Dental Splinting (Ferulization) in Primary and Young Permanent Teeth: Indications and Materials

✅ Abstract
Dental splinting (ferulization) stabilizes mobile or traumatised teeth to promote healing of periodontal and pulpal tissues.

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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.

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✅ 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.

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✅ 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.

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✅ 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.

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✅ 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.

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✍️ 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.

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Traumatic Dental Injuries in Children: Diagnosis and Management

Traumatic dental injuries (TDIs) are highly prevalent in children, particularly in the primary and mixed dentition stages. They represent one of the most common dental emergencies in pediatric patients, often resulting from falls, sports activities, and accidents.

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TDIs not only affect the teeth but may also compromise the supporting periodontal tissues, alveolar bone, and surrounding soft tissues (Andersson, 2018). Early and accurate diagnosis followed by appropriate management is critical to ensure favorable long-term outcomes.

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✅ Types of Traumatic Dental Injuries
TDIs in children are classified according to the World Health Organization (WHO) and the International Association of Dental Traumatology (IADT) guidelines. The main categories include:

° Crown fractures (enamel or enamel-dentin)
° Crown-root fractures
° Root fractures
° Luxation injuries (concussion, subluxation, extrusion, lateral luxation, intrusion)
° Avulsion

Each type of injury presents unique diagnostic features and management protocols.

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✅ Diagnosis
Diagnosis involves clinical examination, radiographic assessment, and patient history. Key diagnostic steps include:

° Assessing tooth mobility, sensitivity, and displacement.
° Evaluating pulp vitality through sensibility testing (in older children).
° Identifying associated soft tissue injuries and possible alveolar fractures.
° Radiographic imaging using periapical, occlusal, or panoramic radiographs depending on injury type.

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✅ Management of Traumatic Dental Injuries

° Crown fractures: Management ranges from smoothing minor enamel fractures to composite restoration or pulp therapy if the pulp is exposed.
° Luxation injuries: Treatment may involve observation, repositioning, splinting, or extraction depending on severity.
° Avulsion: Immediate replantation is the best prognosis for permanent teeth. Primary teeth should not be replanted due to risk of damage to developing permanent successors (Fouad & Abbott, 2020).
° Root fractures: Stabilization with flexible splints and long-term monitoring are essential.

📊 Differences Among Traumatic Dental Injuries in Children

Type of Injury	Key Characteristics	Management Approach
Crown Fractures	Loss of enamel/dentin; pulp may be exposed	Restoration, pulp therapy if exposure occurs
Luxation Injuries	Mobility, displacement, or intrusion of the tooth	Observation, repositioning, splinting, or extraction
Root Fractures	Fracture line affecting root structure	Stabilization with splints, follow-up monitoring
Avulsion	Complete displacement of tooth from socket	Immediate replantation (permanent teeth); no replantation for primary teeth

💬 Discussion
Traumatic dental injuries in children demand immediate and careful intervention to minimize long-term complications, such as pulp necrosis, ankylosis, or developmental disturbances in permanent teeth. The management strategy depends largely on the child’s age, dentition stage, and type of injury. While modern guidelines from the IADT provide structured protocols, challenges include compliance, prognosis prediction, and follow-up in pediatric patients (Bourguignon et al., 2020).

🔎 Recommendations

° Educate parents and caregivers on emergency management of avulsed teeth, emphasizing immediate replantation or storage in suitable media.
° Ensure routine follow-ups to monitor pulp vitality and root development.
° Use protective measures, such as mouthguards, during sports to prevent injuries.
° Apply minimally invasive techniques whenever possible to preserve pulp vitality in young patients.

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✍️ Conclusion
Traumatic dental injuries in children represent complex clinical challenges requiring prompt diagnosis and evidence-based management. A multidisciplinary approach involving pediatric dentists, endodontists, and parents ensures optimal outcomes. Preventive strategies and long-term monitoring are essential to reduce complications and improve the prognosis of traumatized teeth.

📚 References

✔ Andersson, L. (2018). Epidemiology of traumatic dental injuries. Journal of Endodontics, 44(3), S19–S27. https://doi.org/10.1016/j.joen.2017.11.013
✔ Bourguignon, C., Cohenca, N., Lauridsen, E., Flores, M. T., O’Connell, A. C., Day, P. F., ... & Tsilingaridis, G. (2020). International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and luxations. Dental Traumatology, 36(4), 314–330. https://doi.org/10.1111/edt.12578
✔ Fouad, A. F., & Abbott, P. V. (2020). Endodontic-related traumatic dental injuries: Epidemiology, diagnosis, and treatment considerations. Endodontic Topics, 39(1), 1–11. https://doi.org/10.1111/etp.12295

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Pink Tooth in Dentistry: Etiology, Diagnosis, Treatment, and Forensic Relevance

The “pink tooth” phenomenon describes a pink discoloration of dentin visible through the enamel. It can occur both in living patients and postmortem.

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In clinical dentistry, it is associated with trauma, internal resorption, pulp necrosis, or iatrogenic staining, while in forensic contexts it has been linked to deaths caused by drowning, asphyxiation, or cranial trauma. This article reviews the causes, differential diagnosis, clinical and forensic implications, as well as available treatment options.

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✅ Introduction
Dental discolorations are a frequent reason for consultation. Among them, a pink hue in a tooth crown is of particular interest due to its varied etiology. For years, the pink tooth was thought to be exclusive to drowning or asphyxia victims. However, the literature shows that it may also occur in clinical ante mortem cases, associated with pathological or iatrogenic factors. This article aims to provide an updated and precise overview of this phenomenon.

✅ Etiology

➤ Ante mortem / Clinical

° Internal resorption: the most classic cause in living patients; inflamed and vascularized tissue behind the enamel gives rise to a pink shade.
° Dental trauma: intrapulpal hemorrhages diffuse blood pigments into dentin, creating a transient pink discoloration.
° Early pulp necrosis: tissue breakdown releases byproducts that stain dentin.
° Endodontic materials: some sealers and cements may cause pink or reddish staining in the crown.

➤ Post mortem / Forensic

° Caused by hemolysis and hemoglobin diffusion into dentinal tubules.
° Commonly observed in drowning, asphyxia, and cranial trauma, although not exclusive to these causes.
° Environmental factors such as temperature, humidity, and postmortem interval influence the intensity of discoloration.

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✅ Differential Diagnosis

° Medical and dental history: trauma, pulp vitality, prior treatments.
° Vitality tests (cold, heat, electric pulp test).
° Periapical radiography or CBCT to assess resorption extent.
° Differentiate from discolorations caused by systemic conditions, medications, or restorative materials.

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✅ Treatment and Clinical Management

° Initial internal resorption: root canal treatment with disinfection and obturation.
° Intracanal medications: calcium hydroxide between appointments.
° Prosthetic restorations or crowns in cases of structural loss.
° Extraction: last resort when the tooth is unrestorable or has extensive perforations.

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✅ Forensic Relevance

° The pink tooth may suggest drowning or asphyxia but is neither exclusive nor pathognomonic.
° Its probative value is limited and must be interpreted alongside other evidence.
° Intensity and localization of discoloration vary depending on anatomical and environmental factors.

📊 Comparative Table: Pink Tooth — Clinical vs. Forensic Causes

Aspect	Clinical Causes	Forensic Causes
Etiology	Internal resorption, pulp necrosis, dental trauma, endodontic sealers with pigments.	Drowning, mechanical asphyxia, severe cranial trauma, postmortem hematic diffusion.
Characteristics	Pink coloration visible in the pulp chamber or crown; may progress to reddish hues.	Intense pink coloration in the crown, usually homogeneous and associated with postmortem findings.
Relevance	Important for differential diagnosis in clinical dentistry to avoid confusion with forensic cases.	Auxiliary indicator in forensic investigations of criminal or accidental death.
Limitations	May be confused with staining caused by endodontic materials or chronic pulp lesions.	Not exclusive to asphyxia; must be correlated with other forensic findings.

💬 Discussion
The belief that the pink tooth is exclusive to drowning or asphyxia victims has been disproven. In living patients, it may result from internal resorption, trauma, pulp necrosis, or endodontic materials. Postmortem, it is more frequent in asphyxia or drowning, but may also occur under other conditions. Clinically, early diagnosis is essential for tooth preservation, while in forensic dentistry it should be interpreted as a nonspecific finding requiring correlation with other data.

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✍️ Conclusions
° The “pink tooth” is not exclusive to drowning or asphyxia.
° It may occur in both living patients (trauma, necrosis, resorption, materials) and postmortem (hemolysis).
° Early diagnosis improves clinical prognosis and prevents tooth loss.
° In forensic dentistry, it has indicative but not conclusive value for determining cause of death.

📚 References

✔ Carney, K. A., Colloc, T. N. E., & Kilgariff, J. K. (2024). Management of rarely seen internal tunnelling root resorption associated with a maxillary permanent incisor. British Dental Journal, 236(7504), 955–961. https://doi.org/10.1038/s41415-024-7504-7

✔ Nilsson, E., et al. (2013). Management of Internal Root Resorption on Permanent Teeth. Journal of Endodontics, 39(12), 1521–1527. https://doi.org/10.1016/j.joen.2013.08.020

✔ Minegishi, S., et al. (2022). Association of Cadaveric Factors with the Degree and Region of Discoloration in the Phenomenon of Pink Teeth. Applied Sciences, 12(9), 4242. https://doi.org/10.3390/app12094242

✔ Sumi, N., et al. (2023). Study on the Mechanism of the Pink Tooth Phenomenon. Diagnostics, 13(16), 2699. https://doi.org/10.3390/diagnostics13162699

✔ Regalado-Barrera, J. D., Hernández-Salas, C., Murillo-López, E., Reyes-Moreno, D. C., Cano-Sánchez, D., & Rosales-González, H. (2023). Etiology of the pink tooth: a curious postmortem phenomenon. Contexto Odontológico, 13(25), 23-28. https://revistas.uaz.edu.mx/index.php/contextoodontologico/article/view/2568

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Pediatric dental trauma and odontogenic infections remain among the most frequent and challenging conditions faced in children’s oral health. These events can compromise not only the integrity of the teeth but also the function, aesthetics, and overall well-being of young patients.

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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.

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Likewise, odontogenic infections demand prompt and accurate intervention, as they may progress rapidly and affect adjacent tissues or even systemic health. Modern pediatric dentistry emphasizes evidence-based protocols, the use of minimally invasive techniques when possible, and a patient-centered approach that reduces anxiety and improves cooperation.

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By combining preventive strategies, clinical expertise, and multidisciplinary collaboration, dental professionals can ensure safer, more predictable outcomes. This video explores the current knowledge and best practices that empower clinicians to provide effective and compassionate care when facing dental trauma and infections in children.

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Guidelines for the management of traumatic dental injuries in the primary dentition

Dental traumas in pediatric patients represent 18% of all injuries and that is due to the activities of children, and they occur more frequently when they learn to crawl, walk or run.

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.

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We share an article that does not offer different recommendations for the diagnosis and treatment of traumatic injuries in the primary dentition.

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👉 READ AND DOWNLOAD "Guidelines for the management of traumatic dental injuries in the primary dentition" IN FULL IN PDF👈

Day PF, Flores MT, O’Connell AC, et al. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 3. Injuries in the primary dentition. Dent Traumatol 2020;36(4):343-359. https://doi.org/10.1111/edt.12576

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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.

Although oral accidents are not fatal, they do compromise the child's health


Dental trauma should be attended to immediately by a professional, since not only the teeth would be compromised, but also the bone and soft parts such as the lip and tongue.

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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. Trauma can involve not only the tooth, but also the lips, gums, and bone.


It is important to act immediately and take the injured person to a dental hospital or clinic. Getting to a dentist within 30 minutes after the accident can make a difference.

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