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

Kahler, Bill and Heithersay, Geoffrey S. (2008) An evidence-based appraisal of splinting luxated, avulsed and root-fractured teeth. Dental Traumatology, 24 1: 2-10. doi:10.1111/j.1600-9657.2006.00480.x

Author Kahler, Bill
Heithersay, Geoffrey S.
Title An evidence-based appraisal of splinting luxated, avulsed and root-fractured teeth
Journal name Dental Traumatology   Check publisher's open access policy
ISSN 1600-4469
Publication date 2008-02
Sub-type Article (original research)
DOI 10.1111/j.1600-9657.2006.00480.x
Open Access Status
Volume 24
Issue 1
Start page 2
End page 10
Total pages 9
Place of publication Oxford, U.K.
Publisher Blackwell
Language eng
Subject 1105 Dentistry
Abstract The evidence-based methodology involves framing a well defined PICO (problem, intervention, comparison and outcome) question related to a clinical problem and then comprehensively searching for the evidence, which is evaluated to appraise the value of the treatment intervention. For this systematic review of splinting of teeth that have been luxated, avulsed or root-fractured, the clinical PICO question is (P) what are splinting intervention decisions for luxated, avulsed and root-fractured teeth (I) considering that the splinting intervention choice may include (i) no splinting, (ii) rigid or functional splinting for the different types of trauma and (iii) different durations of the splinting period (C) when comparing these splinting choices for the different types of trauma and their effect on (O) healing outcomes for the teeth. A keyword search of PubMed was used. Reference lists from identified articles and dental traumatology texts were also appraised. The inclusion criterion for this review was either a multivariate analysis or controlled stratified analyses as many variables have the potential to confound the assessment and evaluation of healing outcomes for teeth that have been luxated, avulsed or root-fractured. A positive statistical test is not proof of a causal conclusion, as a positive statistical relationship can arise by chance, and so this review also appraises animal studies that reportedly explain biological mechanisms that relate to healing outcomes of splinted teeth. The clinical studies were ranked using the 'Centre of Evidence-based Medicine' categorization (levels 1–5). All 12 clinical studies selected were ranked as level 4. The studies generally indicate that the prognosis is determined by the type of injury rather than factors associated with splinting. The results indicate that the types of splint and the fixation period are generally not significant variables when related to healing outcomes. This appraisal identified difficulties in the design of animal experimentation to correctly simulate some dental injuries. Some of the studies employed rigid splinting techniques, which are not representative of current recommendations. Recommended splinting treatment protocols for teeth that have been luxated, avulsed or root-fractured teeth are formulated on the strength of research evidence. Despite the ranking of these studies in this appraisal as low levels of evidence, these recommendations should be considered 'best practice', a core philosophy of evidence-based dentistry. © 2010 John Wiley & Sons A/S.
Keyword Splinting
Root-fractured teeth
Luxated teeth
Avulsed teeth
Q-Index Code C1
Q-Index Status Provisional Code

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
School of Dentistry Publications
Version Filter Type
Citation counts: TR Web of Science Citation Count  Cited 14 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 19 times in Scopus Article | Citations
Google Scholar Search Google Scholar
Created: Wed, 13 Jan 2010, 16:06:14 EST by Tara Johnson on behalf of Faculty Of Health Sciences