✅ Abstract
Dental splinting (ferulization) stabilizes mobile or traumatised teeth to promote healing of periodontal and pulpal tissues.
📌 Recommended Article :
Video 🔽 How to handle dental trauma? ... Dental accidents and trauma occur with some frequency, the highest incidence is in children and adolescents, but adults are not oblivious to these events.This review summarizes indications in primary and immature permanent dentitions, compares available splinting materials, and provides practical recommendations for clinicians based on current guidelines and evidence.
Advertisement
✅ Introduction
Ferulization (tooth splinting) is the clinical procedure of joining mobile or displaced teeth to adjacent teeth to provide temporary stability during healing. The goals are to reduce pain, protect healing periodontal ligament (PDL), enable reattachment or root development, and facilitate endodontic or restorative therapy when needed. Recommendations for splint type and duration differ for primary teeth and young permanent teeth, and should follow contemporary trauma guidelines.
📌 Recommended Article :
PDF 🔽 Guidelines for the management of traumatic dental injuries in the primary dentition ... The lesions can compromise dental tissue (enamel, dentin, root), dental pulp, alveolar bone, and periodontal ligaments. Soft tissues such as lips and cheeks are also included.✅ Indications: importance and clinical situations
➤ Primary teeth (deciduous dentition)
° Splinting is considered for selected luxation injuries or root fractures when repositioning is attempted and where stabilization will improve function or comfort. However, the decision is conservative because of risks to the developing successor tooth; therefore, non-invasive management is often preferred. Evidence supports flexible, short-term splinting in some primary tooth root fractures to improve outcomes.
➤ Young permanent teeth (immature permanent dentition)
° Splinting is important in extrusive, lateral luxation, root fractures, and avulsions to allow PDL healing and continued root development (apexogenesis). The IADT recommends passive, flexible splints (eg. 0.016" stainless steel or comparable flexible wire/fiber) for most traumatized permanent teeth, typically for 2 weeks (longer—4 weeks—if alveolar fracture or root fracture is present). Early stabilization preserves vascular and PDL healing and can improve pulpal survival in immature teeth.
➤ Why splinting matters
° Proper splinting reduces micromovement, lessens further tissue damage, and facilitates clot stabilization in replanted avulsed teeth and luxation injuries—thereby improving prognosis for both periodontal and pulpal healing.
📌 Recommended Article :
Video 🔽 Dental trauma in children: What can we do? ... Dental trauma occurs in a higher percentage in children and adolescents. The causes are falls and injuries related to games and sports.✅ Types of splints and choice rationale
Clinicians should prefer flexible and passive splints that allow physiologic tooth movement while providing stabilization. Rigid splints are generally avoided because they may cause ankylosis or inhibit PDL healing. Modern options include:
▪️ Wire-composite splints (stainless steel wire + composite) — traditional, widely available.
▪️ Fiber-reinforced composite (FRC) splints — superior aesthetics, less plaque retention, good strength.
▪️ Direct composite splints (wire-free) — quick application but technique-sensitive; some materials demonstrated good short-term retention in training studies.
▪️ Glass ionomer-based connectors — easier removal in some settings, but lower flexural strength.
▪️ Emerging options: 3D-printed or CAD/CAM fabricated removable splints for specific cases, an expanding field with promising early data.
📌 Recommended Article :
Video 🔽 Webinar: Pediatric Dental Trauma and Odontogenic Infections - Dr. Kelly A. Kirtland DDS ... Understanding how to recognize, diagnose, and manage trauma early is crucial for preserving tooth vitality and preventing long-term complications in both primary and permanent dentition.✅ Clinical protocol (practical points)
▪️ Reposition tooth carefully, then place a passive, flexible splint. Follow IADT timing recommendations (commonly 2 weeks; 4 weeks for root/alveolar fractures). Document occlusion and ensure splint does not cause premature contacts.
▪️ Combine splinting with appropriate endodontic management when indicated (eg. immature teeth with necrotic pulp require apexification/regenerative approaches).
▪️ Provide oral hygiene instructions, soft diet, and follow-up radiographs to monitor healing and detect complications (resorption, ankylosis).
💬 Discussion
Current evidence and guidelines emphasize flexibility, passivity, and short duration of splints to maximize periodontal healing and minimize adverse sequelae such as ankylosis or root resorption. Comparative studies show that fiber-reinforced composite splints may offer improved aesthetics and comparable mechanical performance to wire-composite splints, while new technologies (CAD/CAM, 3D printing) can produce customized appliances for special cases. However, heterogeneity in study designs and limited high-quality randomized trials mean clinical judgment and guideline adherence remain essential.
📌 Recommended Article :
Dental Article 🔽 Traumatic Dental Injuries in Children: Diagnosis and Management ... They represent one of the most common dental emergencies in pediatric patients, often resulting from falls, sports activities, and accidents.✍️ Conclusion
Ferulization is a key tool in the management of dental trauma and mobility in both primary and young permanent teeth when appropriately indicated. Choosing a passive, flexible splint and limiting duration according to injury type optimizes healing while minimizing complications. Ongoing advances in materials (FRC, CAD/CAM splints) broaden clinicians’ options but should be adopted guided by evidence and practicality.
🔎 Recommendations
1. Prefer passive, flexible splints (eg. 0.016" stainless wire or FRC) and avoid rigid fixation.
2. Duration: generally 2 weeks for most luxations and avulsions; extend to 4 weeks for root or alveolar fractures as per IADT.
3. Primary teeth: be conservative—splint selectively and weigh risks to successors.
4. Combine splinting with appropriate endodontic, restorative, and follow-up care; monitor radiographically for resorption and ankylosis.
5. When available and indicated, consider fiber-reinforced or CAD/CAM solutions for improved patient comfort and aesthetics, while recognizing cost and accessibility limitations.
📊 Symptoms: Mild - Severe: Splinting Materials — Pros and Cons
| Aspect | Advantages | Limitations |
|---|---|---|
| Wire-composite (stainless steel wire + composite) | Widely available; reliable stabilization; cost-effective; good clinical familiarity | Aesthetic concerns; plaque retention if excess resin; technique sensitivity for passive placement |
| Fiber-reinforced composite (FRC) | Better aesthetics; low profile; good flexural strength; reduced metal visibility | Higher material cost; requires precise technique; may need special fiber handling |
| Direct composite splint (wire-free) | Fast application; no metal components; comfortable for patients | May have lower long-term retention; increases polymerization shrinkage risk if bulky |
| Glass ionomer connectors | Easy to remove; fluoride release may benefit caries-prone patients | Lower mechanical strength; higher wear; less suitable for high-load stabilization |
| CAD/CAM or 3D-printed removable splints | Custom-designed fit; predictable passive support; minimal chair time for placement | Requires lab workflow or in-clinic 3D printing; higher cost; limited data in pediatric trauma |
📚 References
✔ Bourguignon, C., et al. (2020). International Association of Dental Traumatology (IADT) guidelines for the management of traumatic dental injuries. Dental Traumatology. (IADT guidelines).
✔ Deery, C., et al. (2023). Should we splint traumatised primary teeth? British Dental Journal Open / Systematic Review. Retrieved from PubMed Central.
✔ Goswami, M., et al. (2020). Management of traumatic dental injuries using different splinting methods. Journal of Clinical and Experimental Dentistry.
✔ Sobczak-Zagalska, H., et al. (2020). Best splinting methods in case of dental injury. Journal of the American Academy of Pediatric Dentistry / JOCPD (article discussing splint types and techniques).
✔ Šimunović, L., et al. (2025). Three-dimensionally printed splints in dentistry: review and applications. Journal of Clinical Dentistry / MDPI Reviews.
✔ Moon, W., et al. (2022). Mechanical evaluation of dental trauma splints fabricated with various materials. Dental Materials Journal.
📌 More Recommended Items
► Occlusal Splints: Types, Benefits, and Who Needs Them
► The Different Types Of Retainers
► What is the role of space maintainers? Types of maintainers