SPLINTING-2

IMMOBILIZATION PERIOD:The period of splinting is crucial for good prognosis.Initially , it was beleived that the longer the splinting period, the better is the healing. But later it was proved that extending the immobilization period ledd to increased frequency of root resorption and dento alveolar ankylosis. From the earlier immobilization period of 8 months that was practiced in the 1930s, it has now been reduced to few weeks.Kehoe recommended 2-3 months of immobilization , while Douglas and Douglas suggested 6 weeks of splinting for good healing with little or no complications.Andreason has demonstrated that teeth splinted for shorter periods demonstrated better healing that teeth splinted for four or six weeks.It is thus recommended that the period of fixation following avulsion should be kept to a period of 1-2 weeks to avoid root resorption.It also requires about one week to obtain a strong gingival attachment that is sufficient to support the tooth in socket following splinting of an extruded tooth.Extended splinting periods may be required when there is associated injury to the marginal alveolar bone (up to about 6 weeks), or in case of root fractures where immobilization up to 2-4 months may be required.
 The International Association for Dental Traumatology (IADT) guidelines for duration of splinting for traumatic injuries are given below
AVULSION: Flexible splint for 2 weeks except when extraoral time is >60 minutes.
ROOT FRACTURE:Stabilize the tooth with flexible splint for 4 weeks.If root fracture is near cervical are of tooth, stabilization is beneficial for longer period of time (up to 4 months)
CONCUSSION:No splinting is needed.Monitor pulpal condition for atleast 1 year.
SUBLUXATION:A flexible splint to stabilize the tooth for patient comfort can be used for up to 2 weeks.
EXTRUSION:Reposition the tooth by gently re-inserting it in to the tooth socket .Stabilize the tooth for 2 weeks using a flexible splint.
LATERAL LUXATION:Reposition the tooth with forceps to disengage it from its bony lock and gently reposition it into its origional location.Stabilize the tooth for 4 weeks using flexible splint.

SPLINT REMOVAL: Removal of the splint is as important as placement of the splint.Care must be taken not to cause trauma to the teeth and also to remove all the adhesive material from the tooth surface.Inadequate removal of material may favour plaque accumulation and enamel decalcification.However, over zealous removal of the material from the tooth surface can result in roughened surface.There are different ways to remove a splint, such as using hand scalers, ultrasonic scalers, rubber wheels,abrasive discs, high or low speed burs, tungsten carbide burs,etc.Button brackets are routinely removed with debonding pliers and remaining composite material is chipped off with a currette or a bur.The resin from the wire and resin splint is removed with a high speed bur.Fibre splints are removed with a tungsten carbide bur.TTS was found to be the easiest to remove.The composite over the TTS is removed down to the level of the splint and the TTS is  'peeled' off from the tooth with a haemostat.Final polishing of the teeth can be done with finishing discs.
Splint removal time varied for each splint.It was found to be very fast and easy to remove a titanium trauma splint (3.7+/-0.48 min) compared to the wire and composite splint (6.4+/-2.34 min) or a bracket splint (5.2 +/- 1.64 min).
  It has been observed that iatrogenic damage to the enamel is common or unavoidable, regardless of the technique used.Debonding with pliers or hand scalers causes the maximum damage, resulting in chipping of the enamel surface.A better technique would be to reduce the bulk of the resin using finishing burs or discs, although it is difficult to recognize the enamel-resin interface without magnification, making it difficult for clinician to decide 'when to stop'. Soflex discs and Tungsten carbide burs were found to produce least damage to the enamel surface.