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VARIOUS TECHNIQUES OF PERMANENT TEETH SPLINTING IN PERIODONTAL
DISEASES AND OCCLUSAL DISORDERS
Nurmatov Ortiq Sattarovich
PhD Assistant of the Department of Dentistry, Faculty of Postgraduate Education,
Samarkand State Medical Education University
Baxriddinova Mohidil Ravshanxonovna
1st year clinical resident Samarkand State Medical Education University
Abstract:
The article analyzes the use of splinting devices and devices that stabilize occlusion.
Permanent splinting of teeth in occlusal disorders and periodontal tissue diseases and the
elimination of the inflammatory component in periodontal tissues leads to a decrease in tooth
mobility. Progressive inflammation and increased tooth mobility or their absence require the
use of orthopedic temporary or permanent splinting structures that stabilize occlusion with
subsequent prosthetics and splinting of teeth.
Keywords:
orthopedic dentistry, tooth splinting, tooth mobility, periodontal tissue diseases,
occlusal disorders, permanent splinting
The indications for splinting teeth are based on the assessment of their mobility, which
characterizes the functional state of the periodontal tissues. If the bone tissue loss is half the
length of the root, the methods of splinting teeth in the sagittal and transverse directions should
be used. If the bone tissue loss is up to three quarters of the root length, it is additionally
necessary to use vertical splinting. In all cases of splinting loose teeth, it is necessary to
eliminate the problem or minimize the occlusal trauma of the periodontal tissues by choosing
the optimal occlusal scheme and design of the splinting apparatus. Permanent splints are used to:
1. limit tooth mobility in three directions - vertical, sagittal and transverse;
2. create complete or significantly reduced tooth mobility;
3. immobilize teeth for a long period of time. Splinting of mobile teeth is largely determined by
the clinical picture, namely, localized or generalized clinical picture of periodontitis, the form
of which dictates the type of stabilization: frontal for anterior teeth, sagittal for lateral teeth,
frontosagittal and parasagittal or along the arc.
Orthopedic indications for the treatment of periodontal diseases are:
1. Active signs of inflammation in the form of focal or generalized periodontitis;
2. The patient notes tooth migration;
3. The mobility of individual teeth or all within the dental arch is determined;
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4. Food debris remains in the interdental spaces.
When determining inflammation in the periodontium, occlusion correction should be used since
there is a fairly high possibility of tooth displacement after their splinting. Before therapeutic
treatment, it is only necessary to minimize premature contacts on individual teeth or eliminate
occlusal obstacles. Progressive inflammation and increased tooth mobility or their absence
require the use of temporary or permanent orthopedic splinting structures that stabilize
occlusion with subsequent prosthetics and splinting of teeth [15].
When determining persistent tooth mobility and relapses of conservative treatment, permanent
splinting with subsequent dispensary observation is required.
The splinting structure must meet certain requirements:
1. Create a sufficiently strong block of splinted teeth, limiting their movements in three
directions (sagittal, vertical and transverse) within the occlusion field;
2. Be firmly and rigidly fixed on mobile teeth;
3. There should be no food debris left in the interdental spaces;
4. Do not have an irritating effect on the surrounding periodontal tissues;
5. Do not interfere with conservative therapy of periodontal tissues;
6. After grinding the occlusal surfaces of the teeth, do not create blocking moments during
movements of the lower jaw;
7. Optimize the transfer of mechanical chewing load along the vertical axis of the tooth;
8. Do not interfere with the patient's speech and be acceptable in cosmetic terms.
A permanent splint that fixes teeth with periodontal tissue lesions can be non-removable,
removable, or combined.
The splinting properties of removable cast-in-place appliances are provided by the Ney type
clasp system, the use of various claw-shaped processes and occlusal pads, which allow
immobilization of mobile teeth in three planes. Removable splints require cleaning to a greater
extent, which allows conservative periodontal therapy to be performed in fairly good conditions.
Such splint designs are less disruptive to oral hygiene. One of the advantages of using
removable splints is the ability to optimize the functional overload of the affected periodontium,
especially with defects in the dental arches, but without signs of their significant pathological
mobility. At the clinical stage, the remaining teeth and periodontal tissues are assessed. The
next stage is to obtain high-quality silicone impressions and cast models from durable plaster.
In the dental laboratory, on a model installed in a parallelometer, the path of application of the
clasp denture frame is determined, the types and location of the supporting and retaining clasps
are determined. On a refractory model, a metal frame of the clasp denture is cast, which is then
processed and fitted on a plaster model, polished and transferred to the clinic. In the clinic, the
quality of the clasp denture is assessed, the fixation of the supporting and retaining clasps on
the model is noted, and then assessed in the oral cavity. Subsequently, a functional impression
is obtained from the opposite jaw and the central occlusion is determined. In the laboratory, the
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teeth are arranged on the upper and lower jaws. The clinic checks the design of the prostheses,
after replacing the wax composition of the prostheses, they apply the prostheses to the tissues of
the prosthetic bed with careful verification of occlusal contacts.
Such one-piece cast structures require the need to manufacture them with great precision, which
should be ensured by good quality impression materials, high-strength plaster, using
parallelometry methods that allow determining the path of application and fixation of the
prosthesis and precision casting on refractory models, careful fitting of the frame in the
laboratory and subsequent in the clinic [14].
Fixed splints or splint-prostheses ensure reliable fixation of the splinted teeth, forming a block
in one of the planes, or complete stabilization along the arc. With significant loss of bone tissue,
it is indicated to create a block of teeth capable of withstanding the horizontal and vertical
forces that develop during chewing. The rigidity of the splint is ensured by the material from
which it is made. The most optimal design for splinting loose teeth is the use of a cast metal-
ceramic or metal-plastic splint, or a prosthetic splint, which also compensates for defects in the
dental arches. Cast splints can be used for mild and moderate periodontitis and for bone atrophy,
up to 50% in recent years.
All-ceramic prosthetic splints have become quite widespread due to the biological inertness of
the ceramic coating, the possibility of minimal trauma and the availability of therapeutic
measures in the area of the marginal periodontium, and better oral hygiene, since dental
plaque forms in minimal quantities on the glazed surface of the dental prosthesis. The negative
properties of cast splints permanently fixed to the teeth include significant tooth preparation,
especially in the case of fan-shaped divergence, as well as the need for depulpation of the
splinted teeth, which can be included in the splinting block, in the absence of inflammatory
changes in the area of the apical periodontium. It is also very important to take into account
the characteristics of the alloys from which future structures will be made [17], [19], [20], [21].
Intolerance to dental materials can be caused by various reasons: galvanism, allergic reactions
to dental materials, toxic damage to the mucous membrane, etc., therefore, strict quality control
of the materials used is necessary (do not allow the use of counterfeit products) and additionally
conduct a joint analysis of the materials by a dentist and an immunological laboratory [16], [18],
[22].
At the clinical stage, the patient's appearance is assessed, the condition of each tooth is analyzed.
displacement of the dental arches, the type of occlusion and the possibility of reorganizing the
occlusal relationships of the dental arches. After choosing an orthopedic treatment plan, the
remaining teeth are prepared taking into account the future designs of fixed cast dentures. At
the stage of gum retraction, de-epithelialization of the inner surface of the gingival margin is
carried out, which allows for tight coverage of the gum in the neck of each tooth after healing
of the gingival part. Using silicone materials, impressions are obtained, the position of the
central occlusion is fixed, in which cast frameworks are prepared for the teeth of the upper and
lower jaws. After checking the frameworks in the oral cavity and redetermining central
occlusion in the dental laboratory, a ceramic coating is applied. Then they are transferred to the
clinic, where the position of the cast frameworks with ceramics relative to the gingival margin,
the relationship of the dental arches with each other, taking into account the reorganization of
the occlusal contacts, is optimized. Using a copy marker, a fine reorganization of the dental
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contacts in the position of central occlusion is carried out, achieving tight contacts in transverse
movements.
In periodontal diseases complicated by tooth loss, it is necessary to take into account the
appearance of an additional functional load on the remaining teeth, which should be splinted
with removable, non-removable or combinations of these splints, immobilizing, without
overloading, the remaining periodontium of the teeth. With the loss of lateral teeth, the load on
the remaining front teeth increases, under the influence of which the incisors and canines fan
out, which leads to a decrease in the interocclusal height.
Result
there is a risk of functional overload of the temporomandibular joint. Orthopedic
treatment for periodontal diseases involves immobilizing loose teeth, forming a functionally
strong block, and prosthetics of defects. Depending on the defects of the dentition, treatment
can be carried out using fixed, removable, or a combination of them, splints and prostheses.
Intraoral scanning has proven itself very well and has recently become widespread in
orthopedic dentistry. [3], [4], [5], [6]. Using this method, it is possible to obtain an accurate
digital model of the relief of objects in the oral cavity [8], [10], [12], [13]. After obtaining an
optical impression, various protective mouth guards, permanent splints, and splints are
manufactured on CAD/CAM systems. One of the important features of CAD/CAM systems
available on the modern market is their versatility in terms of the choice of construction
materials [6]. The technological capabilities of the equipment provide not only computer
modeling of the future prosthesis model, but also the direct production of the finished product,
which provides, in particular, orthopedic dentistry with the necessary resource for creating
various designs for permanent splinting, taking into account the personal anatomical and
physiological fetures of the facial skull structure [7], [8], [9].
Patients with partial tooth loss and periodontal tissue diseases should be divided into three
groups. The first group includes patients with included defects of the dentition, which can be
restored with a splinting cast denture. With significant defects in the dentition and a developed
inflammatory component of the periodontium, a combination of removable and
Hecbelbx splinting 1001cs0b is possible.
The second group includes patients who have lost chewing teeth on one or both sides, who are
indicated for splinting of the frontal group of teeth and restoration of distal defects using fixed
splints on the frontal group and removable structures in the area of the lateral teeth. In
such situations, it is necessary to provide a design in which the load from the removable denture
would not lead to an overload of the remaining immobilized front teeth [11].
The third group of patients who have lost teeth includes patients with multiple defects of the
dentition. Orthopedic treatment is carried out using fixed, removable and combined splints and
dentures. The treatment plan is determined by the condition of the periodontal tissues of the
remaining teeth, the size and topography of the defects, the doctor's training, the capabilities of
the dental laboratory and the patient.
At the clinical stage, the position of the teeth in the central occlusion is determined, then in the
sagittal and transverse occlusions. After choosing the design of the denture, the teeth are
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prepared, impressions are obtained, and the central occlusion is determined. In the dental
laboratory, cast frames of the fixed splinting parts of the denture are manufactured, which are
adjusted in the oral cavity.
Subsequently, taking into account the new relationships of the dental arches, a ceramic mass is
applied. In the clinic, the prostheses are verified with occlusal contacts in the oral cavity.
Impressions are obtained for the manufacture of the removable part of the dental prostheses in
the laboratory. Finished dentures with fixed and removable parts are adjusted in the oral cavity
at the new occlusion height, taking into account sagittal and transverse movements. The fixed
part of the denture is glazed and fixed with permanent cement. In subsequent observations, fine
grinding of the dental contacts in the dentures is possible.
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INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCHERS
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