Wednesday, September 18, 2013

An evidence based appraisal of splinting luxated, avulsed and root fractured teeth

Resident: Hofelich
Article: An evidence based appraisal of splinting luxated, avulsed and root fractured teeth
Author(s): Bill Kahler, Geoffrey Heithersay
Journal: Dental Traumatology
Year: 2008

Intro: Review of analyses for splinting recommendations post luxation, avulsion and root fracture injuries

Materials and methods:
PICO- P- (problem) what is the evidence to determine splinting
        I - (intervention) intervention may include: no splinting, rigid or functional splinting
       C- (comprehensive) comparing these splinting choices across the different types of trauma and their effect on healing
       O- (outcome) outcomes for the teeth
Pubmed search for splinting related to healing outcomes of traumatized teeth from 1966-2005. 
Inclusion criteria: 
  • clinical studies where the research design included a multivariate analysis or controlled stratified analyses
  • animal studies that examined biological mechanisms associated with splinting of teeth related to healing outcomes of teeth
Review of the literature then examined whether research evidence was being implemented in the recommended guidelines of the IADT and the AAE. 

Results: The types of splints and splinting duration were generally not significant variables when related to healing outcomes. The use of cap splints and ortho bands were associated with a greater frequency of pulp necrosis and pulp canal obliteration compared to acid-etch resin splints and no splint. Some studies of root-fractured incisors reported that rigid splinting did not favor pulpal survival or hard tissue healing and recommended that rigid splinting of root fractured teeth be discontinued. Short term splinting may be sufficient for healing. Current guidelines advise that avulsed and replanted teeth require a functional splint for 7-10 days. An extended period of splinting may be required to stabilize a tooth where there has been extensive loss of marginal bone.  

Summary: Prognosis is determined by the injury, rather than factors associated with splinting. Current protocols recommend splinting treatment for teeth that have been luxated, avulsed, or have a root fracture. The guidelines for splinting root fractures and alveolar fractures are less clear. 

Assessment of article: Mostly talked about the problems with different research and how difficult it is to do a study about dental trauma. Main point: closely criticize articles that dictate treatment.

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