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

Resident’s Name: Brian Schmid DMD Date: 09/04/09
Article title: An evidence based appraisal of splinting luxated, avulsed and root fractured teeth
Author(s): Bill Kahler, Geoffrey Heithersay
Journal: Dental Traumatology
Month, Year: 2008
Major topic: Review of analyses for splinting recommendations post luxation, avulsion and root fracture injuries
Type of Article: Meta-analysis
Findings: Evidence based dentistry involves a search for current best evidence, a critical appraisal of the validity of the research. The paper goes on at length about selection bias, research ethics and appraisal of different kinds of studies. Originally splinting was inspired by jaw bone repair which included long term rigid splinting, but research began to show that this increased the chance of external resoption and pulpal necrosis. In other studies, a splinting time of 1 week showed the tooth to be firm. Current guidelines advise that avulsed teeth require a functional splint for 7-10 days. Recent studies show that the type of splint and splinting time are not significant variables in pulpal periodontal healing. For luxated and root fractured teeth functional splinting for a few weeks is now recommended. Multivariate analyses of the selected studies for this paper revealed that the treatment interventions are not generally significant variables when related to the healing outcome. Prognosis is best predicted by type of injury. In fact, some studies have shown no difference between splinting or not splinting in root fractured teeth but be wary since only teeth with no coronal dislocation were used. Currently for avulsed and replanted teeth only 7-10 days are recommended but longer duration may be required if a large amount of marginal bone was lost.
Key points/Summary: While there are many studies with multiple outcomes, it is still prudent to follow the normal recommendations for luxated, avulsed and root fractured teeth. Always be critical of outcomes as selection bias, limited scope and a variety of other problems can lead to a misapprehension. The prognosis of any trauma in best predicted by the type and degree of injury versus the splinting method.
Assessment of article: Mostly information about PICO and research issues, but it makes its point about closely criticizing articles which dictate treatment.