Polyetheretherketone custom CAD-CAM splint for treatment of periodontally affected mobile anterior teeth

Digital workflow for periodontal splinting with a guided device

OBJECTIVE

To detail a technique for bonding periodontal splint precisely in a digital workflow.

CLINICAL CONSIDERATIONS

Periodontal splinting can be considered to stabilize the mobile teeth, especially for mandibular anterior teeth. Reliable bonding of periodontal splints is a prerequisite for successful clinical performance. However, when bonding the indirect splint to place or making direct splint intraorally, there is a significant risk of mobile teeth drifting away from the splint. To guide accurate insertion of periodontal splint with no risk of displacement of mobile teeth, a guide device fabricated by digital workflow is introduced in this article.

CONCLUSIONS

Periodontal compromised teeth can be provisionally fixed during splinting, with the help of the guided device, and precise bonding of the splint is readily accomplished by using such digital workflow. This technique is not only applicable to the lingual splints, but also suitable for the labial ones.

CLINICAL SIGNIFICANCE

The use of a guided device, after being digitally designed and fabricated, enables to stabilize the mobile teeth, in case of any displacement during splinting. It is straightforward, and beneficial to reduce the risk of complications, such as debonding of the splint, and secondary occlusal trauma.

Effects of Periodontal Splints on Biomechanical Behaviors in Compromised Periodontal Tissues and Cement Layer: 3D Finite Element Analysis

Background: In this study, we evaluated the effect of periodontal splints made from different materials on the stress distributions in compromised periodontal tissues and cement layers, using a computer simulation of mastication. Methods: Twenty-five 3D models were created for a segment of mandibular teeth with different periodontal splints bilaterally extended to the canines. The models were divided into five groups according to the different materials and thicknesses (mm) of the splints: the non-splinted group, PEEK 0.7 group, PEEK 1.0 group, FRC group, and titanium group. Each group was subdivided based on five bone loss levels. Tooth 41 of each model was subjected to vertical and oblique (θ = 45°) static loads of 100 N, respectively, onto the incisal edge. The von Mises stresses and maximum principal stress were analyzed using Abaqus software. Results: Oblique loading resulted in higher stresses on periodontal tissues, cement layers, and splints than those caused by vertical loading. The lower the supporting bone level, the greater the stress difference between the splinted groups and the non-splinted group. In model 133,331, with severe bone loss, the maximum von Mises stress values on the alveolar bone in tooth 41 under oblique loading dramatically decreased from 406.4 MPa in the non-splinted group to 28.62 MPa in the PEEK group and to 9.59 MPa in the titanium group. The four splinted groups presented similar stress distributions in periodontal tissues. The lowest stress level on the splint was observed in the PEEK 0.7 group, and the highest stress level was transferred to the cement layer in this group. Stress concentrations were primarily exhibited at the connectors near the load-carrying area. Conclusions: The tested splinted groups were all effective in distributing the loads on periodontal tissues around splinted teeth with similar patterns. Using splinting materials with low elastic moduli reduced the stress concentration at the splint connectors, whereas the tensile stress concentration was increased in the cement layer. Thus, the use of adhesive cement with a higher elastic modulus is recommended when applying less rigid PEEK splints.