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A splint with a future
A SPLINT
WITH
ALBERT
A FUTURE
L. BORISH, D.D.S
Philadelphia,
Pa.
progress is being measured by the number of teeth that are D ENTISTRY’S being retained. Indiscriminate extraction of teeth is no longer being practiced by men who have learned that, mentally and physically, an individual is happier when he knows that every effort is being made to save his teeth and that his dentist is exercising ingenuity and skill and courage in so performing his task: ingenuity, for there is no set pattern or blueprint to follow when the health of a patient is paramount ; skill, because innate ability and feeling must be expanded by experience and constant or additional training: courage (perhaps this point has not been considered sufficiently in the past) to splint teeth when the easiest way out would be to extract, to parallel each member, and to perform the many added operations just to keep abutments which are so vital to a fixed restoration when, perhaps, the immediate concern of a patient is the relief of immediate discomfort. Certainly, courage is demanded of that operator who performs these many added services because he, and he alone, knows what is best for his patient. The. splinting of teeth has been practiced for many years when mobility and periodontal involvements are such that only by restricting tooth motion and by using the stronger teeth to aid the weaker ones can retention be maintained. Case records prove beyond any doubt that splinting, when used judiciously and skillfully, is a basic tenet in oral rehabilitation. Splinting of anterior teeth presents many more problems than splinting of posterior segments. For that reason, this discussion will be confined to the splinting of the teeth in the anterior portion of the mouth. The ideal preparation for full tooth coverage by the restoration includes the formation of marginal shoulders. The maxillary incisor and cuspid preparations are formed to receive gold cores. Typical shoulder jacket crown preparations are made. During the construction period, the prepared teeth are protected by covering them with a temporary acrylic splint. This also fixes the teeth and represses the gingival tissues from the shoulders of the preparations. The gold cores are cast and fitted individually. Then they are joined, two at a time, until the six are attached into a single unit. Note that the labial surface, from above the incisal edge to just helow the gingival margin, is devoid of gold to allow for a thin labial restoration. Fig. 1 shows this gold understructure from cuspid to cuspid. The labial shoulder is free of gold so that the acrylic veneer jacket will rest on the prepared shoulder to give a more pleasing esthetic result. Fig. 2 shows the understructure cemented in place. Received for publication
Jan. 19: 1952. 253
Volume 2 Number 2
Fig. 2.
Fig. 1. Fig. L-The
gold understructure of the splint which is made by soldering the individual castings together. Fig. Z.-The gold understructure cemented onto the teeth.
Fig. 3. Fig. 3.-Three
Fig. 4. of the acrylic veneer jackets cemented in place. Fig. 4.-The finished restoration.
Fig. 5. Fig. B.-The lingual side of the splint on the cast. Fig. 6.-The lingual side of the splint in the mouth.
Fig. 6.
J. Pros. Den. iMarch, 1952
RORISH
254
It is not advisable to cement all six restorations at one time (Fig. 3). A suggested method would be to place all jackets in their positions, then to remove each jacket as cement is mixed, and to replace the cement-tilled jacket, meanwhile holding the uncemented~jackets in place until all are seated (Fig. I). The lingual views are seen on the cast in Fig. 5 and in the mouth in Fig. 6.
Fig. 7.
Fig. k.
Fig’. T.-The acrylic veneer jackets, labial view. Fig. R.-The individual restorations, cervical vielv.
Fig. :).-The
Fig. lo.-The
individual
restorations, lingual view. Note the female parts of the internal attachments in the cuspid restorations.
splint in place on the cast. The male part of the precision attachment about to he inserted into the female part of the attachment.
is shown
Mandibular cases commonly show retained anterior teeth and edentulous posterior areas. The preparations of the incisor teeth in this jaw may be formed without shoulders because of the peculiar anatomy of these teeth. Gold is carried
Volume Number
2 2
SPLINT
WIT?
A
FUTURE
255
to the gingivolabial margins of the lower teeth since they present no esthetic problem in this area. Individual acrylic veneer jackets are fabricated, and each is fitted to its respective gold core on the understructure which is similar to that shown in Fig. 1. The individual acrylic veneer jackets are to be seen in Figs. 7, 8, and 9. Since this splint is to serve also as a retentive abutment for the restoration of the posterior teeth on either side and since precision or internal attachments are being utilized, the female parts of the attachments are included within the’ gold cores which the acrylic veneer jackets cover. These attachments will be at the distal ends of the splint when it is assembled. Fig. 10 reveals the male ends of the precision attachment on the lingual bar structure which has occlusion rims attached to it. There is but one change in the cementation procedure where precision attachments are included. The end units, whether cemented at the same time or separately, must be positioned with the lingual bar while the male ends are in female receptacles of the precision attachments to insure exactness of placement. This is done to avoid any possibility of discrepancy in the final step. The understructure splint, with individual acrylic veneer units, has many advantages over the one-unit combination of splint and veneers which we formerly used. (1) The esthetic superiority is obvious because each member of the restoration presents and retains its individuality. (2) The future of the appliance is assured. If the extraction of any one tooth should become necessary, the affected tooth can be removed without disturbing the understructure or the restoration. (3) Breakage of any one unit can be repaired with a minimum of patient or operator disturbance. In fact, repair is further simplified by the use of the improved hydrocolloid impression procedures. The necessary steps for the repair Remove the remaining portion of the of a broken jacket veneer are as follows: individual veneer jacket. Make a hydrocolloid impression and pour stone dies, both single and master. Utilize the gold core ‘if it is still satisfactory ; otherwise, wax and fabricate a completely new gold and acrylic veneer jacket and cement it into position. The problem of repair is minimized. (4) The necessity for removing the entire splint with the concomitant worry of disturbing the weaker teeth is obviated. We are assured of solving that problem where the splint is indicated and of having not the slightest concern should a structural disturbance arise. 1301 MEDICAL 2% s. 17TH PHILADELPHIA
TOWER ST. 3, PA.
WITH
ALBERT
A FUTURE
L. BORISH, D.D.S
Philadelphia,
Pa.
progress is being measured by the number of teeth that are D ENTISTRY’S being retained. Indiscriminate extraction of teeth is no longer being practiced by men who have learned that, mentally and physically, an individual is happier when he knows that every effort is being made to save his teeth and that his dentist is exercising ingenuity and skill and courage in so performing his task: ingenuity, for there is no set pattern or blueprint to follow when the health of a patient is paramount ; skill, because innate ability and feeling must be expanded by experience and constant or additional training: courage (perhaps this point has not been considered sufficiently in the past) to splint teeth when the easiest way out would be to extract, to parallel each member, and to perform the many added operations just to keep abutments which are so vital to a fixed restoration when, perhaps, the immediate concern of a patient is the relief of immediate discomfort. Certainly, courage is demanded of that operator who performs these many added services because he, and he alone, knows what is best for his patient. The. splinting of teeth has been practiced for many years when mobility and periodontal involvements are such that only by restricting tooth motion and by using the stronger teeth to aid the weaker ones can retention be maintained. Case records prove beyond any doubt that splinting, when used judiciously and skillfully, is a basic tenet in oral rehabilitation. Splinting of anterior teeth presents many more problems than splinting of posterior segments. For that reason, this discussion will be confined to the splinting of the teeth in the anterior portion of the mouth. The ideal preparation for full tooth coverage by the restoration includes the formation of marginal shoulders. The maxillary incisor and cuspid preparations are formed to receive gold cores. Typical shoulder jacket crown preparations are made. During the construction period, the prepared teeth are protected by covering them with a temporary acrylic splint. This also fixes the teeth and represses the gingival tissues from the shoulders of the preparations. The gold cores are cast and fitted individually. Then they are joined, two at a time, until the six are attached into a single unit. Note that the labial surface, from above the incisal edge to just helow the gingival margin, is devoid of gold to allow for a thin labial restoration. Fig. 1 shows this gold understructure from cuspid to cuspid. The labial shoulder is free of gold so that the acrylic veneer jacket will rest on the prepared shoulder to give a more pleasing esthetic result. Fig. 2 shows the understructure cemented in place. Received for publication
Jan. 19: 1952. 253
Volume 2 Number 2
Fig. 2.
Fig. 1. Fig. L-The
gold understructure of the splint which is made by soldering the individual castings together. Fig. Z.-The gold understructure cemented onto the teeth.
Fig. 3. Fig. 3.-Three
Fig. 4. of the acrylic veneer jackets cemented in place. Fig. 4.-The finished restoration.
Fig. 5. Fig. B.-The lingual side of the splint on the cast. Fig. 6.-The lingual side of the splint in the mouth.
Fig. 6.
J. Pros. Den. iMarch, 1952
RORISH
254
It is not advisable to cement all six restorations at one time (Fig. 3). A suggested method would be to place all jackets in their positions, then to remove each jacket as cement is mixed, and to replace the cement-tilled jacket, meanwhile holding the uncemented~jackets in place until all are seated (Fig. I). The lingual views are seen on the cast in Fig. 5 and in the mouth in Fig. 6.
Fig. 7.
Fig. k.
Fig’. T.-The acrylic veneer jackets, labial view. Fig. R.-The individual restorations, cervical vielv.
Fig. :).-The
Fig. lo.-The
individual
restorations, lingual view. Note the female parts of the internal attachments in the cuspid restorations.
splint in place on the cast. The male part of the precision attachment about to he inserted into the female part of the attachment.
is shown
Mandibular cases commonly show retained anterior teeth and edentulous posterior areas. The preparations of the incisor teeth in this jaw may be formed without shoulders because of the peculiar anatomy of these teeth. Gold is carried
Volume Number
2 2
SPLINT
WIT?
A
FUTURE
255
to the gingivolabial margins of the lower teeth since they present no esthetic problem in this area. Individual acrylic veneer jackets are fabricated, and each is fitted to its respective gold core on the understructure which is similar to that shown in Fig. 1. The individual acrylic veneer jackets are to be seen in Figs. 7, 8, and 9. Since this splint is to serve also as a retentive abutment for the restoration of the posterior teeth on either side and since precision or internal attachments are being utilized, the female parts of the attachments are included within the’ gold cores which the acrylic veneer jackets cover. These attachments will be at the distal ends of the splint when it is assembled. Fig. 10 reveals the male ends of the precision attachment on the lingual bar structure which has occlusion rims attached to it. There is but one change in the cementation procedure where precision attachments are included. The end units, whether cemented at the same time or separately, must be positioned with the lingual bar while the male ends are in female receptacles of the precision attachments to insure exactness of placement. This is done to avoid any possibility of discrepancy in the final step. The understructure splint, with individual acrylic veneer units, has many advantages over the one-unit combination of splint and veneers which we formerly used. (1) The esthetic superiority is obvious because each member of the restoration presents and retains its individuality. (2) The future of the appliance is assured. If the extraction of any one tooth should become necessary, the affected tooth can be removed without disturbing the understructure or the restoration. (3) Breakage of any one unit can be repaired with a minimum of patient or operator disturbance. In fact, repair is further simplified by the use of the improved hydrocolloid impression procedures. The necessary steps for the repair Remove the remaining portion of the of a broken jacket veneer are as follows: individual veneer jacket. Make a hydrocolloid impression and pour stone dies, both single and master. Utilize the gold core ‘if it is still satisfactory ; otherwise, wax and fabricate a completely new gold and acrylic veneer jacket and cement it into position. The problem of repair is minimized. (4) The necessity for removing the entire splint with the concomitant worry of disturbing the weaker teeth is obviated. We are assured of solving that problem where the splint is indicated and of having not the slightest concern should a structural disturbance arise. 1301 MEDICAL 2% s. 17TH PHILADELPHIA
TOWER ST. 3, PA.