Assessment of Periodontal Splinting Procedures Done Using Fiber and Composite Versus Wire and Composite
Aniruddh Menon1, Nashra Kareem2*, Jayanth Kumar Vadivel3
1 Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 600077, Tamil Nadu, India.
2 Senior Lecturer, Department of Periodontics, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 600077, Tamil Nadu, India.
3 Reader, Department of Oral Medicine and Radiology, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 600077, Tamil Nadu, India.
*Corresponding Author
Nashra Kareem,
Senior Lecturer, Department of Periodontics, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 600077,
Tamil Nadu, India.
E-mail:nashrak.sdc@saveetha.com
Received: July 30, 2021; Accepted: August 11, 2021; Published: August 18, 2021
Citation:Aniruddh Menon, Nashra Kareem, Jayanth Kumar Vadivel. Assessment of Periodontal Splinting Procedures Done Using Fiber and Composite Versus Wire and Composite. Int J Dentistry Oral Sci. 2021;8(8):4000-4004. doi: dx.doi.org/10.19070/2377-8075-21000817
Copyright: Nashra Kareem©2021. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.
Abstract
The most common indication for periodontal splinting is to improve the prognosis of mobile teeth and patient comfort and provide better control of the occlusion if the anterior teeth are mobile, which is much widely accepted by the patient rather than extensive and invasive long term periodontal surgery and regenerative procedures. The aim of the present study is to assess the Prevalence of the Fiber with composite vs wire with composite for splinting at Saveetha Dental College. Retrospective data of 281 patients was obtained and segregated. The inclusion criteria included 6-70 years age group, underwent frenectomy/frenotomy and visited between June 2019 to April 2020. Once the data was obtained it was statistically analyzed using SPSS by IBM version 20. Within the limits of the present study it is observed that the most commonly used material for splinting is wire and composite than Fiber and composite. Based on correlation and association tests a positive correlation was noticed between the type of splinting and the duration of splinting with a high statistical significance (p=0.001). Further awareness programmes that should be conducted to bring out better clinical outcomes and help the society holistically.
2.Introduction
3.Conclusion
4.References
Keywords
Splinting; Fibre; Composite; Periodontitis.
Introduction
Periodontitis is an inflammatory disease induced by bacterial biofilms
that accumulate in the gingival margin and characterized by
gingival inflammation, loss of connective tissue attachment and
alveolar bone [1-3]. Various systemic complications can worsen
the periodontal status as well [4-5]. Removal of plaque, calculus,
elimination of deep periodontal pockets and occlusal adjustment
are treatment options and result in healthy periodontium but reduced
height of the supporting tissues [6]. If left untreated, the
continuous loss of the supporting tissues during periodontal disease
progression may result in increased tooth mobility, ultimately
yielding to tooth drifting and exfoliation[7-10]. Tooth mobility
can also be a consequence of occlusal trauma in addition to the
periodontal inflammation and attachment loss which is caused
due a large group of sequential events mediated by many genetic,
cellular and other chemical modulators [11].
From the clinical point of view, it is important to clarify the
reason for increased tooth mobility as a result of widened periodontal
ligament, reduced height of the supporting tissues or
their combination [12]. Tooth mobility is a result of intra-alveolar
displacement of the root and usually assessed by exposing the
crown of the tooth to a certain force and determining the distance
that the crown can be displaced in buccal and/or lingual
direction [13]. Assessment of tooth mobility could be performed
manually/digitally or with the help of instruments such as periodontometer,
the laser vibrometry, Periotest and photogrammetric
measurement method [14-17]. A commonly used device,
Periotest, measures the reaction of the periodontium to a defined
percussion force that is applied to the tooth and delivered by a
tapping instrument. The Periotest values range from - 8 to +
50 where the firm teeth demonstrate values ranging from -8 to
+9 and mobile ones at a range of 30 to 50 [15]. The mobility of
a tooth in the horizontal direction is closely dependent on the
height of the surrounding supporting bone, the width and quality of the periodontal ligament, and the shape and number of roots
present[18-20]. Mobility could cause occlusal instability, discomfort
or pain during function [21]. Occlusal instability could have
negative consequences on tooth tissue relationship, including the
relationship of the teeth to the opposing dentition that could lead
to excessive occlusal forces [6]. The question is whether a healthy
periodontium with reduced height has a capacity similar to that of
the normal periodontium to adapt to traumatizing occlusal forces.
The most common indication for periodontal splinting is to improve
the prognosis of mobile teeth and patient comfort and
provide better control of the occlusion if the anterior teeth are
mobile [22], which is much widely accepted by the patient rather
than extensive and invasive long term periodontal surgery and
regenerative procedures [23-29]. Periodontal splints that redistribute
functional and parafunctional forces achieve stability after
periodontal treatment [30]. The aim of the present study is to
assess the Prevalence of the Fiber with composite vs wire with
composite for splinting.
Materials and Methods
The present study involved a total of 281 patients that underwent
splinting procedures. These included all treatment modalities
of splinting. The study was performed in a university setting
at Saveetha Dental College and Hospitals. Thus the data obtained
from the patients is of the same geographic location and ethnicity.
The ethical approval for collection of retrospective data from
the dental patient management archives was obtained from the
Institutional Ethics Board.
The period of the study was between June 2019 to April 2020.
Once the data was collected the same was verified by using photographs
by two external reviewers who were blinded on the
hypothesis from the present study. This was done to eliminate
the chances of sampling bias. Before the commencement of the
study a clear well defined inclusion criteria was defined. The inclusion
criteria included that:
· Patients should have visited Saveetha Dental College during the
study period.
· Patient has been treated by a resident of Saveetha Dental College,
either an undergraduate or postgraduate student.
· Should have undergone splinting procedures.
· Should have been within the age group of 6 - 70 years.
Out of the study population that was chosen for the study there
was no segregation process, as this would result in sampling bias.
The data segregation was done according to various parameter
such as speciality of clinic in which patient was treated, age of the
patient, gender of the patient etc.
The data that was then tabulated was reviewed by an external reviewer
and screened for internal validity of the study. The data
was then exported to SPSS Software by IBM Version 20 for Statistical
Analysis. Descriptive statistics was performed followed by
Correlation tests to see any kind of correlation or Association between
the different variables taken in the present study. Previously
our team has a rich experience in working on various research
projects across multiple disciplines [31-45]. Now the growing
trend in this area motivated us to pursue this project.
Results & Discussion
The present study consisted of 281 patients who had undergone
splinting with wire and composite, and Fiber and composite at
Saveetha Dental College. Out of the entire study population,
59.1% are males and 40.9% are females. The patients were between
the age group of 16-70 years with a mean age of 37.2 plus
or minus 11.8 years.
Out of the total the splinting procedures wire and composite was
used 85.1% whereas Fiber and Composite 14.9%. Based on duration
provisional splinting was the most widely performed type
(59.1%) followed by Temporary (34.5%) and finally permanent
(6.4%). Lower arch was the more commonly seen arch where
splinting was performed, 63% and in the upper arch 37% was
performed.
Based on correlation and association tests a positive correlation
was noticed between the type of splinting and the duration of
splinting with a high statistical significance (p=0.001). There was
also a strong correlation seen between the duration of splinting
and the arch in which it was performed. Permanent splinting was
performed more commonly in the upper arch whereas provisional
and temporary splinting were performed in the lower arch. It
had a p=0.000 which showed high statistical significance. There was no statistical significance between age of the patient and the
duration of splinting(p>0.05)
Numerous types of splints have been described in the literature,
such as composite resin based ones used in conjunction with adhesive
systems, orthodontic wire, wire-composite [46] or fiber reinforced
composite resin [47], nylon fishing line-composite and
polyethylene [48]. To the authors` best knowledge, the impact of
tooth mobility on the survival of splint materials considering also
the periodontal parameters have not been assessed to date. Within
the limits of the present study it is observed that males undergo
splinting more than females.
In a study conducted by Bhawna G et al., [49] where the prevalence
of smoking was assessed on a national survey it was observed
that males had more usage than females, it is a well known
fact that has been documented through the ages that there is a
clear relationship between smoking and its effect of periodontal
health [50]. Thus this could be the reason why males undergo
splinting more than females. It is observed that the most commonly
used material is wire and composite as compared to fibre
and composite. There are various reasons for the same. This can
be attributed to the fact that there were more chances of debonding
or detachment in the case of Fiber retainers as reported by
Sobouti et al., [51] in a randomised control trial. In another clinical
study conducted by Aliye Akcali et al.,[52] where the clinical
parameters were considered there was no difference in the clinical
parameters that were measured with both these materials. There
is a positive correlation between the arch and the type of material
that is used, this can be attributed to the fact that there Is an
increased aesthetic demand when the upper arch is considered.
There is an added advantage of better esthetics when Fiber and
Composite is considered, thus there should be further studies
and further awareness programmes that should be conducted to
bring out better clinical outcomes and help the society holistically.
Our institution is passionate about high quality evidence based
research and has excelled in various fields [53-63]. We hope this
study adds to this rich legacy.
The limitations of the present study included that it was single
centered and thus all the patients were geographically isolated.
Clinical parameters were not considered in accounting during the
present study.
Graph 1: This bar graph shows the association between the duration of splinting and the material used where blue colour denotes splinting done with wire and composite and green colour denotes splinting with fibre and composite. The X axis denotes the type of splinting and Y axis denotes the number of patients having undergone the procedures. This graph denotes that the most widely preferred duration of splinting is provisional splinting and in all three durations of splinting the most commonly used material is wire and composite. Chi-square test was done and the association was found to be statistically significant. Pearson’s Chi-square value = 14.702, df = 2, p value 0.001 (<0.05) hence statistically significant. p<0.05-Infers Statistically Significant association between material and duration for splinting.
Graph 2: Bar chart shows association between the duration of splinting and the different arches where blue colour denotes the upper arch and green colour denotes the lower arch. In the graph X axis denotes the type of splinting based on duration and Y axis denotes the number of patients having undergone the procedures. Permanent splinting is performed more in the upper arch than the lower arch whereas provisional and temporary splinting is performed more frequently in the lower arch than in the upper arch. Chi-square test was done and the association was found to be statistically significant. Pearson’s Chi-square value = 40.696, df = 6, p value 0.00 (<0.05) hence statistically significant. p<0.05-Infers Statistically Significant association between duration of splinting and arch for splinting.
Graph 3: Bar chart shows association between the duration of splinting and the age of the patient where blue colour denotes permanent splinting, green colour denotes provisional splinting and yellow colour denotes temporary splinting. X axis denotes the age group and Y axis denotes the number of patients having undergone the procedures. Provisional splinting is more prevalent within the 31-40 years age group, permanent splinting is more prevalent in the 41-50 years age groups and temporary splinting is more common in the 31-40 years age group. Chi-square test was done and the association was found to be statistically insignificant. Pearson’s Chi-square value = 15.175, df = 10, p value 0.126 (>0.05) hence statistically not significant. p>0.05-Infers no Statistically Significant association between duration of splinting and age of the patient.
Conclusion
Within the limits of the present study it is observed that the most
commonly used material for splinting is wire and composite than Fiber and composite. Further awareness programmes that should
be conducted to bring out better clinical outcomes and help the
society holistically.
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