Fiber-Splint consists of woven fiber glass strands packaged in a dry (not soaked in any adhesive or composite) tape form, which is cut with serrated scissors to the desired length.  It has a very long, almost indefinite shelf life. Fiber-Splint is used on the tooth surface after acid etching the enamel, then soaking the Fiber-Splint in bonding agent (resin adhesive) and light curing it on the tooth.  Thereafter it is coated with dental composite resin. 

This results in physical properties which are superior to dental resins alone. Being translucent, Fiber-Splint is very aesthetic, almost invisible.  It is also the most economical, metal-free alternative when it is used for incisor replacement.

Fiber-Splint Multi-Layer ML is the second generation of Polydentia's splinting material; it consists of six layers Fiber-Splint sewn together, one over the other. Thus, the individual layers no longer have to be applied onto each other, simplifying handling and saving valuable chair time.

Rationale
(A) RATIONALE OF SPLINTING PERIODONTALLY WEAK TEETH

Predominantly, lingual splinting of mandibular anterior teeth, and palatal splinting of maxillary anterior teeth.

A procedure in which the four incisors are joined at the incisal 1/3rd to increase support. Canine to canine splints are difficult to place and offer no special advantage over just incisor only splinting. However if incisors are very mobile but healthily maintainable in mouth, then canine support can be considered in such situations. It is recommended to splint three teeth together, that is, a central and a lateral incisor together with the canine of the same side as one splint. The same three teeth for the other side.

In particular situations, for example when only one maxillary lateral incisor is mobile, then just splint it with the firm central incisor, do not involve the canine. Similarly when only one central incisor is mobile just splint it with the adjacent central, if firm. Shorter splints work better than long span splints.

Benefits
1.  It allows the patients to chew comfortably.
2.  Mobile teeth become firm. Therefore, allowing the patient to maintain better hygiene. Patient can use regular brush, interdental brush etc., without the fear of knocking down teeth.
3.  As splinting is done in conjunction with other periodontal therapy, such as scaling/curettage/root planning/flap surgery etc, it also is an adjunct to preservation of soft and hard tissues.
4.  Enhances patient's self-confidence.

(B) RATIONALE OF SPLINTING IN TOOTH INJURY
Injured anterior teeth needing stabilisation such as in:

Luxation: For 2-3 weeks
Subluxation: For 1-2 weeks
Extrusion: For 1-2 weeks

For stabilising an injured mobile tooth and to allow periodontal fibers to repair rather than a bony healing (may lead to ankylosis), a splinting time of less than 3 weeks is recommended.

To stabilise a root fracture, a longer splinting time is indicated such as one month to three months, as this will allow calcified tissue to heal.

It is for the clinician to evaluate the tooth for vitality and RCT should be done wherever indicated. RCT access can be gained through the Fiber-Splint if it has been applied lingually.

Many times isolation in recent tooth injury cases is difficult to achieve, also lips may be injured. In such cases Fiber-Splinting can be done on the labial surface of the teeth.

Areas of application for fiber-splint
Splinting:

• Of periodontally weak teeth.
• Post trauma, for luxated/avulsed teeth.

Natural Tooth Pontic (NTP):

• Reusing patient's own incisor tooth as pontic. This is
  done for incisor teeth that are due for extraction (detailed
  technique is described later).
• Using composite alone to build up tooth intra-orally
  when interdental space is less. Acrylic Denture Stock
  Tooth may also be used as a pontic while Fiber-Splint
  works as an external framework.

Orthodontics:

• Retainer post orthodonti therapy
• Space maintenance

Implant Dentistry:

• As a Maryland (Rochette) bridge using stock denture tooth in anterior region
• For reinforcing implant overdentures

Reinforcement:

• Reinforcing long-term provisioned bridges (Fiber-Splint incorporated
  at the time of curing
  
• Denture reinforcement and repair.
  

Future applications:

• Class IV tooth edge build-ups and reinforcement in re-attaching
  patient's own fractured tooth segment.
  
  

Additional indications
Good interproximal adaptation of the glass fiber strip can be achieved using application clips available in the kit.

This figure shows the use of Polydentia's Fiber-Splint application clips.

Removal and repair
REMOVAL: When Fiber-Splint is used in situations such as splinting traumatized teeth, it needs to be removed. Six fluted carbide burs were used under water spray for gross removal of composite overlaying Fiber-Splint and once that is done, either Fiber-Splint can be removed using surgical blade or with fluted carbide burs. Dry the tooth surface frequently in between to identify remaining Fiber-Splint material. Finally twelve fluted carbide burs are used in a feather touch manner which may be followed by a finishing and polishing system. Protective face mask and eyewear (such as Polydentia Vista-Tec protective shields) must be worn during removal procedures.

REPAIR: On rare occasions it may be necessary to repair splinted teeth complex. Practically what I have seen is that Fiber-Splint when done in multiple layers rarely, if at all, breaks.

For repair, refresh the area to be repaired with burs, etch, bond and apply Fiber-Splint and flowable composite in the usual manner.

Follow up and maintenance
Before a splinting procedure,  effort is taken to explain to the patient about the new feeling that he or she is going to have, of teeth being bound together and explain the need for hygiene maintenance. The brushing and tongue cleaning technique remain the same as before splinting; but flossing needs to be modified. Now the floss needs to be threaded from in between the embrasures on the cervical end. Inter-dental brushes are recommended for larger embrasures.  I usually call the patient one week after the Fiber-Splint procedure to check on hygiene maintenance then after one month and then after six monthly for routine check-up and hygiene maintenance. The splint gives the patient new confidence to brush the teeth, use them freely and smile.

Additional clinical cases - recall after 5 and 10 years
Post five years recall, photograph of a 57 year old patient in whom Fiber-Splint was used to retain stock denture tooth as a pontic for tooth no .31.

A patient who was a heavy smoker, lost his tooth 41 to bone loss. I re-fixed his tooth back using Fiber-Splint after cutting off the root portion. The natural tooth pontic of tooth 41 has already been in service for more than 10 years as is seen in this post-placement (after 10 years) photograph and has been in full use as is evident from the attrition seen on its incisal edge, along with its neighbouring abutment teeth.

Mirror view showing the lingual side of the same patient shown in the previous picture. Ten year follow-up photograph

Conclusion
Using Fiber-Splint (Polydentia) for splinting, the dentist can stabilize mobile anterior teeth quickly, with long term reliability. It grants highly aesthetic results and enhances patient's self confidence. DA

NOTICE : Fiber-Splint technique described in this article is based on the author's experience of using the product for more than 15 years. The dentist should use his/her personal judgment in planning and executing treatments that are in the best interests of their patients.

Pictures and captions:

Flow chart

 

Fig 1 - A 25 year old patient seen here his missing maxillary right central incisor replaced. He did not want his adjacent teeth to be grinded down for a conventional bridge, and wanted something that did not involve any surgery like an implant.

Fig 2 - Intra oral radiograph shows a large incisive foramen that would have posed a challenge to place an implant, in an ideal position, without damaging adjacent teeth roots and other vital structures.

Fig 3 - Palatal view

Fig 4 - Labial view

Fig 5 - A "stock" denture tooth of matching shade and proportionate size is selected, to be used as a pontic.

Fig  6 - The selected denture pontic tooth is tried-in for any adjustments that may be required.

Fig 7- Palatal view at the time of try-in

Fig 8 - The bonding palatal surface and its proximal sides of the denture tooth are roughened and extra retentive features are made.

Fig 9 - In the first step, only etch the proximal sides of the abutment teeth without etching the palatal side. A gel based etchant gives less flow and better control.

Fig 10 - Once the etch is washed off and bonding done, flowable composite is used, only in the proximal areas, to hold and stabilise the pontic in position. Clear matrix strips are used for separation. From this step onwards, isolation must be maintained.

Fig 11 - Palatal view after proximal stabilisation (any excess flow of bonding agent on the palatal side must be removed by refreshing with a rotary diamond)

Fig 12 - Now the whole palatal enamel surface along with the pontic tooth is etched, then it will be rinsed off and completely dried.

Fig 13 - After etching and drying, the palatal surface is ready for priming and application of Fiber Bond. At this stage when adhesive bonding agent has been applied to the tooth surface, do not cure.

Fig 14 - Fiber-Splint Multi-Layer has been selected for this case for added strength and time saving.

Fig 15 - Close up of Fiber-Splint Multi-Layer.

Fig 16 - The selected length of Fiber-Splint Multi-Layer is placed alongside Fiber Bond on a clean glass slab.

Fig 17 - Just before the application Fiber-Splint Multi-Layer is allowed to soak completely in Fiber Bond and covered with an opaque non-touching lid until the exact moment of use.

Fig 18 - Palatal adaptation and curing of Fiber-Splint Multi-Layer is complete. Application of Fiber-Splint is best done with Doctor and Assistant team with the doctor adapting and holding the Fiber Splint and the assistant light curing it.

Fig 19 - Palatal view after Fiber-Splint Multi-Layer has been covered with a layer of hybrid composite (to get a smoother surface, more comfortable for the patient) and cured.

Fig 20 - Labial view after palatal composite application.

Fig 21 - Occlusal interferences should be checked and corrected. Excess bonding agent is removed and finishing and polishing procedures are carried out as usual. This ensures superior gingival health over the years.

Fig 22 - Fiber-Splint Multi-Layer retained prosthesis on completion.

Fig 23 - Patient was all smiles after ultra conservative prosthesis which was metal free, economical, single sitting, durable and highly aesthetic.

Fig 24 - Intra oral radiograph upon completion.