Dental splinting is the joining of two or more teeth into a rigid unit by means of fixed or removable restorations/devices. A periodontal splint is an appliance used for maintaining or stabilizing mobile teeth in their functional position. The main objective of splinting is to promote healing and to increase the patients comfort and function.

Objectives :

1. It is used to provide rest
2. For redirection of forces- the 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 the adaptive capacity
4.  To preserve arch integrity-splinting restores proximal contacts, reducing food impaction and consequent breakdown.
5. Restoration of functional stability-restores a functional occlusion , stabilizes mobile abutment teeth and increases masticatory comfort.
6. Phychologic well being-gives the patient comfort from mobile teeth thereby giving him a sense of well being
7. To stabilize mobile teeth during surgical, especially regenerative therapy
8. To prevent eruption of unopposed tooth.

Classification of Splints

1. According to the Period of Stabilization

• Temporary stabilization – worn for less than 6 months eg: Removable/Fixed
• Provisional stabilization – to be worn for months or up to several years eg: acrylic splints, metal bands
• Permanent splints – used indefinitely eg: removal/fixed, intracoronal/extracoronal

2.   According to Type of Material

• Bonded, composite resin button splint
• Braided wire splint
• A-splints

3.   According to the Location of the Tooth

• Intracoronal – Composite resin with wire, Inlays, Nylon wire
• Extracoronal – Tooth-bonded plastic, Night guard and welded bands

Various Commonly Used Splints

1. Splints for Anterior Teeth

• Direct bonding system using acid etch techniques and a light cured resin
• Intracoronal wire and acrylic wire resin splint – It uses preparation of a slot on the lingual aspect of the tooth, and stabilizing the tooth , using a stainless steel wire placed in the slots.

2. Splints For Posterior Teeth

• Intracoronal amalgam wire splints – It uses resin restoration with wire on the proximal amalgam restored areas of the tooth.
• Bite guard
• Rigid occusal splint
• Composite splint

Principle of Splinting

1. Inclusion of sufficient number of healthy teeth : It is suggested that the healthy teeth included in the splint should have double root surface area of the mobile teeth. Since the posterior teeth are multirooted, the number of healthy teeth to be included in the splint in the posterior segment will be less as compared to the anterior.

2.Splint around the arch : Muscles of the lips, cheek and tongue exert some forces on the teeth. Based on the direction of such forces applied on the teeth, the dental arch can be divided into 2 posterior sextants and an anterior sextant. In the posterior sextant, the tongue pushes the teeth buccally and the muscles of the cheek counter act it by pushing them lingually. When the splint is confined to any one sextant, the splinted teeth tend to tilt lingually or outwards depending on the muscular forces. Such a collapse of the splinted sextant can be prevented by including few teeth from adjacent sextant. This is termed splinting around the arch

3. Coronoplasty may be performed to relieve traumatic occlusion.

4. The splint should be fabricated in such a way as to facilitate proper plaque control

5. Splint should be aesthetically-acceptable and should not interfere with occlusion.

Indications of Splinting

• It stabilizes moderate to advanced tooth mobility that cannot be reduced by other means and which has not responded to occlusal adjustment and periodontal therapy.
• When it interferes with normal masticatory functions
• Facilitates scaling and surgical procedures
• Stabilizes teeth after orthodontic treatment
• Stabilizes teeth after acute dental trauma
• In order to prevent tipping and drifting of the teeth
• Prevent extrusion of unopposed teeth

Contraindications

• Moderate to severe tooth mobility in the presence of periodontal inflammation and/primary occlusal trauma
• Insufficient number of firm/sufficiently firm teeth to stabilize mobile teeth
• Prior occlusal adjustment has not been done on teeth with occusal trauma or occlusal interference
• Patient not maintaining a good oral hygiene

Advantages

• May establish final stability and comfort for the patient with occusal trauma
• Helpful to decrease mobility and accelerate healing following acute trauma to the teeth
• Allows remodelling of alveolar bone and periodontal ligament for orthodontically, splinted teeth
• Helpful in decreasing mobility thereby favouring regenerative therapy
• Distributes occusal forces over a wider area

Disadvantages

• All the splints hamper patients self care
• Accumulation of plaque at the splinted margins can lead to futher periodontal breakdown in a patient with already compromised periodontal support
• Number of studies have shown that splinting does not actually reduce tooth mobility once the splint is removed
• The splint being rigid acts as a lever with uneven distribution of forces, even if one tooth of the splint is in traumatic occlusion , it can injure the periodontium of all the teeth
• Developement of caries is unavoidable.