European Archives of Paediatric Dentistry

[Link]

SYSTEMATIC REVIEW

Splinting in the management of dental trauma in the primary

dentition: a systematic review
M. dos Santos Fernandez1 · H. S. Schuch2,3 · A. B. G. Araújo1 · M. L. Goettems1,3

Received: 6 October 2022 / Accepted: 2 March 2023

© The Author(s), under exclusive licence to European Academy of Paediatric Dentistry 2023

Abstract
Purpose The purpose of this study was to gather existing data on the efficacy of tooth splinting (TS) in patients with trau-
matized primary teeth, evaluating their overall prognosis and reported complications.
Methods Electronic searches were performed in seven databases up to Februray/2023. Clinical studies published in the last
two decades and presenting the following characteristics were included: (a) reporting on children with traumatized primary
teeth; (b) describing the efficacy of splinting those teeth. Studies describing imobilization of dental avulsion were excluded.
Results A total of 163 potentially relevant studies were initially found. After title/abstract screening, and full-text evaluation,
three retrospective studies with moderate to high risk of bias were included. The studies described the outcomes of TS in
primary teeth with luxation (intrusion, extrusion, lateral displacement), intra-alveolar root fracture, and/or alveolar fracture.
High clinical success rate was observed for teeth with root fracture. Benefits of spliting teeth with lateral luxation were not
identified, although it may be a reccomended approach. No study was found evaluating TS for alveolar fracture.
Conclusion Based on a low level of evidence, the findings highlight a better clinical success rate of the use of TS in the
management of deciduous teeth with root fractures.

Keywords Splinting · Dental trauma · Deciduous dentition · Primary tooth trauma · Children

Introduction should be based on the best available evidence (Day et al.

2020). Inadequate management of TDIs in the primary
Traumatic dental injuries (TDI) are one of the major causes dentition can cause more severe damage than the trauma
for seeking dental care in childhood, with an overall preva- itself, including the potential of causing further damage to
lence in primary dentition of 24.2% (95% CI 18.24–31.43), the permanent tooth or to its eruption. The degree of tooth
according to a systematic review (Patnana et al. 2021). displacement, tooth mobility, root formation, and the child’s
The immediate or urgent care of TDIs in primary dentition ability to cope with an emergency should be considered by
oral health professionals during treatment planning to avoid
* M. L. Goettems future sequelae of TDIs (Day et al. 2020; Di Giorgio et al.
[Link]@[Link] 2021).
M. dos Santos Fernandez Splinting of traumatized primary teeth may be indicated
mathsantos.f@[Link] to stabilize the tooth in its alveolus, aiming to provide relo-
H. S. Schuch cation of the periodontal ligament, to prevent subsequent
helenasschuch@[Link] trauma and damage to other teeth and adjacent tissues, and
A. B. G. Araújo to promote soft tissue healing (Kahler et al. 2016). Accord-
anabiaga1998@[Link] ing to the International Association for Dental Traumatol-
ogy (IADT) guidelines (Bourguignon et al. 2020; Day et al.
1
School of Dentistry, Federal University of Pelotas, Pelotas, 2020), the most widely adopted protocol for the treatment
Brazil
of injuries in primary dentition, splinting in primary denti-
2
Harvard School of Dental Medicine, Harvard University, tion is recommended for alveolar bone fractures and may be
Boston, USA
indicated in some cases of root fractures and lateral luxations
3
Graduate Program in Dentistry, Federal University of Pelotas, (Day et al. 2020). Even though the IADT recommends the
Pelotas, Brazil

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 European Archives of Paediatric Dentistry

use of flexible splint for a period of four weeks in cases of • P (Population): children with trauma to primary teeth;
radicular fracture, alveolar fracture, or lateral ­dislocation3, • I (Intervention): tooth splinting;
other clinical approaches for splinting primary teeth with • C (Comparator): no tooth splinting, if a comparator group
alveolar fracture are suggested in the literature, including was included;
orthodontic wire in several thicknesses (Akin et al. 2011; Liu • O (Outcome): clinical and radiographic parametres
et al. 2013), resin composite (Pathak et al. 2016; Song et al. (mobility, pulp necrosis, pathological root resorption,
2017), acrylic (Goswami and Eranhikkal 2020), wire with pathological loss of teeth, ankylosis, pathological bone
composite (Kahler et al. 2016; Kim et al. 2012; Shanmugam resorption, and resporption of fracturated root).
et al. 2011), and EVA (Ethylene–Vinyl Acetate copolymer)
vacuum-formed (Chatzidimitriou et al. 2017). The duration Eligibility: inclusion and exclusion criteria
of treatment also varies, ranging from two weeks (Shan-
mugam et al. 2011; Song et al. 2017) to three months (Bour- Clinical studies published within the last two decades (after
guignon et al. 2020; Day et al. 2020; Liu et al. 2013). The 2003), including children with trauma in primary dentition
wide variety of possible trauma scenarios and multiple treat- (luxation injuries, root fracture, and alveolar fracture) were
ment options make it challenging for practitioners to provide eligible. The included human studies comprised randomized
evidence-based treatment and recommend the best treatment controlled clinical trials, controlled clinical trials, retrospec-
option for the patient. As a result, many of the treatments for tive and prospective case–control studies, and case series
TDIs are far from ideal (Andreasen et al. 2012). studies with a minimum follow-up time of 6 months. The
In general, there is limited evidence to support many of IADT guidelines suggest that avulsed primary teeth should
the standard treatments in the primary dentition (Day et al. not be reimplanted after trauma and, therefore, the use of
2020). Traumatology research mostly comprises non-ran- splinting is not recommended in this type of TDIs. There-
domized clinical trials (Cho et al. 2018; Kim et al. 2012; fore, studies that considered the use of splinting in the treat-
Song et al. 2017), which represent lower quality evidence, in ment of avulsed teeth were excluded (Day et al. 2020).
comparison to randomized clinical trials (RCT) (Andreasen
et al. 2012). This is probably due to the ethical issues asso- Search strategy
ciated with getting informed consent from an injured child
to participate in an RCT (Andreasen et al. 2012). Obser- Seven electronic bibliographic databases were screened:
vational studies, however, can provide useful information MEDLINE (via PubMed), Web of Science, Scopus, Scielo,
about dental trauma management. Thus, the aim of this sys- Embase, EBSCO, and Cochrane Library. Search strategies
temtic review was to analyze the published evidence on the were developed for each database using a combination of
benefits of splinting traumatized primary teeth, including free terms and, whenever applicable, indexed terms specifi-
overall prognosis and reported complications. cally to each database. In an effort to identify other relevant
studies, the reference list of the studies included in this sys-
tematic review were further manually assessed, as well as all
issues published between 2013–2023 in major international
Methods
Dental journals (Journal of Dentistry, Dental Traumatology,
and International Journal of Paedriatric Dentistry). A search
This study protocol was registered at the International Pro-
for gray literature was also performed on Google Scholar
spective Register of Systematic Reviews (PROSPERO;
database using an adapted search strategy. Only the first
[Link] under approval code
200 studies were screened for eligibility on this database.
#CRD42021240885. This manuscript follows the Preferred
Initially, no restrictions of language or date of publication
Reporting Items for Systematic Reviews and Meta-Analy-
were applied. The last search was run on 23rd February,
ses (PRISMA) statement checklist (Page et al. 2021). The
2023. The full search strategy for each database is described
authors declare no potential conflict of interest with respect
in Appendix 1.
to the research, authorship, and/or publication of this study.
Results of literature searches were uploaded in the End-
note 20.1 program (Clarivate ­Analytics©, Thomson Reuters,
Review question New York, NY, USA), and duplicate records were removed.
Two researchers (MSF and ABGA) independently screened
The present study is based on the following review question: all titles and abstracts considering the abovementioned eli-
“Does splinting of traumatized primary teeth improve clini- gibility criteria. The same two researchers independently
cal outcomes?”. The PICO strategy was used to guide the assessed the full text of the included studies, and discrep-
construction of the research question and literature search ancies were solved by a third researcher (MLG). Regard-
(da Costa Santos et al. 2007), as presented below: ing study selection, kappa coefficients between the two

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European Archives of Paediatric Dentistry

researchers were 0.95 and 0.97 for title/abstract and full-text which seven were excluded because they did not evaluate the
selection, respectively. efficacy of splinting in primary teeth and eight (Akin et al.
2011; Bonanato et al. 2009; Chatzidimitriou et al. 2017;
Data extraction and synthesis of evidence Di Giorgio et al. 2021; Liu et al. 2013; Pathak et al. 2016;
Santos et al. 2021; Shanmugam et al. 2011) because they
A data extraction sheet based on the Cochrane Consumers where case reports. Therefore, 3 retrospective studies (Cho
and Communication Review Group’s data extraction tem- et al. 2018; Kim et al. 2012; Song et al. 2017) were included
plate was adapted for this study. The following data were (Table 1). Figure 1 presents the flow chart of study inclusion
extracted: (a) author; (b) year; (c) country; (d) study design; process following the PRISMA statement recommendation.
(e) sample size; (f) age group and sex; (g) type of trauma; All studies included were conducted in Korea (Cho et al.
(h) milimeters of luxation; (i) diagnostic methods used in the 2018; Kim et al. 2012; Song et al. 2017). The treatment
first examination; (j) type of splinting; (k) protocol; (l) other success rate of the use of resin wire-split in the treatment
details; (m) control group; (n) period of time to seek treat- of children (n = 10) with the presence of intra-alveolar root
ment; (o) duration of treatment; (p) follow-up time; (q) diag- fracture (n = 16 teeth) after a mean follow-up period of
nostic methods used in the last/follow-up examination; (r) 23 months is described in the Kim et al. (2012) study (Kim
main results/effect measurements; and (s) main conclusions. et al. 2012). Song et al. (2017) presented the success rate of
A third reviewer (MLG) double checked all extracted data. treatment of teeth with lateral (n = 38) and intrusive (n = 14)
Due to the high heterogeneity among the methods of luxation using different splinting techniques after an average
the included studies, no meta-analysis could be performed. follow-up period of 22 months, although they did not dif-
Therefore, results are presented in a qualitative data ferentiate the intervention techniques according to the type
synthesis. of trauma (Song et al. 2017). Finally, the study by Cho et al.
(2018) described the clinical success of using flexible round
Quality assessment of included studies stainless steel wire and flowable composite resin (n = 137)
with different types of dental trauma (53, 84, and 15 teeth
Two independent reviewers (MSF and ABGA) appraised with root fracture, lateral and extrusive luxation, respec-
the quality assessment of observational studies using the tively) compared with children with traumatized teeth who
Newcastle–Ottawa Scale (N-OS) (Stang 2010). The N-OS did not receive splinting (control group) after more than six
contains eight items, categorized into three dimensions: months of follow-up (Cho et al. 2018).
selection, comparability, and outcome. A star scoring sys-
tem is used for semi-quantitative assessment of study quality. Quality assessment
Studies are graded one star each for all items except com-
parability, which has the potential to score up to two stars, All studies included in this review had a score < 5 (mean:
with the maximum possible score being nine. Studies are 4.3) in the N-OS criteria evaluation, and were classified as
rated from 0–9, with those studies rating 0–2 (poor quality), low quality (n = 3) (Cho et al. 2018; Kim et al. 2012; Song
3–5 (fair quality), 6–9 (good/high quality). Disagreements et al. 2017) (Table 2). Lower scores were mainly related
between the reviewers were resolved by discussion with to the lack of representativeness of the sample (selection
a third reviewer (MLG). All procedures in this step were domain) and the absence of a control group (comparability
checked by a third reviewer (HSS). In this evaluation step, domain).
the kappa coefficient between the two researchers was 0.93.
Synthesis of included studies

Results Two studies observed low clinical success rates (reduced

mobility) in laterally luxation or extruded teeth that were
Study selection and characteristics immobilized by splinting (Cho et al. 2018; Song et al. 2017).
In the Song et al. (2017) study, the positive prognosis treat-
The searches performed in all electronic databases yielded ment for immobilization of traumatized primary teeth was
163 potentially relevant studies [MEDLINE/PubMed less frequent in those with extrusive (> 40%) and lateral
(n = 45); Web of Science (n = 25); Scopus (n = 12); Sci- luxation (40%), as well as among those with intrusive dis-
ELO (n = 1); Embase (n = 8); Cochrane Library (n = 6); location (> 50%), than in splinted teeth with other types of
EBSCO (n = 66)]; seven additional studies were identified injuries (subluxation, concussion and avulsion—clinical
in the manual search. Subsequently, a total of 69 duplicates success rate higher than 60%); this study did not included
were removed. Thus, 101 records were screened by title a control group (Song et al. 2017). Nevertheless, Cho et al.
and abstract reading. From these, 18 full-text were read, of (2018) identified that the highest failure rates (including

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 Table 1  Data extracted from the original retrospective studies
Author (year) country Sample (n)—age Type of trauma Splinting (type and durantion Control group Follow-up Main results
treatmeant)

13
(Cho et al. 2018) (n = 182 teeth) (1) Intra-alveolar root fracture Flexible round stainless steel Monitoring only (non- > 6 months Root fracture
Republic of Korea Mean age: 41.1 (SD 15.6) (n = 53) wire and flowable compos- intervention group Postoperative prognosis was
months (2) Lateral luxation (n = 107) ite resin n = 92) successful in 66.7% (n = 22)
(3) Extrusive luxation Time of splinting depended of the splinted tooth and 30%
(n = 22) on factors, such as persis- (n = 6) in the monitoring only
tence of increased mobility, group (p = 0.012). Splinted
type of trauma and interfer- group was 4.67 times more
ence of nutritional habits likely to have a clinical
success than the observation
group (95% CI 1.406–15.484;
p = 0.012)
Luxation injuries
Splinting did not show a better
prognosis in luxation injuries.
In teeth with lateral luxa-
tion, prognostic success was
observed in 35.7% (n = 15) of
the teeth in spliting group and
38.5% (25) of teeth in obser-
vation only group (p = 0.839).
In teeth with extrusive
luxation, success was 13.3%
(n = 2) in splinting group and
57.1% (n = 4) in observation
only group (p = 0.054)
(Kim et al. 2012) (n = 16 teeth) Root fracture Semi-rigid (resin wire-splint) Not reported Mean Total resorption of the
Republic of Korea Mean age: 44.3 months Splinting time ranged from 4 23.6 months fractured root fragment was
to 8 weeks (mean 5.1) (between 14 observed in 14 of 16 immobi-
and 36) lized teeth, with a resorption
period of less than 10 months
Root-fractured primary teeth
can be maintained by reduc-
ing tooth mobility and immo-
bilizing with a semi-rigid
splint. The treatment success
rate was good and fractured
tooth were retained or physi-
ologically exfoliated without
pulp treatment
European Archives of Paediatric Dentistry
 European Archives of Paediatric Dentistry

the presence of pulp necrosis, pathological root resorption,

teeth was 58.9%. Success rate

was nearly 40% for teeth with
lateral luxation and extrusive
higher rate identified was for
teeth with extrusive luxation

of splinting luxated primary

(28.9%) and lateral luxation
pathological loss of teeth, ankylosis, and pathological bone

124 splinted teeth. Success

treated with splinting. The

Prognosis was evaluated in

Of a total of 1,736 luxated
teeth, 202 (13.2%) were
resorption) were present in the groups of teeth with lateral
(64.3%) and extrusive (86.7%) dislocation that received
splinting, compared to the control group (61.5% and 42.9%,
respectively).
Main results

Also, Cho et al. (2018) compared the success prognosis of

luxation
(22.2%)
teeth with root fractures that received splinting with a con-
trol group and revealed a difference between these groups;
the splinting group was 4.67 times more likely to have
Mean 22.1
> 6 months;

clinical success (absence of complications on clinical and

(SD 14.5)
Follow-up

months

radiographic examinations at follow-up checks) than in the

“observation only” group (95% CI 1.40–15.48; p = 0.012).
The better clinical success rate of immobilization treatment
of teeth with intra-alveolar root fracture was also highlighted
in the Kim et al. (2012) study, where 14 of the 16 fractured
teeth that were immobilized preserved tooth vitality with the
Control group

Not reported

rapid resorption of the fractured root; no disturbance in the

eruption of permanent teeth and no pathological change in
the apical area were observed.
Splinting (type and durantion

resin (n = 79); nylon splints

and flowable resin (n = 9);

flowabele composite resin

Flexible tri-flex stainless

Discussion
Flexibe wire and flowable

composite resin (n = 2);

Mean splint duration was

steel wire and flowable

The present systematic review aimed to advance knowl-

edge on whether splinting is beneficial to TDI in primary
2.4 weeks
treatmeant)

dentition. Only three publications (Cho et al. 2018; Kim

(n = 2)

et al. 2012; Song et al. 2017) fulfilled the inclusion criteria

and were therefore included. Indeed, a standardized clinical
trauma study is challenging to design because of the several
(2) Intrusive luxation (n = 14)

patient, trauma, and treatment variables involved. Clinical

(1) Lateral luxation (n = 38)

trials could potentially address issues of bias, although this

(3) Extrusive Luxation

study design would not always be ethically appropriated, as

well as feasible to conduct (Kahler and Heithersay 2008).
Type of trauma

The body of evidence yielded in this review presented

better clinical success rates for teeth with root fracture (Cho
(n = 11)

et al. 2018; Kim et al. 2012) and, on the other hand, the
use of splinting in teeth with lateral luxation and extrusion
showed no additional benefits than monitoring only (Cho
et al. 2018). A previous systematic review included 12 stud-
Mean age: 42.1 (SD 17.4)

ies and concluded that the studies generally indicate that the
prognosis is determined by the type of injury rather than
Author (year) country Sample (n)—age

factors associated with splint, such as type of spling and

(n = 202 teeth)

fixation period (Kahler and Heithersay 2008). Evidence on

months

the severity of trauma affecting treatment outcomes was

demonstrated in the study of Song (2017), which evaluated
splinted teeth and identified a higher success rate for less
severe injuries.
Table 1  (continued)

Republic of Korea

According to the IADT guidelines, the treatment of

(Song et al. 2017)

teeth with root fracture depends on fracture-related aspects,

such as the presence of displacement of the coronal frag-
ment and mobility. In general, if the coronary fragment is
not displaced or is displaced with little mobility, even in the

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 European Archives of Paediatric Dentistry

Fig. 1  Flowchart of the search

process according to PRISMA
guidelines (2020)

Table 2  Methodological quality assessment of retrospective studies instability, associate the use of flexible retainer attached to
(Newcastle–Ottawa scale) adjacent teeth for fragment stabilization and subsequent fol-
Study Selection Compara- Outcome Total low-up of the healing process and monitoring of the pulpal
bility vitality for four weeks (Day et al. 2020). Studies that evalu-
ated the effect of splinting in the treatment of primary teeth
Cho et al. (2018) 2 – 3 5
with root fractures in this systematic review, regardless of
Kim et al. (2012) 1 – 3 4
fracture-related aspects, found that the use of this approach
Song et al. (2017) 1 – 3 4
can be a viable alternative to promote pulpal survival (Cho
Maximum scores: selection = 4; comparability = 2; outcome = 3; et al. 2018; Kim et al. 2012). A recent scoping review that
total = 9 gathered the findings from case reports and a retrospective
- domain not contemplated = score zero study highlighted that immediate repositioning and semi-
rigid splinting could be conservative methods to prevent
presence of occlusal interference, no intervention is recom- loss of traumatized primary teeth (Spinas et al. 2022). Yet,
mended. When there is the presence of a displaced coronary this finding should be interpreted with caution, in light of
fragment with major mobility and interfering with occlusion, the design of the included studies (Kahler and Heithersay
two approaches may be employed: (1) coronal extraction and 2008). Immobilized teeth with dislocation of the coronal
maintenance of the apical fragment for subsequent resorp- fragment have a lower tendency of healing than non-splinted
tion; or (2) cautious coronal repositioning and, in cases of teeth with no displacement (Andreasen et al. 2004). Thus,

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European Archives of Paediatric Dentistry

it is suggested that the lower success rate may be directly not be reimplanted (Day et al. 2020), we did not evaluate
associated with the severity of dental trauma (Kahler and the outcomes of stabilizing teeth completely detached from
Heithersay 2008; Kahler et al. 2016), and reinforces the con- their sockets.
servative approach recommended. In cases of alveolar fractures in the primary dentition,
Regarding luxation injuries, options of interventions for overall, the management should be performed by (a) repo-
the management of luxated teeth include monitoring only, sitioning displaced bone segments that are mobile and/or
extraction, splinting, repositioning, and repositioning/splint- causing occlusal interference (Day et al. 2020), followed by
ing (Assunção et al. 2011). Given the benefits of providing (b) splinting with a flexible retainer on adjacent uninjured
a more conservative approach to traumatized primary teeth teeth for four w­ eeks3. This management seeks to promote
(Cunha et al. 2007), and avoiding unnecessary and addi- stable restoration of bone continuity to the prejury posi-
tional damage (Goswami et al. 2020), in most cases moni- tion (Day et al. 2020; McTigue 2009). No studies have been
toring only is the recommended management (Day et al. included evaluating patients with alveolar fracture, which
2020). Repositioning a traumatized tooth with an injured can be explained by the limited number of cases and difficul-
periodontal ligament is likely to increase the pressure that ties in performing studies in an urgency situation.
already exists in the nutrient vessels to the tooth, increas- No clinical or radiographic evidence of adverse effects to
ing the chances of ischemia and necrosis (Soporowski et al. the use of splinting was reported in any of the studies. It was
1994). Most luxation injuries heal spontaneously, and a not possible to evaluate if the types of splints and splinting
conservative approach in the immediate dental trauma man- duration were generally related to healing outcomes. Regard-
agement is recommended (Flores 2002). Thus, the current ing time, in primary teeth, IADT recommends four weeks of
international guidelines state that in cases of extrusive dis- splinting, regardless of trama type. In a study with perma-
location, extraction is recommended only if the tooth were nent teeth, Andreasen et al. reported that splinting for peri-
diagnosed with excessive or extruded mobility (above three ods greater than 4-weeks appeared to provide no beneficial
millimeters); otherwise, wait for natural repositioning under healing outcome for root-fractured teeth, thereby providing
monitoring. In intrusively dislocated primary teeth it is also evidence in support of the current guidelines.
recommended to wait for the spontaneous repositioning of Different dental splint materials have been described for
the tooth (independent of the direction of displacement). first aid treatment of dental trauma injuries. Wire-compos-
Nevertheless, monitoring is the main management approach ite splints, using metallic wires up to 0.4 mm are one of
for laterally dislocated teeth; however, in severe dislocation the most commonly mentioned for flexible fixation. Also,
cases, two treatment options are available: (1) extraction nylon-composite splints are known as flexible splints. Other
when there is a risk of aspiration or ingestion of the tooth; options have been suggested, such as plastic strip made
(2) cautious repositioning of the tooth to the original posi- from a bottle of a sterile sodium chloride, but no study was
tion using digital pressure and, if unstable in its new posi- found in primary dentition so far. All studies included in
tion, splint for 4 weeks using a flexible splint attached to the this review used flexible/semi-rigid splints. Noteworthy, a
adjacent uninjured teeth (Day et al. 2020). functional splint retains the tooth in the socket but is flexible
A cross-sectional study analyzed the distribution of enough to allow functional stimulation of the periodontium
the different types of treatment used for luxation injuries (Kahler and Heithersay 2008; Kahler et al. 2016). In accord-
(n = 1703) in Brazilian children between the ages of zero to ance, splinting decisions in the guidelines for treatment of
five years treated at an emergency service department for a traumatic injuries by the International IADT indicate a
decade. In general, the results highlighted that monitoring flexible splint for luxated, root-fractured teeth, and alveolar
(74%) and spliting fixation (9%) were the main approaches fracture. Also, the current trend for functional splints is sup-
of choice for the management of dislocations (Assunção ported in published reviews assessing trauma in permanent
et al. 2011). It is important to highlight that, even though dentition (Kahler and Heithersay 2008).
old (Andreasen et al. 2012; Flores 2002; Flores et al. 2001) During the selection of studies in this systematic
and current (Day et al. 2020) guidelines do not recommend review, eight case reports were identified that described
the use of splinting on extruded or intruded primary teeth, the outcomes associated with the use of splinting in
this practice is commonly reported (Di Giorgio et al. 2021; the management of traumatized teeth (Akin et al. 2011;
Shanmugam et al. 2011). In the study of Song, of a total of Bonanato et al. 2009; Chatzidimitriou et al. 2017; Di Gior-
1736 luxated teeth, 202 (13.2%) were treated with splinting. gio et al. 2021; Liu et al. 2013; Pathak et al. 2016; San-
The higher rate was observed for teeth with extrusive luxa- tos et al. 2021; Shanmugam et al. 2011). All case reports
tion (28.9%) and lateral luxation (22.2%), but splints were reported splinting as a viable technique for immobiliz-
also used in cases of intrusive luxation, concussion, subluxa- ing traumatized deciduous teeth, regardless of the type
tion, and avulsion. Moreover, considering that international of TDIs (lateral dislocation, intrusive root fracture, and
guidelines recommend that avulsed primary teeth should mandibular alveolar fracture) and the splinting technique

13
 European Archives of Paediatric Dentistry

used (rigid or semi-rigid). After the last follow-up evalua- Conclusion

tion (12–57 months), the main findings related to splinting
of traumatized teeth were biofunctional tooth preservation The synthesis of the low-quality original retrospective
without pathological signs and symptoms, integral main- studies included in this systematic review supports the
tenance of the periodontal ligament, and normal occlu- conservative approach suggested by the IADT guidelines,
sion (Akin et al. 2011; Bonanato et al. 2009; Chatzidimi- which recommend the use of splint for the management
triou et al. 2017; Di Giorgio et al. 2021; Liu et al. 2013; of root fracture in primary teeth in some cases. Benefits
Pathak et al. 2016; Santos et al. 2021; Shanmugam et al. of splinting teeth with lateral luxation were not identified,
2011). Although these findings are important and useful although it may be a recommended approach occasionally.
to guide practitioners to perform the treatment of TDIs Also, no study was found evaluating splinting for alveolar
considering the particularities of each case, their clini- bone fractures.
cal applicability should be carefully assessed. The reports
of these clinical cases partially diverge from the findings Supplementary Information The online version contains supplemen-
tary material available at [Link] oi.o​ rg/1​ 0.1​ 007/s​ 40368-0​ 23-0​ 0792-4.
found in the observational studies included in this review,
where satisfactory clinical success rates associated with Acknowledgements Matheus dos Santos Fernandez and Ana Beat-
the use of splinting was identified only in primary teeth riz Gonçalves Araújo hold a scientific initiation CNPq scholarship for
with root fracture. This may be justified by the difference undergraduate. Helena Silveira Schuch held a Young Talent Schol-
arship from CAPES’s Internacionalization Program (CAPES/PrInt
in the study design, since most often case reports tend to - #88887.363970/2019-00).
describe favorable clinical outcomes related to the inter-
vention performed. Author contributions MSF: conceptualization, project administration,
Low level of scientific evidence from the included studies formal analysis, data curation, writing and review–original draft; HSS:
project administration, formal analysis, writing and review–original
is clearly the main limitation of this review, since most of draft; ABGA: data curation, writing and review–original draft; MLG:
them report on non-randomized studies. Therefore, findings conceptualization, project administration, formal analysis, data cura-
should be considerd with caution. Each TDI case presents tion, writing and review–original draft.
its particularities, including both factors related to the TDI
Funding This study was financed by the CAPES (Coordenação de
itself and to the healing process. Even cases that suffered Aperfeiçoamento de Pessoal de Nível Superior), Brazil - Finance Code:
the same type of trauma may have high variability in terms 001/2020-2021.
of severity, for example cases of lateral luxations may dif-
fer in the magnitude of the displacement and the degree of Data availability All data and information related to this study may be
requested from the corresponding author ([Link]@[Link].
involvement of soft tissues. Additionally, characteristics of br), according to the FAIR Data Principles (www.​force​11.​org/​group/​
the child, the family, and the environment should be consid- fairg​roup/​fairp​rinci​ples).
ered, such as the child’s and family’s degree of cooperation
and the child’s medical status. Declarations
The findings of any systematic review are only as robust
Conflict of interest The authors declare no potential conflict of inter-
as the original supporting literature, and the limited evidence est with respect to the research, authorship, and/or publication of this
provided by this systematic review reflect the limitations of study.
the original studies. The authors are mindful of the barriers
in conducting studies in Traumatology, especially in TDI
in primary teeth. However, carefully documenting all steps
of the management of TDI cases will be beneficial not only References
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using different types of splints: a case series. Int J Clin Pediatr jurisdictional claims in published maps and institutional affiliations.
Dent. 2020;13(2):199–202. [Link] oi.​o rg/​1 0.​5 005/​j p-​j ourn​
als-​10005-​1746. Springer Nature or its licensor (e.g. a society or other partner) holds
Goswami M, Rahman B, Singh S. Outcomes of luxation injuries to exclusive rights to this article under a publishing agreement with the
primary teeth-a systematic review. J Oral Biol Craniofac Res. author(s) or other rightsholder(s); author self-archiving of the accepted
2020;10(2):227–32. [Link] manuscript version of this article is solely governed by the terms of
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