Periodontal splinting is a common dental procedure used to stabilize loose or mobile teeth and reinforce weakened gum tissue. This technique can help restore comfort and function when teeth become loose due to periodontal disease, injury, or other causes.

Periodontal splinting involves attaching loose or drifting teeth to nearby healthy, stable teeth using a dental splint made of composite material or thin wire. The splint connects the loose teeth together to provide a unified structure and redistribute biting forces across multiple teeth instead of just one.

By binding loose teeth to their neighbors, a periodontal splint transforms them into a more robust and immobile unit. It acts like a cast keeping the injured finger in place to heal. This stabilization and redistribution of pressure prevents further movement of mobile teeth, giving the gums and bone tissue a chance to reattach and regenerate.

Periodontal splinting is commonly performed on the front teeth, frequently the first to exhibit looseness, especially from gum disease progression. It provides both functional and cosmetic benefits. Splinting can reduce discomfort, improve chewing ability, prevent tooth drift and loss, aid gum healing, and support implants or bridges.

Many modern periodontal splints utilize strong, thin fibers such as Ribbond, which are coated with a bonded composite resin material similar to dental fillings. The fibrous composite material offers advantages over older metal wire splints.

The fibers are adaptable and can tightly integrate between the teeth, providing excellent rigidity and durability to the splint. The composite resin coating is tooth-colored, minimizing aesthetic impact unlike metal wires. The splint can be precisely shaped and customized to the patient’s teeth.

The resin material chemically and micro-mechanically bonds to tooth structure for additional reinforcement. Research shows the fibrous composite splints distribute stress more uniformly. This enhances stability and reduces any damage to the periodontal ligaments.

The fiber material also facilitates oral hygiene around the bonded splint, which is crucial for periodontal health. Composite splints are thin yet strong, providing superb stabilization without much bulk or discomfort in the mouth.

There are several options when it comes to periodontal splint types and methodology:

  • Temporary or provisional splints – These non-permanent splints stabilize teeth temporarily, allowing healing. They can be made chairside from fiber, wire, or acrylic.
  • Permanent or fixed splints – This type permanently attaches teeth using fixed restorations. It may involve crowning the teeth and using metal bands to link the crowns into a robust unified structure.
  • Passive splints – Passive splints simply immobilize and do not exert active forces on teeth. Examples are wire or composite resin splints.
  • Active splints – Active splints employ forces on teeth to intentionally reposition or orthodontically move them. These include orthodontic bands or arch wires.
  • Intra-coronal splints – Intra-coronal splints fit inside a prepared channel within the teeth created by the dentist. The ribbon splint is embedded for maximum rigidity.
  • Extra-coronal splints – Extra-coronal splints are placed externally on the surface of teeth and bonded for stabilization. These are commonly used as they are non-invasive.

The choice of splint type depends on factors like the severity of looseness, number of teeth involved, desired longevity, cost, and restorability of the teeth. Conventional wire or newer fiber-reinforced composite resin splints can both offer reliable stabilization.

The total duration of the periodontal splint procedure can vary considerably based on the individual case and complexity:

  • Simple splint placement may take as little as 30 minutes to 1 hour.
  • More involved procedures with extensive tooth preparation or intra-coronal splints can take 2 or more hours.
  • If combining the splint with crown placement, plan for additional time. Crowning each tooth typically takes up to an hour.
  • Factors like the number of teeth being splinted and additional restorations needed also add time.
  • The first appointment is often focused on examination, diagnosis, and thorough treatment planning.
  • Splint fabrication time depends on the materials and method used. Prefabricated wire or fiber splints speed up the process.

With careful planning and streamlined techniques, many periodontal splint placements can be performed within a single office visit.

However, severely compromised cases with extensive restoration needs may require multiple longer appointments to complete.

When teeth become excessively loose, it can negatively impact important oral functions like chewing, breathing, and speech. Periodontal splinting helps restore proper function by stabilizing the teeth.

  • Chewing – Splinting greatly improves chewing capacity by redistributing biting forces over multiple teeth again. The immobilized teeth can better withstand chewing pressure. It eliminates discomfort from loose teeth movements during eating.
  • Breathing – Loose teeth can slowly drift and lead to gaps forming. This allows extra air to pass in and out while breathing or speaking. Splinting prevents gaps from widening, improving breathing control.
  • Speech – Certain consonant sounds like “s” rely on precise teeth contact. A splint prevents loose teeth from moving during speech, improving enunciation.
  • Comfort – Immobilizing loose teeth eliminates the unpleasant sensation of teeth wiggling in the gums. This restores dental comfort.

The periodontal splinting procedure aims to maintain or regain proper oral functionality for optimal dental health and daily life. The stabilized bite enables effective chewing, clear speech, and improved breathing control again.

Periodontal splinting offers many benefits but also some inherent risks to consider:

# Benefits

  • Stabilizes loose teeth and eliminates painful movement
  • Aids periodontal healing and regeneration around teeth
  • Restores ability to chew, speak, and breathe properly
  • Redistributes biting forces more evenly
  • Prevents tooth movement, tipping, and further loosening
  • Can aid bone grafting or implants for missing teeth
  • Provides psychological relief from tooth looseness worries

# Risks and Complications

  • Excessive wear or breakage of the splint material over time
  • Risk of decay around the margins of the splint if oral hygiene is poor
  • Possible irritation or discomfort from the splint during the adaptation period
  • Adverse reactions in extremely rare cases to bonding agents used
  • Splinting alone will not cure or halt gum disease progression
  • Long-term prognosis still depends on effectively controlling periodontal infection

When performed properly, periodontal splinting offers a favorable benefit-to-risk ratio in the majority of cases. Like all procedures, there are some inherent risks. Following the dentist’s at-home care instructions helps minimize any complications.

Protecting oral health should be the priority after getting a periodontal splint. Excellent at-home care and hygiene is crucial:

  • Careful brushing – Gently brush around splint margins thoroughly at least twice daily. Use a soft brush and watch for bleeding, which indicates potential irritation.
  • Flossing – Use thin floss to clean between the teeth and under the splint. Be gentle when threading it through.
  • Rinsing – Rinse daily with an antiseptic mouthwash to prevent bacterial buildup and infection around the bonded splint.
  • Cleaning aids – Interdental brushes and water irrigation devices help clean splint areas.
  • Follow-up visits – See the dentist as directed for required adjustments and plaque removal.
  • Diet – Avoid very hard, chewy, or sticky foods which could damage the splint. Cut food into smaller pieces.

With diligent at-home care and oral hygiene, periodontal splint complications can be minimized for optimal dental health.

For patients with diagnosed bruxism or teeth grinding issues, an occlusal splint can be an effective part of protective periodontal treatment:

  • Worn over the teeth like a mouthguard, a custom occlusal splint provides a cushioning barrier during grinding or clenching while sleeping.
  • This prevents destructive grinding forces from damaging teeth, gums, and periodontal ligament tissues.
  • It absorbs and distributes occlusal forces evenly over all the teeth, reducing pressure on any one area.
  • It can minimize chipping or fractures of tooth structure.
  • It protects against excessive wear of tooth enamel.
  • It reduces muscle tension and soreness of the jaw joints linked to bruxism.
  • It may help reposition the jaw to aid relaxation of chewing muscles and reduce grinding reflex intensity.

When used consistently and properly, an occlusal splint is an important therapy for minimizing the effects of grinding or clenching and preventing further periodontal injury.

For most routine dental splint placements, significant pain is uncommon during the procedure. There are several reasons periodontal splinting is not typically very painful:

  • Local anesthesia is used – The gums around the affected teeth are numbed using an injection, preventing pain.
  • Little to no tooth drilling – Unlike a filling, often no tooth drilling is required, minimizing sensitivity.
  • Bonding agents used – Bonding composite resins are relatively gentle on the enamel surface.
  • Minor adjustments only – No major tooth reshaping is required in most cases. Only minor adjustments are made to improve the fit of the splint.
  • Careful tooth isolation – Cotton rolls, cheek retractors, and suction are used to ensure the teeth stay clean and dry during placement, preventing irritation.
  • Minimal time – Quick bonding techniques minimize the length of time teeth are exposed and prepared.

With proper numbing and clinical care, patients generally experience only mild sensitivity or discomfort during the splint placement process. Any postoperative soreness is also usually minor and manageable with over-the-counter pain medication as needed.

The use of local anesthesia is routine and recommended for patient comfort during periodontal splint placement:

  • Injection – This involves delivering the anesthetic solution via a small injection into the gingival tissues surrounding the affected teeth. The numbness lasts for several hours.
  • Topical – A numbing gel may first be applied to the injection site to minimize any pinprick sensation.
  • Type of anesthetic – Common choices are lidocaine, articaine, or bupivacaine formulations. These all provide effective and safe dental numbing.
  • Quantity – Only a small amount is needed to sufficiently numb just 2-4 teeth for splint placement. This minimizes post-procedure numbness duration.
  • Supplemental – Additional small injections can supplement the anesthesia as needed if the initial dosage wears off before completing treatment.

Thanks to modern local anesthetics, the periodontal splinting procedure can generally be performed comfortably using minimal amounts of dental numbing agents. This facilitates a pain-free experience for the patient.

The intended longevity and purpose of the dental splint determines how long it needs to remain on the teeth:

  • Temporary splints – These are designed for short-term stabilization from several weeks to months. They can be removed later once healing has occurred.
  • Transitional splints – These medium-term splints aim to immobilize teeth for several months up to 2 years. They can be replaced with a permanent splint if needed.
  • Permanent splints – Fixed restorative splints are designed for long-term durability and can potentially last for many years.
  • Healing from injury – If splinting due to trauma, temporary stabilization for around 2 weeks allows initial bone and ligament healing.
  • Gum disease stabilization – For looseness from gum disease, using a splint for at least 4-6 months allows gum tissues to reattach and strengthen.

The periodontist will determine an appropriate recommended splint duration tailored to the specific clinical needs and goals. Regular progress exams help evaluate when the splint can be removed or replaced.

Meticulous oral hygiene is extremely important after periodontal splint placement to prevent complications:

  • Brushing and flossing around the splint takes extra care and time. Using specialized tools can aid in cleaning.
  • Supplementary use of antiseptic mouthwash helps reduce bacterial buildup.
  • More frequent professional cleaning appointments allow plaque removal from splinted areas.
  • Despite best efforts, some additional plaque accumulation around the bonded margins still occurs.
  • Gingivitis and further periodontal infection are risks if inflammation and bacteria are not well controlled.

While posed challenges, oral hygiene can be maintained with diligence, patience, and proper home care technique. The dentist will provide specific hygiene guidance for caring for the splinted teeth and gingival tissues.

While an adjustment period is needed, eating with a periodontal splint is possible by following certain precautions:

  • Take care when first chewing, as sensitivity or soreness may be felt until the bite equilibrates.
  • Cut harder foods into smaller pieces to reduce pressure on the immobilized teeth.
  • Avoid very sticky, hard, crunchy, or chewy foods that could damage the splint. Caramel, nuts, popcorn, hard candy, and chewing ice should be avoided.
  • Start with softer foods and work back up to a normal diet as tolerated.
  • Thoroughly clean the teeth and splint after eating to remove any trapped food particles.
  • Take anti-inflammatory medication as recommended to reduce any initial swelling.

With time, the bite will adapt to the splint, and patients are often able to resume a relatively normal diet. But care should always be taken to not over-stress the stabilized teeth and protect the integrity of the splint.

The cost of periodontal splint treatment depends on several factors:

  • Extent of the procedure – Simple splinting is less expensive than multiple crowns with fixed bridges between teeth.
  • Type of materials used – Gold or porcelain restorations cost more than composite resin and fiber splints.
  • Dentist fees – Specialist periodontist fees tend to be higher than general dentists.
  • Dental insurance – Coverage and percentages paid by insurance can reduce out-of-pocket costs.
  • Location – Costs are generally higher in metro areas versus rural areas.

On average, direct costs may range between:

  • $250 – $500 per tooth for simpler composite resin splinting.
  • $500 – $1,500+ per tooth for more complex rehabilitation with crowns and fixed bridgework.

Additional costs may accrue for anesthesia, temporaries, impressions, oral sedation, or follow-up visits. When considering expense, the benefits of potentially saving severely loose or drifting teeth often outweighs splint costs.

In conclusion, periodontal splinting serves an important role in stabilizing mobile teeth and stopping progressive loosening.

When performed by a skilled dentist or periodontist, splinting can durably reinforce loose teeth, allowing improved function and extended tooth lifespan. However, Orthodontic treatment can serve as an alternative to splinting.

It repositions teeth to distribute forces evenly. However, any underlying periodontal disease must be managed before orthodontic treatment can commence.

With regular dental exams and proper daily oral hygiene, complications can be minimized. Patients with loose or shifting teeth should discuss options with their dentist.

Useful Links:

The impact of splinting timepoint of mobile mandibular incisors on the outcome of periodontal treatment—preliminary observations from a randomized clinical trial

Periodontal splinting: A review before planning a splint

Survival of nonsurgically splinted mandibular anterior teeth during supportive maintenance care in periodontitis patients