Comfort and discomfort of dental trauma splints – a comparison of a new device (TTS) with three commonly used splinting techniques

Abstract  – The present experimental study compared four dental trauma splints in 10 volunteers. The evaluated splints included a wire-composite splint (WCS), a button-bracket splint (BS), a resin splint (RS), and the newly developed titanium trauma splint (TTS). All splints were bonded to the labial surfaces of the maxillary lateral and central incisors and left in place for 1 week. After splint removal, the next splint was placed after a 1-week rest period. The sequence of splint application was randomized for each individual. The following subjective parameters were assessed using a visual analogue scale: sensitiveness of splinted teeth, irritation of the gingival margin, irritation of the lips, impairment of speech, eating and oral hygiene. The results show that the application of BS leads to a significantly higher irritation of the lips and greater impairment of speech compared to other splints ( P  < 0.05). The RS leads to an increased and significantly higher irritation of the gingiva ( P  < 0.05) owing to a significant increase in cleaning difficulties ( P  < 0.05). In conclusion, WCS and TTS appear to be more accepted splints according to a subjective assessment by 10 volunteers.     

Influence of wire extension and type on splint rigidity – evaluation by a dynamic and a static measuring method

Abstract – Objectives: To evaluate the influence of wire dimension and wire length on the splint rigidity of wire‐composite splints in vitro. Materials and Methods: A custom‐made artificial model was used. The central incisors simulated ‘injured’ teeth with increased mobility, and the lateral incisors and canines served as ‘uninjured’ teeth with physiological mobility. To assess horizontal and vertical tooth mobility before and after splinting, the Periotest and Zwick methods were applied. Teeth 13–23 were splinted using wire‐composite splint 1 (WCS1; Dentaflex 0.45 mm) and wire‐composite splint 2 (WCS2; Strengtheners 0.8 × 1.8 mm). Splint length was varied by successively shortening the wire. The influence of wire dimension was tested using t‐test and Wilcoxon–Mann–Whitney test with the Bonferroni‐Holm procedure (α = 0.05). To test the influence of wire length, anova and Kruskal–Wallis tests as well as Tukey range and Wilcoxon test with Bonferroni‐Holm procedure were applied (α = 0.05). Results: Wire dimension significantly influenced splint rigidity (P < 0.05). The wire length significantly influenced the splint rigidity of WCS1 in the horizontal dimension and WCS2 in the horizontal and vertical dimensions (P < 0.05). Splint rigidity was significantly reduced when splinting only ‘injured’ teeth compared with splints including ‘uninjured’ adjacent teeth (P < 0.05). No differences were found between splints including one or two ‘uninjured’ teeth on each side (P > 0.05). Conclusion: WCS1 is flexible compared with the more rigid WCS2. The wire length influences the rigidity. To ensure adequate fixation and reduce the risk of enamel damage during splint removal, the splint should include only one ‘uninjured’ tooth bilaterally.     

Rigidity evaluation of quartz‐fiber splints compared with wire‐composite splints

Abstract – Aim: To evaluate the influence of reinforcement material on in vitro dental splint rigidity. Materials and Methods: A custom‐made artificial model was used. The central incisors simulated ‘injured’ teeth with increased mobility, and the lateral incisors served as ‘uninjured’ teeth with physiologic mobility. The Periotest and Zwick methods were used to assess horizontal and vertical tooth mobility before and after splinting, and relative splint effect (SpErel) was calculated. Teeth 12–22 were splinted using two wire‐composite splints (WCS), WCS1 (Dentaflex 0.45 mm), and WCS2 (Strengtheners 0.8 × 1.8 mm) as well as four quartz‐fiber splints, QS1 (Quartz Splint UD 1.5 mm), QS2 (Quartz Splint Rope 1.5 mm), QS3 (Quartz Splint Woven 2.5 mm), and QS4 (dry fibers 667 tex). The influence of the splint type was evaluated using anova , Tukey range, and the Dunnett‐T3 test (α = 0.05). To test the influence of initial tooth mobility, the t‐test was applied (α = 0.05). Results: Reinforcement materials significantly influenced splint rigidity (P < 0.05). The horizontal and vertical SpErel of WCS1 compared with WCS2 and QFSs1–4 was statistically significant (P < 0.05). Significant differences were found when comparing the horizontal SpErel of WCS2 with WCS1 and QSs1–4 (P < 0.05). SpErels of the ‘injured’ and ‘uninjured’ teeth showed significant differences (P < 0.05). Conclusion: WCS1 is flexible compared with the more rigid WCS2 and QSs1–4. Initial tooth mobility influences SpErel. The flexible WCS1 can be recommended for splinting dislocation injuries whereas the semi‐rigid/rigid WCS2 and QS1–4 can be used for horizontal root fractures and alveolar process fractures. The QS1–4 provide good esthetic outcome.     

Rigidity of commonly used dental trauma splints

Abstract – Background/Aims: The stability of immobilization devices varies from flexible to rigid, depending on the trauma. We evaluated the rigidity of various commonly used splints in vitro Material and Methods: An acrylic resin model was used. The central incisors simulated injured teeth, with increased vertical and horizontal mobility. The lateral incisors and canines stimulated uninjured teeth. Tooth mobility was measured with the Periotest^® device. Vertical and horizontal measurements were made before and after splinting, and the difference between values was defined as the splint effect. We evaluated 4 composite splints, 3 wire‐composite splints, a titanium trauma splint, a titanium ring splint, a bracket splint, and 2 Schuchardt splints Results: For all injured teeth and all splints, there was a significant splint effect for the vertical and horizontal dimensions (P < 0.05). For injured teeth, the composite splints produced the largest changes in vertical tooth mobility; wire‐composite splints 1 and 2, using orthodontic wires, produced the smallest vertical splint effects. For uninjured teeth, the Schuchardt 1 splint and the bracket splint produced the largest splint effects; wire‐composite splints 1 and 2 produced only a slight change in tooth mobility. Composite splints 2 and 3 produced the largest horizontal splint effects for injured teeth, and the 4 composite splints produced the largest horizontal splint effects for uninjured teeth. The most horizontally flexible splints were the titanium trauma splint and wire‐composite splints 1 and 2. Conclusions: According to the current guidelines and within the limits of an in vitro study, it can be stated that flexible or semirigid splints such as the titanium trauma splint and wire‐composite splints 1 and 2 are appropriate for splinting teeth with dislocation injuries and root fractures, whereas rigid splints such as wire‐composite splint 3 and the titanium ring splint can be used to treat alveolar process fractures.     

Rigidity of various fixation methods used as dental splints

Abstract Horizontal and vertical rigidity of teeth fixed with seven types of denial splints were evaluated by two tooth mobility measuring devices. Altogether 21 dissected sheep mandibles including soft tissues were used for the experiments in which Fermit, flexible wire-composite, Kevlar, Fiber, Protemp, rigid wire-composite and Triad Gel splints were applied to four incisors. The mean rigidity of the central incisors within the splint was measured by means of Mühlemann periodontometer (horizontal mobility) and Periotest (horizontal and vertical mobilities). Mobility values of teeth before splinting were used as covariants and the values with the splints were illustrated as adjusted mobility. Statistical significance between the rigidity of various splints was analyzed by an unpaired t-test. It was shown that the most rigid splints both in horizontal and vertical directions were Triad Gel, rigid wire-composite and Fermit splints. Kevlar and Fiber splint allowed more horizontal movement than other splints. Protemp and flexible wire-composite splints proved to produce adequate lateral support for the fixed teeth and allowed vertical flexibility which is experimentally known to improve periodontal healing of luxated teeth.     

Rigidity of various fixation methods used as dental splints.

Horizontal and vertical rigidity of teeth fixed with seven types of dental splints were evaluated by two tooth mobility measuring devices. Altogether 21 dissected sheep mandibles including soft tissues were used for the experiments in which Fermit, flexible wire-composite, Kevlar, Fiber, Protemp, rigid wire-composite and Triad Gel splints were applied to four incisors. The mean rigidity of the central incisors within the splint was measured by means of Mühlemann periodontometer (horizontal mobility) and Periotest (horizontal and vertical mobilities). Mobility values of teeth before splinting were used as covariants and the values with the splints were illustrated as adjusted mobility. Statistical significance between the rigidity of various splints was analyzed by an unpaired t-test. It was shown that the most rigid splints both in horizontal and vertical directions were Triad Gel, rigid wire-composite and Fermit splints. Kevlar and Fiber splint allowed more horizontal movement than other splints. Protemp and flexible wire-composite splints proved to produce adequate lateral support for the fixed teeth and allowed vertical flexibility which is experimentally known to improve periodontal healing of luxated teeth.     

Development of new artificial models for splint rigidity evaluation

Abstract – Aim: We developed two versions of an artificial model and assessed their suitability for splint rigidity evaluation. These models allowed the simulation of traumatically loosened teeth and the use of the acid‐etch technique for splint application. Materials and methods: A straight and half‐round arch bar model with bovine tooth facets were manufactured. Using the Periotest method, tooth mobility was evaluated before (PTVpre) and after (PTVpost) splinting. Two types of previously investigated wire‐composite splints, WCS1 (Dentaflex 0.45 mm; Dentaurum) and WCS2 (Strengthens 0.8 × 1.8 mm; Dentaurum), were applied (n = 10) to each model. The relative splint effect (SpErel = ΔPTV/PTVpre) was calculated, and the working times for the models and splints were evaluated. Student’s t‐test and the Mann–Whitney U‐test were employed with Bonferroni correction for multiple hypotheses. Results: When comparing the relative splint effect of the ‘injured’ central incisors between the models within one splint type, differences were only found for tooth 21 (WCS2; P < 0.008); for comparisons of splints within one model type, differences were detected for both incisors and model types (P < 0.008). With the straight model, significantly less working time was necessary (P < 0.05). Conclusion: Using these models for in vitro splint rigidity evaluation, the splints can be applied with the acid‐etch technique and tooth mobility can be individually adjusted. WCS1 is considered flexible compared to the more rigid WCS2. The results from the straight and the round model were predominantly closely related to each other. In terms of working time, the straight model is superior to the round model.     

An evaluation of the Periotest® method as a tool for monitoring tooth mobility in dental traumatology

Abstract – Background/aim: The Periotest^® method is a technique for the objective assessment of tooth mobility. The aims of this study were to determine normal Periotest^® values in the vertical and horizontal dimensions of periodontally healthy teeth in individuals aged 20–35 years and investigate the reliability of Periotest^® in terms of intra‐series and inter‐series reproducibility before and after applying a dental trauma splint in vivo. Materials and methods: Periotest^® values were measured in periodontally healthy dental students (n = 33; mean age 24.7 years) at reproducible measuring points in the vertical and horizontal dimensions, before and after splint insertion. Three readings were taken per series to observe the intra‐series reproducibility; three series were measured to test inter‐series reproducibility (Friedman‐test; P ≤ 0.001). Two different wire‐composite splints, 0.45 mm Dentaflex and 0.8 × 1.8 Strengtheners, were inserted and the Periotest^® values were measured. Results: The median Periotest^® values before splinting were: canines ‐2.5, lateral incisors ‐0.9, and central incisors 0.0 for the vertical dimension, and canines 1.1, lateral incisors 3.2, and central incisors 3.6 for the horizontal dimension. The intra‐series and inter‐series Periotest^® values were highly reproducible. Conclusion: The Periotest^® method provides highly reproducible results. Focused on dental trauma, the method can be applied diagnostically during the splint and follow‐up period and for evaluating splint rigidity.     

Laboratory comparison of a titanium trauma splint with three conventional ones for the treatment of dental trauma.

AIM: This was to evaluate the efficacy of a Titanium Trauma Splint (TTS) by comparing it with three other devices commonly used in the care of dental trauma, a Resin Splint (RS), Button-Bracket Splint (BS) and a Wire- Composite Splint (WCS). METHODS: The four types of splints were applied on experimental dental models, including in the splints the teeth from canine to canine of each maxilla. Two load-tests for each device were applied with the dental model inclined to 45 degrees or less, and increasing forces were applied to the incisal edges from 0N to 50N, in the first test, and from 0N to 100N in the second. At the same time the displacement involved of the splinted teeth was assessed and then the ratio between the two measured sizes was graphically represented. RESULTS: In the level tests the displacements of the splinted teeth caused by the force of 80N were: 0.39 mm for the BS, 0.37 mm for the TTS, 0.35 mm for the WCS and 0.30 mm for the RS. In the inclined tests, the splints under the effect of 40N, showed displacements as: 1.65 mm RS, 1.83 mm BS, 1.89 mm TTS and 2.16 mm WCS. CONCLUSION: With the exception of RS as to rigidity, the other three splints were practically the same in response. Considering other characteristics, the TTS proved to be a promising device for the treatment of dental traumas.     

Biomechanical effects of splint types on traumatized tooth: a photoelastic stress analysis

Abstract –  This study was undertaken to assess the effect of splint type on stresses occurring around traumatized tooth by photoelastic stress analysis. Three semi-rigid splint types – a wire-composite splint, fiberglass splint and titanium trauma splint – were utilized for comparisons. Extracted left upper central and lateral incisors and the canine tooth of an otherwise healthy patient were embedded equidistantly in photoelastic resin. For all cases studied, a static axial and 20° oblique force of 100 N was applied on the lateral incisor in separate sessions. The experiments were undertaken without any splint application (unsplinted, control) after which the splints, adhesively bonded to the labial aspects of teeth, were consecutively tested. During each loading sequence, generation of isochromatic fringes was observed in the field of a polariscope, and photographed by a digital camera. Quantification of fringes was performed on magnified images, transferred to a PC. Under vertical loading, the highest stresses in the apical regions were observed for the unsplinted and ribbond-splint groups, whereas the lowest fringes occurred with the use of orthodontic wire as a splinting medium. Titanium trauma splint had absolutely no effect on reduction of stresses, as the fringe orders were slightly higher than the unsplinted lateral tooth. The use of orthodontic wire resulted in lowest fringe orders around the traumatized tooth.     

In vitro comparison of the flexibility of different splint systems used in dental traumatology

Abstract – Aim: The aim of the study was to evaluate the flexibility of five different splint systems [polyethylene fibre‐reinforced splint (Ribbond^® THM, Ribbond Inc., Seattle, WA, USA), resin splint (RS), wire‐composite splint (WCS), button‐bracket splint (BS) and titanium trauma splint (TTS)] commonly used in clinical practice for the treatment of dental traumatic injuries involving the periodontal supporting tissues. Materials and methods: For the experimental study, a resin cast of the upper arch was manufactured, where teeth 11, 12 and 21 (used for the stress analysis) were inserted in a non‐rigid fashion so as to allow for replacement, whereas the other teeth were permanently fixed to the corresponding sockets. Two different test sessions were performed for each splint: (i) stress analysis with increasing intensity ranging between 0 and 50 N directed along the tooth’s longitudinal axis; (ii) stress analysis with 45° of oblique force of increasing intensity ranging between 0 and 30 N. For each loading direction, five recordings were conducted without a splint, followed by five with the splint applied. The energy required to modify the position of the teeth was calculated for both the splinted and un‐splinted teeth and the difference between the two values was determined. Energy variation was assessed for the testing of both axial (ΔE_a) and oblique force (ΔE_o). ΔE represents the rigidity index of the analysed contention devices: high ΔE values correspond to high rigidity materials. Results: The RS showed the highest ΔE value for the axial stress analysis, whereas the highest ΔE value at a 45° was recorded for the WCS and RS. For both tests, the lowest ΔE values were recorded for the TTS and Ribbond THM splints. Conclusions: The data show that the contention devices with the highest flexibility are the TTS and the Ribbond THM as they exhibit a lower energy variation needed for splint deformation compared with the other materials that were examined.     

Effect of luxation type on pulpal blood flow measurements: a long-term follow-up of luxated permanent maxillary incisors

Laser Doppler flowmetry (LDF) is a non-invasive method to assess pulpal blood-flow (PBF). Dental injury has been associated with significant PBF reduction. The purpose of this study was to assess whether (i) the type of luxation trauma may affect PBF measurements and (ii) whether luxation type-related measurements may show short- and long-term changes of PBF values. In 41 trauma patients, 69 maxillary incisor treated by repositioning and splinting, and the respective contralateral homologous tooth were investigated by LDF to assess local PBF values. Perfusion units were recorded in four sessions, on the day of splint removal, and 12, 24 and 36 weeks after splint removal. Statistical analysis consisted of univariate analysis of variance for repeated measurements. For the LDF measurements, the main effect of the variable 'session' was not significant (P = 0.119). However, there was a significant 'session'/'luxation type' interaction (P = 0.000). Analysis of simple session-within-luxation type effects revealed intrusive luxations to be associated with a significant decrease in PBF values (P = 0.000), while subluxations (P = 0.568), lateral luxations (P = 0.980), extrusive luxations (P = 0.910), and avulsions (P = 0.996) showed no significant difference between session-related values. The PBF measurements did not change over time for the contralateral incisors (P = 0.996). The LDF may become useful in the detection of pulpal ischaemic episodes in luxated maxillary incisors after repositioning and splinting. Further studies are warranted to assess the validity of the diagnosis of post-traumatic 'ischaemic episodes' by comparing it with histological tooth pulp changes, and by determining how well it may predict course and response to treatments in clinical trials.     

The effect of splint material and thickness on tooth mobility after extraction and replantation using a human cadaveric model

Although current guidelines for the treatment of traumatic injuries recommend the use of 'flexible' splints, the precise definition of what is considered flexible versus rigid has not been rigorously defined, leaving the clinician with a wide range of options for this critical factor. The purpose of this study was to quantify and compare the effect of eight different splints on tooth mobility after extraction and replantation using a human cadaveric model. Following strict selection criteria including complete root maturation, lack of periodontal disease, normal bone levels, and crown integrity, a maxillary central incisor was atraumatically extracted and splinted with eight different splints. The experimental splints included a 30-pound test monofilament nylon-composite splint and six wire-composite splints made of wires of 0.012' (0.3 mm), 0.016' (0.4 mm), or 0.020' (0.5 mm) diameter stainless steel (SS) or nickel titanium (NT). A direct composite splint represented the most rigid type of splint. These eight splints were applied five times each, and tooth mobility was measured before and after each splint was applied. The average splint effect, defined as the difference between the presplint and the postsplint measurements quantified using the Periotest, was calculated for each splint and compared. No significant differences were found between the nylon-composite and the wire-composite splints. There was significantly less tooth mobility with the direct composite splint compared to all other splints. In conclusion, the results of this study suggest that nylon and SS or NT wires up to 0.016' diameter are significantly more flexible than direct composite splints and thus may be better suited for the splinting and management of traumatized teeth.     

Evaluation of pulpal blood flow after tooth splinting of luxated permanent maxillary incisors

Abstract –  Laser Doppler flowmetry (LDF) is a non-invasive method to assess pulpal blood flow (PBF). Dental injury has been associated with losses of pulpal sensibility. The purpose of this study was to assess whether LDF could be used to detect short- and long-term changes of PBF values of luxated permanent maxillary central incisors after repositioning and splinting. In 18 trauma patients, a single maxillary incisor treated by repositioning and splinting, and the respective contralateral homologous tooth were investigated by LDF to assess local PBF values. Perfusion units (PU) were taken in four sessions: on the day of splint removal, and 12, 24, and 36 weeks after splint removal. Analysis of the luxation type-related PBF measurements revealed intrusion type-related PBF values to be associated with a significant decrease in PBF values ( P  < 0.05), while lateral luxation and extrusion type-related PBF values showed no significant difference between the session-related values ( P  > 0.05). PBF measurements did not change over time for the contralateral incisors ( P  > 0.05). Teeth affected by an intrusion-type luxation injury remained unresponsive to sensitivity testing at follow up, while 3 (60%) developed grey discoloration of the crown. LDF may become useful in the detection of ischemic episodes of luxated maxillary central incisors after repositioning and splinting. Further studies are warranted to assess the validity of post-traumatic 'ischemic episodes' by comparing it to histological tooth pulp changes.     

Direct application of fiber-reinforced composites in splinting in a case of periodontitis. II

Attachment loss through advanced periodontitis results in tooth mobility, and then loss of teeth. To prevent progression it is needed to eliminate any exciting agent and correct functional disorders in consequence of disease. Regeneration of periodontium is impossible and mastication is difficult because of tooth mobility. Long-term maintenance of mobile teeth is doubtful. We have to prevent the extraction of these teeth to stabilise them by a splint made of material that is inexpensive, reparable, provides sufficient support for the artificial tooth. Fiber-Reinforced Composite (FRC) fulfills the above requirements. In their case-reports the authors demonstrate the practical application of splinting with FRC materials. In these cases the FRC splints are not only periodontal splints but they act as orthodontic retainers or supports for an artificial tooth.     

Splints made of wire and composite: an investigation of lateral tooth mobility in vivo

Abstract In 103 posttraumatic splints, lateral tooth mobility was measured with Periotest immediately before and after the routine splint removal. The splints were made of composite resin and an 0.017×0.025″ orthodontic steel wire. 481 teeth were measured. A statistic evaluation revealed that the immobilisation effect did not exceed normal tooth firmness. Fixation to one neighbouring tooth had less effect than fixation to two. Adjacent tooth gaps reduced the effect. Splint extensions had no influence. With the use of the Periotest device, more than 50% of all teeth with a true mobility of 20 Periotest-units or more were detectable as mobile in spite of the fixed splint.     

Vertical dimension increases in the adult rhesus monkey: a pilot study.

Tooth impaction, increased muscle activity, and histologic changes in the bone of the temporomandibular joint have been reported following attempts to increase the vertical dimension of occlusion. The purpose of this research was to study the effects of increases in the vertical dimension of occlusion on bone density at five levels of the mandible in the adult rhesus monkey, and to assess dentoalveolar changes by lateral cephalometric radiographs and mounted diagnostic casts. Mandibular cobalt chromium splints measuring 3 mm in height at the first molar, providing even occlusal contact to the maxillary anterior and posterior teeth, were cemented in place on two monkeys. Five similar monkeys without splints were used as controls. Computed tomograms were completed to evaluate bone density bilaterally at five levels of the mandible after 3 months of splint wear. Pretreatment and posttreatment lateral cephalometric radiographs and mounted diagnostic casts were completed to assess tooth impaction. Periodontal ligament (PDL) thickening and mobility of molars and premolars were evaluated before splint placement and after splint removal. There was no statistically significant difference in the bone density levels of the animals with splints compared with the controls. Minimal dentoalveolar changes were observed.     

In vitro splint rigidity evaluation – comparison of a dynamic and a static measuring method

Abstract – Objectives: The aim of this in vitro study was to investigate a dynamic and static tooth mobility assessment method in terms of reproducibility and correlation. Materials and Methods: A custom‐made artificial model was used. The central incisors simulated ‘injured’ teeth with increased mobility, and the lateral incisors served as ‘uninjured’ teeth with physiological mobility. To assess tooth mobility, three consecutively repeated measurements were taken, in the vertical and horizontal dimensions before and after splinting, using the Periotest method as well as the Zwick universal testing machine. Reproducibility of the measurements was tested using anova and the Bonferroni post hoc test (α = 0.05). Correlation was analysed using Spearman’s rank correlation (α = 0.05). Results: No significant differences were found when comparing the three consecutively taken Periotest values and the vertical Zwick values (P > 0.05). In the horizontal dimension, the first Zwick values differed from the second and third values (P < 0.05). Only a few random correlations (P < 0.05) were found when comparing the two assessment methods. Horizontal and vertical measurements within one method did not correlate (P > 0.05). Conclusions: The Periotest and vertical Zwick values are highly reproducible. The measurements of the two methods do not correlate; therefore, a conversion of Periotest values into metric displacement data is not feasible. The two methods provide different valuable information about tooth mobility. The Periotest method describes the damping characteristics of the periodontal ligament while the Zwick method reveals quantitative metric values.     

Comparison of the flexibility of various splinting methods for tooth fixation

An experimental model was constructed to test the flexibility of the arch bar splint and the Schuchardt splint as compared with a newly introduced wire-composite splint. Vertical movement in 4 flexible incisors was tested by producing compressive forces between 15-95 Newtons on the incisal edges. The thinnest wire-composite splint was also tested for lateral flexibility by producing palatal forces from 2 angles. Movement without the splint served as the control. The tests showed that a 0.3 mm thick wire-composite splint had the flexibility closest to the control, followed by the arch bar splint, and 0.4 mm and 0.5 mm wire-composite splints, while the Schuchardt splint virtually prevented vertical movement. Lateral movement was markedly reduced by the 0.3 mm wire-composite splint as compared with the control with both a 10 degree and a 45 degree force. The experiments showed that a 0.3 mm wire-composite splint can be regarded as acting as a functional fixation allowing slight vertical movement of the teeth during immobilisation; it should be recommended for tooth fixation whenever possible.     

A review of the clinical management of mobile teeth

The clinical management of mobile teeth can be a perplexing problem, especially if the underlying causes for that mobility have not been properly diagnosed. In some cases, mobile teeth are retained because patients decline multidisciplinary treatment that might otherwise include strategic extractions. This article discusses the relationship between occlusion and tooth mobility with an emphasis on identifying differences between increased mobility and increasing mobility. The indications, contraindications, and basic principles of tooth splinting are also reviewed. Provisional and definitive splints are defined and described with their respective occlusal considerations. Some mobile teeth can be treated through occlusal equilibration alone (primary occlusal trauma). Whereas mobile teeth with a compromised periodontium can be stabilized with the aid of provisional and/or definitive splinting (secondary occlusal trauma). It is important to consider splint therapy, because it may not only improve the prognosis of teeth, but may actually enhance the stability of the final prosthodontic treatment. The ultimate goal of successful management of mobile teeth is to restore function and comfort by establishing a stable occlusion that promotes tooth retention and the maintenance of periodontal health.