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

3CCOSMETIC TRIBUNE | OctOber 2010 Clinical to become a monobloc with the composite. The quartz splint is developed as a woven fibre using extremely thin strands of glass fibres. The weave pattern imbibes certain physical attributes to the material. It allows force distri- bution in such a manner that it create the previously mentioned clinical zero memory effect and not resist and inhibit crack propa- gation. All of the above-mentioned effects are achieved without any compromise to the strength of the material. In fact, the quartz fibre will enhance and strengthen the monobloc that is created with the amalgamation of the unfilled resin, quartz fibre, flowable com- posite, and micro-/nano-filled composite material. Since the material is available pre-impregnated and is soaked in unfilled resin, it becomes all the more easier to use the splint right out of the box. The zero memory allows it to be adapted extremely easily around a curved arch with- out polymerisation. Once ideal adaptation has been achieved, it can be polymerised in that posi- tion and then layered with micro/ nano composite to complete the splint (Figs. 11–14). Another critical factor in the variety of situations for which a splint is indicated is the width and thickness of the material. Too thick a material can be an encum- brance for placement and final positioning. An ideal thickness is between 0.1 and 0.25 mm. The thinner the material becomes, the lower its ability to reinforce and strengthen will be. The quartz splint is in the 0.2 mm thickness range, making it useful in almost all clinical situations. The quartz splint is available in a variety of patterns and widths. The recommended pattern for intra-oral splinting is the woven pattern. This is available in widths of 1.5 mm, 2.5 mm and 4 mm. Of these three, the 1 mm design is most suited for use as a retention splint in post-orthodontic cases in which the teeth are neither extremely mobile nor do they exhibit gingival recession and loss of the supporting structures. The 2 mm fibres are most ide- ally suited for teeth afflicted with previous periodontal disease. When the teeth are large in size and exhibit clinical crowns larger than the anatomical crowns, the 3 mm fibre may be used in lieu of the 2 mm fibre. The quartz splint has a unique design — much like a braided rope — giving it extremely high flexur- al strength values after complete polymerisation. The design of the material requires it to be between 1 and 2 mm in diameter. A deep groove has to be cut into the teeth where the splint is being placed to enable it to be adapt- ed optimally. This design can be utilised when in cases in which an occlusal splint design is used to stabilise maxillary or mandibular premolars. Other than the woven and rope patterns, the quartz splint is avail- able as a unidirectional fibre. This is not to be applied in clinical situ- ations, but rather as a laboratory reinforcement material used to develop poly-ceramic prostheses. The quartz splint also has a 4 cm x 4 cm mesh that can be applied in denture repairs, for example. With material benefits aid- ing and improving the functional aspect of splints, there has been a newer approach possible owing to the enhancement of bonding den- tistry technology. Shade match- ing, polishability, enhanced bond strength and much longer-lasting composites have all contributed to a much greater usage of direct bonding procedures in everyday dentistry. The emphasis this has given to aesthetic procedures has been tremendous. Similarly, the quartz fibre-based composite splint in a dentition with pre-existing peri- odontal damage can be enhanced to achieve a much better aesthetic result (Figs. 15–19). Although function has been the paramount and most critical issue when placing a periodontal splint, aesthetics now also play an impor- tant role. The patient and the clinician may not be completely satisfied with function. It is quite easy to apply standard bonding principles of a diastema closure to ensure that the basic substructure is appropriately located and thereby enable an excellent aesthetic outcome with longevity. This modification of a function- al splint to an aesthetic splint can be easily applied for anterior teeth exhibiting extensive mobility or migration. Several of these cases can be seen in Figures 15–24, in which the maxillary anterior teeth presented with diastemas and pro- Fig. 21: Preparations done on the palatal surface; the area where the splint is to be placed has been grooved. Fig. 22: A tin foil template placed on the grooved area to measure the size of the required splint. Fig. 23: The woven quartz splint placed in the prepared area on the palatal surface of the maxil- lary anteriors. Fig. 24: The completed splint. Dr. Ajay Kakar is in private practice spe- cialising in periodontics and implantology in Mumbai in India. He is the secretary of both the International Academy of Periodontology and the Indian Academy of Aesthetic & Cos- metic Dentistry. He lectures extensively in India and abroad and runs a web portal for Indian dentistry at www.bitein.com. Kakar can be contacted at ajay@bitein.com or at +91 98210 15579. About the author Fig. 16: Lingual view of the same patient with mobile lower central incisors. Fig. 15: Buccal view of a patient with mobile lower central inci- sors. Fig. 18: Buccal view of the splint done with the woven quartz splint. Fig. 17: A tin foil template used to measure the size of the required splint. Fig. 20_A case requiring post-orthodontic retention of the upper incisors; the splint is to be placed on the palatal sur- face of the maxillary anteriors. Fig. 19: Lingual view of the splint done with the woven quartz splint. clinations coupled with mobility. The results have been very satis- factory. This article has only touched on the fundamental concepts of splints and the new improvisa- tions available in terms of materi- al technology. CT