DT U.S. Edition, October 2010, Vol. 5, No. 21

COSMETIC TRIBUNE The World’s Cosmetic Dentistry Newspaper · U.S. Edition By Dr. Ajay Kakar, India Fig. 3: The fibre in place and poly- merised after being coated with flowable composite. g CT page 2C OctOber 2010 www.dental-tribune.com VOl. 3, NO. 10 Periodontal disease is initiated in the main as gingivitis, which in a smaller subset of individuals progresses to the more advanced form referred to as periodonti- tis. Gingivitis is restricted to the marginal gingival area and does not lead to destruction of osseous tissue. Gingivitis is the progression to periodontitis, which encompasses extensive loss of bone surround- ing the tooth. Modern-day therapy can generally ensure the arrest of the progression of periodontal destruction and, in favourable situations, even the regenera- tion of all the components of the periodontal apparatus, albeit to a much lesser extent than the origi- nal. Of the periodontal structures, the loss of soft tissue makes the process of complete regeneration much more difficult. In such circumstances, wherein the inflammation and infection has been controlled and the dis- ease activity has been curbed, it becomes imperative that the den- tition, which is definitely compro- mised owing to the pre-existing damage, be supported and addi- tional aids provided to create the optimum function, coupled with aesthetics. One of the key issues in such dentitions is the mobility of the teeth. Such mobility may be localised to certain teeth and in a specific path of motion or may be much more generalised and afflict many teeth. In either case, the benefits of immobilisation are multiple. The comfort level of the patient is sufficient reason to use this treatment option for mobile teeth. Additionally, this also leads to tremendous patient motiva- tion and compliance in maintain- ing oral hygiene, which directly translates into better periodontal health. Furthermore, an immo- bile tooth will heal much faster and better than a mobile one. Any regenerative therapy carried out around afflicted mobile teeth will have better results than would have been the case had the teeth been immobilised (Figs. 1–4). Another critical manifesta- tion of periodontal disease, when coupled with imbalanced occlusal loads, is the sequel of migration that results from such a clinical situation. Migration, an extremely slowly developing phenomenon, leads to drastic consequences that can usually be optimally corrected only by using orthodontic appli- ances. But even this correction requires a permanent splinting procedure to ensure that the con- cerned teeth remain in place and do not migrate away once again. Maintenance of periodontally compromised teeth with direct splinting: current materials and options Fig. 4: The completed splint with direct bonding composite build- up to achieve a pleasing aesthetic result. Fig. 5: A case of migration of the central incisors. Fig. 6: A splint done followed by recontouring of the tooth and direct bonding composite build- ups. Fig. 2: Grooves prepared on the buccal surface of the incisors at the incisal third to enable placement of the fibre. Fig. 1: A common periodontal situ- ation with mobile anterior max- illary teeth causing discomfort. (Photos/Provided by Dr. Kakar) This same technique can be used routinely by orthodontists to place permanent non-invasive quartz splints. Another possible use of quartz glass fibre splints is in cases of alveolar fractures. The advent of bonding dentistry and the easy- to-use quartz splint fibre make it a very strong contender for the stabilisation and immobilisation of anterior alveolar fractures. A key factor towards achieving the end point of a good and long- lasting splint is the base mate- rial used in conjunction with the composite restorative material for building and applying the splint. It is very important that the splint functions like a monobloc and bonds optimally to the enamel and dentine. In order to provide this monobloc effect, the substruc- ture has to chemically bond and be in unison with composite restor- ative material. In order to provide near-opti- mum bonding, the substructure and the entire monobloc, which has to be built up, have to be very closely adapted to the teeth around all the curves, right into the inter- proximal spaces. This means that the fibre material should have physical properties that allow curving and very easy manipula- tion into any shape (Figs. 5, 6). The required materials for achieving a high quality functional and aesthetic splint are: • a pre-impregnated glass fibre-