A tip for perio splinting of teeth

Recently I performed a splinting procedure for mobile lower incisors in a perio patient. She presented with significant calculus buildup and radiography showed severe bone loss. Therefore I knew that once I removed the calculus which was bridging the teeth together there would be at least grade 2 mobility. Everstick perio was the product I used. This is because I wasn't prosthodontically adding a tooth onto the bridge and everstik perio has half the amount of fibres as everstick C&B (2000 as compared to 4000) therefore would be thinner and more comfortable.

I knew that once I cleaned the calculus off the teeth would be hard to handle as they would be mobile. If done under rubber dam I would not be able to check the occlusion until the teeth were bonded and the dam was off. This may be disasterous as the bridge will be hard to remove if the occlusion is wrong.

What I did was ensure the occlusion was comfortable at rest (sometimes it may not be due to traumatic occlusion) Then I flowed some composite on the labial surfaces to tack them together. Therefore once I cleaned the calculus off, the teeth were held in their ideal position. I then bonded the bridge onto the lingual. However, due to the temporary labial bridge, I was unable to place a rubber dam properly. A cuff technique could be used as an alternative if rubber dam is desirable.

Place the fibres as incisally as possible without hindering the occlusion to keep it away from the critical gingival area and to reduce forces on the fibres.

The labial composite bridge slightly dislodged before the end of the procedure. Although it ended well, in the future I would spot etch the labial of the teeth to allow better retention of the temporary bridging. It should still dislodge fairly easily after spot etching.