SPLINTING OF TEETH FOLLOWING

TRAUMA: A REVIEW AND A NEW

SPLINTING RECOMMENDATION
B Kahler,J-Y Hu, CS Marriot-Smith, GS Heithersay
Australian Dental Journal 2016; 61:(1 Suppl) 59–73

Presented by: Dr. Shrinivas Garje

Guided by: Dr. Sharath Shetty
INTRODUCTION

• Splinting has been advocated after repositioning of a tooth/teeth to stabilize

the tooth/teeth and to optimize healing outcomes for the pulp and/or the
periodontal ligament.

• A splint has been defined as ‘an apparatus used to support, protect or

immobilize teeth that have been loosened, replanted, fractured or subjected
to certain endodontic surgical procedures’

• Historically, splinting of teeth utilized the principles of jaw bone fracture

with rigid, long-term immobilization for a few months.
• The validity of this approach was questioned when studies showed rigid
immobilization increased the incidence of pulp necrosis and external root
resorption.

• The use of flexible splints arose when animal experimentation reported a lower
incidence of ankylosis when teeth were subjected to masticatory forces, which
suggested that splints should provide some functional movement of the
traumatized teeth.

• A flexible splint allows functional movement in contrast to a rigid splint where the
injured teeth are immobilized.
• A systematic review and metanalysis on auto-transplanted teeth reported that the
ankylosis rate was three times higher with wire and composite resin splinting
when compared with suture splinting, suggesting the importance of physiological
movement on healing outcomes. (Chung W-C 2014)

• Another study showed that teeth splinted for just 1 week were clinically firm,
which indicated shorter splinting times could be considered. (Andreasen1975)

• As a consequence of these and other studies, the International Association of

Dental Traumatology (IADT) guidelines recommend splinting types that are
flexible rather than rigid and employed for shorter duration.
• The current recommendations of the IADT are summarized in Table
 The purpose of this review was to examine the IADT guidelines in relation
to splints and the splinting duration for the different types of trauma.

 In addition, a new protocol for splinting traumatized teeth is proposed that

combines ease of application and removal with no or minimal damage to
enamel.
• Ideally splint should meet the requirements which have been modified from

1. avulsions with subsequent

Andreasen’s original recommendations in 1972:
replantation

2. root fractures

3. alveolar fractures

4. jaw fractures

5. and luxation injuries

1. Allow periodontal ligament reattachment and prevent the risk of further
trauma or swallowing of a loose tooth.

2. Be easily applied and removed without additional trauma or damage to

the teeth and surrounding soft tissues.

3. Stabilize the injured tooth/teeth in its correct position and maintain

adequate stabilization throughout the splinting period

4. Allow physiologic tooth mobility to aid in periodontal ligament healing.

5. Not irritate soft tissues.

6. Allow pulp sensibility testing and endodontic access

7.Allow adequate oral hygiene.

8. Not interfere with occlusal movements.

9.Preferably fulfil aesthetic appearance.

10. Provide patient comfort.

TYPES OF SPLINTS IN CURRENT USE
Composite and wire splints:
• Composite and wire splints are perhaps the most commonly used in clinical practice
and are flexible splints when the wire has a diameter of no greater than 0.3– 0.4
mm.

• An example of a wire and composite resin splint is shown

• Another example of a composite and wire splint following an avulsion and
subluxation injury to the central incisors.

• In this case the left central incisor was not replanted as the tooth was lost. An
aesthetic splint was provided
 Composite and fishing line splints:

• An alternative to wire is where fishing

line replaces wire and the line is
secured with composite resin.
• A nylon purchased from hardware
store attached to the teeth with
colored composite resin.
• The colored composite provides a guide for the
removal of the splint to minimize damage to
enamel. A composite resin and whipper snipper nylon splint
and purple colored composite.
 Orthodontic wire and bracket splints:
• Orthodontic brackets bonded to the teeth with a resin-based
orthodontic cement and connected with a light 0.014 NiTi flexible
wire.
• An example of this splint is shown where the patient has sustained
traumatic injuries to the maxillary right central and lateral incisors
and the maxillary right central incisor.
• Orthodontic bracket splints allow teeth that have been intruded or
not repositioned correctly to have the occlusal relationships
modified at a later date.
• However, care must be taken that orthodontic forces do not
develop stress that disturbs the healing phase of an injured tooth.
• While this type of splint was found to be irritating to the lips when
compared to composite and wire splints and titanium trauma
splints, this is generally not considered to be a clinical problem as
any lip irritation can be avoided with the application of wax.
 Fibre splints:
• Fibre splints use a polyethylene or Kevlar fibre mesh
and are attached either with an unfilled resin such as
OptibondTM FL (Kerr, USA) and/or with composite
resin.
• Materials such as Fiber-Splint (Polydentia SA
Mezzovico-Vira, Switzerland), RibbondTM (Ribbond
Inc., Seattle, USA) or EverStick (Stick Tech Ltd,
Turku, Finland), which is a silinated E-type glass
fibre, are commercially available.
• An example of a Fiber-Splint is shown following an
avulsion injury of the maxillary left central and lateral
incisor teeth.
• In a study of 400 root-fractured teeth by Andreasen
et al., fibre splints were associated with the highest
frequency of favourable healing outcomes.
Titanium trauma splints
• The titanium trauma splint developed by von Arx18 is a flexible
splint made of titanium, 0.2 mm thick and 2.8 mm wide
(Medartis AG, Basel, Switzerland).
• It has a rhomboid mesh structure which is secured to the tooth
with flowable composite resin.
• A disadvantage of this splint type is its relatively high cost.
• In this application composite resin was used instead of
flowable resin .
• The patient initially presented with an arch bar splint which
was replaced with a titanium trauma splint because of gross
irritation to the gingival tissues.
Arch bar splints:
• Arch bar splints were initially adopted for maxillary and mandibular
fractures in the 1870s and adapted for dentoalveolar trauma.
• A metal bar is bent into the shape of the arch and fixed with
ligature wires.
• Disadvantages of this technique are that this type of splint is rigid
and arch bars may loosen and cause irritation.
• There may also be physical damage from the ligature wires to the
gingival tissues and the integrity of the cemento-enamel junction.
Wire ligature splints:
• Wire ligature splints are sometimes used by oral
surgeons in clinics where dental splinting materials
may not be available .
• These splint types are generally rigid and impinge on
the gingival tissues with resulting inflammation, taken
immediately after splint removal.
Composite splints:
• Resin composite applied to the surfaces of teeth is a rigid splint
and accordingly is not recommended in the IADT guidelines.
• However, example of a composite resin splint applied to the
labial surfaces of the maxillary right central incisor and adjacent
teeth.
• Composite splints that are bonded interproximally to adjacent
teeth are also reported to be prone to fracture.
• Furthermore, composite splints resulted in greater gingival
irritation when compared with wire and composite, an
orthodontic bracket splint or the titanium trauma splint.
• The potential for iatrogenic damage for all splints that utilize
composite resin as the adherent cannot be understated and is
discussed further in the section below on ‘splint removal’.
 A splint for medical emergency departments
• An innovative approach in splinting developed by Dr
Peter Foltyn at St Vincent’s Hospital, Sydney, is the
use of Stomahesive (ConvaTec Inc.), a skin barrier
adhesive material used for superficial skin trauma.
• This material can crudely hold teeth in the socket
and cover coronal fractures to reduce sensitivity
when patients are seen in emergency medical
departments out of hours of routine dental practice.
• However, this approach could require further repositioning with
subsequent splinting in a dental office.
• Other temporary splinting may be provided by the use of the
patient’s mouthguards, orthodontic retainers, or aluminum foil
adapted to the dental arch and covered with thermoplastic
The stomahesive splint removed to
acrylic. reveal a crown-root fracture of the
• The suturing of avulsed and/or luxated teeth as part of maxillary right central incisor and
uncomplicated crown fractures of
emergency treatment has been described as an alternative the left central and lateral incisors.
approach.
A flexible splint
• Berthold et al. reported in an in vitro study that composite and
wire splints where the wire was 0.41 rectangular orthodontic wire
or 0.45 multistranded flexible orthodontic wire and the titanium
trauma splint were flexible splints.
• A wire composite splint consisting of three stranded wires
measuring 0.8 mm x 1.8 mm was found to be rigid. Four resin
composite splints were also tested and found to be rigid.
• It was also reported that composite splints may break during the
immobilization period and were difficult to remove.
• In a further study Berthold et al. found that the wire length
influences rigidity and these authors recommended splinting only
one uninjured tooth bilaterally.
• In the study by Berthold et al. teeth were set in an acrylic resin model
and periodontal mobility was mimicked with a soft silicon impression
material.
• To avoid this limitation, Kwan et al. used a human cadaveric model.
• The results of this study also found composite splints and composite
and wire splints where the wire diameter was greater than 0.4 mm
were deemed to be rigid splints.
• These authors considered a wire thickness of 0.4 mm as the clinical
threshold for flexible and rigid splints.
• The use of nylon fishing line with a 20-pound test strength also
allowed for physiologic movement and provided the advantage of a
more aesthetic appearance than a metal wire bonded across the
anterior teeth.
• Ebeleseder et al. in a study of 103 post-traumatic splints
made of composite resin and 0.017 x 0.025″ orthodontic
steel wire where mobility was tested with Periotest
mobility measurements reported immobilization did not
exceed normal tooth firmness.
• These authors also found that there was no benefit from
extending the splint to more than one adjacent firm tooth.
• The IADT guidelines recommend a flexible splint for all
injury classifications except for alveolar fracture where no
recommendation is given.
Splinting duration
• Splinting duration times as advocated in the IADT guidelines for the
specific injury types are also.
• However, a systematic analysis of splinting duration and periodontal
outcomes for replanted avulsed teeth found that periodontal outcomes
were unaffected by splinting duration when comparing short-term
splinting (14 days or less) and long-term splinting (over 14 days).
• These authors reported that the evidence for an association between
short-term splinting and an increased likelihood of functional periodontal
healing or decreased incidence of replacement resorption was
inconclusive.
• It was concluded that there was no evidence to refute the current
guidelines and suggested that periodontal outcomes were unaffected by
splinting duration.
• It seems surprising that the IADT guidelines for avulsed teeth
with extended extraoral dry time greater than 60 minutes
recommend flexible splinting for 4 weeks despite the knowledge
that the predictable outcome will be ankylosis with replacement
resorption due to the death of the periodontal ligament cells.
• Furthermore in animal experimentation with monkeys, teeth
that were splinted for 30 days demonstrated increased areas of
root resorption and ankylosis when compared to teeth splinted
for only 7days.
• This suggests that the duration of splinting for all avulsion cases
should be 2 weeks rather than 4 weeks for teeth replanted with
greater than 60 minutes of extended dry time.
• Andreasen et al. in a study of 400 avulsed and replanted teeth
found that there were no significant differences between teeth
splinted from 0 to 20 days and 21 to 40 days, suggesting that it is
inconsequential whether avulsed teeth are splinted for either 2 or
4 weeks.
• However, animal and human studies which demonstrated that
strong gingival attachment to support a tooth in the socket is
attained after just 1 week suggest that the shorter duration of 2
weeks is indicated for both avulsion guidelines.
• Indeed, in the latter study the frequency and extent of
replacement resorption was significantly lower in the non-splinted
teeth compared to the splinted teeth.
• As animal experimentation has shown that normal masticatory stimulation
can partially prevent the development of ankylosis in teeth following
extraction and replantation, 7 a shorter splinting duration would appear
advantageous.
• Interestingly, the American Association of Endodontists recommendations
make no distinction in either of these avulsion categories and recommend
splinting for 2 weeks only, irrespective of the extraoral time.
• An evidence-based appraisal of luxated, avulsed and root-fractured teeth
also found that splinting duration was generally not a significant variable
when related to healing outcomes.
• Relevant findings will be discussed later under the specific injury types.
However, the guidelines are just recommendations and there may be
instances when patient comfort dictates that functional splinting duration
be extended, e.g. a traumatized immature maxillary central incisor which
continues to be mobile, especially if the lateral incisors are yet to erupt.
Levels of evidence
• Kahler and Heithersay found that all studies regarding decisions
about splint type and duration included in their systematic
review were only Level 4 studies as categorized by the ‘Centre of
Evidence-based Medicine’.
• Most of the studies were retrospective in design. Randomized
clinical trials are not applicable in splinting decision choice
studies as it would not be ethical to deny patients the
appropriate splinting choice as advocated in the guidelines .
• In their review only studies that conducted a multivariate
analysis of variables that may affect outcomes were included.
Multivariate analyses

• Many factors have the potential to affect healing outcomes for traumatized
teeth. In addition to splinting types and splinting duration, other variables
identified included the age and gender of the patient, stage of root
development, severity of the trauma and degree of dislocation.
• If the tooth was avulsed, other factors should also be considered such as the
length of time before replantation, the storage medium utilized and whether
further repositioning of the tooth is required.
• This evidence based review identified studies where a multivariate analysis
was undertaken so that associations between the variables identified in
univariate analyses could be determined.
• The review identified 12 papers that utilized a multivariate
analysis for the following injuries: alveolar fractures,31
luxations,32–34 luxation and avulsion,35 avulsion,27,36,37 and
root fractures.
• Using a similar search study as employed in the 2008 review, only
one further paper was identified that employed a multivariate
analysis and this was a prospective study on intrusion injuries.
The significance of these papers will be discussed below in
relation to each type of injury.
Luxation injuries

• The type of splint and fixation period in multivariate analysis studies were
generally not significant variables on healing outcomes.32–35,41
Andreasen et al. did find that fixed splinting with orthodontic bands and
composite resin splints was a significant variable for the development of
intracanal calcification.
• The less traumatic application of a wire and composite resin splint
showed similar outcomes as teeth which were not splinted.
• Another study of 172 luxation injuries immobilized with rigid splints
consisting of cap splints, ligature wires +/- acrylic coverage reported that
the fixation period was a significant variable for loss of alveolar bone.
• The mean duration of immobilization in this study was 52 days. It is
plausible in these instances that longer periods of immobilization
resulted in bone loss from periodontitis associated with oral hygiene
difficulties.
• In a study of 140 intruded teeth, the type of splint (i.e. flexible, semi-rigid
or rigid) and the length of splinting time (shorter or longer than 6 weeks)
were not significant in healing outcomes on teeth that were surgically
repositioned.
Concussion and subluxation

• The IADT guidelines recommend a flexible splint for 2 weeks

for subluxation injuries.
• However, splinting is generally not required for concussion Or
subluxation injuries.
• Importantly, where multiple teeth have had more severe
injuries, adjacent teeth with either subluxation or concussion
injuries can be splinted without damage to the periodontal
ligament.
• 43 In a study of 637 luxated teeth, teeth with concussion or
subluxation injuries were splinted only if there were other
injured teeth.
Extrusion
• The IADT guidelines recommend a flexible
splint for 2 weeks for extrusive luxation
injuries.
• An example of an extrusion injury where
there was a dehiscence of the gingival tissues.
• The repositioned tooth was splinted with
composite resin, which is likely to have
allowed physiologic movement as it was only
bonded to the adjacent central incisor.
• However, as the tooth had an open apex,
continued root maturation and intracanal
calcification had occurred at a 12-month
review.
Lateral luxation
• The IADT guidelines recommend a flexible
splint for 4 weeks for lateral luxation injuries.
Intrusion
• The IADT guidelines recommend a flexible
splint for 4 weeks for intrusive luxation
injuries where the intruded tooth/teeth have
been repositioned.
Avulsion
• The IADT guideline recommends a flexible splint for 2 weeks for
avulsion injuries. For teeth that have been avulsed and the extraoral dry
time is greater than 60 minutes, the recommendation is a flexible splint
for 4 weeks.
• The paradox of the recommendation for the latter injury was discussed
earlier. The type of splint and fixation periods were not significant
variables in a multivariate analysis for pulp and periodontal healing
outcomes in a study of 400 replanted teeth.
• In another study of 128 replanted teeth, the fixation period was not a
significant variable on healing outcomes. The type of fixation was not
disclosed.
• In an experimental study on the effect of splinting upon
periodontal healing after replantation of permanent incisors in
monkeys, the authors reported that in teeth replanted after 18
minutes, the frequency and extent of replacement resorption
was significantly lower in non-splinted teeth compared to the
splinted teeth.
• A limitation of this study is that the teeth were splinted with
an orthodontic band-acrylic splint and the rigid nature of this
splint may have also accounted for the extent of the
resorption.
Root fracture
• The IADT guideline recommends a flexible splint for 4 weeks for
root-fractured teeth. In cases where the root fracture occurred in
the cervical third of the root, the recommendation is for a flexible
splint for 4 months.
• The type of splint and fixation periods were generally not significant
variables in studies that used a multivariate analysis for assessment
of pulp necrosis and type of healing/non-healing of the root-
fractured fragments.
• However, some significant relationships were noted in a study of 95
root-fractured teeth. The type of splint was found to be significant
for nonhealing between the fractured segments.
• In a study of 400 root-fractured teeth, cap splints had the
lowest and Kevlar fibres the highest frequency of favourable
healing outcomes.
• No difference was noted in healing outcomes for splinted and
non-splinted teeth when teeth were not displaced. No effect on
healing was noted when treatment was delayed for more than 3
days.
• However, it has been suggested that a splint is best placed
within 24 hours.
Root-fractured maxillary left central incisor that was not splinted as there was no
displacement. At the 5-year review, the tooth has healed with connective tissue between
the fractured fragments.
• A high cervical root
fracture where the
maxillary left central incisor
was rigidly splinted with a
wire and composite resin.
• The tooth was
subsequently extracted for
orthodontic concerns and a
histological examination
revealed hard tissue
healing between the
fractured fragments.
• A conclusion from the examination of this tooth specimen was that
hard tissue healing occurred primarily from the dental pulp.
• This has led to an alternative view regarding the splinting of root
fractures located near the cervical region as logically it would seem
that rigid splinting would provide a greater chance of
uncomplicated pulp healing than the mobility associated with a
flexible splint.
• Andreasen et al. reported that with optimal repositioning of the
coronal fragment, positive pulp sensibility was a frequent finding in
teeth with a dislocation of up to 0.5 mm and still occurred in 25% of
cases where the displacement was 0.5 to 1 mm.
• Figure shows a root-fractured maxillary central incisor where the fracture is in the cervical
third of the root. In this instance the root was first splinted with a flexible splint of composite
resin and wire.
• At 6 weeks the tooth was responsive to pulp sensibility testing so an orthodontic wire
retainer (a rigid splint) was constructed and placed, and then the flexible composite resin
and wire splint removed. This was done as a recent report has suggested this approach to
minimize adverse effects of further trauma.
• Figures were taken at a 4-year review. It must be emphasized that in this
case there have been no adverse effects from rigid splinting, which is
not surprising as it is also commonly used to control relapse following
orthodontic treatment.
• Figure shows a maxillary right
central incisor where the
root-fractured coronal
fragment was also avulsed.
• The tooth had three different
splints in a 24- hour period.
• In Fig. the tooth was splinted
with a composite resin splint
placed interproximally that
debonded within hours of
being placed.
• A composite resin and wire splint also debonded and was replaced
with a fibre Ribbond splint which was the type of splint associated
with the highest frequency of associated favourable outcomes in a
study of 400 root-fractured teeth.
• Pulp necrosis and infection of the root canal system was evident
at 6 weeks and hence the coronal fragment had root canal
treatment and was filled with mineral trioxide aggregate.
 • The coronal fragment was endodontically treated and
A 6 weeks, a gingival swelling was evident as well as
extrusion of the tooth and stretching of the fibre splint. the coronal fragment was root filled with mineral
trioxide aggregate.
• Radiograph taken at the 10year review. A calcific barrier
at the apex of the coronal fragment as a response to the
placement of the mineral trioxide aggregate as well as
intracanal calcification of the apical fragment is evident.
The adjacent incisor teeth were root filled in the interim
period as a consequence of the original injury.
• It has been shown experimentally that debonding pliers generate
shearing forces that result in irreversible damage to the enamel.
Additionally, the forces exerted may disturb the periodontal
healing of the injured tooth.
• Both hand and ultrasonic scalers caused distinctive patterns of
enamel detachment and therefore it was concluded that they
should not be used for composite removal.
• A similar recommendation applied to the use of diamond burs. The
same study found that tungsten carbide burs and Soflex discs
resulted in the least damage to the enamel. The use of
magnification was also recommended to best identify the enamel-
resin interface.
The development of a new and simplified splinting regimen:
• Clearly, a major limitation with the acid-etch composite resin
technique commonly used in splinting traumatized teeth is the
difficulty in removal of the resin due to its strong bond strength to
enamel.
• Iatrogenic damage to enamel is also an inevitable outcome.
Hence research was initiated within the Discipline of
Endodontology at The University of Adelaide to evaluate
alternative splinting adhesive systems which could be easily
applied, have sufficient bond strength to withstand physical forces
during the splinting period, yet be easily removed without
damage to enamel.
• The principal researcher of the study, Jun-Yi Hu, developed an
experimental model designed to simulate the dentoalveolar complex
which then allowed standardized, reproducible evaluations of
splinting techniques using several test bonding adhesives.
• The model was then used to investigate the clinical application of a
splint using nylon fishing line (0.55 mm, Penn Professional fishing line
– equivalent to 40 lb line) attached with 12 dental adhesive materials.
• Some of the materials tested were in current usage and other
alternative materials had been developed primarily for use in
orthodontics.
• The specific aims of the study were to assess various splinting
techniques in respect to the ease of application and removal, and the
effect on tooth structure following splint removal.
• Prior to the application of the test adhesive, a stereomicroscopic
analysis of a defined area of the enamel surface of each test specimen
was made to form a baseline for post-removal analyses.
• The mounted teeth were then subjected to a 24-hour thermocycling
and a functional wear test which was followed immediately by a shear-
bond test using a Hounsfield Universal Testing Machine.
• The defined enamel surfaces were then examined
stereomicroscopically to assess surface roughness, enamel damage and
the presence of residual adhesive material.
• The results of this study identified GC Fuji Ortho as fulfilling the
requirements of an ideal splinting adhesive material because of its ease
of application without the need for enamel etching, ability to with
stand physical forces during the splinting period, an most importantly
ease of removal with minimal or no damage to the enamel surface.
• The application of this research has been developed both
experimentally and clinically and is now the favoured splinting regimen
taught in the field of dental traumatology to undergraduate students at
the School of Dentistry, The University of Adelaide.
• The clinical procedures carried out on a volunteer friend of one the
investigators are illustrated. The ‘injured tooth’ was the maxillary left
central incisor.
The recommended procedures are as follows:
(1) After repositioning the injured tooth, the labial surfaces of the teeth to be splinted are
cleaned and dried.
(2) A suitable length of 40Lb nylon fishing line is fitted to the labial surfaces of the injured
tooth and the two adjacent teeth.
(3) A capsule of Fuji Ortho LC is then gently tapped or shaken to loosen the powder. The
end of the capsule plunger is then pressed against a flat surface so that it is flush with
the body of the capsule, prior to activation for 1 second with an applicator gun and then
mixed at high speed in an amalgamator/mixer for 10 seconds. The working time after
mixing is 3 minutes at 23 °C.
(4) GC Fuji Ortho LC capsule is then syringed onto the labial surfaces of the uninjured adjacent
teeth and the fishing line is applied to the unpolymerized material . A cotton pellet moistened
in water can be used to facilitate the manipulation of the GC Fuji Ortho LC over the nylon
fishing line.
(5) A groove is then created on the incisal aspect of the GC Fuji Ortho LC material and the
enamel surface using a flat plastic instrument.
(6) The GC Fuji Ortho LC is then partially light cured for 10 seconds.
(7) GC Fuji Ortho LC is then syringed onto the labial surface of the repositioned injured central
incisor while maintaining its correct position with finger pressure . Again a cotton pellet
moistened in water can be used to manipulate and smooth the splinting material.
(8) Light-cure the entire splint for 40 seconds.
(9) Trim the excess nylon fishing line and with scissors smooth the splint with a carborundum
or Soflex disk to complete the splint application .
(10) Splint removal – using stable finger rests, removal of the splint is effected using either a
spoon excavator or flat plastic against the created ledge on the incisal margin of the GC Fuji
Ortho LC material . Any remaining material can be simply removed with
a spoon excavator followed by simple enamel polishing with a rubber cup and prophylactic
paste.
• While GC Fuji Ortho LC has been shown to fulfil the requirements of
an ideal splinting adhesive material, a practical alternative is GC Fuji
2 which has similar physical characteristics and handling properties,
and is more commonly used in dental practices.
• Fifth-year dental student evaluation of the handling of the two
materials was strongly in favour of GC Fuji Ortho LC.
• The technique is not confined to flexible splints and incorporation
of wire of at least 0.8 mm diameter into GC Fuji Ortho LC may be
used where rigid splinting is indicated. Again this method of fixation
has the advantage of simplicity of application and removal.
CONCLUSIONS:

• While the type of splint and the splinting duration have not been
generally shown to affect healing outcomes, the IADT guidelines
support the use of flexible splints whenever possible.
• This has often been achieved with the use of composite resin or
orthodontic brackets and light wire. Both of these techniques
have been shown to cause iatrogenic damage to the enamel.
• A new protocol using a resin activated glass ionomer cement has
been proposed that offers ease of application and removal with
minimal or no iatrogenic damage to enamel.
• GC Fuji ORTHO LC is a light-cured, resin
reinforced glass ionomer ideally suited for
bonding orthodontic brackets, bands and
appliances.
• Its ability to be placed in the presence of
moisture with no need for phosphoric acid
etching simplifies the bonding procedure.
• Its unique formulation helps to reduce the risk
of decalcification, which helps maintain the
soundness of enamel.
• Additionally, debonding can be accomplished
faster with less risk of damaging the enamel
than with composite resin bonding systems.
FIBRE REINFORCED COMPOSITE RESIN :

ADVANTAGES:
• Strong with tensile strength 3 Gpa.
• Unsurpassed fracture toughness, modulus of
elasticity 171 Gpa.
• Water absorption is less than 1%.
• Superior ease of use and manageability because
its “memory free’.
• Suture splints may be required if there are
multiple missing teeth, or in the mixed dentition
where conventional splinting is not possible
Effects of splinting periods on periodontal healing outcomes
 Splint removal
• Removal of rigid arch bar splints or interdental wiring is often a difficult
process involving unwiring and cutting of wires close to the gingival margins
with potential damage to soft tissues.
• Removing a splint in which composite resin has been used is not only time
consuming, but iatrogenic injury to the enamel is an inevitable outcome.
• Techniques of composite removal may involve debonding pliers,
handscalers, ultrasonic scalers, tungsten carbide burs, diamond burs, Soflex
disks, rubber wheels and cups.
Case report
• A 7-year-old male patient had traumatic avulsion of his upper
left central incisor (tooth 21) because of falling down accident.
• His parents kept the avulsed tooth with tap water and went to the nearest
dental clinic. At the clinic, the dentist replanted the avulsed tooth into the
socket with semi-rigid fixation using resin and wire.