IT IS well established what is generally the conventional approach by the dental practitioner to a shaking tooth. When I was a young dentist thirty years ago me and my colleagues competed by seeing who can be the first to fill a bucket with teeth we extracted. Back then, what was thought to be excessive mobility was accepted as the only criteria to condemn a tooth to extraction. But the considered view of many experts today is that other factors should be taken into account before the hasty, stereotype approach is adopted. The intention obviously is to try to maintain, if possible, the tooth or teeth in the patient’s mouth for some more time, despite the fact that it may be shaking abnormally. This is achieved by a technique known as splinting.

Splinting refers to the joining together of two or more teeth to increase their resistance to applied forces. It involves binding a group of teeth together so that the biting forces are shared by a large number of teeth instead of being borne by the affected tooth. Splint therapy, by the immobilisation of teeth, was historically based upon the assumption that mobility (shaking) causes pocket information. Prior to the current understanding of the development of periodontal disease, the basic therapy was immobilisation of teeth. It was assumed that horizontal forces were more destructive than vertical loading forces. However, experiments done since 1931 confirmed that this is not true.

Excessive tooth mobility can be a severe impairment of the function and comfort of some patients. When advanced gum disease has resulted in tooth migration (movement), extrusion (tooth appears to become longer), or progressive mobility, splinting should definitely be a consideration in the treatment as an adjunctive aid in periodontal therapy. It is believed that increasing mobility in the diseased dentition is harmful and should be treated by splinting. That is not to say that there are extreme cases which definitely require extraction.

There are several benefits derived from splinting. First, it allows the patient to chew comfortably because the shaking teeth become firm and the patient can use a regular brush, inter-dental brush, etc. without the fear of knocking down teeth. Splinting is done in conjunction with other periodontal therapy, such as scaling, root planning, flap surgery etc. It is also an adjunct to the preservation of hard and soft tissue thereby enhancing the patient’s self-confidence because he/she is getting the opportunity to keep their own natural teeth.

In the healthy, splinting is done when the patient receives a blow to the mouth whereby the anterior teeth become loose. In such cases of acute trauma, it is believed that splinting can aid in the repair of the injured attachment apparatus. Perhaps one can appropriately compare splinting in dentistry with the method placing a broken limb in a plaster cast for proper healing of the bone to occur. The principle is identical.

Splinting following adult orthodontic movement may be indicated to retain teeth in their new positions. Its efficacy is based on the fact that the splinting in this instance will allow remodeling of the alveolar (ridge) bone and allow the rearrangement of the fibres of the ligament that connects to the tooth to the jaw bone.

Splinting can sometimes be used in the treatment of occlusal disorders such as bruxism, clenching of the teeth often during sleep. These para-functional habits can cause changes similar to primary occlusal trauma (abusive biting such as opening beverage corks with the teeth) and are sometimes treated with rubber bite planes or night guards, which are forms of splints. The splinting of teeth can also be used to prevent the over eruption or drifting of unopposed teeth as well as to replace missing teeth. Materials used include acrylic resin, steel wire, silver amalgam and other metals. Splinting may be either short-term (three weeks) or long-term (nine weeks) or permanent.