PERIODONTICS. applied to a tooth or teeth with normal periodontal

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1 09Strssler:Strssler 8/6/09 9:48 AM Pge 3 ce dentlcetody.com Test Tooth Stiliztion Improves Periodontl Prognosis: A Cse Report Howrd E. Strssler, DMD As ptients re keeping their teeth throughout their lifetimes due to dvnces in periodontl tretment, the progression of periodontl disese does continue. For ptients with moderte to severe chronic periodontitis, the development of tooth moility cn e significnt fctor compromising tretment prognosis. Moility my e cused y inflmmtion of the periodontium, loss of periodontl ttchment, or functionl or prfunctionl forces on teeth. 1 Splinting of teeth is considered to n importnt component of occlusl tretment when tooth moility is present. This rticle discusses how stiliztion of moile periodontlly involved teeth cn improve the long-term prognosis. A clinicl cse is presented to demonstrte the tretment outcome tht cn e chieved with stiliztion technique. TOOTH STABILIZATION A splint hs een defined s n pprtus, pplince, or device employed to prevent movement or displcement of frctured or movle prts. 2 In dentistry, splinting or tooth stiliztion usully refers to joining teeth together either unilterlly or ilterlly, to trnsmit incresed stility to the entire restortion. Typiclly, splint is indicted due to single tooth or multiple teeth hving moility. Sper 3 presented 4 gols of occlusl tretment: (1) to control the mount of loding tht occurs t the temporomndiulr joint; (2) to control the lod tht the tooth receives so tht the periodontium is not overstressed; (3) to control the lod plced on the occluding surfces of the teeth; nd (4) to produce n occlusl reltionship with no pthologicl symptoms for the muscles of mstiction. When moile teeth re present, tooth stiliztion with splinting cn e fctor for successful occlusl tretment. Trnow nd Fletcher 4 descried the indictions nd contrindictions for splinting periodontlly involved teeth. They stted tht the rtionle to splint teeth should e sed upon the degree of periodontl compromise of the dentition, sed upon the mount of rdiogrphic one loss nd/or mesured tooth moility. The primry resons to control tooth moility with periodontl splinting re: (1) primry occlusl trum; (2) secondry occlusl trum; nd (3) progressive moility, migrtion, nd pin on function. Primry occlusl trum is defined s injury resulting from excessive occlusl forces pplied to tooth or teeth with norml periodontl support. Secondry occlusl trum is injury resulting from norml occlusl forces pplied to tooth or teeth with indequte periodontl support. Tooth moility hs een shown to contriute to decresed mstictory nd occlusl function, s well s ptient discomfort when eting. Identifiction of progressive moility requires repeted clinicl oservtions over period of weeks to months. In the pst, the use of splinting of periodontlly compromised teeth ws contentious. The presumption ws tht the use of splinting to control tooth moility ws required to control gingivitis, periodontitis, nd pocket formtion. It ws s ssumed tht moility hd direct reltionship to ttchment loss nd verticl osseous defect formtion. Another ssumption ws tht incresing tooth moility ws direct consequence of trumtic occlusion, ruxism, nd clenching. Consensus lso pointed to the fct tht even norml physiologic function including mstiction nd swllowing contriuted to tooth moility. 5 A numer of periodontl clinicl studies investigted these ssumptions. When teeth were occluslly overloded nd other vriles tht contriute to periodontl disese were controlled, it ws difficult to produce gingivitis, periodontitis, nd pocket formtion. 6,7 Another study reported no correltion etween splinting nd reduced tooth moility during initil periodontl therpy. 8 Control of tooth moility with splinting fter osseous surgery did not reduce moility of the Figure 1. Rdiogrphic view of mxillry dentition demonstrting 60% one loss. Figure 2. Clinicl ppernce of mxillry nterior teeth fter scling nd root plnning: () fcil view nd () lingul view. individul teeth. 9 Tooth moility, however, cn e controlled nd mnged with splinting therpy The evidence demonstrtes support for the tooth stiliztion vi splinting to improve the periodontl prognosis. 1,11-17 Once teeth re splinted the splint must e mintined, nd the ptient nd clinicin must e committed to reclls on regulr sis for periodontl mintennce. Splinting of teeth is long-term commitment y clinicin nd ptient. Occlusion hs een ssocited with periodontl helth. 18 Glickmn 19 postulted model referring to the role of controlling norml occlusl forces in otining improvements in gingivitis nd periodontitis tht cuse gingivl inflmmtion. His concept descried tht trum from occlusion hd the potentil to result in infrony pockets nd verticl osseous defects. Werhug, et l20,21 reviewed similr hypothosis nd concluded tht there ws little evidence to vlidte reltionship etween trum from occlusion nd severity of periodontl tissue rekdown. Occlusl trum nd moility in the periodontlly compromised dentition cn contriute to deteriorting periodontl prognosis. 1,13,14,18 continued on pge ## SEPTEMBER 2009 DENTALCETODAY.COM

2 09Strssler:Strssler 8/6/09 9:49 AM Pge 4 4 Tooth Stiliztion Improves... continued from pge In clinicl studies with teeth occluslly overloded, while other vriles tht contriute to plque-induced periodontl disese were controlled, it ws difficult to produce gingivitis, periodontitis, or pocket formtion. 6,7 Studies investigting posterior tooth moility estlished tht during nd fter periodontl initil therpy there ws no significnt difference in the moility of nonsplinted teeth nd splinted teeth (fter removl of the splint). 8-10,22 Incresed tooth moility is detected cliniclly nd descried in terms of mplitude of displcement of the clinicl crown. Agin, it must e reiterted tht the cuse of detected tooth moility should e further clrified whether y reduced height of supporting tissues s result of plque-induced periodontl disese, or y trum from occlusion, or comintion thereof. Tooth moility is reported during periodontl chrting, often using the Miller Index. 23 Degree 0 moility is considered physiologic, wherey the tooth is moile within the lveolus t pproximtely 0.1 to 0.2 mm in horizontl direction. The Miller index defines degree 1 moility s tooth tht moves pproximtely 0.5 to 1.0 mm. A degree 2 moility will exceed 1 mm in horizontl direction. A degree 3 clssifiction refers to tooth tht not only hs fcil-lingul component ut lso is depressile. There is no dout tht splinting does reduce tooth moility while the splint is in plce. 1,10,11,24-26 Currently, it is generlly ccepted tht tooth moility is n importnt clinicl prmeter in predicting periodontl prognosis of those teeth. 27 The min resons to stilize the periodontlly compromised dentition with splinting include: decresing ptient discomfort, incresing occlusl nd mstictory function, nd improving the periodontl prognosis of moile teeth. 28 Further, regenertive procedures using memrnes nd one grft hve greter predictility if tooth movement is eliminted. 29,30 Over the yers there hve een mny different restortive techniques used for splinting teeth. Before dhesive restortive dentistry hd een introduced the optiml choice for splinting teeth ws the use of full coverge cst restortions. Ech tooth to e splinted hd crown plced nd ll the crowns were joined together. 11,31 DENTALCETODAY.COM SEPTEMBER 2009 Figure 3. Fcil preprtion of the mxillry nterior teeth c Figure 5. Completed restortion with the fier reinforced splint nd direct composite resin veneering: () fcil view, () lingul view, nd (c) rdiogrphic view. Figure 6. Surgicl tretment with n piclly positioned flp with osseous contouring: () fcil view nd () lingul view. Figure 4. Plcement of the Riond fier reinforcement rion: () fcil view nd () lingul view. Figure 7. Gingivl tissues sutured with modified verticl mttress suture: () fcil view nd () lingul view. The dvntge of this technique ws tht the teeth could e stilized with n crylic resin provisionl restortion during periodontl tretment. At the completion of ctive therpy the definitive cst restortion ws fricted nd completed. Over the reltively short period of time of tretment for some teeth the prognosis ws difficult to define nd could led to premture replcement of the porcelin-metl fixed-prtil denture splint s teeth were lost. A more conservtive pproch hd een reported using cst gold restortion for the lingul surfces of the moile teeth, with the used of pin retention plced in the tooth preprtions nd cst into the metl frmework. 32 The clinicl success of dhesive onded composite resin to etched enmel led to cse reports nd techniques using vriety of mterils. One modifiction of the cst metl lingul splint ws use of resin onded dhesive technique to retin the splint. 33,34 Direct plcement, single visit splints hve een descried. Clinicl techniques using wires twisted round teeth nd covered with resins, 12 metl nd nylon mesh emedded into resins, 35 nd for posterior teeth the use of chnnels prepred into the occlusl nd proximl surfces of teeth or into existing mlgm restortions with either cst rs or thick wires plced in the chnnels nd covered with resins hve een reported. 36,37 Clinicl filures of these mterils were common ecuse of loding stresses plced on the splint during norml nd prfunction. 12,38 Repirs of these splints usully led to overcontoured nd overulked restortions. These overcontoured restortions led to hygienic difficulties nd food nd plque retention. 14,25 Composite resins y their chemicl nture re rittle mterils. In function when supporting pontics or stilizing moile teeth, crcks within the connector res cn led to outright frcture The introduction of ondle reinforcement rions nd fiers, when emedded into composite resins, creted lminted structure with improved physicl properties nd greter resistnce to frcture. Reserch with fier reinforced composite resins hs demonstrted tht oth glss, eg, Splint-It (Pentron Clinicl) nd ultr-high moleculr weight polyethylene (UHMWPE) fier reinforcement, eg, Riond THM (Riond) mterils provide n increse in flexurl strength nd flexurl modulus of composite resins Clinicl evlutions of onded fier reinforced composite resins restortions for oth splinting nd for fixed prtil dentures hve een cliniclly successful When selecting reinforcement fiers for use in periodontl splinting, since ll such mterils provide dentl composite resins with equivlent reinforcement properties, ese of use nd n ssortment of widths of the fiers re primry criteri. In multiuser evlution, ese of use ws primry criterion for cceptnce of use of ondle fier reinforcement. 39 The following cse report descries the use of fier-reinforced composite resin splint plced to stilize severely periodontlly compromised dentition in order to evlute tooth prognosis. Over the next 6 yers, the ptient s complince in orl hygiene nd periodontl mintennce improved the overll periodontl prognosis, leding to the tretment of the remining mxillry teeth with porcelin-metl fixed prtil denture. This cse report demonstrtes tht continued on pge ##

3 09Strssler:Strssler 8/6/09 9:49 AM Pge 5 5 Tooth Stiliztion Improves... continued from pge using the tretment techniques descried when tretment plnning similr clinicl situtions cn led to improved periodontl prognosis. CASE REPORT In yer-old femle presented to the dentl school clinic for tretment. She hd pst history of drug use, smoking, nd psychitric tretment for depression. Her first visit ws due to cute pin tht resulted in tooth extrction. She expressed desire to seek regulr tretment. A tretment pln ws formulted nd she ws dignosed with dult moderte periodontitis. Over the next 6 yers she sought only intermittent Figure 8. Eight-weeks post surgery. Figure 9. A 3-yer recll of splint nd porcelin veneers. cre, with tretment for dentl emergencies relting to cute pin. In erly 1997 the ptient returned, nd ws exmined nd tretment plnned. She hd chnges in her life circumstnces tht would led to receiving more regulr cre nd following through on tretment. This nrrtive will focus on the ptient s periodontl cre nd restortive recommendtions sed upon her periodontl conditions (Tle 1) (Figure 1). One fculty memer hd suggested n immedite mxillry denture sed upon the ptient s periodontl sttus nd finncil limittions. The ptient rejected the ide of extrcting the mxillry teeth. For the ptient s periodontl condition, scling nd root plning, occlusl djustment to stilize her occlusion, nd periodontl splinting with onded fier reinforced rion composite splint ws plnned. Periodontl nd occlusl trum DENTALCETODAY.COM SEPTEMBER 2009 Tle. Clinicl findings mxillry rch April 7, 1997 c Missing: Nos. 1, 2, 3, 6, 13, 14, 15, 16 Generl one destruction: 60% one loss; generlized 3 to 4 mm one loss Widened PDL: generlized Moility: Grde 1: Nos. 4, 7, 8, 10, 12 Grde 2: Nos. 5, 11 Grde 3: No. 9 Furction involvement: No. 12 Infrony Defects: Nos. 4-D; No.5-D; No.9-M; No.10-M Prognosis mxill: 3 to 5 yers gurded Adult moderte periodontitis Posterior ite collpse Primry occlusl trum Figure 10. A 6.5-yer recll of splint: () fcil view, () right fcil view, nd (c) left fcil view. contriute to tooth moility. Due to finncil considertions, the tretment pln for n occlusl djustment nd the plcement of fier splint ws sed upon the ptient s desire to not hve removle prtil denture to provide for posterior support. In 1997, the plcement nd restortion of implnts ws not s commonplce s it is tody, s furthermore, the cost of implnt tretment would hve mde restortion of the posterior re with implnts unfesile for this ptient. Although fier splints would e provisionl solution considering the ptient s extensive one loss (60%) nd significnt tooth moility c 5 to 10 yers gurded Figure 11. Preprtions of the mxillry teeth for porcelin-metl fixed prtil denture: () fcil view, () right fcil view, nd (c) left fcil view. without posterior occlusl support, the ptient ws willing to hve repirs of the splint s would e needed when frctures occurred. Teeth Nos. 4, 7, 8, 10 nd 12 hd degree 1 moility; teeth Nos. 5 nd 11 hd degree 2 moility; nd tooth No. 9 ws depressile with degree 3 moility. Since the focus is whether or not splinting nd tooth stiliztion contriute to improvement in periodontl nd tooth prognosis, tretment of the mxillry rch will e presented. As prt of initil therpy ll the teeth were scled nd root plned nd polished (Figures 2 nd 2). To control occlusion nd occlusl trum, the teeth were occluslly djusted. Also, since the prognosis ws gurded for mny of the remining mxillry teeth, the decision ws to plce fier reinforced composite resin splint to include ll the mxillry teeth (Nos. 4 to 12) efore pocket elimintion surgery. The design of the fier splint included endodonticlly treted tooth No. 5 where doule fier rion would e plced into the pulp chmer, nd this doule fier would e included in the pontic re of No. 6 to crete em effect, strengthening the connectors of this directly plced fixed prtil denture. 39 The dvntges of directly onded fier reinforced composite resin splint is tht it is single-visit procedure nd llows for n evlution of tooth prognosis efore tretment plnning porcelin-metl fixed prtil denture. 1,31 Mxillry splints plced on the lingul surfce with reinforcement mterils hve the disdvntge of wer through the composite resin, perforting into the reinforcement mteril, nd the forces of occlusion function ginst the ond to the teeth cn led to frcture nd filure. 25,46 Perfortion into the fier reinforcement mteril wekens the splint, nd for the ptient ecomes source of irrittion due to the roughness creted on the lingul surfce due to the exposed fier. 41,45 With tooth preprtion on the fcil surfce of nterior teeth to void overcontouring of the restortion (Figures 3) nd occlusl preprtions for the posterior teeth, the splint ws to e fricted. Plcing the fier reinforcement rion on the fcil surfce is indicted for ptients with occlusion on the lingul surfce 46,47 nd in clinicl circumstnces when the ptient hs deep overite. 48 A structurl enefit of plcing the fier rion on the fcil surfce is tht the fier emedded into the dhesive composite resin is on the tensile side of the restortion, which plces the forces of occlusion on the splint in fvorle direction. The fier rion improves the flexurl strength of the composite resin on the fcil surfce. 40,41,45 For this cse, UHMWPE lenoweve, lock-stitch fier rion (Riond Reinforcement Rion, Riond) ws used. After etching, nd dhesive nd initil composite resin plcement, the fier rion ws plced (Figures 4 nd 4). The restortion ws completed with fcil veneering of the mxillry nterior teeth nd composite resin pontic for the No. 6 site (Figures 5 nd 5). The ptient ws shown how to mintin continued on pge ##

4 09Strssler:Strssler 8/6/09 9:49 AM Pge 6 6 Figure 12. Completed porcelin-metl fixed prtil denture (Nos. 4 to 12): () fcil view nd () lingul view. periodontl helth of the splinted teeth nd remove plque with vriety of interproximl clening ids. Surgicl tretment for pocket elimintion included n piclly positioned flp with osseous contouring (Figures 6 nd 6). The tissue ws piclly positioned using modified verticl mttress suture to stilize the gingivl tissues piclly on the teeth (Figures 7 nd 7). Eight-weeks post surgery, the heling ws excellent (Figure 8). The ptient hd n esthetic complint of drk tringles in the gingivl emrsures of the mxillry nterior teeth. The decision ws to plce porcelin veneers on Nos. 6 to 11. Since cost ws mjor fctor in tretment decisions, the teeth were prepred for porcelin veneers, impressed, nd temporized. The veneers (Cerinte Porcelin Veneers, Den-Mt) were fricted nd pid for with reserch ccount. The ptient ws plced on 3- to 4-month periodontl mintennce recll schedule. Over the next 3 yers the ptient reduced her smoking hit, nd ecuse of her own work nd personl schedule, mintined 4- to 6- month recll schedule for periodontl mintennce. Three yers fter tretment, the ptient hd excellent periodontl helth with miniml periodontl pocketing, nd the splint nd veneers were performing t cliniclly cceptle level (Figure 9). Over the next 3.5 yers the splint ws repired 2 times t the mesil nd distl connector of the pontic on No. 6 with susequent frcture of the porcelin veneer on tooth No. 7. At the 6.5 yer recll the periodontl helth ws eing mintined (Figures 10 nd 10). It ws recommended to the ptient tht insted of repiring the splint nd porcelin veneers, her periodontl prognosis ws good nd it ws Figure 13. A 12-yer recll of porcelin-metl fixed prtil denture splint (Nos. 4 to 12): () fcil view nd () rdiogrphic view. time to restore the mxillry teeth with porcelin-metl fixed prtil denture. Her work sitution nd dentl insurnce llowed her to follow the restortive recommendtions. The splint ws removed nd the mxillry teeth were prepred for porcelin-metl fixed prtil denture (Figures 11 nd 11). The completed restortion ws cemented with glss ionomer cement (Figures 12 nd 12). Twelve yers erlier, the ptient ws dignosed with dult moderte periodontitis with gurded prognosis for the mxillry teeth. After tretment of the mxillry rch with initil periodontl therpy of scling nd root plning, plcement of periodontl splint fricted with lenoweve, UHMWPE fier rion (Riond) reinforced dhesive light-cure composite resin, nd then surgiclly treted with n piclly positioned flp with osseous recontouring, the ptient ws plced on periodontl mintennce progrm. Six nd hlf yers fter fier-reinforced composite resin splinting, the ptient s mxillry rch ws restored with fixed prtil denture. At the 12 yer recll, the mxillry teeth demonstrte recession nd cervicl notching djcent to the fixed prtil denture ut with miniml gingivl pocketing nd dignosis of gingivitis (Figures 13 nd 13). During the lst recll, the ptient hd mndiulr nterior teeth nd the missing mndiulr incisor replced with composite resin pontic nd fier reinforced dhesive composite resin fixed prtil denture (Riond THM, [Riond]). Note the proing depth chnges prior to the initition of periodontl tretment nd splinting in 1997 nd continuing over the 12 yers of recll (Figure 14). The ptient hs mintined the remining mxillry teeth. Figure 14. Comprison periodontl chrting of proing depths from strt of periodontl initil therpy, t 4.5-yer recll, nd t 12-yer recll. CONCLUSION In the pst, the use of splinting of periodontlly compromised teeth ws contentious. The presumption ws tht splinting to control tooth moility ws required to control gingivl inflmmtion, periodontitis, nd pocket formtion. The use of splinting therpy in conjunction with control of occlusl trum cn contriute to improved prognosis of periodontlly compromised dentitions. This rticle presents 12-yer recll cse for periodontlly compromised mxillry dentition in which the teeth were occluslly djusted nd splinted s prt of periodontl therpy. This ptient ws resonly complint in her ttention to orl hygiene nd following the periodontl mintennce regimen. Splinting of the mxillry rch hs contriuted to n outstnding result of chnging the periodontl prognosis for the mxillry teeth from eing gurded to good. The ptient is considering the plcement of posterior implnts to further stilize the occlusl support nd function. Acknowledgement The following clinicins provided clinicl tretment nd help with this ptient: Drs. Cludi Crvlho-Storch, Brdley Phillips, Jessic Isenerg, Hrln Shiu, nd Chrlson Choi. References 1. Serio FG. Clinicl rtionle for tooth stiliztion nd splinting. Dent Clin North Am. 1999;43: Hllmon WW, Crrnz FA, Drisko CL, et l, eds. Periodontl Literture Reviews: A Summry of Current Knowledge. Chicgo, Ill: Americn Acdemy of Periodontology; Strssler: plese verify the uthors of this reference. 3. Sper FM. Fundmentl occlusl therpy considertions. In: McNeill C, ed. Science nd Prctice of Occlusion. Chicgo, Ill: Quintessence Pulishing Co; 1997: Trnow DP, Fletcher P. Splinting of periodontlly involved teeth: indictions nd contrindictions. N Y Stte Dent J. 1986;52: Werhug J. Justifiction for splinting in periodontl therpy. J Prosthet Dent. 1969;22: Bhskr SW, Orn B. Experimentl occlusl trum. J Periodontol. 1955;26: Rmfjord SP, Kohler CA. Periodontl rection to functionl occlusl stress. J Periodontol. 1959;30: Kegel W, Selipsky H, Phillips C. The effect of splinting on tooth moility. I. During initil therpy. J Clin Periodontol. 1979;6: Gller C, Selipsky H, Phillips C, et l. The effect of splinting on tooth moility. II. After osseous surgery. J Clin Periodontol. 1979;6: Ludench KW, Stoller N, Lster L. The effects of periodontl surgery on horizontl tooth moility. J Dent Res. 1977;56:(Specil Issue):288, strct Amsterdm M. Periodontl prosthesis. Twentyfive yers in retrospect. Alph Omegn. 1974;67: Pollck RP. Non-crown nd ridge stiliztion of severely moile, periodontlly involved teeth. A 25-yer perspective. Dent Clin North Am. 1999;43: Lindhe J, Nymn S. The role of occlusion in periodontl disese nd the iologicl rtionle for splinting in tretment of periodontitis. Orl Sci Rev. 1977;10: Forosco A, Grndi T, Cotti B. The importnce of splinting of teeth in the therpy of periodontitis. Minerv Stomtol. 2006;55: Mosedle RF. Current indictions nd methods of periodontl splinting. Dent Updte. 2007;34: Bruch H, Ehrlich J, Yffe A. Splinting review of the literture [in Herew]. Refut Hpeh Vehshinyim. 2001;18: Girgi M, Lindhe J. Tooth moility nd periodontl disese. J Clin Periodontol. 1997;24: Jin LJ, Co CF. Clinicl dignosis of trum from occlusion nd its reltion with severity of periodontitis. J Clin Periodontol. 1992;19: Glickmn I. Occlusion nd the periodontium. J Dent Res. 1967;46: Werhug J. The infrony pocket nd its reltionship to trum from occlusion nd sugingivl plque. J Periodontol. 1979;50: Mnson JD. Bone morphology nd one loss in periodontl disese. J Clin Periodontol. 1976;3: Renggli HH, Schweizer H. Splinting of teeth with removle ridges iologicl effects. J Clin Periodontol. 1974;1: Miller SC. Textook of Periodonti. 3rd ed. Phildelphi, P: The Blkiston Co; 1950: Schrer P. die stegkonstruktion ls vesteigungemittel im vestgeiss [thesis]. Zurich, Switzerlnd: University of Zurich; Strssler HE, Heri A, Gultz JP. New-genertion onded reinforcing mterils for nterior periodontl tooth stiliztion nd splinting. Dent Clin North Am. 1999;43: Wheeler TT, McArthur WP, Mgnusson I, et l. Modeling the reltionship etween clinicl, microiologic, nd immunologic prmeters nd lveolr one levels in n elderly popultion. J Periodontol. 1994;65: McGuire MK, Nunn ME. Prognosis versus ctul outcome. II. The effectiveness of clinicl prmeters in developing n ccurte prognosis. J Periodontol. 1996;67: Bernl G, Crvjl JC, Muñoz-Viveros CA. A review of the clinicl mngement of moile teeth. J Contemp Dent Prct. 2002;3: Cortellini P, Tonetti MS, Lng NP, et l. The simplified ppill preservtion flp in the regenertive tretment of deep introny defects: clinicl outcomes nd postopertive moridity. J Periodontol. 2001;72: Fugzzotto PA. Specil considertions, tretment selection criteri, nd cse reports. Postgrd Dent. 1999;6: SEPTEMBER 2009 DENTALCETODAY.COM

5 09Strssler:Strssler 8/6/09 9:49 AM Pge 7 7 Tooth Stiliztion Improves... continued from pge 31. Siegel SC, Driscoll CF, Feldmn S. Tooth stiliztion nd splinting efore nd fter periodontl therpy with fixed prtil dentures. Dent Clin North Am. 1999;43: Tutin FS, Miller GE. Nonprllel pin splinting for moile teeth. J Prosthet Dent. 1973;29: Rochette AL. Attchment of splint to enmel of lower nterior teeth. J Prosthet Dent. 1973;30: Wood M, Thompson VP. Anterior etched cst resin-onded retiners: n overview of design, friction, nd clinicl use. Compend Contin Educ Dent. 1983;4: Strssler HE, Serio FG. Stiliztion of the nturl dentition in periodontl cses using dhesive restortive mterils. Periodontl Insights. 1997;4: Lituks EL. An mlgm nd composite resin splint for posterior teeth. J Prosthet Dent. 1973;30: Fusym T. Permnent splint of highly moile teeth. J Prosthet Dent. 1973;30: Miller TE. A new mteril for periodontl splinting nd orthodontic retention. Compendium. 1993;14: Clinicl Reserch Assocites. Reinforcement fiers, for splinting teeth. CRA Newsletter. 1997;21: Strssler HE, Krhri V, Rudo D. Effect of fier reinforcement on flexurl strength of composite. J Dent Res. 2001;80:221. Astrct Krhri VM, Strssler H. Effect of fier rchitecture on flexurl chrcteristics nd frcture of fier-reinforced dentl composites. Dent Mter. 2007;23: Ellkw AE, Shortll AC, Mrquis PM. Influence of fier type nd wetting gent on the flexurl properties of n indirect fier reinforced composite. J Prosthet Dent. 2002;88: Ayn E, Celenk S. Polyethylene fier-reinforced composite inly fixed prtil dentures: two-yer preliminry results. J Adhes Dent. 2005;7: Unlu N, Belli S. Three-yer clinicl evlution of fier-reinforced composite fixed prtil dentures using prefricted pontics. J Adhes Dent. 2006;8: Krhri VM, Rudo DN, Strssler HE. The development nd clinicl use of leno-woven UHMW- PE rion in dentistry. Proceedings of the Society for Biomterils. 2003;29:15. Astrct Iniguez I, Strssler HE. Polyethylene rion nd fixed orthodontic retention nd porcelin veneers: solving n esthetic dilemm. J Esthet Dent. 1998;10: Strssler HE. Plnning with dignostic csts for success with direct composite resin onding. J Esthet Dent. 1995;7: Vitsentzos SI, Koidis PT. Fcil pproch to stiliztion of moile mxillry nterior teeth with steep verticl overlp nd occlusl trum. J Prosthet Dent. 1997;77: Dr. Strssler is professor in the Deprtment of Endodontics, Prosthodontics, nd Opertive Dentistry t the University of Mrylnd Dentl School. He cn e reched t strssler@umrylnd.edu. Disclosure: Dr. Strssler hs received reserch funding from Riond. DENTALCETODAY.COM SEPTEMBER 2009

6 09Strssler:Strssler 8/6/09 9:49 AM Pge 8 ce Test 117 To sumit Continuing Eduction nswers, use the nswer sheet on pge XX. Plce n X in the ox corresponding to the nswer you elieve is correct, detch the nswer sheet from the mgzine, nd mil to Dentistry Tody Deprtment of Continuing Eduction. This rticle is ville for 2 hours of CE credit. 8 The following 16 questions were derived from the rticle Tooth Stiliztion Improves Periodontl Prognosis: A Cse Report, y Howrd E. Strssler, DMD on pges xx through xx. Lerning Ojectives After reding this rticle, the individul will lern: The effects of tooth stiliztion on the long-term prognosis of teeth with moility due to periodontl disese. A technique for stilizing moile teeth vi splinting. 1. Moility of teeth my e cused y:. inflmmtion of the periodontium.. loss of periodontl ttchment. c. functionl or prfunctionl forces on teeth. d. ll of the ove. 2. A splint hs een defined s n pprtus, pplince or device employed to prevent movement or displcement of frctured or movle prts. In dentistry splinting usully refers to joining teeth together to trnsmit stility to the entire restortion.. Both sttements re flse c. Both sttements re true 3.Tooth stility is importnt in occlusl tretment. According to Sper the gols of occlusl tretment re:. to control loding tht occurs t the temporomndiulr joint.. to control mrginl lekge t the occlusl interfce of restortive mterils. c. to control lod plced on the occluding surfces of teeth. d. oth nd c. 4.The primry reson(s) for periodontl splinting of moile teeth is (re):. primry occlusl trum.. secondry occlusl trum. c. progressive moility. d. ll the ove. 5. Primry occlusl trum is defined s:. wer on teeth during prfunction.. injury tht results from excessive occlusl forces pplied to tooth or teeth with norml periodontl support. c. injury tht results from norml occlusl forces pplied to tooth or teeth with indequte periodontl support. d. moility of teeth due to gingivl inflmmtion nd one loss. 6.Tooth moility cn e controlled with splinting therpy. Once the teeth re splinted the splint only needs to e in plce for 6 months to one yer to llow the teeth to stilize, then it cn e removed.. Both sttements re true c. Both sttements re flse 7. Occlusion is n importnt component of periodontl helth. Occlusl trum nd moility in the periodontlly compromised dentition cn contriute to deteriorting periodontl prognosis.. Both sttements re true c. Both sttements re flse 8.Tooth moility cn e detected cliniclly nd is descried sed upon displcement of the tooth crown when moved with 2 rigid dentl instruments.the chrting of tooth moility is sed upon the:. Loe-Silness index.. Miller Index. c. Dow Jones Index. d. Periodontl index. 9.The min resons for stilizing the periodontlly compromised dentition with splinting include:. reduces clculus deposition.. reduces cervicl cries. c. improves periodontl prognosis of moile teeth. d. ll of the ove. 10. Periodontl splinting hs een ccomplished with ll the following techniques EXCEPT.. Fixed prtil dentures (crown nd ridge). Polyvinyl siloxne onding c. Nonprllel pin splint d. Direct dhesive composite with fier reinforcement 11. In the pst, composite resins emedded with wires, metl mesh, nd nylon mesh hd clinicl filures ecuse:. they were too nrrow for teeth.. they were too wide for teeth. c. they were too long for teeth. d. loding stresses plced on the splint during norml nd prfunction cused frcture. 12. Composite resins re rittle mterils. Bondle reinforcement rions nd fiers of ultr high moleculr weight polyethylene (eg, Riond) nd glss, eg, (Splint-It), when emedded in composite resin with splinting, crete lminted structure with improved physicl properties of the composite nd greter resistnce to frcture.. Both sttements re true c. Both sttements re flse 13. In the cse report mxillry splint with leno-weve, lock-stitch ultr high moleculr weight polyethylene rion (Riond) ws plced on the fcil surfce. The reson(s) for plcing the splint on the fcil surfce ws(were):. plces the forces of occlusion on the tensile side of the restortion, resisting the forces of occlusion.. voids wering through the composite, which would cuse perfortion to the fier reinforcement nd weken the splint. c. performtion of the composite into the fier splint cn cuse roughness on the lingul surfce due to exposed fier. d. ll of the ove. 14. When using fier reinforced rion for splinting, fter tooth clening nd/or preprtion, the tooth is etched, nd dhesive nd composite resin re plced.the fier is then emedded into the composite resin efore light curing.. Both sttements re true c. Both sttements re flse 15. In the cse report the fier reinforced composite resin dhesive splint ws plced to stilize the ptient s moile teeth ecuse of the gurded periodontl prognosis. As prt of tretment the teeth were scled nd root plned, nd fter splinting, this ptient hd pocket elimintion surgery ecuse of the severity of her periodontl condition.. Both sttements re true c. Both sttements re flse 16.The use of splinting therpy in conjunction with control of occlusl trum cn contriute to improved prognosis of periodontlly compromised dentitions.the only type of splinting therpy tht will work to stilize teeth is fier reinforcement of composite resin.. Both sttements re true c. Both sttements re flse Now ville dentlcetody.com. Simply log on nd follow the esy directions. Certifiction will e sent to you vi e-mil. SEPTEMBER 2009 DENTALCETODAY.COM