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Periodontal Splinting -An Adjunct to Non-Surgical Periodontal Therapy to

Manage Tooth Mobility

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DOI: 10.46998/IJCMCR.2022.22.000541

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 International Journal of
ISSN 2692-5877 Clinical Studies & Medical Case Reports
DOI: 10.46998/IJCMCR.2022.22.000541
Case Report
Periodontal Splinting - An Adjunct to Non-Surgical Periodontal Therapy to
Manage Tooth Mobility
Ayesha Hanif 1,*, Haroon Rashid Baloch2, Ali Kazi3 and Javairia Waqasi4
1Department of Periodontology, Ziauddin College of Dentistry, Ziauddin University, Pakistan
2Department of Prosthodontics, Ziauddin College of Dentistry, Ziauddin University, Pakistan
3Department of Operative Dentistry, Ziauddin College of Dentistry, Ziauddin University, Pakistan
4Dental graduate, Ziauddin College of Dentistry, Ziauddin University, Pakistan

*
Corresponding author: Ayesha Hanif, MDS Periodontology, Sr. Lecturer, Periodontology, Ziauddin College of Den-
tistry, Ziauddin University, Karachi, Pakistan
Received: October 03, 2022 Published: October 24, 2022

Abstract

As periodontal disease progresses, it leads to progressive loss of attachment apparatus subsequently leading to tooth mobility.
The resultant tooth mobility adversely impacts the phonetics, function, comfort and speech of an individual. A proper case selec-
tion with considerably stronger teeth available to support the mobile teeth and where the oral hygiene will not be compromised,
a periodontal splint is a viable adjunctive treatment option. This case reports discusses splinting of mobile lower anterior teeth
of a 37-year-old male presenting with the mobility grades between II and III. A fiber reinforced resin composite splint (Ribbond)
is applied to alleviate patient’s discomfort and restore function while preparing the patient for future soft tissue periodontal
surgery. Ribbond presents with superior elasticity, adaptability, reparability, bonding and resistance to fracture as compared to
other conventional methods of splinting. The easier and quicker application along with superior aesthetics, makes Ribbond the
material of choice for periodontal splinting.

Keywords: Periodontal splinting; Ribbond; Tooth mobility; Fiber reinforced resin composite

Introduction With technological advancements and incorporation of newer

Tooth mobility is one of the sequelae of the advancing peri- materials, the supposed ill effects of the periodontal splints
odontal diseases [1] which is a consequence of acute periodon- have considerably been eliminated [7,9,10]. This case report
tal apparatus inflammation [1], trauma from occlusion, and discusses the application of periodontal splint as an adjunct
apical shift of the rotational center of the tooth as bone loss to periodontal therapy, for a severe chronic periodontitis case,
progresses. Tooth mobility has been widely investigated as using fiber-reinforced composite - Ribbond [9,11] to stabilize
the measure of functional condition of the periodontium along the dentition prior to soft tissue augmentation for phenotype
with being a possible aggravating factor for the periodontal modification [6].
disease [2]. The resultant tooth mobility adversely impacts the
masticatory and phonetic function of the patients while also Case Report
reducing patient’s comfort [2,3]. Loss of periodontium around A 37-year-old male presented to the dental OPD at the Ziaud-
the teeth subjects them to secondary occlusal trauma which din University, Karachi, Pakistan, with the chief complain
further contributes to tooth mobility [4]. In such conditions, of mobile anterior teeth, resulting in difficulty in speech and
a periodontal splint, as described by the American Academy mastication. The patient presented with the history of smoking
of Periodontology glossary of periodontology is, ‘an appliance 8-10 cigarettes per day, however he had quit smoking for four
designed to immobilize and stabilize loose teeth’ [5] is the pro- months at the time of presentation. The patient was a lawyer by
posed treatment option [3,6,7]. It is pertinent to mention here profession and hence had the requirement to be able to speak
that periodontal splinting alone does not treat mobility. It is an coherently and confidently. The patient accepted that he had
adjunct to the periodontal therapy [6,8]. With careful selection been negligent towards his oral hygiene but now is motivated
of the case for periodontal splinting, the life expectancy of mo- to follow oral hygiene religiously and was seeking the option
bile teeth is considerably increased [3], periodontium reaches a to retain the natural teeth.
stable environment to promote reattachment of lost supporting On examination, we observed heavy calculus deposits around
tissues [3,6,7] and improves the functionality, comfort and aes- lower anterior teeth. Tooth mobility as per Miller’s mobility
thetics for the patient [6,7]. However, periodontal splinting has index [12] showed that all incisors were mobile showing grade
come under scrutiny by some critics who consider periodontal II mobility with 41 showing grade III mobility. Periodontal
splinting to adversely affect patient’s oral hygiene measures re- charting, peri-apical x-rays and clinical examination classified
sulting in deterioration of periodontium [8]. this case as Stage III grade C periodontitis. After describing the
Copyright © All rights are reserved by Ayesha Hanif *, Haroon Rashid Baloch, Ali Kazi and Javairia Waqasi
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DOI: 10.46998/IJCMCR.2022.22.000541
ijclinmedcasereports.com Volume 22- Issue 4

case details and management options to the patient, the patient observed. Bonding agent was then applied on the etched sur-
consented to go for periodontal splinting once the follow up af- faces with the help of a micro brush, air dried and then cured
ter supportive periodontal therapy results in stable periodonti- with LED light for 15secs x2. The interproximal areas were
um and then a later attempt at the gingival phenotype modifica- blocked with polysiloxane (light body impression material) for
tion for the stability of periodontium. All the case pictures were stabilization of teeth and blocking out gingival area. The Rib-
taken with patient’s consent to be reproduced for educational bond strip was carefully held with the special instrument and
purposes, case documentation and evaluations at the follow up. wetted with resin before being safe to be held with the gloved
After meticulous supra and subgingival scaling and polishing hand. The excess resin was blotted. A thin layer (approx.
(under local infiltration) at the first visit, the patient was kept 0.5mm) of Ribbond securing composite was placed on the pre-
on follow up of 2 weeks, 4 weeks, 8 weeks and was kept on pared surfaces of the teeth. Holding the Ribbond with the metal
supportive periodontal therapy (Figure 1). On the fourth visit, plier, it was carefully adapted to the lingual and interproximal
periodontal splinting was done on the lower anterior teeth with surfaces of the teeth following the contour and anatomy (Fig-
Ribbond. The area was isolated for the preparation with cotton ure 2). The excess composite was removed and the Ribbond
rolls. A sterilized aluminium foil was used as the measure by was tack-cured (5 secs per tooth). Flowable composite was
tightly adapting it to the teeth. The measured foil was then used then carefully applied to cover all the fibers of the Ribbond
as a template for the Ribbond strip. Teeth 33-43 were etched and it was thoroughly cured for 30 secs per tooth (Figure 3).
with 37% phosphoric acid for 15 seconds and the etchant was Finally followed by occlusion check, finishing and polishing.
then washed off. After drying, a white frosty appearance was The patient mentioned that the splint was smooth and comfort-
able as well as aesthetic.

Figure 1

Figure 2

Citation: Ayesha Hanif *, Haroon Rashid Baloch, Ali Kazi and Javairia Waqasi. Periodontal Splinting - An Adjunct to Non-Surgical Periodontal Therapy
to Manage Tooth Mobility. IJCMCR. 2022; 22(4): 001
DOI: 10.46998/IJCMCR.2022.22.000541 2
ijclinmedcasereports.com Volume 22- Issue 4

Figure 3

Figure 4
At 4 months follow up, the patient presented with decreased of the forces on stronger teeth, thereby reducing the occlusal
pocket depth, stabilized dentition and comfortable mastication load on reduced periodontium. It is also noted that splinting
and speech. At this stage, the patient was scheduled for free induces bone remodeling process to prevent bone loss [15]. As
gingival graft therapy for phenotype modification (Figure 4). is noted in the reported case, the literature supports the im-
proved comfort, aesthetics and function of the patient as the
Discussion splint provided stability to the mobile teeth which will also be
Fiber reinforced resin composite splints are quickly gaining beneficial to eventual clinical attachment gain [7,9,10,14]. The
popularity as the material of choice for periodontal splinting. most pivotal prerequisite for a periodontal splinting case to be
It provides close adaptation to the tooth contours making them a success is the proper selection of the case. Taking care of the
failure resistant. They are bondable, reparable, aesthetic and indications and contraindications of the procedure will lead to
easier and quicker to adapt than the conventional wired splints clinically and functionally favorable outcomes in the long term
[11,13]. Periodontal splints are widely accepted and practiced [6,7]. Similarly, selection of appropriate splinting material fa-
as an adjunctive treatment for tooth mobility [14]. Literature vors the outcome too [1,9]. Based on the available data, it can
shows that splinting produces high survival rates and favor- be noted that splinting can be considered as an essential part of
able periodontal status of the splinted teeth over a considerable periodontal treatment to increase the lifespan of periodontally
follow up [3]. Splinting of the teeth helps in the redistribution compromised teeth with extended mobility.

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ijclinmedcasereports.com Volume 22- Issue 4

Conclusion 4. Ishikawa I, McGuire MK, Mealey B, et al. Consensus report on

As periodontal infection progresses, tooth mobility is an in- occlusal trauma: Effect and impact on the periodontium. Ann
Periodontol, 1999; 4: 108.
evitable consequence of loss of attachment. It affects the pa- 5. Search the Glossary - AAP Connect, 2022.
tient’s ability of speech, mastication and phonetics. Periodontal 6. Bali V, Singh RJ, Thind BSK. Review article on criteria for se-
splints are used in these conditions to alleviate these symptoms lection of patient for periodontal splinting. Int J Health Sci, 2021;
while also promoting stability of the periodontium, preven- 281–284.
tion of bone loss, gain in attachment loss and restoration of 7. PR486: Splinting of periodontal compromised teeth - results of
long-term conservative periodontal treatment in a university set-
function. Although periodontal splinting has had its fair share ting. J Clin Periodontol, 2018; 284–285.
of criticism in terms of aggravating plaque accumulation and 8. Kathariya R, Devanoorkar A, Golani R, Shetty N, Vallakatla V,
worsening attachment apparatus, the newer materials and tech- Bhat MY. To Splint or Not to Splint: The Current Status of Peri-
nological advancements evade the disadvantages quoted ear- odontal Splinting. J Int Acad Periodontol, 2016; 8; 18(2): 45-56.
lier in the literature. To manage and save periodontally mobile 9. Rauch A, Mehlhorn S, Mühle M, Ziebolz D. A glass fiber-rein-
forced resin composite splint to stabilize and replace teeth in a
teeth, periodontal splint are a proposed adjunctive treatment periodontally compromised patient. Case Reports in Dentistry,
option. 2020; 2020: 1–7.
10. Li L-J, Yan X, Yu Q, Yan F-H, Tan B-C. Multidisciplinary
Author contribution non-surgical treatment of advanced periodontitis: A case report.
AH performed the procedure and wrote the manuscript. HRB World J Clin Cases, 2022; 10(7): 2229–2246.
11. Periodontal splint – Ribbond. Ribbond, 2022.
checked and helped with the manuscript. AK helped in picto- 12. Miller SC. Textbook of Periodontia, 3rd ed. Philadel-phia: The
rial documentation of the procedure. Blakeston Co.; 1950.
Competing interest 13. Eminkahyagil N, Erkut S. An innovative approach to chairside
The authors declare no competing interest. provisional replacement of an extracted anterior tooth: use of
fiber-reinforced ribbon-composites and a natural tooth. J Prost-
References hodont, 2006; 15: 316-320.
1. Pramesti LS, Rahmawati S. Periodontal therapy with intracoro- 14. Mangla C, Kaur S. Splinting- A Dilemma in Periodontal Thera-
nal fiber splint in case of tooth mobility with crowded anterior in py. Int J Res Health Allied Sci, 2018; 4(3): 76-82.
adolescents: A case report. KnE Med, 2022; 359–369. 15. Machtei EE, Hirsch I. Retention of hopeless teeth: the effect on
2. Glargia M, Lindhe J. Tooth mobility and periodontal disease. J the adjacent proximal bone following periodontal surgery. Jour-
Clin Periodontol, 1997; 24(11): 785–795. nal of Periodontology, 2007; 78(12): 2246–2252.
3. Graetz C, Ostermann F, Woeste S, Sälzer S, Dörfer CE, Schwen-
dicke F. Long-term survival and maintenance efforts of splinted
teeth in periodontitis patients. J Dent, 2019; 80: 49–54.

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