Multiple-abutment anterior splints can be fabricated with the Inlay-Flange method to unify weak teeth. Periodontally weakened teeth can serve for decades longer. Once stability is achieved osteoclasia from hypermobility is managed and co-therapies to reduce inflammation can take hold with an improved prognosis.
This therapy serves the very beneficial clinical goal in treatment planning of separating the anterior segment from the posterior when a partial denture is planned,avoiding the always problematic Kennedy Class IV teeter-totter configuration. It also is far more acceptable to the patient to retain their natural incisors, their natural appearance, and improved comfort when mobility is no longer a daily discomfort.
BENEFITS OF THE INLAY-FLANGE BRIDGE FOR PERIODONTAL SPLINTING:
The essential benefits of this restoration to the patient are its
- low cost if full fee is paid
- covered by most dental plans
- low endodontic impact because entry into dentin is shallow
- negligible periodontal irritation because margins are supragingival
- minimal aesthetic alteration
- short prep and placement visits
- durable-not a stopgap measure
- comfortable due to low bulk
For the dentist and technician…..
- it is a forgiving prosthesis of low clinical and laboratory complexity
- it is stiff
- far more compact than resin-fiber splints
- adapts flexibly to the typical progress of periodontal disease, continuing to serve if teeth fail periodontally. A hopeless root can be removed and the natural tooth converted to a pontic with little apparent change from the patient’s perspective.
INDICATIONS FOR PLACEMENT
This splint can be used where the clinical picture is as follows.
- Alveolar bone is disappearing as the crown to root ratio reaches 2 to 1 or worse. Classic fixed prosthodontic texts suggest a minimal 1:1 Crown:Root ratio for longevity, so that full coverage would not be indicated in such a case.
- The teeth cannot be stabilizes even if inflammation is controlled, because of the unfavorable C/R ratio.
- Consequently, the patient cannot eat comfortably.
- Budget constraints, prognosis, dental IQ concerns, patient tolerance, or technical obstacles preclude fixed full coverage, implants or other conventional treatment.
- Tooth malpositions and rotations prevent a workable vertical path of insertion for fixed or, for that matter, removable treatment.
IMPACT ON PATIENT PERIODONTAL AND QUALITY OF LIFE:
The patient may be just starting a more healing path in their life, perhaps waking up from an alcohol/tobacco/coffee/physical inactivity/stress kind of lifestyle, and so the prognosis although uncertain, may be about to improve.
Improved dental stability can be a springboard in this personal journey back to health. Not losing one’s teeth is a powerfully transformative turnaround in consciousness.
Whereas, losing one’s teeth is a life defeat of major proportions for many patients.
The presenting conditions are a common constellation, which relate strongly to our increasing population of dentate seniors.
HISTOLOGICAL BASIS FOR SPLINTING:
The foundation for splinting rests on firm histological grounds: splinting arrests the osteoclasia and widening PDL that we see in high mobility cases as they approach terminal periodontal bone loss. Once splinted, bony support rebuilds for the whole lower anterior segment, giving many more years of service.
After placing over 50 of these splints and seeing the impact on the mouth and patients,I believe it provides a clinical solution to this perennially thorny set of clinical problems. Our patients retain their natural teeth longer, while practitioners enjoy a sound night’s sleep.