Wednesday, May 16, 2018

An Evidence-Based Appraisal of Splinting Luxated, Avulsed, and Root-Fractured Teeth


An Evidence-Based Appraisal of Splinting Luxated, Avulsed, and Root-Fractured Teeth

Department of Pediatric Dentistry
Lutheran Medical Center

Resident’s Name: Wayne Dobbins DDS MS                                                                      Date: 5/16/18
Article Title: An Evidence-Based Appraisal of Splinting Luxated, Avulsed, and Root-Fractured Teeth
Author(s):  Kahler et al.
Journal: Pediatric Dentistry
Date: Dental Traumatology 2008
Major Topic: Trauma Tx
Main Purpose: systematic review of splinting of teeth that have been luxated, avulsed or root-fractured,
Summary:

Dentists are required to decide on treatment decisions and interventions for unscheduled emergency patients when they present with oro-facial or dento-alveolar trauma.

It is generally accepted and recommended that teeth subjected to trauma should be splinted after repositioning of the tooth to prevent displacement and further injury to the pulp or the periodontal ligament during the healing phase.

Current guidelines advise that avulsed teeth require a functional splint for 7–10 days so as to allow for functional or physiological movement of the root. A functional splint retains the tooth in the socket but is flexible enough to allow functional stimulation of the periodontium. The results of recent studies, however, have challenged the current guidelines for the management of avulsed teeth, with evidence that the type of splint and duration of the splinting period are not significant variables in pulpal or periodontal healing.

Studies generally indicate that the prognosis is determined by the type of injury rather than factors associated with splinting.

The prognosis for the healing outcome is more dependent on the type of injury rather than the effect of the splinting. For example, in teeth where the coronal fragment had been displaced, the splinted teeth had a significantly lower frequency of healing than non-splinted teeth with no displacement. It is likely therefore, that the lower rate of frequency of healing is a consequence of more severe trauma that produced the displacement rather than the splinting technique.

The types of splints and splinting duration were generally not significant variables when related to healing outcomes.

Extended fixation periods, however, appeared to increase the frequency and extent of root resorption and dentoalveolar ankylosis which was far more predominant in teeth that were splinted for 30 days than in teeth splinted for 7 days

Surface and inflammatory resorption was first noted at 1 week and replacement resorption noted at 2 weeks although the extent and frequency of the resorptive areas slightly increased for the 8-week observation period.

In conclusion, the results of this article indicate that the types of splint and the fixation period are generally not significant variables when related to healing outcomes.

Presently, flexible splinting is only assumed to assist in periodontal healing, but from this article it appears the injury will indicate prognosis, not the type or duration of splinting.



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