A new aesthetic element has been added to the functional splint design for the management of patients with advanced periodontal disease. Read in depth about the entire technique devised at Sanjeevni by Dr Ajay Kakar and Dr. Anupama Patil. A couple of cases have been shown to demonstrate the final outcome of the Splint.

Long term maintenance of periodontally compromised teeth in which infection control has been achieved and active disease has been eliminated is now a sought after goal of periodontal therapy. Remarkable strides in material technology of bonding dentistry has now made it possible to create very good, functional, durable, strong splints with excellent aesthetics in otherwise very compromised clinical situations.

One of the most common fallouts of periodontal disease and subsequent therapy is clinically long teeth due to recession and severe malposition of teeth due to pathologic migration and mobility. These displaced teeth are further compromised due to the occlusal forces which now tend to become more angular rather than along the vertical long axis of the teeth. It almost becomes mandatory in such situations to carry out a good long term splint. One of the major problems with the splinting of displaced teeth is the large amount of interproximal spaces which exist and cannot be so easily eliminated. These spaces generally are a resultant of the migration and recession which has already taken place.

The material of choice today for splinting in such clinical situations is glass fibres, which are available in the general tooth shade range and composites. The glass fibres on polymerization, provide sufficient strength to withstand the occlusal forces if placed in the appropriate position taking into consideration the various directions of force that the concerned teeth are subjected to. The splint design has to also incorporate the basic fundamental principles whereby the afflicted teeth are splinted with supporting teeth in which the long axis of movement of the afflicted teeth differs from that of the supporting teeth.

Another material which can bee used in place of glass fibres is a material called Ribbond which is a leuno weave fibre which also chemically bonds with composite materials and provides adequate strength and function. The origins of glass fibres for periodontal splints can be partly attributed to Paul Belvedere who laid out the guidelines for such splints. Even though good function and stability is very easily achieved with these splints one major drawback is the aesthetics which gets considerable compromised especially if the teeth have migrated and large interproximal spaces are seen.

A comprehensive approach towards the aesthetic management of such situations as well as an improved function approach has been conceived of by the authors and a new splint design with an additional approach of a "Splint Makeover" has been defined and presented.

The Aesthetic splint has been basically designed for the management of upper or lower anterior teeth which have open embrasures and gingival recession with mobility ranging anywhere from Grade I to Grade III. The different clinical situations where it can be applied are as follows

• Periodontally compromised teeth with migration
• Post Orthodontic maintenance of teeth in position
• Migration of anterior teeth with age and increased occlusal forces
• Anterior alveolar fracture cases

Keeping in accordance with the principles of fracture resistance, force dissipation and crack propagation in glass fiber/composite hybrid materials there are certain design parameters which are mandatory. Ideally upper anterior teeth should be splinted from the buccal side as the splint/tooth interface on this surface will be subjected to the least amount of shear forces. It should be noted that shear bond strengths of composite to tooth, even today is the weakest link in the entire composite tooth complex. The justification of placing such a splint on the buccal surface is that the upper anterior teeth tend to move outward in a buccal direction with the movement being from the palate to the outer side. If a splint has to retain and resist this movement from the palatal surface it would be subjected to maximum shear forces and the shear resistance of composite/tooth bonds are not exceptionally high. It would be much more safer and stronger to place the splint on the outer surface since then it would not be subjected to such high shear forces. This surface would rather have to resist tensile forces which is acceptable since the tensile bond strengths are much more higher for composite/tooth interfaces.

It may be acceptable to place a splint on the palatal surface of upper anterior teeth provided there is sufficient occlusal clearance, the teeth are firm and stable and/or the splint is being carried out for the sole purpose of acting as an orthodontic retainer. In such situations it may be possible to get away with a palatal splint as long as there is no premature occlusal contact in either centric or lateral and protrusive movements.

In the case of lower anterior teeth it is generally far better to place the splint on the lingual surface as the shear forces on the teeth would be more on the buccal surface vis a vis the lingual surface. Occasionally it may be necessary to create a wrap around design for certain teeth which have a very high degree of mobility and additional support is required for the same. The basic design considerations and preparation remains the same for maxillary as well as mandibular teeth. The following principles and guidelines are basically created for the glass fiber splint although the same could be easily incorporated even is a different material like Ribbond is used.

The steps involved in creating the Aestheti splint are as follows

• Identification of the number of teeth to be splinted i.e. extent of the splint
• Isolation with cheek retractors or rubber dam
• Shade selection of the involved teeth
• Tooth preparation
• Sizing and trimming the glass fiber for the splint
• Acid etching of the prepared teeth
• Application of bond layer
• Placement of the glass fiber along with flowable/regular composite material
• Final polymerization of the glass fiber
• Completing the splint with regular composite material
• Occlusal Adjustment
• Reevaluation of the splint
• Isolation of the splint area
• Placing Retraction Cords
• Acid etching of all the involved teeth
• Application of bond layer
• Building up the interproximal spaces
• Finishing and Polishing

The extent of the splint is defined by a number of factors. These factors are, the number of afflicted teeth, the severity of the mobility, the individual tooth position and the location of the teeth along the arch form. An attempt should be made as far as possible, to include terminal stable teeth in the splint design to provide adequate support to the afflicted teeth with compromised bone. A principle to be followed is regarding the long axis of movement of the teeth in question. Any given tooth will always display mobility along a certain vertical long axis of movement along which the movement is essentially in a bucco lingual direction. The idea of splinting teeth together is to prevent movement of teeth by fusing multiple teeth with different long axis of movements. In addition providing terminal stable teeth in the splint gives additional support to the overall prosthesis.

Since the splint is an outcome of adhesive dentistry materials it has to follow all the norms and rules of basic bonding dentistry. One of the prime requisites for success in bonding dentistry is to have absolute isolation and not allow any contamination of the tooth surfaces. In addition glass fibres have to be adapted in the groove on the tooth surface and this procedure is carried out sequentially tooth by tooth and as this is done the balance of the fibre cannot be contaminated at all.

When carrying out maxillary buccal splints isolation can be done with a cheek retractor and cotton rolls. The tongue generally is isolated from the area of work by default due to the anatomy. It is a must to have a high vac suction to remove the acid as well as maintain isolation. When working on mandibular anterior teeth, life becomes very easy if isolation is done with a rubber dam. The rubber dam helps in controlling the tongue as well as keeping away crevicular fluids and saliva. Placing a rubber dam on lower anterior teeth is a very simple procedure and does not take more than a few minutes. Once placed the availability of a rubber dam saves considerable amount of time during the actual procedure. If a rubber dam is being placed it is wise to extend the dam to one additional tooth on either side of the area being splinted.

Groove Prepartion: One the extent of the splint has been ascertained and the terminal teeth identified the tooth preparation is started. A groove has to be prepared extending from the distal aspect of one terminal tooth till the distal aspect of the other terminal tooth. The groove has to begin from the buccal surface about 0.5 to 0.75 mm median to the distoproximal line angle. The groove also ends on the other terminal tooth in the same position. The groove runs right through the entire buccal surfaces of all the intermediary teeth. The groove has to actually dip into both the proximal surfaces of all the intermediary teeth as well as the mesio-proximal surfaces of the terminal teeth. The groove should ideally be prepared with an air rotor using a thick blunt ended tapering fissure bur. The groove should be ideally prepared in one smooth stroke without any irregularities on the lateral line angles of the groove. The bur should be placed in the starter position and light pressure applied till the required depth is achieved. The groove should be ideally between 0.5 to 0.75 mm deep. Once the bur has been introduced and the preferred depth achieved, the bur should be moved laterally towards the adjacent tooth. It is ideal to hold the bur at 90 degrees to the buccal surface at all time and also to make the groove as parallel as possible to the incisal line angle. This entails that the bur will actually move almost 90 degrees when preparing the groove on the proximal walls. It is almost as if the bur tip is making an arc around the crown in a circumference which is always equidistant from the incisal line angle. It is good idea to place the air rotor handpiece in the required position and guide it with the finger of the other hand while preparing the groove from one proximal surface to another. This helps in controlling the depth and direction of the bur while cutting into the tooth surface.

The groove should be placed in the incisal third of the tooth surface when prepping for a maxillary splint. The placement is more or less the same when placing a lingual mandiular splint also. On a relative basis the position of the groove is slightly more apical in the mandibular teeth vis a vis the maxillary teeth. A very important criteria affecting the groove position when there are open interproximal spaces is the location of the contact point or area. This contact point or area will be created when the buildup is being done. If the groove is incorrectly placed it will dictate the fiber placement which in turn, will dictate the build up and location of the contact point/area. The depth of the incisal embrasure which will also be created has to be also envisaged. A very short incisal embrasure does not look aesthetic and hence the groove cannot be place too close to the incisal line angle.

A minor advantage of a slightly apical position of the mandibular groove is that it allows the operator to utilize the starting bulge of the cingulum which may act as a seat for placement of the fiber.

Beveling the Groove: The next step is to bevel all the margins of the groove. This step is necessary to obtain precise aesthetics since the bevel will help in blending the composite material with the tooth surface to create a natural appearance. The bevel can be done with a medium to thick round headed tapered fissure diamond bur or its equivalent. The bevel should be a 30 to 40 degree bevel on all the surface margins of the groove. It is a good idea to first bevel either the incisal margin or the apical margin. Once one of the margins has been beveled then the other margin should also be beveled. Then the proximal ends of the groove on each of the involved teeth should also be beveled.

The bur should be held at an angle of about 45 degrees to buccal surface and lightly brushed along the margins. The bevel should extend about 1 to 1.5 mm from the groove along the buccal margins. It is a good idea to view the grooves from a lateral angle to be able to visualize the margins and extent of the bevels. Once the beveling is done the preparation is complete.

The next step is to prepare the glass fiber for adaptation. The fiber has to be longer than the actual arc around which it is to be placed since the fiber has to partially wrapped around the proximal surfaces. The extension of the fiber around these surfaces has to be taken into consideration when trimming it. Once the required length has been determined it is cut with a special scissor and it is ready for placement. It is imperative that the fiber not be handled even with gloved fingers and not contaminated at all. It should be handled gently with a clean tweezer and placed on the tooth surface just prior to the actual bonding. The fiber also should be exposed to too much of light and preferably placed under a cover till the time that it has to be bonded onto the tooth surface. It should be realized that the fiber is a resin preimpregnated fiber and the resin may start polymerizing on exposure to light. In case a material like Ribbond is being used for the splint, the fiber has to be soaked in unfilled resin prior to application.

The next step is to etch the prepared area for 15 to 20 seconds. It should be noted that enamel may be etched for upto 20 seconds but the dentin should only be etched for about 5 to 10 seconds. The base of the groove will generally be in dentin and hence the acid should be first aplied along the peripheries of the groove and the beveled area of all the teeth and then lastly placed within the groove. By the time the acid etch gel is placed in the last of the teeth the first tooth that has been etched is ready for washing. The next step is to start washing the teeth with a gentle stream of water. A high vac suction should be placed adjacent to the tooth being washed to directly drain off the acid thereby preventing the unpleasant taste as well as any untoward interaction of the acid with oral tissues. The acid generally used is 35% phosphoric acid or any material supplied by the manufacturer along with the bonding agent being used. As of today it is preferable not to use the Self Etching Primer based sixth generation bonding agents for splinting since the bond strengths achieved with these agents to enamel is questionable and most of the tooth surface area is enamel rather than dentin. Once the etching agent has been washed off thoroughly the teeth should be further washed for a minute or two with a copious flow of water to totally remove any possible traces of any residual acid. It is important to note the teeth should only be dried and not dessicated completely. Complete dessication is more harmfull and should be avoided.

The next step is to apply the bonding agent. The preferred choice today is to carry out wet bonding i.e. apply the bond on a relatively wet tooth surface. The bond should be taken on a bond applicator and lightly applied all over the prepared tooth surface. It should be ascertained that the entire tooth surface is totally covered with the bonding agent. Depending upon the system being used and the manufacturers instructions, either one layer or two or three layers of bond have to be applied. The bond is then lightly dried with a light blast of air after waiting for about 15 seconds. This is to allow the solvent as well as the priming agent which is generally included in the fifth generation bonding agents to evaporate. Once the bonding agent has been dried with a gentle stream of air it should be polymerized with a light cure gun. All areas of the teeth where the bond has been applied has to be poylmerized for 20 seconds. After the polymerization the bonded area should have a shiny glassy appearance.

The next step is to place the fiber in the grooves. Prior to placement of the fiber small amounts of flowable composite material should be placed in the grooves of the teeth. The overhead dental light should be slightly moved away from the oral cavity and not focused on the area of operation as the overhead light could polymerize the flowable material. The flowable should not polymerize at all and has to be spot cured to hold the fiber in place and absolutely well adapted to the tooth surface of the groove. A very common clinical situation is the splinting of lower or upper incisors using the canines as the terminal support teeth. This requires the fiber to be adapted and placed around six teeth. Strict maintenance of isolation is a must as the fiber is being adapted and spot cured. These above requirement make it mandatory to have at least two assistants for the operating dentist i.e. six handed dentistry. One assistant is required to handle the suction and spot cure the fibers which the second assistant is required for help in adapting the fiber and protecting the unadapted fiber from being either contaminated or partially polymerized.

The adaptation of the fiber should be initiated from one end of the groove. The fiber is to be picked up with a small tweezer and then placed in the end of the groove. The fiber should be adapted around the tooth in the groove and the other end of the fiber pressed into the end of the groove of the same tooth on the other proximal surface. When this is done the free end of the fiber tends to get picked up and has to be held in place. The fiber can be held in the groove either with the help of the two prongs of a fine tweezer or with two probes. The second assistant should at this point hold the fiber in the next interproximal space. The fiber should then be spot cured onto the first tooth on which the fiber is properly adapted inside the groove. The tooth surface should be polymerized for about 5 seconds which holding some protective metal surface over the adjacent fiber so that it does not get polymerized without being adapted to its requisite tooth. Once the fiber has been spot cured into place the same procedure is to be repeated for the adjacent tooth. This is then further repeated till the entire fiber has been spot cured and polymerized in place. If necessary a slight amount of flowable composite can always be placed in the groove to adapt the fiber perfectly.

Once the spot polymerization is completed any free spaces in and around the fiber should be covered with flowable composite. The fiber running from tooth to tooth in the interproximal spaces should be also covered with flowable composite which will totally impregnate the basic fiber. Once this is done the entire splint should be completely polymerized making sure that all areas of the fiber as well as composite have been exposed to a 20 second curing cycle. This will completely polymerize the fiber and bond it to the tooth surface.

The next step is select the composite of the right shade and start filling up the groove with the composite and making sure that the material spreads on the lateral surfaces of the tooth and completely covers the groove area and blends in with the tooth surface. A non stick plastic composite instrument is very useful for placing the composite. Specialized hand instruments are available for blending in the composite to the tooth surface. The composite material in the right shades should be adapted and the entire preparation filled and blended in with intermittent curing cycles to polymerize the material. The splinted section should then be examined in detail and if any spaces are present they should be filled in and polymerized. Once the entire material has been placed the next step can be carried out. The operator has to make sure that there is no exposed fiber in the splint at all. All the fiber should be completely layered with composite material. Once this is completed the rubber dam or the cheek retractors and cotton rolls can be removed and the patient given a break. The entire splint is then washed and cleaned with a water spray. A small hint while removing the cotton rolls is to make them wet prior to removing them. The dry cotton tends to stick to the mucosa and may cause

If the splint is not being done over for aesthetic purposes and no interproximal spaces exist the splint should be polished thoroughly with all the requisite steps as described in the following spaces.

The next step is to adjust the occlusion and confirm that the splinted teeth have a group centric position contact and that there are no individual discluding teeth in lateral and protrusive movements. If there is any single tooth in the group of splinted teeth which has a premature contact it has to be adjusted till such time that group function is achieved. It is not necessary that always the tooth in question among the splinted teeth has to be reduced. It may be prudent to adjust the opposing arch tooth in case the tooth is not in balance with occlusal plane of the particular arch. When adjusting the occlusion an attempt must be made to achieve as close as possible a flat and level occlusal plane for both the arches. If any teeth are adjusted then the adjusted areas should also be subjected to a polishing regimen like the composite material.

Once the occlusal adjustment is complete the splint should be reevaluated and a plan made for the makeover and closure of the interproximal spaces in as aesthetic a fashion as possible. The splinted group of teeth should be observed from all angles and the arch form taken into consideration after which the final plan for the makeover is formulated and the process initiated by once again isolating the area in question. It is not possible to isolate the splinted teeth with a rubber dam anymore and hence only a cheek retractor and cotton rolls have to suffice. The chances of contamination are much lesser now since the teeth have been immobilised and only small increment of composite material have to be added to the teeth. In case of any unavoidable contamination, the process can be started all over again from that point onwards and still completed without any great damage. After isolating the involved teeth as well as the fiber surfaces should be refreshed by very lightly running a carbide bur over the entire involved surface area.

It is almost mandatory to place retraction cords in the sulcus of all the splinted teeth. Many a times a splint is done much before total periodontal therapy is completed. Invariably there is some amount of persistent gingival inflammation and this tends to lead to crevicular fluid contamination on the tooth surface which has to be avoided at all costs. Hence placement of retraction cords prior to starting the build up procedure is a very good idea. An additional reason is that the build ups have to be blended much more towards the neck of the teeth than just the splint. The splint is generally placed in the incisal third of the tooth and hence cords are not required during that step. Another advantage of the retraction cord is that any excess bond or composite material around the crevicular margin is easily controlled and removed when the retraction cords are removed after the build up.

The next step is to now acid etch the splinted area. The etch now will be over enamel and the splinting material. The area of extension of the acid etch is slightly varialble since it depends upon the design of the "Splint Makeover". The etch is to be applied for a period of 15 to 20 seconds and then washed off in a similar manner as described earlier. Even the composite coated fiber between the teeth should be etched and bonded just like enamel.

The next step is to apply bond over the etched area. The bond is applied with a bond applicator and cured with light after allowing the solvents to evaporate. The guidelines and principles used are the same as described it.

Once the bonding has been completed the build up to create an aesthetic splint and merging the fibers and blending them with the teeth is to be done. One of the most crucial factors in achieving excellent results is having selected the correct shade. It is not necessary that a single shade of composite will do the trick. Teeth very often have different shades from coronal to incisal and the various color gradients have to be noted down prior to initiating the procedure. Matrix bands cannot be used for this procedure since the teeth have been fused together. The use of wedges is also not advised as they will cause sharp margins which are very difficult to smoothen subsequently. The entire build up procedure can be divided into a series of steps. These steps are as the authors do the procedure and can be individually modified for personal convenience as long as none of the basic principles are being violated.

Identify and Evaluate: The first step is to identify the area form where the build up has to be initiated. A general rule of thumb is to start from the widest interproximal area first. Also make sure that you check out and evaluate the width of the existing teeth and co-relate it with the existing space. If the evaluation is tricky, measure the width of the teeth and the space and come to a proper conclusion. The idea of initiating the build up in the widest interproximal space is that this will lend flexibility in modifications as the build up progresses. In case the diastemas are more or less equidistant, the build up should be started from the lateral most areas and moved towards the midline. This again allows for some amount of flexibility in width correction.

Layer by layer increment: Always start the build up from the cervical third of the tooth and build upwards. Add material to the proximal surface at the cervical level and slowly progress towards the incisal. When working on a given diastema keep adding one layer each to either of the proximal surfaces. Do not try to build up tooth first and then shift focus to the adjacent tooth surface.

Blending each layer: As each layer is added it has to be blended with the tooth surface from all angles i.e. buccal, palatal, proximal and incisal. This is very necessary to be able to achieve a smooth homogenous finish and also to avoid entrapment of air in the build up which will mar the aesthetics and also weaken the structure. This blending can be achieved with a variety of composite instruments that the operator is comfortable with. The authors prefer to use a triple angled # 3 Thompson composite instrument, which has the plane of the working blade offset from the perpendicular.

3/4^th build up model: The build up of the first selected interproximal space should be left unfinished at about 3/4^th of the way and the next space should then be closed. Do not finish the entire build up of the first started space and then the next. This again helps in giving an overall perspective on the aesthetics of the job being done. It also allows for subtle modifications to be done which will help in creating as appropriate a finish as possible within the constraints of the case. Once all the spaces have been closed about 3/4^th of the way up a reevaluation from all possible angles and a check on the arch form goes a long way in obtaining a successful result. The fiber which has been placed prior to this procedure will always span the entire interproximal width. This fiber has been placed proximally whereever the contact points or rather contact areas between the teeth are to be created. Do not add material onto the fiber bar and make it thicker. Rather add the layers on the proximals and grow then towards the center, encompassing the fiber bar as the layers are added. As mentioned earlier, in each layer maintain the proximo-buccal line angle for each tooth.

Contact Points / areas: The most tricky part of the entire build up is to create very natural looking contact point/areas. The contact points have to be created in the same place where the fiber has been placed in the proximal groove area. It is necessary that the fiber has been placed following the natural contour with the fiber dipping into the embrasure area. The proximal line angles have to blend in and be a smooth curve and the contact area should be placed as deep as possible on the proximal surface to give it a very natural look. The more closer the contact point/area is towards the palatal area the more aesthetic the appearance. The contact point/area looks more natural when open embrasures are created on the incisal as well as the apical zones.

Characterisation: Individual characteristics for the teeth should be incorporated while adding the composite material rather than created by reducing the trimming at a latter stage. The characteristics should be incorporated with the body shades which are used. Once these have been created the body shade is generally covered and blended with an incisal shade which may be clear, superclear or any translucent shade of choice. These blending shades have to be applied to the proximals also. The translucent shades create the beautiful effect of very natural characterisations by appearing to be embedded into the tooth structure.

Creating Ilusions: The key to obtaining very good esthetics in this procedure is the creation of illusions. There is no other direct aesthetic procedure which demands more application of all visionary illusions than the Aesthetic splint. The reason, as already cited earlier is that teeth which have migrated and are in extremely unnatural positions and totally out of alignment have to maintained in their positions. Not only have they to be maintained, but a aesthetic appearance has to be created with all the restrictions and limitations applicable.

If any two involved teeth start looking too wide because of the inordinately large space in between them, an illusion has to be created to make them look narrower. Add a slightly darker shade on the palatoproximal side and keep the labio proximal line angle slightly mesial to actual. This will make the tooth appear a bit longer. You can also actually add a little material incisally, if possible, and make the tooth longer to reduce the effect of the increased width. Add ripples to the buccal aspect. This will break the reflected light and create an illusion of narrowness. At times it may become necessary to add a layer of material to the entire buccal surface when the job is viewed from the incisal aspect.

If there is a large embrasure space between a canine and the lateral, build up the canine slightly more at the cost of the lateral and it will look better. If the same is the case between the central and the lateral, build up the lateral at the cost of the central. Always try to maintain the centrals as equal and absolutely alike each other. As the build up nears completion see to it that the incisal embrasures are as natural as possible. This is very crucial between the two centrals and then between the centrals and laterals.

Self cleansing design: Oral hygiene and minimal plaque collection is a must for a long life of the splint. The most crucial area of the tooth for maintenance is the apical embrasure. Since the use of a floss is ruled out by default a gradual natural shaped embrasure should be created wherein a proxabrush tip can be easily introduced and maintained. There should be no sharp angles or shoulders or overhangs or butt joints or irregular rough surfaces created.

The first step in finishing and polishing is to remove all the cords that have been placed. It is important to remember how many cords have been placed so that there is no cord inadvertently left behind. As the cord is removed any excess composite which is stuck with the cord also gets removed. The next step is to eliminate any overhang at the cervical borders of the splint. This should be done with a very fine diamond or carbide tip. All the cervical margins should be checked diligently from all surfaces and polished till even the finest probe cannot discern a joint between the composite material and the tooth.

Then the entire splint should be polished with a multi fluted finishing carbide bur using very light strokes mainly on the flat surfaces. It is the operators discretion to select the appropriate carbide bur. The use of carbide burs on proximal walls should be avoided as much as possible. It is far more preferable to used a Profin system to polish the proximal surfaces. The profin provides multiple advantages in that it can be easily adapted and placed in the smallest of embrasure areas. The reciprocal action and safe side eliminates chances of damage to the other tooth surfaces or inadvertent reduction of any other involved areas. The next step is to check for the occlusion and again eliminate any premature contacts with the carbide bur. Avoid using a diamond or any other cutting bur for occlusal adjustment. The occlusal corrections should be carried out prior to the final polishing as it may be necessary to even reduce natural tooth surfaces in some locations which should also be ultimately polished. Check for occlusal prematurities in centric as well as in lateral and protrusive movements.

The next step is the final polishing which should be preferably done with finishing discs and then with silicone finishers like the Kenda polishers. One of the best finishing discs are the coarse to fine range of Hawe Neos. A slow speed motor should be used for this and all the involved areas completely finished till an absolutely smooth finish is created and the entire section starts gleaming. Then the silicone finishers are to be used and the fine one should be used with a polishing paste to achieve the sheen of a natural tooth.

The splint design has been found to serve two extremely important functions. It not only generates a very highly aesthetic appearance for the patient, but also serves to strengthen and protect the core splint and thereby increase the life of the splint. This procedure adds a new dimension to the aesthetic component of periodontal therapy. It does make it a requirement to know and apply almost all the tenets of bonding procedures to make it possible to create a natural and aesthetic appearance.

One aspect to be always considered is that these cases are all compromise cases and cannot be brought around to achieve perfect aesthetic smiles. Even thought the attempt is there to adhere to the golden proportion norms of teeth sizes, it has to be adapted and many a times totally ignored due to the existing position of the teeth which cannot be helped. It is the operators discretion to be able to adapt and apply and create beauty out of discrepancy and disharmony. The splint tends to become more of a work of art rather than just a clinical procedure for function and aesthetics.

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