Title Splinting of an avulsed tooth with a mature apex is recommended for no more than 14 days to facilitate periodontal healing
Clinical Question When treating an avulsed tooth with a mature apex, does short-term splinting over long-term splinting improve periodontal healing rates?
Clinical Bottom Line For patients with avulsed teeth that have mature apices, short-term splinting of no more than 14 days is recommended over long-term splinting to improve periodontal healing. There is insufficient data, based on the reviewed evidence, to change the currently recommended guidelines by the American Association of Endodontists, which recommends a flexible splint for up to 14 days.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
19290892Hinckfuss/2009138 teeth in 4 studiesSystematic review of non-randomized trials
Key resultsThis systematic review (SR), based on 138 avulsed teeth used in two retrospective and two prospective studies, compares splint duration at 14 days or less to more than 14 days. Study reveals that successful periodontal healing is not significantly affected by treatment duration. In addition, there is inconclusive data on the effect of duration of splinting on post-treatment replacement resorption.
20797655Miller/2010Case report and review of systematic review of 138 teethCase report
Key resultsEvidence based decision-making was utilized for this case report. Two PICO questions were generated evaluating duration of the splinting and timing of root canal after trauma. The review of the available information shows there is no evidence to suggest a deviation from current clinical practice guidelines for treatment of an avulsed tooth and splint duration.
21557097Werder/201142 avulsed teeth in 37 individualsProspective Cohort Study
Key resultsWhile no descriptive statistics were performed due to the small sample size, it was noted that periodontal healing was not affected by whether teeth were splinted for 14 days or less, or more than 14 days. For teeth splinted for less than 14 days, 10/22 teeth showed periodontal healing while those splinted for greater than 14 days, 10/20 showed periodontal healing. Although insignificant, it was noted that 6/20 teeth that were splinted for more than 14 days had to be extracted due to replacement resorption, compared to only 1/22 for those splinted less than 14 days. The authors stated that the favorable success rate of 20/42 teeth for periodontal healing was due to three factors: short extra-oral dry time, storage of the teeth in a physiologic medium and topical application of a glucocorticoid.
Evidence Search (("fractures, avulsion"[MeSH Terms] OR ("fractures"[All Fields] AND "avulsion"[All Fields]) OR "avulsion fractures"[All Fields] OR "avulsion"[All Fields]) OR ("replantation"[MeSH Terms] OR "replantation"[All Fields] OR "reimplantation"[All Fields])) AND ("splints"[MeSH Terms] OR "splints"[All Fields] OR "splint"[All Fields]) AND duration[All Fields]
Comments on
The Evidence
Validity: The purpose of the SR was to reconcile the available data to consensus for splinting duration and optimal periodontal healing in avulsed teeth. There was not enough data to support that splinting duration has an impact on periodontal healing of the avulsed tooth. Both the SR and case report suggest further research is needed to ascertain whether splinting duration has an impact on the periodontal healing of the avulsed tooth. Studies included in the systematic review by Hinckfuss et al all have small sample sizes, ranging from 17-51 teeth with a total of 138 teeth evaluated. A more recent, retrospective study by Werder et al, is an attempt to further this research but also had a small sample size and fails to conclude significant difference in periodontal healing in regard to long and short-term splinting. Perspective: There is no evidence to support a deviation from established guidelines regarding duration of splinting of an avulsed tooth at this time. There is insignificant and insufficient data to suggest that long-term splinting is more harmful to the patient in this scenario. However, there appears to be many confounding factors that influence the periodontal healing of avulsed teeth that prevents researchers from recommending a longer duration for splinting. These confounding factors include: intervention timing for endodontic therapy, use of rigid versus non-rigid splint, the medium in which the avulsed tooth is presented to the clinician and most importantly, extra-oral dry time.
Applicability This CAT applies to the avulsed tooth with closed apices, an infrequent clinical encounter. That noted, overall treatment of this condition is complex and often has a poor prognosis if the aforementioned confounding factors are not managed properly. All evidence reviewed suggests that there is no sufficient data to alter established guidelines for splinting duration of an avulsed tooth. Therefore, the American Association of Endodontists (2013) published guidelines are the most current best practice recommended.
Specialty (Endodontics) (General Dentistry) (Oral Surgery) (Orthodontics) (Pediatric Dentistry) (Periodontics) (Restorative Dentistry)
Keywords Splint, duration, avulsion, reimplantation
ID# 3288
Date of submission 11/16/2017
E-mail hawkinstk@livemail.uthscsa.edu
Author Tyler Hawkins, DMD
Co-author(s) Sukhpreet K Sandhu, DDS
Co-author(s) e-mail SandhuSK@livemail.uthscsa.edu
Faculty mentor
Faculty mentor e-mail
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
Comments and Evidence-Based Updates on the CAT
None available