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Continuing Education
Tooth Stabilization ImprovesPeriodontal Prognosis:
A Case ReportAuthored by Howard E. Strassler, DMD
Course Number: 117
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ABOUT THE AUTHORS
Dr. Strassler is professor in the Depart-ment of Endodontics,
Prosthodontics,and Operative Dentistry at the Universityof Maryland
Dental School. He can bereached at [email protected].
Disclosure: Dr. Strassler has received research fundingfrom
Ribbond.
INTRODUCTION
As patients are keeping their teeth throughout theirlifetimes
due to advances in periodontal treatment, theprogression of
periodontal disease does continue. For patientswith moderate to
severe chronic periodontitis, the developmentof tooth mobility can
be a significant factor compromisingtreatment prognosis.Mobility
may be caused by inflammation ofthe periodontium, loss of
periodontal attachment, or functionalor parafunctional forces on
teeth.1 Splinting of teeth isconsidered to an important component
of occlusal treatmentwhen tooth mobility is present.
This article discusses how stabilization of mobileperiodontally
involved teeth can improve the long-termprognosis. A clinical case
is presented to demonstrate thetreatment outcome that can be
achieved with a stabilizationtechnique.
TOOTH STABILIZATION
A splint has been defined as an apparatus, appliance,or device
employed to prevent movement or displacementof fractured or movable
parts.2 In dentistry, splinting or toothstabilization usually
refers to joining teeth together eitherunilaterally or bilaterally,
to transmit increased stability tothe entire restoration.
Typically, a splint is indicated due to asingle tooth or multiple
teeth having mobility. Spear3presented 4 goals of occlusal
treatment: (1) to control theamount of loading that occurs at the
temporomandibularjoint; (2) to control the load that the tooth
receives so thatthe periodontium is not overstressed; (3) to
control the loadplaced on the occluding surfaces of the teeth; and
(4) toproduce an occlusal relationship with no pathologicalsymptoms
for the muscles of mastication.
When mobile teeth are present, tooth stabilization withsplinting
can be a factor for successful occlusal treatment.
Tarnow and Fletcher4 described the indications
andcontraindications for splinting periodontally involved
teeth.They stated that the rationale to splint teeth should bebased
upon the degree of periodontal compromise of thedentition, based
upon the amount of radiographic bone lossand/or measured tooth
mobility. The primary reasons tocontrol tooth mobility with
periodontal splinting are: (1) primaryocclusal trauma; (2)
secondary occlusal trauma; and (3)progressive mobility, migration,
and pain on function.
Primary occlusal trauma is defined as injury resultingfrom
excessive occlusal forces applied to a tooth or teethwith normal
periodontal support. Secondary occlusaltrauma is injury resulting
from normal occlusal forcesapplied to a tooth or teeth with
inadequate periodontalsupport. Tooth mobility has been shown to
contribute todecreased masticatory and occlusal function, as well
aspatient discomfort when eating. Identification of
progressivemobility requires repeated clinical observations over
aperiod of weeks to months.
In the past, the use of splinting of periodontallycompromised
teeth was contentious. The presumption wasthat the use of splinting
to control tooth mobility wasrequired to control gingivitis,
periodontitis, and pocketformation. It was assumed that mobility
had a directrelationship to attachment loss and vertical osseous
defect
Continuing Education
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Recommendations for Fluoride VarnishUse in CariesManagement
LEARNING OBJECTIVES:
After reading this article, the individual will learn:
The effects of tooth stabilization on the long-termprognosis of
teeth with mobility due to periodontal disease.
A technique for stabilizing mobile teeth via splinting.
Tooth Stabilization ImprovesPeriodontal Prognosis:A Case
Report
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formation. Another assumption was that increasing toothmobility
was a direct consequence of traumatic occlusion,bruxism, and
clenching. Consensus also pointed to the factthat even normal
physiologic function including masticationand swallowing
contributed to tooth mobility.5
A number of periodontal clinical studies investigatedthese
assumptions.When teeth were occlusally overloadedand other
variables that contribute to periodontal diseasewere controlled, it
was difficult to produce gingivitis,periodontitis, and pocket
formation.6,7 Another studyreported no correlation between
splinting and reducedtooth mobility during initial periodontal
therapy.8 Control oftooth mobility with splinting after osseous
surgery did notreduce mobility of the individual teeth.9 Tooth
mobility,however, can be controlled and managed with
splintingtherapy.10-12 The evidence demonstrates support for
toothstabilization via splinting to improve the
periodontalprognosis.1,11-17 Once teeth are splinted the splint
must bemaintained, and the patient and clinician must becommitted
to recalls on a regular basis for periodontalmaintenance. Splinting
of teeth is a long-term commitmentby clinician and patient.
Occlusion has been associated with periodontalhealth.18
Glickman19 postulated a model referring to the roleof controlling
abnormal occlusal forces in obtainingimprovements in gingivitis and
periodontitis that causegingival inflammation. His concept
described that traumafrom occlusion had the potential to result in
infrabonypockets and vertical osseous defects. Waerhaug, et al20and
Manson21 reviewed a similar hypothosis and concludedthat there was
little evidence to validate a relationshipbetween trauma from
occlusion and severity of periodontaltissue breakdown. Occlusal
trauma and mobility in theperiodontally compromised dentition can
contribute to adeteriorating periodontal prognosis.1,13,14,18
In clinical studies with teeth occlusally overloaded,while other
variables that contribute to plaque-inducedperiodontal disease were
controlled, it was difficult toproduce gingivitis, periodontitis,
or pocket formation.6,7Studies investigating posterior tooth
mobility establishedthat during and after periodontal initial
therapy there was nosignificant difference in the mobility of
nonsplinted teeth and
splinted teeth (after removal of the splint).8-10,22
Increasedtooth mobility is detected clinically and described in
termsof amplitude of displacement of the clinical crown. Again,
itmust be reiterated that the cause of detected tooth
mobilityshould be further clarifiedwhether by reduced height
ofsupporting tissues as a result of plaque-inducedperiodontal
disease, or by trauma from occlusion, or acombination thereof.
Tooth mobility is reported duringperiodontal charting, often using
the Miller Index.23 Degreezero mobility is considered physiologic,
whereby the toothis mobile within the alveolus at approximately 0.1
to 0.2 mmin a horizontal direction. The Miller index defines a
degree1 mobility as a tooth that moves approximately 0.5 to 1.0mm.
A degree 2 mobility will exceed 1 mm in a horizontaldirection. A
degree 3 classification refers to a tooth that notonly has a
facial-lingual component but also is depressible.
There is no doubt that splinting does reduce toothmobility while
the splint is in place.1,10,11,24-26 Currently, it isgenerally
accepted that tooth mobility is an importantclinical parameter in
predicting periodontal prognosis ofthose teeth.27 The main reasons
to stabilize theperiodontally compromised dentition with splinting
include:decreasing patient discomfort, increasing occlusal
andmasticatory function, and improving the periodontalprognosis of
mobile teeth.28 Further, regenerativeprocedures using membranes and
bone graft have greaterpredictability if tooth movement is
eliminated.29,30
Over the years there have been many differentrestorative
techniques used for splinting teeth. Beforeadhesive restorative
dentistry had been introduced theoptimal choice for splinting teeth
was the use of fullcoverage cast restorations. Each tooth to be
splinted had acrown placed and all the crowns were joined
together.11,31The advantage of this technique was that the teeth
could bestabilized with an acrylic resin provisional restoration
duringperiodontal treatment. At the completion of active therapythe
definitive cast restoration was fabricated andcompleted. Over the
relatively short period of time oftreatment for some teeth the
prognosis was difficult todefine and could lead to premature
replacement of theporcelain-metal fixed-partial denture splint as
teeth werelost. A more conservative approach had been reported
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Tooth Stabilization Improves Periodontal Prognosis: A Case
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using a cast gold restoration for the lingual surfaces of
themobile teeth, with the used of pin retention placed in thetooth
preparations and cast into the metal framework.32
The clinical success of adhesive bonded compositeresin to etched
enamel led to case reports and techniquesusing a variety of
materials. One modification of the castmetal lingual splint was use
of a resin bonded adhesivetechnique to retain the splint.33,34
Direct placement, singlevisit splints have been described. Clinical
techniques usingwires twisted around teeth and covered with
resins,12 metaland nylon mesh embedded into resins,35 and for
posteriorteeth the use of channels prepared into the occlusal
andproximal surfaces of teeth or into existing amalgamrestorations
with either cast bars or thick wires placed in thechannels and
covered with resins have been reported.36,37Clinical failures of
these materials were common becauseof loading stresses placed on
the splint during normal andparafunction.12,38 Repairs of these
splints usually led toovercontoured and overbulked restorations.
Theseovercontoured restorations led to hygienic difficulties
andfood and plaque retention.14,25
Composite resins by their chemical nature are brittlematerials.
In function when supporting pontics or stabilizingmobile teeth,
cracks within the connector areas can lead tooutright
fracture.39-42 The introduction of bondablereinforcement ribbons
and fibers, when embedded intocomposite resins, created a laminated
structure withimproved physical properties and a greater resistance
tofracture. Research with fiber reinforced composite resinshas
demonstrated that both glass, eg, Splint-It (PentronClinical) and
ultra-high molecular weight polyethylene(UHMWPE) fiber
reinforcement, eg, Ribbond THM(Ribbond) materials provide an
increase in flexural strengthand flexural modulus of composite
resins.39-41
Clinical evaluations of bonded fiber-reinforcedcomposite resin
restorations for both splinting and for fixed-partial dentures have
been clinically successful.43-45 Whenselecting reinforcement fibers
for use in periodontalsplinting, since all such materials provide
dental compositeresins with equivalent reinforcement properties,
ease of useand an assortment of widths of the fibers are
primarycriteria. In a multiuser evaluation, ease of use was a
primary criterion for acceptance of use of bondable
fiberreinforcement.39
The following case report describes the use of a
fiber-reinforced composite resin splint placed to stabilize
aseverely periodontally compromised dentition in order toevaluate
tooth prognosis. Over the next 6 years, thepatients compliance in
oral hygiene and periodontalmaintenance improved the overall
periodontal prognosis,leading to the treatment of the remaining
maxillary teethwith a porcelain-metal fixed-partial denture. This
casereport demonstrates that using the treatment
techniquesdescribed when treatment planning similar
clinicalsituations can lead to improved periodontal prognosis.
CASE REPORT
In 1991 a 40-year-old female presented to the dentalschool
clinic for treatment. She had a past history of drugabuse, smoking,
and psychiatric treatment for depression.Her first visit was due to
acute pain that resulted in a toothextraction. She expressed a
desire to seek regulartreatment. A treatment plan was formulated
and she wasdiagnosed with adult moderate periodontitis. Over the
next6 years she sought only intermittent care, with treatment
fordental emergencies relating to acute pain. In early 1997
thepatient returned, and was examined and treatmentplanned. She had
changes in her life circumstances thatwould lead to receiving more
regular care and followingthrough on treatment.
This narrative will focus on the patients periodontalcare and
restorative recommendations based upon herperiodontal conditions
(Table) (Figure 1). One facultymember had suggested an immediate
maxillary denturebased upon the patients periodontal status and
financiallimitations. The patient rejected the idea of extracting
themaxillary teeth. For the patients periodontal condition,scaling
and root planing, occlusal adjustment to stabilizeher occlusion,
and periodontal splinting with a bonded fiberreinforced ribbon
composite splint was planned.
Periodontal and occlusal trauma contribute to toothmobility. Due
to financial considerations, the treatment planfor an occlusal
adjustment and the placement of a fiber
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Tooth Stabilization Improves Periodontal Prognosis: A Case
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splint was based upon the patients desire to nothave a removable
partial denture to provide forposterior support. In 1997, the
placement andrestoration of implants was not as commonplaceas it is
today, as furthermore, the cost of implanttreatment would have made
restoration of theposterior area with implants unfeasible for
thispatient. Although fiber splints would be aprovisional solution
considering the patientsextensive bone loss (60%) and significant
toothmobility without posterior occlusal support, thepatient was
willing to have repairs of the splint aswould be needed when
fractures occurred. TeethNos.4, 7, 8, 10, and 12 had degree
1mobility; teethNos. 5 and 11 had degree 2 mobility; and tooth No.9
was depressible with a degree 3 mobility.
Since the focus is whether or not splintingand tooth
stabilization contribute to improvementin periodontal and tooth
prognosis, treatment ofthe maxillary arch will be presented. As
part ofinitial therapy all the teeth were scaled and rootplaned and
polished (Figures 2a and 2b). Tocontrol occlusion and occlusal
trauma, the teethwere occlusally adjusted. Also, since theprognosis
was guarded for many of theremaining maxillary teeth, the decision
was toplace a fiber reinforced composite resin splint toinclude all
the maxillary teeth (Nos. 4 to 12)before pocket elimination
surgery. The design ofthe fiber splint included endodontically
treatedtooth No. 5 where a double fiber ribbon would beplaced into
the pulp chamber, and this doublefiber would be included in the
pontic area of No.6 to create a beam effect, strengthening
theconnectors of this directly placed fixed-partialdenture.39 The
advantages of a directly bondedfiber reinforced composite resin
splint is that it is asingle-visit procedure and allows for an
evaluationof tooth prognosis before treatment planning
aporcelain-metal fixed-partial denture.1,31
Maxillary splints placed on the lingual surface
withreinforcement materials have the disadvantage of wear
through the composite resin, perforating into thereinforcement
material, and the forces of occlusion functionagainst the bond to
the teeth can lead to fracture and
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Tooth Stabilization Improves Periodontal Prognosis: A Case
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Figure 1. Radiographic view of maxillary dentition demonstrating
60%bone loss.
Figure 2. Clinical appearance of maxillary anterior teeth after
scaling and rootplaning: (a) facial view and (b) lingual view.
Table. Clinical Findings Maxillary Arch April 7, 1997Missing:
Nos. 1, 2, 3, 6, 13, 14, 15, 16
General bone destruction: 60% bone loss; generalized 3 to 4 mm
bone loss
Widened PDL: generalized
Mobility: 1 degree: Nos. 4, 7, 8, 10, 12
2 degrees: Nos. 5, 11
3 degrees: No. 9
Furcation involvement: No. 12
Infrabony Defects: No. 4-D; No. 5-D; No. 9-M; No. 10-M
Prognosis maxilla: 3 to 5 years guarded 5 to 10 years
guarded
Adult moderate periodontitis
Posterior bite collapse
Primary occlusal trauma
ba
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failure.25,46 Perforation into the fiber reinforcement
materialweakens the splint, and for the patient becomes a source
ofirritation due to the roughness created on the lingualsurface due
to the exposed fiber.41,45 With tooth preparationon the facial
surface of anterior teeth to avoidovercontouring of the restoration
(Figure 3) and occlusalpreparations for the posterior teeth, the
splint was to befabricated. Placing the fiber reinforcement ribbon
on thefacial surface is indicated for patients with occlusion on
thelingual surface46,47 and in clinical circumstances when
thepatient has a deep overbite.48 A structural benefit of
placingthe fiber ribbon on the facial surface is that the
fiberembedded into the adhesive composite resin is on thetensile
side of the restoration, which places the forces ofocclusion on the
splint in a favorable direction. The fiberribbon improves the
flexural strength of the composite resinon the facial
surface.40,41,45
For this case, a UHMWPE leno-weave, lock-stitch fiberribbon
(Ribbond Reinforcement Ribbon, [Ribbond]) wasused. After etching,
and adhesive and initial compositeresin placement, the fiber ribbon
was placed (Figures 4aand 4b). The restoration was completed with
facialveneering of the maxillary anterior teeth and a
compositeresin pontic for the No. 6 site (Figures 5a to 5c). The
patientwas shown how to maintain periodontal health of thesplinted
teeth and remove plaque with a variety ofinterproximal cleaning
aids.
Surgical treatment for pocket elimination included anapically
positioned flap with osseous contouring (Figures6a and 6b). The
tissue was apically positioned using amodified vertical mattress
suture to stabilize the gingivaltissues apically on the teeth
(Figures 7a and 7b). At 8weeks post surgery, the healing was
excellent (Figure 8).The patient had an aesthetic complaint of dark
triangles inthe gingival embrasures of the maxillary anterior
teeth. Thedecision was to place porcelain veneers on Nos. 6 to
11.Since cost was a major factor in treatment decisions, theteeth
were prepared for porcelain veneers, impressed, andtemporized.The
veneers (Cerinate Porcelain Veneers, Den-Mat) were fabricated and
paid for with a research account.The patient was placed on a 3- to
4-month periodontalmaintenance recall schedule. Over the next 3
years thepatient reduced her smoking habit, and because of her
own
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Tooth Stabilization Improves Periodontal Prognosis: A Case
Report
Figure 3.Facial preparation of themaxillary anterior teeth.
Figure 4.Placement of theRibbond fiberreinforcement ribbon:(a)
facial view and(b) lingual view.
a
b
Figure 5.Completed restorationwith the fiberreinforced splint
anddirect composite resinveneering:(a) facial view,(b) lingual
view, and(c) radiographic view.
a
b
c
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work and personal schedule, maintained a 4- to6-month recall
schedule for periodontalmaintenance. Three years after treatment,
thepatient had excellent periodontal health withminimal periodontal
pocketing, and the splintand veneers were performing at a
clinicallyacceptable level (Figure 9).
Over the next 3.5 years the splint wasrepaired 2 times at the
mesial and distalconnector of the pontic on No. 6 withsubsequent
fracture of the porcelain veneer ontooth No. 7. At the 6.5 year
recall the periodontalhealth was being maintained (Figures 10a
to10c). It was recommended to the patient thatinstead of repairing
the splint and porcelainveneers, her periodontal prognosis was
goodand it was time to restore the maxillary teethwith a
porcelain-metal fixed-partial denture. Herwork situation and dental
insurance allowed herto follow the restorative recommendations.
Thesplint was removed and the maxillary teeth wereprepared for a
porcelain-metal fixed-partialdenture (Figures 11a to 11c). The
completedrestoration was cemented with a glass ionomercement
(Figures 12a and 12b).
Twelve years earlier, the patient wasdiagnosed with adult
moderate periodontitis witha guarded prognosis for the maxillary
teeth.After treatment of the maxillary arch with initialperiodontal
therapy of scaling and root planing,placement of a periodontal
splint fabricated witha leno-weave, UHMWPE fiber ribbon
(Ribbond)reinforced adhesive light-cure composite resin,and then
surgically treated with an apicallypositioned flap with osseous
recontouring, thepatient was placed on a periodontalmaintenance
program. Six and half years afterfiber-reinforced composite resin
splinting, thepatients maxillary arch was restored with
afixed-partial denture. At the 12 year recall, themaxillary teeth
demonstrate recession andcervical notching adjacent to the
fixed-partialdenture but with minimal gingival pocketing and
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Tooth Stabilization Improves Periodontal Prognosis: A Case
Report
a b
Figure 6. Surgical treatment with an apically positioned flap
with osseouscontouring: (a) facial view and (b) lingual view.
Figure 8. Eight weeks post surgery. Figure 9. Facial preparation
of themaxillary anterior teeth.
a b
Figure 7. Gingival tissues sutured with a modified vertical
mattress suture:(a) facial view and (b) lingual view.
a
b
c
Figure 10. A 6.5-year recall ofsplint: (a) facial view, (b)
right facialview, and (c) left facial view.
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a diagnosis of gingivitis (Figures 13a and 13b).During the last
recall, the patient had
mandibular anterior teeth and the missingmandibular incisor
replaced with a compositeresin pontic and fiber reinforced
adhesivecomposite resin fixed-partial denture (RibbondTHM). Note
the probing depth changes prior tothe initiation of periodontal
treatment andsplinting in 1997 and continuing over the 12years of
recall (Figure 14). The patient hasmaintained the remaining
maxillary teeth.
CONCLUSION
In the past, the use of splinting ofperiodontally compromised
teeth wascontentious. The presumption was that splintingto control
tooth mobility was required to controlgingival inflammation,
periodontitis, and pocketformation. The use of splinting therapy
inconjunction with control of occlusal traumacan contribute to
improved prognosis ofperiodontally compromised dentitions.
Thisarticle presents a 12-year recall case for aperiodontally
compromised maxillary dentitionin which the teeth were occlusally
adjusted andsplinted as part of periodontal therapy. Thispatient
was reasonably compliant in herattention to oral hygiene and
following theperiodontal maintenance regimen. Splinting ofthe
maxillary arch has contributed to anoutstanding result of changing
the periodontalprognosis for the maxillary teeth from beingguarded
to good. The patient is consideringthe placement of posterior
implants to furtherstabilize the occlusal support and function.
Acknowledgement
The following clinicians provided clinicaltreatment and help
with this patient: Drs. ClaudiaCarvalho-Storch, Bradley Phillips,
JessicaIsenberg, Harlan Shiau, and Charlson Choi.
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Tooth Stabilization Improves Periodontal Prognosis: A Case
Report
a
b
c
Figure 11. Preparations of themaxillary teeth for
porcelain-metalfixed-partial denture: (a) facial view,(b) right
facial view, and (c) leftfacial view.
a
b
a
b
Figure 12. Completed porcelain-metal fixed-partial denture(Nos.
4 to 12): (a) facial viewand (b) lingual view.
Figure 13. A 12-year recall ofporcelain-metal fixed-partial
denturesplint (Nos. 4 to 12): (a) facial viewand (b) radiographic
view.
Figure 14. Comparison periodontal charting of probing depths
from start ofperiodontal initial therapy, at a 4.5-year recall, and
at a 12-year recall.
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fiberreinforcement on flexural strength of composite. J Dent
Res.2001;80:221. Abstract 854.
41. Karbhari VM, Strassler H. Effect of fiber architecture
onflexural characteristics and fracture of fiber-reinforced
dentalcomposites. Dent Mater. 2007;23:960-968.
42. Ellakwa AE, Shortall AC, Marquis PM. Influence of fiber
typeand wetting agent on the flexural properties of an indirect
fiberreinforced composite. J Prosthet Dent. 2002;88:485-490.
43. Ayna E, Celenk S. Polyethylene fiber-reinforced
compositeinlay fixed partial dentures: two-year preliminary
results.J Adhes Dent. 2005;7:337-342.
44. Unlu N, Belli S. Three-year clinical evaluation of
fiber-reinforced composite fixed partial dentures
usingprefabricated pontics. J Adhes Dent. 2006;8:183-188.
45. Karbhari VM, Rudo DN, Strassler HE. The development
andclinical use of leno-woven UHMWPE ribbon in
dentistry.Proceedings of the Society for Biomaterials.
2003;29:15.Abstract 529
46. Iniguez I, Strassler HE. Polyethylene ribbon and
fixedorthodontic retention and porcelain veneers: solving
anesthetic dilemma. J Esthet Dent. 1998;10:52-59.
47. Strassler HE. Planning with diagnostic casts for successwith
direct composite resin bonding. J Esthet Dent.1995;7:32-40.
48. Vitsentzos SI, Koidis PT. Facial approach to stabilization
ofmobile maxillary anterior teeth with steep vertical overlapand
occlusal trauma. J Prosthet Dent. 1997;77:550-552.
Continuing Education
9
Tooth Stabilization Improves Periodontal Prognosis: A Case
Report
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POST EXAMINATION INFORMATION
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POST EXAMINATION QUESTIONS
1. Mobility of teeth may be caused by:a. inflammation of the
periodontium.b. loss of periodontal attachment.c. functional or
parafunctional forces on teeth.d. all of the above.
2. A splint has been defined as an apparatus, appliance ordevice
employed to prevent movement or displacementof fractured or movable
parts. In dentistry splintingusually refers to joining teeth
together to transmitstability to the entire restoration.a. Both
statements are falseb. The first statement is true, the second
statement is falsec. Both statements are trued. The first statement
is false, the second statement is true
3. Tooth stability is important in occlusal treatment.According
to Spear the goals of occlusal treatment are:a. to control loading
that occurs at the temporomandibular joint.b. to control marginal
leakage at the occlusal interface ofrestorative materials.
c. to control load placed on the occluding surfaces of teeth.d.
both a and c.
4. The primary reason(s) for periodontal splinting ofmobile
teeth is (are):a. primary occlusal trauma.b. secondary occlusal
trauma.c. progressive mobility.d. all the above.
5. Primary occlusal trauma is defined as:a. wear on teeth during
parafunction.b. injury that results from excessive occlusal forces
appliedto a tooth or teeth with normal periodontal support.
c. injury that results from normal occlusal forces applied toa
tooth or teeth with inadequate periodontal support.
d. mobility of teeth due to gingival inflammation andbone
loss.
6. Tooth mobility can be controlled with splinting therapy.Once
the teeth are splinted the splint only needs to bein place for 6
months to one year to allow the teeth tostabilize, then it can be
removed.a. Both statements are trueb. The first statement is true,
the second statement is falsec. Both statements are falsed. The
first statement is false, the second statement is true
Continuing Education
10
Tooth Stabilization Improves Periodontal Prognosis: A Case
Report
-
7. Occlusion is an important component of periodontalhealth.
Occlusal trauma and mobility in the periodontallycompromised
dentition can contribute to a deterioratingperiodontal prognosis.a.
Both statements are trueb. The first statement is true, the second
statement is falsec. Both statements are falsed. The first
statement is false, the second statement is true
8. Tooth mobility can be detected clinically and is
describedbased upon displacement of the tooth crown when movedwith
2 rigid dental instruments.The charting of toothmobility is based
upon the:a. Loe-Silness index.b. Miller index.c. Mobility index.d.
Periodontal index.
9. The main reasons for stabilizing the periodontallycompromised
dentition with splinting include:a. reduces calculus deposition.b.
reduces cervical caries.c. improves periodontal prognosis of mobile
teeth.d. all of the above.
10. Periodontal splinting has been accomplished with allthe
following techniques EXCEPT.a. Fixed-partial dentures (crown and
bridge)b. Polyvinyl siloxane bondingc. Nonparallel pin splintd.
Direct adhesive composite with fiber reinforcement
11. In the past, composite resins embedded with wires,
metalmesh, and nylon mesh had clinical failures because:a. they
were too narrow for teeth.b. they were too wide for teeth.c. they
were too long for teeth.d. loading stresses placed on the splint
during normal andparafunction caused fracture.
12. Composite resins are brittle materials.
Bondablereinforcement ribbons and fibers of ultra-high
molecularweight polyethylene (eg, Ribbond) and glass, eg,
(Splint-It),when embedded in composite resin with splinting, create
alaminated structure with improved physical properties ofthe
composite and a greater resistance to fracture.a. Both statements
are trueb. The first statement is true, the second statement is
falsec. Both statements are falsed. The first statement is false,
the second statement is true
13. In the case report a maxillary splint with a
leno-weave,lock-stitch ultra-high molecular weight
polyethyleneribbon (Ribbond) was placed on the facial surface.
Thereason(s) for placing the splint on the facial surfacewas
(were):a. places the forces of occlusion on the tensile sideof the
restoration, resisting the forces of occlusion.
b. avoids wearing through the composite, which would cause
aperforation to the fiber reinforcement and weaken the splint.
c. performation of the composite into the fiber splint can
causeroughness on the lingual surface due to exposed fiber.
d. all of the above.
14. When using a fiber reinforced ribbon for splinting,
aftertooth cleaning and/or preparation, the tooth is etched,
andadhesive and composite resin are placed.The fiber is
thenembedded into the composite resin before light curing.a. Both
statements are trueb. The first statement is true, the second
statement is falsec. Both statements are falsed. The first
statement is false, the second statement is true
15. In the case report the fiber reinforced composite
resinadhesive splint was placed to stabilize the patientsmobile
teeth because of the guarded periodontalprognosis. As part of
treatment the teeth were scaledand root planed, and after
splinting, this patient hadpocket elimination surgery because of
the severity ofher periodontal condition.a. Both statements are
trueb. The first statement is true, the second statement is falsec.
Both statements are falsed. The first statement is false, the
second statement is true
16. The use of splinting therapy in conjunction with controlof
occlusal trauma can contribute to improvedprognosis of
periodontally compromised dentitions.The only type of splinting
therapy that will work tostabilize teeth is fiber reinforcement of
composite resin.a. Both statements are trueb. The first statement
is true, the second statement is falsec. Both statements are
falsed. The first statement is false, the second statement is
true
Continuing Education
11
Tooth Stabilization Improves Periodontal Prognosis: A Case
Report
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Continuing Education
Tooth Stabilization Improves Periodontal Prognosis: A Case
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