Lindhe J et al in
1983.
1) progressive mobility of teeth as a result of
gradually increasing width of the periodontal
ligament in teeth with loss of alveolar bone
height.
2) indicated when mobility disturbs chewing
ability or comfort.
3) Another consideration requiring stabilization
is increased segmental bridge mobility
despite splinting in a sextant of teeth.
CONTRAINDICATIONS
Splinting with fixed cast restorations Splinting is not indicated for the
is not indicated if occlusal stability patient who is comfortable during
cannot be obtained with the normal mastication yet has increased
provisional acrylic bridge. The mobility of a tooth or teeth with loss
alternative treatments are the of alveolar bone and a normal width
complete denture or the full implant- of periodontal ligament without
supported prosthesis increasing mobility or tooth migration
OBJECTIVES FOR SPLINTING
WITH FPD
tooth mobility is
the patient is able
normal or at least
to function
no longer
comfortably
increasing
interference of the
splint to normal Interference with
interproximal wear phonetics
and mesial drift
Glickman et al. (1961) evaluated the effects of
splinting teeth in hyperocclusion using five
Rhesus monkeys. The forces which applied to
1 tooth in a splint were transmitted to all teeth
within the splint. The direction of the initial
force was maintained and comparable areas
of the splinted periodontium were affected.
The bifurcation and bifurcation areas were
most susceptible to excessive force. Forces
applied to non-splinted teeth were not
transmitted to adjacent teeth and force
sufficient to cause necrosis did not cause
pocketing.
Nyman et al. (1975) studied 20 patients who had
originally exhibited severe periodontal
breakdown and extensive tooth loss. Extensive
fixed bridgework was placed following
periodontal therapy and the patients monitored
for 2 to 6 years. No further bone loss was
observed between the insertion of the fixed
bridgework and the final examination. The
authors reported no increase in PDL width of the
abutments or changes in mobility.
REFERENCES
O Clinical periodontology : Carranza
O Clinical periodontology : Jan lindhe
O DCNA volume 43
O Grant Stern and listgarten
O Ramfjord
O Decision making in Periodontics : Walter B
Hall
O Glickman I, Stein RS, Smulow JB. The effect
of increased functional forces upon the
periodontium of splinted and non-splinted
teeth. JPeriodontol. 1961;32:290-300
O E. Griffin Cole,To Splint or Not To Splint:
Treating Periodontally Compromised
Teeth by Improving Occlusion May 2005
Contemporary Esthetics and Restorative
Practice
O Trauma from occlusion: a review
Commander R. “Dave” Rupprecht, DC,
USN 2004
O Dr P. Jayachandran ,Tooth Mobility, JSIPK
,Nov 2009