Management of Periodontally Involved Anterior Teeth by Glass Fiber-Reinforced Composite Splinting: A Clinical Report With 5-Year Recall
Management of Periodontally Involved Anterior Teeth by Glass Fiber-Reinforced Composite Splinting: A Clinical Report With 5-Year Recall
Management of Periodontally Involved Anterior Teeth by Glass Fiber-Reinforced Composite Splinting: A Clinical Report With 5-Year Recall
Case Report
*Corresponding Author:
Dr. Sandeep Anant Lawande
Email: drsanlaw@rediffmail.com
Abstract: Periodontal disease results in attachment loss and damage to the supporting alveolar bone leading to tooth
mobility. In majority of cases, the mandibular incisors are the teeth showing the first signs of mobility. The clinical
management of periodontally involved teeth remains a challenge to the clinician. Splinting may be indicated for
individual mobile tooth as well as for the entire dentition. The main objectives of splinting include decreasing patient
discomfort, increasing occlusal and masticatory function, enhancing esthetics and improving the periodontal prognosis of
mobile teeth. Fiber-reinforced composites provide one of the better alternatives for splinting of teeth. This clinical report
describes a technique of splinting of periodontally involved mandibular anterior teeth using glass fiber-reinforced
composite resin with a follow-up period of five years.
Keywords: periodontal splinting, tooth mobility, fiber-reinforced composite, splint, periodontally involved teeth
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Lawande SA & Lawande GS.; Saudi J. Oral. Dent. Res.; Vol-1, Iss-2(Jun-Aug, 2016):74-79
CLINICAL REPORT 3M ESPE, USA) for a period of 30 seconds (Figure 4).
A female patient aged 45 years presented with Care was taken so that the etchant flows in the
the chief complaint of mobile lower central incisors and interdental areas of the teeth to be splinted. The teeth
discomfort while eating. On clinical examination, were then copiously irrigated to remove all acid
periodontal pocket depths ranged from 4 to 6 mm residues, gently dried and isolated. A resin adhesive
involving the proximal aspects of mandibular right (Single Bond, 3M ESPE, USA) was applied to the
lateral incisor and extending to the left first premolar. etched enamel surfaces and light-cured for 10 seconds.
Grade II mobility in relation to 31 and grade I mobility
of 41 were recorded according to the Miller’s index. A thin layer of microhybrid composite resin
Gingival recession of 2 to 4 mm was noted in relation to (Filtek Z250, 3M ESPE, USA) was placed on the
the involved teeth (Figure 1). Further examination also lingual surfaces of the teeth and extended slightly to the
revealed positive tension test indicating presence on an proximal surfaces of each tooth. The wetted fiber splint
aberrant labial frenal attachment in relation to the section was gently pressed into the composite resin and
mandibular incisor region. Difficulty in maintaining any excess resin was adapted for achieving a smooth
plaque control was evident with the presence of plaque surface. It was then light-cured for 40 seconds for each
and calculus in this area. Radiographic examination tooth from the lingual and proximal directions (Figure
revealed over 50% bone loss in relation to the 5). A smoothening layer of composite resin was applied
mandibular central incisors (Figure 2). No relevant over the surface especially covering loose ends of the
medical history was revealed by the patient. fiber splint to prevent fraying and then light-cured for
20 seconds for each tooth. The occlusion was checked
A treatment plan was formulated to include for any interference and adjusted. Esthetic contouring
scaling and root planing, periodontal splinting to allow was done with the help of finishing burs and diamonds.
stabilization for the mobile teeth followed by Finishing and polishing were performed using
periodontal surgery of the involved teeth. At the initial aluminium oxide sandpaper discs (Sof Lex, 3M ESPE,
consultation, the plan of extending the splint from USA) and composite resin polishing paste (Figure 6).
canine to canine in the mandibular region was carefully
explained to the patient but the patient consented to the Once the teeth were stabilized, open flap
compromised treatment plan of getting only the central debridement was performed for the involved teeth. In
incisors splinted. addition to this, the management of aberrant labial
frenum was accomplished by performing a frenectomy
Periodontal therapy started with an initial procedure, which involved complete removal of the
preparation phase which consisted of scaling and root frenum including its attachment to the underlying bone
planing and minor occlusal adjustment. The patient was (Figure 7). A week later, the patient was recalled, suture
educated on the importance of maintaining a strict removal performed and the healing was noted to be
plaque control. Three weeks later, as the condition uneventful (Figure 8). The patient was given strict
improved with a favorable plaque control, it was instructions on maintaining meticulous oral hygiene by
decided to perform periodontal splinting using glass using an interdental brush on a daily basis, in addition
fiber-reinforced composite involving the mobile central to routine oral hygiene practices.
incisors as described in the following procedure.
Fig 2: Radiographic view of mandibular incisors Fig 6: Facial view after splinting