Tooth mobility is defined as the movement of a tooth in its socket as a result of an externally applied force.
All teeth have a slight degree of physiologic mobility, which varies for different teeth and at different times of the day.
However, the continuous loss of the supporting tissues in progressive periodontitis may result in increase in the tooth mobility which is Pathologic.
CLASSIFICATION
Mobility is graded according to the ease and extent of tooth movement as follows
- Normal mobility
- Grade I - Slightly more than normal.
- Grade II- Moderately more than normal.
- Grade III- Severe mobility faciolingually and/or mesiodistally, combined with vertical displacement.
ASSESSMENT OF MOBILITY
Tooth mobility is clinically measured in two simple ways-
- When pressure is placed on individual teeth while the jaws are apart (Bidigital mobility).
- That seen when teeth are in function (Fremitus).
Bidigital mobility: One of the following methods is employed-
- Tooth is held firmly between the handles of 2 metallic instruments, or
- With one metallic instrument and one finger.
Fremitus: Fremitus (functional mobility) is the movement of teeth during function or parafunction. Fremitus can often be detected earlier than bidigital mobility and has been associated in the presence of inflammation with increased bone and attachment loss (pocket formation) when compared to teeth without fremitus.
To test for fremitus, the index finger is placed on the labial surface of maxillary teeth and the patient is asked to grind in lateral and protrusive movements. Any movement seen or felt is considered fremitus.
TREATMENT
The reduction of mobility is an important objective of periodontal therapy. Root planing, curettage, oral hygiene and surgery may cause the teeth to tighten as inflammation is resolved. However, transient increase in mobility may occur immediately after surgery. Occlusal adjustment, periodontal orthodontics and restorative dentistry may alter occlusal relationships and redirect forces, thereby reducing traumatism. This may result in the teeth becoming firmer. Increasing the support of loose teeth may also increase their firmness; the device used for such treatment is the splint.
Stabilization of mobile teeth
Two types of stabilization-
- Permanent – full crowns splinted together.
- Temporary
A splint is any appliance that joins two or more teeth to provide support.
Temporary splints are used to –
- determine whether an increasingly mobile tooth will respond to treatment.
- stabilize excessively mobile teeth during scaling and root planing, occlusal adjustment, and periodontal surgery.
- serve as retainers following minor tooth movement.
- provide long term stabilization for loose teeth when mobility has been increasing or
- the mobility interferes with function
- permanent fixed splinting is inadvisable because of the patient’s poor health or economic status.
- The teeth have a doubtful prognosis and complicated fixed splinting procedures are inadvisable.
- There is insufficient time to make permanent fixed splints.
5. Stabilize teeth loosened by trauma.
HOW DO SPLINTS WORK?
Loose teeth splinted to adjacent firm teeth may become stabilized. When many teeth are loose, adjacent sextants should be included in the splint. Teeth tend to loosen bucco-lingually, yet may remain firm mesiodistally. Adjacent sextants therefore have complimentary strengths. Cross arch splinting reduces mobility to the least common denominator. Teeth are thus immobilized and occlusal forces are better distributed. Traumatism is minimized, repair is enhanced, and teeth may become firm again. Even when the teeth do not tighten, the splint serves as an orthopedic brace that permits useful function of loose teeth. Teeth with reduced support often are hyper mobile. This mobility may gradually increase if the teeth are not splinted. Hyper mobility decreases bone density in the coronal interproximal periodontium but does not change the level of the crest.
INDICATION
Moderate to advanced mobilities (2 degrees or more) are present and cannot be treated by any other means.
Splinting should only be used with other necessary measures such as root planning, oral hygiene instructions, pocket elimination, and occlusal adjustment.
Whenever pre-prosthetic surgery or orthodontic measures are called for, they should be completed before splinting whenever possible.
Temporary splinting is a useful adjunct in many areas of treatment. External splints are preferable because they are disposable. They may be used to facilitate instrumentation (root planning, curettage, occlusal corrections) that might be difficult on lose teeth. They are of benefit in periodontal surgery, particularly when bone grafts or new attachment is attempted.
Types of splints
Temporary Splints –
a. External splints: ligatures, tooth-bonding plastic splints, welded band splints, continuous clasps and night guards.
b. Internal splints: acrylic, composite resin with or without embedded wire or amalgam with an embedded wire, nylon fishing line, acrylic A- splint and acrylic and gold provisional splints.
Permanent Splints –
- Removable- external
- Continuous clasp devices
- Swing-lock devices
- Over denture
2. Fixed- internal
- Full coverage, 3/4th coverage crowns and inlays
- Posts in root canals
- Horizontal pin splints
- Partial dentures and splinted abutments
- Removable-fixed splints
- Full or partial dentures on splinted roots
- Fixed bridges incorporated in partial dentures, seated on posts and copings
3. Cast-metal-resin bonded fixed partial dentures (Maryland splints)
4. Combined
- Partial dentures and splinted abutments
- Removable-fixed splints
- Full or partial dentures on splinted roots
- Fixed bridges incorporated in partial dentures, seated on posts and copings
5. Endodontic
CONCLUSION
Almost all splints demand an extra measure of motivation and diligence from the patient in plaque control. Splinting should be undertaken only in patients who have proved their willingness and ability to perform these measures. Clinically mobile teeth can be successfully treated and maintained.
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