Splinting can save mobile teeth.
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Photoelastic models were used to visualize stresses developed in teeth and supporting bone by cantilever fixed partial dentures where the most distal abutments had either crater or trough osseous defects. The effects of splinting the periodontally involved teeth to one or more additional sound teeth were studied. It was shown that for a cantilever fixed partial denture with either normal periodontal support, or a distal abutment with a moderate degree of mobility and bone loss, the following can be concluded: (1) occlusal forces on a cantilever fixed partial denture were significantly distributed to only the three teeth closest to the loaded cantilever, (2) optimum stress reduction occurred with the splinting of a periodontally compromised tooth to two periodontally sound teeth. Increasing the number of splinted abutments did not result in a proportional reduction of stress in the periodontium, and (3) no significant cross-arch sharing of occlusal loads was seen.
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This report presents a case requiring a combination of restorative dentistry and orthodontic treatment in a mature adult patient. Occlusal splint and periodontal therapies were used initially. Orthodontic treatment combined the use of the occlusal splint and fixed appliance in the maxillary arch. Sectional fixed appliances were used in the mandibular arch. The final restorations were fixed--movable bridges in the mandibular arch and a removable tooth and mucosally borne prosthesis in the maxilla. Retention of the orthodontic result was provided by the fixed prostheses in the lower arch and the continued wear of a full coverage maxillary occlusal splint at night served to prevent relapse of the upper teeth.
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PATIENT: The patient was 60-year-old male whose chief complaint was esthetic problem due to median diastema. After orthodontic treatment, an adhesion-fixed metal splint was placed to retain 3-3. After 11 months, the metal retainer on 3 partially debonded. The retainer on 3 was removed and 3 was connected to 4 with an adhesion-mechanically fixed metal splint. Six months later, 3 was separated from 2+2 and connected to 4 5 with the conventional crown restoration. DISCUSSION: The prognosis is good. This result is attributed to the decrease of splint length and the application of the adhesion-mechanical retainer. These seemed to increase the rigidity and prevent deformation of the splint, thus reducing tensile or shear stress applied to the adhesion interface and improving the bonding durability. CONCLUSION: This clinical case suggested that the range of splinting and design of retainer affect the durability of adhesion-fixed metal splints.
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