Periodontal Splintleme: Materyaller, Endikasyonlar ve Klinik Sonuçlar
Özet
Periodontal hastalıklar, periodontal dokularda ilerleyici yıkım ve diş kaybına yol açan multifaktöriyel inflamatuvar bir süreç olup, klinik bulgular arasında mobilite, ataşman kaybı, patolojik migrasyon ve ileri olgularda diş kaybı yer alır. Periodontal tedavide mobilitenin fonksiyon, konfor ve oklüzal stabilite üzerindeki olumsuz etkileri nedeniyle splintleme, uygun endikasyon durumunda destekleyici bir tedavi yöntemi olarak uygulanmaktadır. Literatürde splint materyalleri kompozit-tel, fiber, polietilen, E-glass, misina, braket, titanyum ve akrilik gibi çeşitli sınıflara ayrılmakta; bu materyaller estetik, elastikiyet, rijidite ve biyomekanik davranış açısından farklı özellikler göstermektedir. İn vitro ve in vivo çalışmalar, fiber ve yarı sert splintlerin stres dağılımında daha dengeli sonuçlar sağladığını; esnek materyallerin travmatize dişlerde daha uygun olduğunu; titanyum ve CAD/CAM temelli splintlerin ise estetik ve biyouyumluluk açısından avantaj sunduğunu bildirmektedir. Uzun dönem takiplerde splintlenen dişlerde periodontal parametrelerde iyileşme, stabilite artışı ve yüksek sağkalım oranları rapor edilmiştir. Sonuç olarak, Faz I tedaviyle birlikte uygulanan splintleme, mobil dişlerde fonksiyonel stabilite sağlayarak klinik ve radyografik iyileşmeye katkıda bulunan etkili bir yaklaşımdır.
Periodontal diseases are multifactorial inflammatory conditions that lead to progressive destruction of periodontal tissues and tooth loss, with clinical findings including mobility, attachment loss, pathological migration, and, in advanced cases, tooth loss. Due to the negative effects of mobility on function, comfort, and occlusal stability in periodontal therapy, splinting is applied as a supportive treatment method when appropriately indicated. In the literature, splint materials are classified into various categories such as composite–wire, fiber, polyethylene, E-glass, fishing line, bracket, titanium, and acrylic, and these materials exhibit different characteristics in terms of esthetics, elasticity, rigidity, and biomechanical behavior. In vitro and in vivo studies have reported that fiber and semi-rigid splints provide more balanced stress distribution, flexible materials are more suitable for traumatized teeth, and titanium and CAD/CAM-based splints offer advantages in terms of esthetics and biocompatibility. Long-term follow-up studies have demonstrated improvements in periodontal parameters, increased stability, and high survival rates in splinted teeth. In conclusion, splinting performed in conjunction with Phase I periodontal therapy contributes to functional stabilization of mobile teeth and supports both clinical and radiographic improvement, representing an effective treatment approach.
Referanslar
Ericsson I, Giargia M, Lindhe J, et al. Progression of periodontal tissue destruction at splinted/non-splinted teeth. An experimental study in the dog. Journal of Clinical Periodontology. 1993;20:693-698. doi: 10.1111/j.1600-051x.1993.tb00693.x
Graetz C, Plaumann A, Schlattmann P, et al. Long-term tooth retention in chronic periodontitis - results after 18 years of a conservative periodontal treatment regimen in a university setting. Journal of Clinical Periodontology. 2017;44:169-177. doi: 10.1111/jcpe.12680
Velioğlu MS, Ülkü SG, Ünlü N. Periodontal Olarak Umutsuz Bir Dişin Replantasyonunun 10 Aylık Takibi – Olgu Sunumu. Selcuk Dental Journal. 2023;327-331.
Aslan C, Acun Kaya F. (2022). Splintlemede Kullanılan Materyaller ve Splint Tipleri. Van Diş Hekimliği Dergisi, 3(2), 16-22.
Kwon SO. [Philosophical background of evidence-based medicine]. Uisahak. 2004;13:335-346.
Graetz C, Ostermann F, Woeste S, et al. Long-term survival and maintenance efforts of splinted teeth in periodontitis patients. Journal of Dentistry. 2019;80:49-54. doi: 10.1016/j.jdent.2018.10.009
Lee C, Do JH, Takei HH, et al. Determination of Prognosis Newman, M.G., Klokkevold, P.R., Elangovan S., Hernandez-Kapıla, Y., Newman and Carranza's Clinical Periodontolgy and Implantology 14th ed., 2024; pp 540-552. St. Louis, Missouri: Elsevier.
Nyman SR, Lang NP. Tooth mobility and the biological rationale for splinting teeth. Periodontology 2000. 1994;4:15-22. doi: 10.1111/j.1600-0757.1994.tb00002.x
Tokajuk G, Pawinska M, Stokowska W, et al. The clinical assessment of mobile teeth stabilization with Fibre-Kor. Advances in Medical Sciences. 2006;51(1):225-226.
Bhuvaneswari P, Gowri T, Ram Kumar GD, et al. Periodontal splinting: A review before planning a splint International Journal of Applied Dental Sciences. 2019;5(4): 315-319.
Shah HK, Sharma S, Shrestha S, et al. Splinting with Composite and Wire: Cheap, Flexible Option for Stabilizing Traumatized Teeth Case Report. Journal of Nepalese Society of Periodontology and Oral Implantology. 2020;4(1):43-46 DOI:10.3126/jnspoi.v4i.30904.
Zhang Y, Kang N, Xue F, et al. Survival of nonsurgically splinted mandibular anterior teeth during supportive maintenance care in periodontitis patients. J Dent Sci. 2023;18: 229-236. doi: 10.1016/j.jds.2022.05.025
Sobczak-Zagalska H, Emerich K. Best Splinting Methods in Case of Dental Injury-A Literature Review. Journal of Clinical Pediatric Dentistry. 2020;44:71-78. doi: 10.17796/1053-4625-44.2.1
Mazzoleni S, Meschia G, Cortesi R, et al. In vitro comparison of the flexibility of different splint systems used in dental traumatology. Dental Traumatology. 2010;26:30-36. doi: 10.1111/j.1600-9657.2009.00843.x
Kumbuloglu O, Saracoglu A, Ozcan M. Pilot study of unidirectional E-glass fibre-reinforced composite resin splints: up to 4.5-year clinical follow-up. Journal of Dentistry. 2011;39:871-877. doi: 10.1016/j.jdent.2011.09.012
Gürses M, Öncü E. Güncel periodontal splintlere genel bakış. Selcuk Dental Journal. 2019; 6: 105-109 Doi: 10.15311/selcukdentj.296328.
Berthold C, Thaler A, Petschelt A. Rigidity of commonly used dental trauma splints. Dental Traumatology. 2009;25:248-255. doi: 10.1111/j.1600-9657.2008.00683.x
Berude JA, Hicks ML, Sauber JJ, et al. Resorption after physiological and rigid splinting of replanted permanent incisors in monkeys. Journal of Endodontics. 1988;14:592-600. doi: 10.1016/S0099-2399(88)80056-6
Dawoodbhoy I, Valiathan A, Lalani ZS, et al. Splinting of avulsed central incisors with orthodontic wires: a case report. Endodontics and dental traumatology. 1994;10:149-152. doi: 10.1111/j.1600-9657.1994.tb00541.x
Gigon S, Peron JM. [Semi-rigid bracket splinting of teeth after traumatic luxation]. Revue de Stomatologie et de Chirurgie Maxillo-faciale. 2000;101:272-275.
Shetye OA, Dentoalveolar Injuries and Wiring Techniques. Bonanthaya K, Panneerselvam E, Manuel S, et al. Oral and Maxillofacial Surgery for the Clinician. 2021;1013-1037. DOI:10.1007/978-981-15-1346-6_50.
Horie N, Shimoyama T, Nama Y, et al. A vacuum-formed splint for luxated tooth with a repositioning on the model. Journal of Clinical Pediatric Dentistry. 2005;29:123-125. doi: 10.17796/jcpd.29.2.b1l241m5744v16q2
Adatia A, Kenny DJ. Titanium Trauma Splint: An Alternative Splinting Product. Japan Career Development Association. 2006;72( 8):721-723.
Waqasi j HA. Periodontal splinting with fiber reinforced splint. International Dental Journal. 2024;74:S293.
Rauch A, Mehlhorn S, Muhle M, et al. A Glass Fiber-Reinforced Resin Composite Splint to Stabilize and Replace Teeth in a Periodontally Compromised Patient. Case Reports in Dentistry. 2020:8886418. doi: 10.1155/2020/8886418
Kwan SC, Johnson JD, Cohenca N. The effect of splint material and thickness on tooth mobility after extraction and replantation using a human cadaveric model. Dental Traumatology. 2012;28:277-281. doi: 10.1111/j.1600-9657.2011.01086.x
Baena Lopes M, Romero Felizardo K, Danil Guiraldo R, et al. Photoelastic stress analysis of different types of anterior teeth splints. Dental Traumatology. 2021;37:256-263. doi: 10.1111/edt.12618
Ben Hassan MW, Andersson L, Lucas PW. Stiffness characteristics of splints for fixation of traumatized teeth. Dental Traumatology. 2016; 32:140-145. doi: 10.1111/edt.12234
Zhang C, Liu Q, Yang J, et al. A digital technique for splinting periodontally compromised mobile teeth in the mandibular anterior region. The Journal of Prosthetic Dentistry. 2021;125:560-563. doi: 10.1016/j.prosdent.2020.03.004
Sonnenschein SK, Betzler C, Rutters MA, et al. Long-term stability of splinted anterior mandibular teeth during supportive periodontal therapy. Acta Odontologica Scandinavica. (2017);75:475-482. doi: 10.1080/00016357.2017.1340668
Sonnenschein SK, Kilian S, Ruetters M, et al. Changes in periodontal parameters of splinted versus non-splinted posterior teeth during ten years of supportive periodontal therapy - A retrospective evaluation. Clinical Oral Investigation. 2024;28:283. doi: 10.1007/s00784-024-05679-2
Sonnenschein SK, Ziegler P, Ciardo A, et al. The impact of splinting mobile mandibular incisors on Oral Health-Related Quality of Life-Preliminary observations from a randomized clinical trial. Journal of Clinical Periodontology. 2021;48:816-825. doi: 10.1111/jcpe.13454
Jepsen S, Caton JG, Albandar JM, et al. Periodontal manifestations of systemic diseases and developmental and acquired conditions: Consensus report of workgroup 3 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. Journal of Periodontology. 2018;89(1):S237-S248. doi: 10.1002/JPER.17-0733
Referanslar
Ericsson I, Giargia M, Lindhe J, et al. Progression of periodontal tissue destruction at splinted/non-splinted teeth. An experimental study in the dog. Journal of Clinical Periodontology. 1993;20:693-698. doi: 10.1111/j.1600-051x.1993.tb00693.x
Graetz C, Plaumann A, Schlattmann P, et al. Long-term tooth retention in chronic periodontitis - results after 18 years of a conservative periodontal treatment regimen in a university setting. Journal of Clinical Periodontology. 2017;44:169-177. doi: 10.1111/jcpe.12680
Velioğlu MS, Ülkü SG, Ünlü N. Periodontal Olarak Umutsuz Bir Dişin Replantasyonunun 10 Aylık Takibi – Olgu Sunumu. Selcuk Dental Journal. 2023;327-331.
Aslan C, Acun Kaya F. (2022). Splintlemede Kullanılan Materyaller ve Splint Tipleri. Van Diş Hekimliği Dergisi, 3(2), 16-22.
Kwon SO. [Philosophical background of evidence-based medicine]. Uisahak. 2004;13:335-346.
Graetz C, Ostermann F, Woeste S, et al. Long-term survival and maintenance efforts of splinted teeth in periodontitis patients. Journal of Dentistry. 2019;80:49-54. doi: 10.1016/j.jdent.2018.10.009
Lee C, Do JH, Takei HH, et al. Determination of Prognosis Newman, M.G., Klokkevold, P.R., Elangovan S., Hernandez-Kapıla, Y., Newman and Carranza's Clinical Periodontolgy and Implantology 14th ed., 2024; pp 540-552. St. Louis, Missouri: Elsevier.
Nyman SR, Lang NP. Tooth mobility and the biological rationale for splinting teeth. Periodontology 2000. 1994;4:15-22. doi: 10.1111/j.1600-0757.1994.tb00002.x
Tokajuk G, Pawinska M, Stokowska W, et al. The clinical assessment of mobile teeth stabilization with Fibre-Kor. Advances in Medical Sciences. 2006;51(1):225-226.
Bhuvaneswari P, Gowri T, Ram Kumar GD, et al. Periodontal splinting: A review before planning a splint International Journal of Applied Dental Sciences. 2019;5(4): 315-319.
Shah HK, Sharma S, Shrestha S, et al. Splinting with Composite and Wire: Cheap, Flexible Option for Stabilizing Traumatized Teeth Case Report. Journal of Nepalese Society of Periodontology and Oral Implantology. 2020;4(1):43-46 DOI:10.3126/jnspoi.v4i.30904.
Zhang Y, Kang N, Xue F, et al. Survival of nonsurgically splinted mandibular anterior teeth during supportive maintenance care in periodontitis patients. J Dent Sci. 2023;18: 229-236. doi: 10.1016/j.jds.2022.05.025
Sobczak-Zagalska H, Emerich K. Best Splinting Methods in Case of Dental Injury-A Literature Review. Journal of Clinical Pediatric Dentistry. 2020;44:71-78. doi: 10.17796/1053-4625-44.2.1
Mazzoleni S, Meschia G, Cortesi R, et al. In vitro comparison of the flexibility of different splint systems used in dental traumatology. Dental Traumatology. 2010;26:30-36. doi: 10.1111/j.1600-9657.2009.00843.x
Kumbuloglu O, Saracoglu A, Ozcan M. Pilot study of unidirectional E-glass fibre-reinforced composite resin splints: up to 4.5-year clinical follow-up. Journal of Dentistry. 2011;39:871-877. doi: 10.1016/j.jdent.2011.09.012
Gürses M, Öncü E. Güncel periodontal splintlere genel bakış. Selcuk Dental Journal. 2019; 6: 105-109 Doi: 10.15311/selcukdentj.296328.
Berthold C, Thaler A, Petschelt A. Rigidity of commonly used dental trauma splints. Dental Traumatology. 2009;25:248-255. doi: 10.1111/j.1600-9657.2008.00683.x
Berude JA, Hicks ML, Sauber JJ, et al. Resorption after physiological and rigid splinting of replanted permanent incisors in monkeys. Journal of Endodontics. 1988;14:592-600. doi: 10.1016/S0099-2399(88)80056-6
Dawoodbhoy I, Valiathan A, Lalani ZS, et al. Splinting of avulsed central incisors with orthodontic wires: a case report. Endodontics and dental traumatology. 1994;10:149-152. doi: 10.1111/j.1600-9657.1994.tb00541.x
Gigon S, Peron JM. [Semi-rigid bracket splinting of teeth after traumatic luxation]. Revue de Stomatologie et de Chirurgie Maxillo-faciale. 2000;101:272-275.
Shetye OA, Dentoalveolar Injuries and Wiring Techniques. Bonanthaya K, Panneerselvam E, Manuel S, et al. Oral and Maxillofacial Surgery for the Clinician. 2021;1013-1037. DOI:10.1007/978-981-15-1346-6_50.
Horie N, Shimoyama T, Nama Y, et al. A vacuum-formed splint for luxated tooth with a repositioning on the model. Journal of Clinical Pediatric Dentistry. 2005;29:123-125. doi: 10.17796/jcpd.29.2.b1l241m5744v16q2
Adatia A, Kenny DJ. Titanium Trauma Splint: An Alternative Splinting Product. Japan Career Development Association. 2006;72( 8):721-723.
Waqasi j HA. Periodontal splinting with fiber reinforced splint. International Dental Journal. 2024;74:S293.
Rauch A, Mehlhorn S, Muhle M, et al. A Glass Fiber-Reinforced Resin Composite Splint to Stabilize and Replace Teeth in a Periodontally Compromised Patient. Case Reports in Dentistry. 2020:8886418. doi: 10.1155/2020/8886418
Kwan SC, Johnson JD, Cohenca N. The effect of splint material and thickness on tooth mobility after extraction and replantation using a human cadaveric model. Dental Traumatology. 2012;28:277-281. doi: 10.1111/j.1600-9657.2011.01086.x
Baena Lopes M, Romero Felizardo K, Danil Guiraldo R, et al. Photoelastic stress analysis of different types of anterior teeth splints. Dental Traumatology. 2021;37:256-263. doi: 10.1111/edt.12618
Ben Hassan MW, Andersson L, Lucas PW. Stiffness characteristics of splints for fixation of traumatized teeth. Dental Traumatology. 2016; 32:140-145. doi: 10.1111/edt.12234
Zhang C, Liu Q, Yang J, et al. A digital technique for splinting periodontally compromised mobile teeth in the mandibular anterior region. The Journal of Prosthetic Dentistry. 2021;125:560-563. doi: 10.1016/j.prosdent.2020.03.004
Sonnenschein SK, Betzler C, Rutters MA, et al. Long-term stability of splinted anterior mandibular teeth during supportive periodontal therapy. Acta Odontologica Scandinavica. (2017);75:475-482. doi: 10.1080/00016357.2017.1340668
Sonnenschein SK, Kilian S, Ruetters M, et al. Changes in periodontal parameters of splinted versus non-splinted posterior teeth during ten years of supportive periodontal therapy - A retrospective evaluation. Clinical Oral Investigation. 2024;28:283. doi: 10.1007/s00784-024-05679-2
Sonnenschein SK, Ziegler P, Ciardo A, et al. The impact of splinting mobile mandibular incisors on Oral Health-Related Quality of Life-Preliminary observations from a randomized clinical trial. Journal of Clinical Periodontology. 2021;48:816-825. doi: 10.1111/jcpe.13454
Jepsen S, Caton JG, Albandar JM, et al. Periodontal manifestations of systemic diseases and developmental and acquired conditions: Consensus report of workgroup 3 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. Journal of Periodontology. 2018;89(1):S237-S248. doi: 10.1002/JPER.17-0733
