⦁ Mobile Teeth Splinting
Periodontitis, which is an advanced form of periodontal disease, causes destruction of both soft and hard tissue components of the tooth supporting structures leading to tooth mobility. Tooth mobility is considered as the extent of horizontal and vertical tooth displacement created by examiners force. Assessment of tooth mobility is considered as an integral part of periodontal assessment because it is one of the important signs in the diagnosis of periodontal diseases. Hence, the reduction of tooth mobility is one of the prime objectives of periodontal therapy.
Tooth mobility is usually graded into Grade 1, 2, and 3 in periodontal healthcare delivery using Miller tooth mobility index because it has bearing on the choice of treatment and prognosis prediction. The mechanism through which periodontitis cause tooth mobility include inflammatory disruption of the periodontal tissues, widening of the periodontal ligament, attachment loss, alveolar bone loss, and occlusal trauma. The occlusal trauma here is considered as secondary occlusal trauma because the tissue destruction occurs in the presence of normal occlusal forces on the mobile tooth due to the weakened supporting tissues. Branschofsky et al. reported that secondary trauma from occlusion is frequently seen in periodontally compromised patients.
Tooth mobility results in occlusal instability, masticatory disturbances, and impaired quality of life. The continued movement of the mobile tooth during oral function further damages the periodontium, accelerating the disease process thereby leading to tooth loss. The initial awareness of tooth mobility in patients may be from tooth tenderness experience on mastication followed by pain on sudden tooth displacement when biting on hard foods or from inadvertent trauma. The anterior labial or lateral tooth displacement that results in fanning and elongation of clinical crown with poor appearance is the esthetic challenge associated tooth mobility. Individuals experiencing tooth mobility may resort to unilateral mastication and dietary restriction as their coping mechanisms. Teeth cleaning is also difficult thereby leading to the worsening of oral hygiene status by plaque accumulation. These factors trigger a positive feedback mechanism which will be truncated only if appropriate treatment is rendered or the untreated tooth is lost [Figure 1].
Splinting is a well-accepted integral part of holistic periodontal treatment which results in morale boost, improved patient comfort, and oral functions. Composite splinting reinforced with 0.5 mm HSS wire may be used to facilitate healing of periodontally compromised teeth with mobility after they have been treated with nonsurgical periodontal therapy and occlusal adjustment.