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Types of mobility:
1. physiological mobility.
2. pathological mobility.

Physiological mobility;
All teeth have slight degree of mobility.
They vary in different times in a day.
They are greatest in the morning and progressively decreased
due to the extrusion of teeth during limited occlusal contact
during sleep.

 



obility beyond the physiological range is termed abnormal or

pathological mobility.
Increased mobility is caused by one or more of the following
factors:
- loss of the tooth support due to bone loss.
- trauma from occlusion.
- extension of inflammation from the gingiva or from the
periapex into the pdl.
- periodontal surgery temporarily increases the tooth
mobility.
- tooth mobility is increased in pregnancy and some times
in menstrual cycle or by the use of hormonal contraceptives.
- some pathological process of the jaws. Which includes
osteomyelitis and tumors of the jaws.

 



ASSESSENT OF OBILITY:
1. Its is elicited by exerting pressure on one side of the
tooth under examination with an instrument or fingertip while
placing a finger of the other hand on the other side of the tooth
and its neighbour which is used as a fixed point so that relative
movement can be discerned.


 



2. other way is to place finger over the facial surface of the

teeth while the patient grinds the teeth.
3. Periodontometer which is invented by muhelmann (1954) which
is measured tooth displacement when a small force was applied to
the tooth.


 



4. Schulte et al (1992) have produced the periotest, which is a

refinement of the muhlemann device.
- periotest is a horizontal rod which taps the tooth at a
known velocity on impact the tooth is deflected and the contact
time recorded. This ranges between 0.3-2.0 milliseconds, being
shorter for stable than for mobile teeth.


 



THE DEGREE OF OBILITY:

1) grade 1: just discernible, 0.2- 1mm in a horizontal direction.
grade 2: Easily discernible, and over 1mm labiolingual
displacement.
grade 3: well-marked labiolingual displacement, mobility of
the tooth up and down in an axial direction.
2) grade 1: slightly more than normal.
grade 2: moderately more than mormal.
grade 3: severe mobility faciolingually and mesiodistally,
combined with vertical displacement.


 CORRELATION BETWEEN TOOTH MOBILITY AND
OCCLUSION

Occlusal trauma:
Occlusal trauma is described as trauma to the
periodontium from functional or parafunctional
forces causing damage to the attachment
apparatus of the periodontium by exceeding its
adaptive and reparative capacities.

-
 Occlusal trauma
There are two forms of occlusal trauma are recognized:
1. |rimary occlusal trauma is a condition in which the
pathologic occlusal forces are considered the principal etiology
for observed changes in the periodontium.
2. Secondary occlusal trauma occurs when the
periodontium is already compromised by inflammation and bone
loss. Consequently, occlusal forces which might otherwise be well
tolerated in a healthy periodontium,now have deleterious effects
because of preexisting periodontal disease. Teeth with a reduced
adaptive capacity and compromised periodontium may then
migrate when subjected to certain occlusal forces.

K
Other factors that contribute to tooth mobility
include:
r The number and distribution of the remaining teeth
in the arch.
r The number of roots, root form, root proximity,
amount of interradicular bone, and a history of root
amputation


 ]
  

According to glossary of periodontic terms is ´an

appliance designed to stabilize mobile toothµ
The Glossary of Prosthodontic Terms defines
splinting as ´«the joining of two or more teeth into
a rigid unit by means of fixed or removable
restorations or devices.µ
The term Splint by definition is an appliance used
for immobilization of injured or diseased parts.


 
]  ]


-The main objective of splinting is to decrease

movement three-dimensionally
-This objective often can be met with the proper
placement of a cross-arch splint.


ßnilateral splints that do not cross the midline tend to
permit the affected teeth to rotate in a faciolingual
direction about a mesio-distal linear axis.


-If splinting is to achieve any measure of success, the
center of rotation of the affected teeth must be
located in the remaining supporting bone. In this way,
the affected teeth are able to resist tooth movement.
Otherwise, the prognosis for any splint will be
unfavorable if the occlusal or masticatory forces
exceed the resistance provided by the splinted
teeth.(alone W, Koth D).
- Thus, the ideal splint should reorient and redirect all
occlusal and functional forces along the long axis of
teeth, prevent tooth migration and extrusion, and
stabilize periodontally weakened teeth(Ferencz J.
Splinting.) 
 
]

1. It should incorporate as many firm tooth as necessary to

reduce the extra load on the individual teeth to a minimum.
2. It should hold the tooth rigid and not impose torsional
stresses on the incorporated teeth.
3. It should extent around the arch, so that the antero
posterior forces and faciolingual forces are counteracted.
4. It should not interfere with the occlusion. If possible, gross
tooth disharmonies should be eliminated before the
application of the splint.
5. It should not irritate the pulp.
6. It should not irritate the soft tissues.
7. It should be designed so that it can be kept clean.
Interdental embrasure spaces 
should not be blocked by a
splint.

 Indications and Contraindications for
Splinting

Indication:
- when a patient presents with multiple teeth that
have become mobile as a direct result of gradual
alveolar bone loss.
- when the patient presents with increased tooth
mobility
-accompanied by pain or discomfort in the affected
teeth.
-Splinting may be a way to gain stability, reduce or
eliminate the mobility, and relieve the pain and
discomfort.

Contraindications:
-Splinting teeth is not recommended if occlusal
stability and optimal periodontal conditions cannot be
obtained.
-Any tooth mobility present before treatment must
be reduced by means of occlusal equilibration
combined with periodontal therapy; otherwise if the
tooth involved does not respond, it must be extracted
prior to proceeding from provisional restorations to
definitive treatment.
-
 
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The temporary splints are

- Simple wire ligature.
- composite resin splint
- vaccum-formed removable acrylic splint.
Indications:
1)Trauma caused by occlusal and oral parafunctions
2) It can be used as an emergency procedure with extremely
mobile tooth
3) It serves to reduce trauma ² mechanical, instrumental-
during periodontitis therapy


 ð ]


ïThe serve as a fixed splint for a few days to several

weeks.
-They are seldom used today because of the esthetic
considerations


 ð ]


PROCEDßRES:
- Soft steel wire of 0.25mm diameter is wrapped
around the facial and the oral surface of the teeth to
be splinted.
-The ligature/splint is tightened by twisting the
ends.
-The stabilization of the individual teeth is
accomplished by the application of interdental
ligatures.
- Acid-etch resin stops/ thin mix of quick set
acrylic may be applied to the labial surface to prevent
the wire from sliding apically
- The wire ligature/splint is used intra and post-
operatively, in most cases in combination with a wound
dressing.
 ð ]
]

Circumferential wiring
 
] ] ]


ïThey are most commonly used fixed splint.

- They can be used with or without tooth
preparation.
- without a cavity preparation or grooves they
are strong enough
- Fracture of such a splint is common if more
than 3-4 teeth are included.
- Newer fiber splint tooth stabilization are
used.

 
] ] ]


With no tooth preparation:

- following thorough cleaning of teeth and
under the rubberdam,
- the proximal surfaces are acid etched and
resin is applied.
- The apical region must be left open for oral
hygeine.


 
 A

 
A


 ]


-This is a removable temporary splint

-They can be made of acrylic resin pulled under
vaccum.
- They are used only for short period of retention for
individual teeth.
-Some splints were formely used as bitegaurd in the
treatment oral parafunctions.
-Any way this is not proved to be effective and today
michigan splint is used.


 -
 ]  A]
 ]  ]


SEIPERANANT/ PERANENT:
1)It enhance masticatory comfort when teeth
are highly mobile
2) To stabilize the teeth during periodontal
healing space esp following regenerative therapy
3)awaiting long term prognosis
4) Retention following orthodontic treatment

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] ] ]
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In case of class III caries with mobile tooth this type of splints
are used.

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Rubber dam placed and cavity is
restored with composite resin.


Resin is cured. Finished and polished Note: the apical area of
tooth is not include in
the restoration. This is
to facilitate ID cleaning.


 
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 ]
 


-They are fabricated as a cast chrome- cobalt alloy

frameworks incorporating typical partial denture
clasps.
-They are indicated for wearing in nights.
- often in the retentive appliance following
orthodontics or surgical therapy.

 ]  A]
 ]  ]


PERANENT SPLINTING:
1. used for complex rehabilitation where the abutments
are highly mobile or only few abutments must support the
reconstruction,particularly when such abutment teeth have
minimal periodontal support.
2. distribution of occlusal forces when parafunctions cannot be
eliminated. In such cases there is a increasing tooth mobility and
tooth migration


 
 ]


ïSoon after the introduction of the acid etch

technique for anterior restorations, the so called
adhesive bridges and adhesive splints were propagated
by Rochette in 1973.
-Recently this technique had been refined particularly,
various methods for enamel preparation have been
developed, that ensures adequate retention of such
reconstructions following only very conservative
preparation (marinello et al 1988).


 -
]


Procedure :
- A Rubber dam must be placed in the area of operation before
acid-etching and subsequent seating of the splint.
-An elegant preparation only in enamel which is scarcely visible
because enamel must be maintained, otherwise adhesion following
acid etch is not guaranteed because only bonding to enamel is
secure.
-proximal surfaces of the teeth are rendered parallel
- fine grooves are prepared.
- for occlusal support, shallow, peg-shaped depressions at the
margin and above the lingual tubercle are created.
- the incisal edges are not included for aesthetic reasons.

 - 
]
]

ïThe extra coronal splints are seated with the

composite resin.
ïThe splints should be placed in such a way that it
should facilitate scaling and possible surgical
interventions can be continued without compromise.


Radiograhic findings shows Case report : there is grade two
prounced attachment loss in mobility in 31,41
31,32 and also between
41,42

In order to decrease the trauma during impeding

periodontal therapy and increase the patient comfort ²
an extracoronal splint was-planed.
Tooth preparation which is
confined only to the enamel

K
when a cobalt chrome splint is used then it is called a
rochette without tooth preparation.


  
]


-Composite resin restoration can be placed in adjoining teeth and

cured to eliminate any interproximal separation.
-These restoration can be further re-inforced with
- metal wires.

- glass reinforced fibers or pins


 -Telescoping crowns soldered together can also be used.
- crowns can splinted to each other by solder joints or precision
attachments.

Precision joints are cemented in the adjacent tooth with appropriate


tooth preparation.
 
 ]


They are modification of the modification of linked crown splint

is the multiple pin hole splints.
The reduce the tooth tissue loss.
Three parallel pin holes are made in the tooth to be splinted.
ßsually six teeth are included in the splint
Pin retention is not as good as inlays or the crowns, therefore
this appliance can only be used successfully where functional
forces are not acting.


 ]
. 
]

r In the posterior region a series of linked OD inlays are made

with full occlusal coverage can make a satisfactory splint.
r Inlays that fit into the dovetail preparations in the lingual
surface of the anterior teeth may be displaced if an excessive
anterior forces are exerted on any individual tooth.



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They are used in orthodontics

They lingually bonded to the tooth.
It is flexible and it allows tooth within the splint to exert
physiological mobility.
The wire used is flexible, rectangular, braided, stainless steel
and 0.0125 inches.
They are placed in the lingual portion of the teeth after etching
and bonding agent is applied and cured after flowable composite
is applied
Disadvantages:
They are subjected to mechanical stress.
when it is too thin and it is not passively placed on the enamel
-
then there is undesirable tooth movement .
] ]
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-In case of advanced, aggressive periodontitis, the

stability of the periodontal treatment results must be
over an extended period of time before seating a
definitive, fixed replacement.

- In order to avoid any trauma to the highly mobile

teeth during this consolidation periods, the use of
fixed long term temporary is warranted.

 ethod:
-due to aggressive periodontitis if there is any
discrepancies in the arch alignment.


If the planned fixed bridgework reconstruction requires a
harmonic dental arch then a minor orthodontic procedure can
be done despite of advanced attachment loss.


- During open periodontal therapy wire ligature splints were
applied to reduce trauma during the surgical procedure.


-Tooth preparation is done and the temporary crowns
are placed.
-Later a long term temporary bridges are placed.
-They have an unsure prognosis!
Advantages:
- greater stability of the contruction.
- better distribution of chewing forces.
- psychological well being.


Final finished restoration


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Fiber- splint tooth stabilization


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