Evidence-based Assessment of the Splinting Period for Replanted Avulsed Incisors

Specific guidelines are available to dentists for the management of avulsed teeth. The principles of evidence-based dentistry (EBD) can be used to assess whether clinicians are using the best clinical strategies based on currently available evidence in their approach to replantation of avulsed incisors. Objective: To use the principles of EBD to answer the PICOT statement: (P) For a replanted avulsed permanent incisor, (I) Does short term splinting for 14 days or less, (C) Compared with long term splinting for more than 14 days (O) Increase the likelihood of successful healing after tooth replantation? Methods: A literature search was performed across four internet databases: Ovid Medline, the Cochrane Library, PubMed, and ISI Web of Science resulting in 36,470 citations for this PICOT Statement. Limiting citations to those in English and removing duplications produced a set of 16,090 titles that were sieved in accord with EBD principles. Relevant papers (n=780) were selected for abstract assessment. This evaluation selected 89 papers for examination; 3 papers (102 total teeth) met the final criteria for meta-analysis. Results: The weighted odds ratio for functional healing (without resorption) with short term splinting was 0.92 (95% CI 0.23; 3.76; not statistically significant). The weighted odds ratio for acceptable healing (without progressive root resorption) with short term splinting was 2.51 (95% CI 1.04; 6.04; statistically significant P=0.04). The odds ratio for replacement root resorption with short term splinting was 0.14 (95% CI 0.04; 0.51; statistically significant P=0.003). Conclusion: Current evidence indicates that for replanted avulsed permanent incisors there is no increase in the likelihood of functional healing with short term splinting. Short term splinting is however, more likely to result in healing without progressive root resorption and less likely to result in replacement root resorption. (Support: Research Committee, School of Dental Science, The University of Melbourne).