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FROM the ARCHIVES

The last thing I want to do in this modest article is initiate a philo-sophical debate about the benefits

of splinting mobile teeth.

Most dentists recognize that splinting loose teeth won’t create attachment gain. If you don’t treat the underlying cause of the bone loss, the teeth will probably be just as mobile after you remove the splint as they were before they were splinted.

Then there’s also the “Exactly-who’s-influencing-whom?” question. Are the strong teeth helping the weak teeth more than the weak teeth are hurting the strong teeth? More than once I’ve splinted a mobile tooth to two stable teeth... only to wind up with three mobile teeth (NOT my objective.)

But the fact that splinting won’t cure perio disease doesn’t mean it’s superfluous.

Stabilizing mobile teeth may buy some time during periodontal diagnosis. The current consensus among researchers is that excessive mobility should be prevent-ed during attachment regeneration.1 And temporary splinting is standard operating procedure after periodontal treatment, traumatic loosening or replanting, and after adult orthodontics.

At the very least, hyper-mobility inter-feres with mastication and comfort. For unfortunate patients with hopelessly un-stable anteriors, some low-cost splinting may improve their quality of life. Direct adhesive splinting provides a fast low-cost alternative to traditional prosthetic splinting. This makes it worth considering for patients of limited means, or for cases where a poor prognosis precludes a mas-sive investment in cast metal.

The simplest splint of all

If mandibular teeth have only slight-to-moderate mobility, the easiest option is direct adhesive bonding to adjacent teeth. This approach is absolutely non-invasive and completely reversible.

C&B-Metabond’s unique resilience (its low modulus of elasticity) makes it

excellent for direct splinting applications. Mobile teeth are never equally mobile. Furthermore, they wobble in different directions. This puts considerable stress on the resin linking them.

Highly filled composites (the kind you typically use for restorations) and most resin cements are relatively inflexible. As a result they tend to fracture quickly when used to connect teeth in splinting applications.2

Because C&B-Metabond is resilient, it tends to absorb stress and reduce the fracture potential.

At least, to a point.

According to Milton Glicksman, DDS (New Bedford, MA) who has considerable experience using C&B-Metabond for one-appointment splints “C&B-Metabond alone makes the world’s best direct periodontal splint for lower anteriors. For a strong, esthetic splint just use the clear powder with the Neelon technique.”

However when the teeth are hypermo-bile or subjected to extreme forces, it’s prudent to add some reinforcement to the adhesive. For example, in the pos-terior, Dr. Glicksman adds twisted wire to the cement. “On upper anteriors I use C&B-Metabond to bond Ribbond® into a channel and then cover it with composite (to improve the wear resistance.)”

An example – A dentist wanted to splint mobile anteriors #23-26 to improve function and to pre-serve them as long as possible. However, the questionable prognosis plus economic concerns precluded a traditional casting. Instead, he decided to adhesively bond the teeth. After treating the proximal surfaces with the Red Enamel Activator (phosphor-ic acid), the teeth were rinsed and dried. C&B-Metabond’s Base (4 drops) and catalyst (1 drop) were mixed in one well of the ceramic mixing dish, and a scoop of C&B-Metabond’s clear powder placed in the second well.

The liquid was brushed onto the proxi-mal areas. Then using the brush-dip (or

A 10-minute Adhesive Splint For Mobile Teeth From Nelson Gendusa, D.D.S. – Director of Research

Fig. 1

Fig. 2

Fig. 4

Fig. 3

(Fig. 1) In an simple 10-minute proce-dure, C&BMetabond is applied using the brush/dip technique.

(Fig. 2) Because he used C&B-Meta-bond’s clear powder, the adhesive splint is almost invisible.

(Fig. 3) As you can see, the result looks pretty good. After 3 years 7 months, there has been no further gingival recession. Though the bone level remains perilously low, the teeth are comfortable and stable.

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Neelon) technique the cement was applied (Fig. 1). Though the entire cementing pro-cedure took approximately ten minutes, the patient was kept in the chair for an additional 20 minutes to assure complete polymerization of the resin.

The clear powder is generally reserved for cases like these where you want the adhesive to be inconspicuous. As you can see in the photo taken one month later (Fig. 2), the esthetics are quite good.

A quick comparison of the recall pho-tograph taken 3yrs 7mos later with the 1-month photo shows that gingival reces-sion has stopped (Fig. 3).

The radiograph (3yrs 7mos) reveals peril-ously little bone support (Fig. 4). Never-theless, the teeth remain comfortable and continue to function.

Here’s a golden oldie (Quite literally considering the alloy used)...Fiber reinforcing materials have made direct adhesive splinting so easy and predictable that I doubt anyone would still splint teeth like this today. But I’m including it to make several points about splinting ... and C&B-Metabond.

For one thing this was one of the first cases ever cemented with C&B-Meta-bond. This splint was bonded way back in 1980... almost 2 decades ago. No other adhesive can show you this kind of long-term success.

(Fig. 5) In 1979 a female patient presented at the Ma-saka Dental Clinic suffering severe periodontal disease. During the next 14 months the patient responded well to perio therapy, and it was decided the prognosis was good enough to splint the lower anteriors.

Fig. 5

(Fig. 9) Here’s the radio-graph taken 14 yrs 3 mos. after cementation. The anteriors remained stable.

Fig. 9

(Fig. 11) However, the splint was not entirely trouble-free. After slightly more than 17 years, the lingual plate on the right canine popped off.*

Fig. 11

(Fig. 12) In this particular case, after the loose wing was sectioned, the canine was found to be so stable that it continued to function un-splinted.

Fig. 12

(Fig. 10) A lingual view of the splint 15 years, 5 months after cementation. Though there was some tissue resorption, the teeth remained stable without complications.

Fig. 10

(Fig. 7) To do this, a piece of orthodontic wire was temporarily bonded to the facial surfaces.

Fig. 7

(Fig. 8)A lingual splint was cast of gold-platinum alloy. The casting was heat-treated in an oven to oxidize the surface. (Since the 4-META molecule bonds to metal-lic oxides, heating a noble metal to encourage oxida-tion can double or triple the bond strength.) The splint was then bonded to the linguals of #22-26 using C&B-Metabond mixed with the opaque powder.

Fig. 8

Fig. 6

(Fig. 6) Though the radiograph revealed substantial alveolar support, the teeth were highly mobile ... SO mobile in fact that they had to be stabilized before an impression could taken.

*Partial debonds like this are the bane of bonded bridges. Repair often poses a serious problem, because you may have a devil of time removing the bonded portion. This is one of the reasons I’m not among the bigger fans of the Maryland-type bonded bridge. Furthermore, retentive wings rarely wait 17 years to pop!

References 1 Annals of Periodontology - 1996 World Workshop in Periodontics. p 627) 2 Heinz B. Fabrication and strategic significance of a special resin composite splint in advanced periodontitis. Quint Int. Vol:27, p44, Jan 96)