Splinting of periodontal disease affected lower incisors restored with all ceramic crowns – Dr. Alejandro Bertoldi Hepburn (Argentina) These incisors have an important loose of bone and present mobility which generates discomfort to the patient. They will be splinted with a resin matrix quartz fiber reinforced strand (Quartz Splint, RTD)

The teeth had been restored with all ceramic crowns with alumina core beneath the covering feldespatic porcelain. The crowns won't be removed for the splinting. The patient smokes. Because of the teeth mobility she couldnt perform her hygiene properly and the periodontal disease got worse.

Notice the change of position of the teeth (especially 4.1) after the placement of the rubber dam.

QUARTZ SPLINT UD (RTD) was the selected fiber strand for the splinting. The product is presented in separated compartments.

Using diamond burs - medium size grain - a groove was performed in the lingual side of the crowns to create the space for the fiber strand. The fiber strand is cut and checked in lenght and width. The alumina base of the crown must not be exposed while creating the groove for the fiber strand.

The feldespatic porcelain is treated with an oral sandblaster (MIcroetcher, Danville) to create a micro roughened surface and get adhesion to the fiber strand.

10% hydrofluoric acid gel is also applied over the feldespatic porcelain surface for etching and get even better micromechanical retention.

The etched porcelain surface look opaque and porous after rinsing away the acid gel with water and air drying.

QUARTZ SPLINT RESIN is applied and photoactivated over the etched porcelain surface.

A high ceramic filled flowable composite resin (Grandio Flow, VOCO) is applied in the interproximal spaces and photoactivated. The teeth are now stabilized in their correct position.

Once the teeth were stabilized and didnt move, the positioning of the fiber strand inside the groove was much easier.

The fiber strand should be properly accommodated inside the groove.

The free space between the fiber strand and the porcelain surface is filled by the flowable composite. The composite will also cover the fiber strand and restore the anatomy of the crowns. Excess of the composite in the interproximal space was removed with a brush.

Afterwards, both the fiber strand and composite resin were photoactivated.

Medium and fine grain size diamond burs were also used to eliminate excess of composite resin and shape the anatomy. Attention should be given to the finishing of the interproximal spaces to avoid future accumulation of plaque.

A suitable rubber polisher was also used for the anatomy shaping and polishing of the composite and porcelain.

Inmediate post operative situation. The composite resin nor the fiber strand are visible by the buccal side. Notice that the interproximal spaces have not been shut; the hygiene of the area wont be altered.

Teeth are stable and don't move. The patient feels comfort and will be able to carry out her hygiene in a much better way. The prognosis of the periodontal disease becomes more favorable.