Patients' frequently asked questions
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What is meant by periodontal splinting?
The ligating, tying, or joining of periodontal involved teeth to one another in order to stabilize and immobilize the affected teeth.
Mobile lower anterior teeth is a common complaint of dental patients with fairly advanced periodontal disease. The treating of these mobile teeth is often not very successful. The mobility is caused by a loss of supporting bone around the roots of the teeth. Even comprehensive periodontal treatment can not replace this missing bone and the prognosis for these teeth is poor. In the majority of cases the lower four incisors (the four teeth between the two lower canine teeth) are the teeth showing the first signs of mobility.
What treatment options are available for mobile teeth?
The most logical way to treat the mobility once the active periodontal disease is under control would be to splint these mobile teeth. Various methods of splinting are employed by dentists. The most frequently used technique is to use orthodontic stainless steel wire, bonded on to the lingual surface (or inside) of the teeth with composite (white filling material) which acts as a splint. This method has some success but the metal wire is quite rigid, and this type of splint tends to debond and fail in time. Another disadvantage of this technique is that there is no true bonding between the metal wire and the composite filling material. There can also be aesthetic compromises with this technique, but the concept is good and these splints are an option if nothing better is available.
What are other treatment options available to these patients in need of periodontal splinting?
The other options are mostly quite invasive and non-reversible. They can involve:
1. The extraction of the mobile teeth, and replacing the extracted teeth with a removable, partial denture.
2. Cast precious metal splints.
3. Extractions of the mobile teeth and replacement with dental implants. This may not be possible as these may require expensive and technique sensitive bone grafting procedures to provide a bony foundation for the implants as bone is lost in the periodontal disease.
What does the literature say about splinting?
“Severely mobile teeth, if in health, can be retained almost indefinitely.” - (Pollack, 1999)
“Used correctly, periodontal splinting can greatly improve the comfort, prognosis and outcome for a patient with serious periodontal disease. But used incorrectly, splinting can cause further deterioration in periodontal health.” - (Roger F Mosedale, Dental Update 2007)
“Splinting is not a substitute for periodontal treatment.” - (RE Rada, ‘Mechanical stabilization in mandibular anterior segment’, Quintessence Int 30:243-248, 1999)
But more importantly:
- The underlying periodontal disease must first be treated
- Splinting is not a quick solution to simply stabilize loose teeth
- Splinting is always a part of a periodontal treatment plan
- The patient must be able to maintain the splint and the gingivae and keep the area clean, and thus disease free.
- The necessity of regular follow-up visits to an oral hygienist cannot be stressed enough.
What is the everStick periodontal splint?
A relatively new technique for splinting mobile teeth is available in the everStick periodontal splint. The fibre reinforced composite periodontal splint stabilizes the mobile teeth and ensures a more comfortable chewing function for the patient. In this technique, glass fibre strands embedded into a polymer bis GMA matrix (resin) are used to reinforce the composite white filling material, which splints the mobile teeth together. The glass fibre bundles are embedded into the same matrix as is found in the composite (white filling) material and true bonding is obtained between the fibres and the composite filling material. The bond obtained between composite resins and etched enamel is the strongest bond possible in the oral cavity ( Bond strength of approximately 28 MPa). The flexural strength of the everStick fibres is as high as that of chrome cobalt cast metal but the splint has the advantage of not being completely rigid, but has a modulus of elasticity very close to that of dentine. The elasticity of the fibres may be beneficial to the healing of the supportive dental tissue. A fibre splint constructed in this way will form an reliable integrated structure which will give a potentially long term solution to the problem of mobile teeth. The fibres are transparent and unnoticeable when covered with the tooth coloured composite filling material. It is therefore possible to create an aesthetically pleasing splint on the inside of the mobile teeth.
What does the procedure involve?
Almost all cases of FibreBond splinting are completed without local anaesthesia. A very shallow groove is prepared on the lingual (inside) surface of the teeth, which are to be splinted. The groove does not normally extend into the dentine of the teeth, but stays within the enamel where the best bonding will be obtained. Placing rubber dam isolation in these cases will simplify the procedure for both the dentist and the patient and is recommended.
What happens if I have already lost a tooth?
Another exciting benefit of the fibre bond periodontal splint is the possibility of replacing a missing tooth by building up an artificial tooth, directly onto the fibre splint. There are several methods of constructing a replacement tooth. In some carefully selected cases the patients own tooth can be bonded onto the fibre splint. In some cases the option of using an acrylic denture tooth can also be bonded to the splint. It is also possible to use Composite filling material to construct a replacement tooth. This composite tooth can also be reinforced with everStick fibres.
What will a procedure like this cost me?
The whole procedure is completed in one session and should not take longer than an hour. The fact that these fibres are high technology materials and the treatment requires special skills the fee charged might differ from practice to practice. The average fee for a fibrebond splint from canine to canine will be £450 (to be discuss with the dentist).