Use of evidence-based decision-making in private practice for emergency treatment of dental trauma: EB case report

This article illustrates the use of the evidence-based process in clinical practice to answer questions that arose when a patient presented with dental trauma.

The patient had avulsion of the maxillary right central incisor and lateral luxation and alveolar bone fracture partially encasing the roots of the maxillary left central and lateral incisors. At the emergency treatment the dentist replanted the teeth but had 2 questions regarding the impending treatment for the patient regarding the optimal timing of root canal therapy and splint duration that would result in the best outcome and prognosis for healing.

The evidence-based process was used to help answer the clinical queries. Two focused clinical (PICO) questions were written, and 2 separate searches were conducted for each PICO question. Four databases were searched for systematic reviews, meta-analyses, critical summaries and practice guidelines.

A total of 3 systematic reviews, 8 practice guidelines, 1 critical summary, and 1 Cochrane protocol were found.

For replanted avulsed teeth, with closed apices, successful periodontal healing is improved when elective extirpation of the pulps occurs within 14 days. Second, guidelines recommend a flexible splint for up to 2 weeks for avulsed teeth with an extension of 2 to 4 weeks possibly needed for lateral luxation and with breakdown of marginal bone. However, evidence shows that an association between short-term splinting and an increased likelihood of functional periodontal healing, acceptable healing, or decreased development of replacement resorption, appears inconclusive and that the types of splint and the fixation period are not significant variables when related to healing outcomes. The evidence-based method was efficient, and very helpful in optimizing the management of the emergency dental treatment.