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Prosthodontic Splints

Chapter · January 2019

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Mohammed M Fouad
Faculty of Dentistry, Mansoura University, Al Mansourah, Egypt
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CHAPTER: 1

SPLINTS

BY

Mohammed M Fouad
Professor of Prosthodontics
Faculty of Dentistry
Mansoura University

2019

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INTRODUCTION
Types of jaw fractures:
1.Closed (simple): which occur when the fracture in the bone is not
associated with an open wound.
2.Opened (compound): which occur when an open wound exists.
3.Comminuted fracture.
4.Greenstick fracture.
5.Atrophic fracture.
6.Pathologic fracture.
7.Favorable Vs Unfavorable fracture.

The treatment of jaw fracture:

The treatment of jaw fracture consists essentially of:
1.REDUCTION:
Placing the fragments in their normal anatomical position.
This can be done directly (intraoral) or on cast after impression of the
fractured jaw.
2.IMMOBILIZATION:
Fixing fragments in their normal anatomical position.
The maxilla can be utilized as a stable base for immobilizing the
fractured mandible.
Methods of immobilization:
A)Wire loops (Direct wiring, Eyelet wiring, Interdental wiring) with
complete set of teeth.
B)Arch bars, used when the patient has an insufficient number of teeth.

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C)Splints:
IN DENTULOUS PATIENTS: Labiolingual, metal cap, cast metal,
lingual, occlusal wafer, palatal-occlusal and kingsley splints.
IN EDENTULOUS PATIENTS: Gunning and Kingsley splints.
3.REHABILITATION:
Restoring function to normal.
IMPRESSION FOR FRACTURED JAW:
If the patient has sufficient number of sound teeth available for fixation
or is edentulous in either or both arches, it is necessary that
impressions of the arches be made and duplicated casts are made. In
addition to serving as diagnostic study models the casts allow various
types of fracture splints to be constructed. The pain, swelling, trismus
and excessive salivation associated with fractures make the task more
difficult. With careful planning and preparation, good impressions may
be obtained.
• Some precautions must be considered during impression of a
fractured jaw:
a)Accurate impressions should be made from first time to save the
patient the distress of repeated attempts.
b)Elastic impression materials with accurate surface details are used.

c)Shallow impression-trays are used if metal cap splints are to be

constructed.
D)Sectional impression technique is used if there is any mobility
between fragments.
E)Impression of the opposite arch is made to help in re-assembling the
fragments.

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SPLINTS
DEFINITION OF SPLINTS:
Appliances used for immobilization of tissues (Fractured jaw bones,
mobile teeth).

USES OF SPLINTS:
1.In treatment of jaw fractures.
2.As an aid in plastic surgery of the facial structures.
3.In surgical treatment of prognathism.
4.In conjunction with bone or metal graft of jawbones.
5.In periodontal treatment to support mobile teeth.
IDEAL REQUIREMENTS OF SPLINTS:
1.Enough rigidity and immobility.
2. Restore the patient’s occlusion as much as possible.
3.Comfortable.
4.Allow early movement of the mandible.
5.Minimum injury to the standing teeth, bone or soft tissues.
6.Minimum disturbance to normal function.
7.The least possible interference to occlusion.
8.Speed and ease of construction.

ADVANTAGES OF SPLINTS:
1.Allow good fixation of the fragments for a long period of time.
2.Do not harm the teeth and supporting structures.
3.Early movement of the mandible can be attained and thus prevent
the onset of trismus.
4.Extension from the splint to support edentulous fragment can be
done.

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5.Little post-operative attention is needed.

DISADVANTAGES OF SPLINTS:
1.Metal splints require good standing teeth.
2.Needs special training and require laboratory work.

TYPES OF SPLINTS:
I-In dentulous patients:
A - Fixed splints:
As metal cap splint.
B - Removable splints :
• Labiolingual splint.
• Fenestrated Splint.
• Cast metal splints.
• Lingual splint.
• Occlusal wafer.
• Palatal-Occlusal splint.
• Kingsley splint.

II-In edentulous patients

• Gunning splint.
• Kingsley splint.

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Labiolingual splint (Stout sectional splint or acrylic splint):

This type is used when the patient is dentulous or partially edentulous
to aid in treatment of fractures without or with minimum displacement.
It is constructed so that an acrylic band fits around the labiobuccal
surfaces of the teeth as well as the lingual aspects, leaving the
occlusal surfaces uncovered. A stainless steel wire connects the two
acrylic portions (labiobuccal and lingual) posteriorly around the last
remaining tooth. This wire acts as a hinge. A button at the labial portion
is divided into two halves.

Labiolingual splint

CONSTRUCTION OF LABIOLINGUAL SPLINT:

1.Impression should extend to the vestibule and casts are obtained.
2.The splint is waxed up leaving the occlusal surface free.
3.A button is made in the front region of the splint.
4.Stainless steel wire is bent and placed distal to the last molar, so that
the buccal pan is attached to the lingual through these wires.
5.The splint is flasked and processed in clear acrylic resin. After
polishing holes are drilled at interproximal areas to allow wiring of the
splint over the contact points.

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6.After polishing of the splint, it is separated at the middle of the button

and in edentulous area by separating disc.
7.The fracture is reduced under anesthesia, and then the splint is fitted
in place. Legation wire is used around the button.
8.Additional fixation may be obtained by wiring the splint to the
posterior teeth on both sides.
9.Wire lugs and hooks may be incorporated in the buccal flanges to
facilitate immobilization.
10.The splint may be lined by zinc oxide impression paste or other
types of soft liners before fixation.

Fenestrated Splint:
This splint is utilized primarily when there are deciduous teeth or when
the clinical crowns are not available.

Fenestrated Splint

It is constructed in the form of one-piece acrylic device which is

designed to fit the dentition of one arch through fenestrations in the
occlusal surface.

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Wire lugs and hooks may be incorporated in the buccal flanges to

facilitate immobilization.This splint may also be constructed of silicone
if greater flexibility is desired, as in heavily irradiated teeth.

Lingual splint:
• Lingual splint is useful in parasymphyseal fractures of the mandible to
prevent the adverse muscular forces from causing lingual collapse and
overlap of the fractured segments.
• This splint may be fabricated from cast metal made prior to the
resection to provide sufficient rigidity that stabilizes jaw fragments. It
may be fabricated with acrylic since it will be used for 4-6 weeks
only.• This splint may be secured directly to the inner aspect of the
dental arch by wiring or incorporated with the wire that legate the
buccually placed arch bar to the teeth.

Lingual splint

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Occlusal Wafer:
The occlusal wafer is generally used for intermaxillary fixation of fully
dentulous patients who have occlusion that is inadequate for a positive
index.
Although this splint is frequently constructed of acrylic, cast metal may
be used when thickness and strength are critical.
The occlusal-incisal surfaces of both arches are covered with the
splint, and immobilization is achieved with elastic bands on Ivy loops or
arch bar.

Occlusal Wafer

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Palatal-Occlusal Splint:

Palatal-Occlusal Splint

This splint is particularly useful for fixation of maxillary segmental

osteotomies.
It covers the palate, the occlusal surfaces, and the incisal edges,
including the incisal third of the labial surfaces.
Fixation to the maxilla is achieved with interdental wiring.
Intermaxillary fixation is usually not necessary if prematurities are
eliminated on the occluding surface.

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Bite plane occlusal splint

INDICATION:
Bruxism – trauma from occlusion (tooth wear- clicking – pain –
tenderness) – premature occlusal contact- disc displacement
CONSTRUCTION:
If vertical dimension lost, squash bite wax is used to restore VD at
correct centric relation or centric occlusion, then processed into acrylic
resin and retained by Adams wire clasp or wired to the interproximal
embrasures of the teeth.

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Cast metal splints:

A cast device may be constructed for long-term immobilization or when
strength and rigidity are important. The cast metal allows the possibility
for many designs.
This splint offers superior fit, rigidity without being bulky, smooth,
easier to clean and more comfortable for the patient. However, cast it
consumes time to construct and is expensive for the patients.
TYPES:
A.One piece splint (Simple metal splint):
It should be used only when the position of the fragments can be
clearly determined by occlusion with natural teeth in the opposing jaw
also when there is very little displacement or swelling.
B.Two pieces metal splint (Sectional cast metal splint):
With screws connecting bars, sectional cast metal splints with
localizing plates.

One piece splint (Simple metal splint) Two pieces metal splint (Sectional
cast metal splint)

CONSTRUCTION OF CAST METAL SPLINTS:

1.The cast of the fractured jaw is sectioned at the line of displacement.
If there is no displacement, the cast is used as it is.

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2.If sectional impression is made the 2 fragments are assembled into

their original - position guided by the articulation with the cast of the
opposite arch. The two fragments are attached by plaster base.
3.The reassembled cast is duplicated. The splint is waxed up on to
duplicate cast. The design of the cast depends on the extent of fracture
and the purpose of splinting. Silver palladium or cobalt chrome alloys
are generally used for casting splints. In case of the two-piece metal
cast the female element or the under plate may be waxed onto the
pattern or soldered on after. The metal splint is then cast and the over
plate screwed to under plate.

Gunning splint
An acry1ic device used to immobilize the edentulous jaws in occlusion
and to hold together fractured segments of mandibular or maxillary
bones.
TYPES:
• One piece gunning splint.
• Two piece gunning splint.
• Sectional gunning splint
• Modified gunning splint.

One piece gunning splint:

It is constructed for both arches as one piece.
The disadvantage of such arrangement is that it is overworked, difficult
to manipulate and it cannot be wired to the jawbones.

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One piece gunning splint Two piece gunning splint

Two piece gunning splint:

Two separate splints with V-shaped grooves on the occlusal surface of
one arch and projections to fit these grooves on the opposite arch
gives better results.
Steps for two piece gunning splint construction:
1.The impression technique is the same; the cast is prepared in the
same manner.
2.Two layers of modeling wax are adapted 2mm short than anatomical
outline.
3.Occlusion bite rims are constructed for each arch. Spaces are
created in the rims in the anterior teeth areas to facilitate, functions
(breathing, feeding and possible vomiting especially postanaesthesia).
4.Vertical and centric relations are registered. The models are
mounted on an articulator.
5.At the occlusal surface male and female buttons 3 to 5 mm deep are
created or shaped so that the two splints can be interlocked to
maintain proper centric.

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6.Two to four stainless steel wire loops or hooks are placed on both
buccal flanges of waxed tip bases.
7.The waxed splint is flasked and processed in acrylic resin.
8.The splint is lined with soft-liner to act as cushion.
9.Circumferential wiring is used to fix the mandibular splint in position.
The maxillary splint is suspended to the zygomatic arches and nasal
spine. The two splints are wired together.
10.After healing takes place the intermaxillary wiring may be removed
and the splint is left for a period of time. This will allow early mobility of
the mandible, which is not available with conventional Gunning splint.
Extraoral fixation can be applied if the surgery is contra-indicated.

Note:
If the patient has dentures, casts are poured and then mounted. The
dentures are removed and the splint is waxed on the models. This way
we do not have to make impressions for the patients, and the records
are already established.
If old dentures are not available, it is quite difficult to reassemble the
cast of displaced fragments and to put the two casts into the right
relation. The contour of the ridge is taken as a guide to assemble the
cast. Parallelism between the opposite ridges may be used to mount
the two cast in acceptable relation.

Sectional gunning splint

Sectional gunning splint is designed for immediate immobilization of
the resected mandible to minimize postsurgical deviation. It is basically
a two-piece gunning splint with indices designed for possible use as
flange prosthesis and a locking mechanism for immobilization.

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Modified gunning splint:

A modified gunning splint may be produced by altering existing
complete dentures or by repairing and altering fractured complete
dentures. It is similar to the two-piece Gunning splint and is particularly
useful in the fixation of fractures. The incisors can be removed to
create a feeding hole. Wire hooks or interdental Ivy loops may be
added in each quadrant to facilitate immobilization. Holes are also
drilled in the buccal flanges to fixate the splints,

Sectional gunning splint Modified gunning splint

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Kingsley splint:
• A modified stock tray in emergency of fractured maxilla or cast metal
splint for long term treatments .
• May be designed to fit dentulous or edentulous patient.
• Consists of an intraoral portion embracing the teeth or edentulous
alveolar process, to which solid wire arms are attached.
• These arms are projected between the lips, and were carried round
the sides of the face to provide attachment for bandages passing over
the head, for fractures of the maxilla.

Kingsly splint

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