II. Indications

III. Mechanism

  1. Secure tooth with temporary splint to adjacent teeth

IV. Preparation

  1. Dental Anesthesia
    1. See Periapical Block
    2. See Inferior Alveolar Block
  2. Dry the teeth
    1. Place a cotton pledget or dental sponge in the recess or vestibule between the lip and teeth
    2. Consider oxygen via Nasal Cannula to facilitate drying
  3. Tooth Alignment
    1. Have patient bite on a Tongue blade to ensure positioning and alignment during the Splinting

V. Technique: Coe-Pak Splint

  1. Mix and form Coe-Pak periodontal paste
    1. Mix equal parts of catalyst and base on an impermeable disposable surface
      1. Mix for 30-60 seconds
    2. Place in a basin of sterile water
      1. Soak Coe-Pak to allow for manipulation (Coe-Pak sticks to any dry surface)
      2. Wet gloves thoroughly
    3. Remove Coe-Pak from water and roll and mold with gloved fingers
      1. Splint should be wide enough to cover three teeth
      2. Splint should be tall enough to cover Gingiva and enamel (but not past biting surface)
  2. Apply Coe-Pak to teeth
    1. Dry teeth well (Coe-Pak requires a dry surface)
    2. Apply formed Coe-Pak splint to the facial (outer) surface of the teeth
      1. Include at least one tooth (preferably two) to either side of the avulsed or luxated tooth
      2. Splint should be applied to both the Gingival and enamel surface (may irritate Gingiva)
      3. Splint should not extend past or over the Occlusal (biting) surface
      4. Apply the splint firmly to the teeth and Gingiva to ensure adhesion
      5. Work the paste into the spaces between the teeth
    3. Coe-Pak splint may also be applied to the tooth oral (inner) surface
      1. Typically not needed if the facial surface splint is well applied
  3. Resources
    1. Dental Box: Stabilizing Teeth
      1. https://www.youtube.com/watch?v=2GNAQwOid1I

VI. Technique: Improvised Metal Splint with Tissue Adhesive

  1. Prepare splint material
    1. Obtain the thin metal ridge from an N-95 respiratory mask (or other Splinting material)
    2. Trim the metal strip to cover 3 teeth (the affected tooth and one to either side)
    3. Round the edges of the metal strip to eliminate sharp edges
  2. Apply Tissue Adhesive (n-butyl-2-cryanoacrylate)
    1. Apply Tissue Adhesive to the edges of the affected tooth, securing it to the adjacent teeth
    2. Apply Tissue Adhesive to the both the metal strip and the surface of the three teeth (region of splint)
    3. Firmly apply the metal strip to the three teeth and hold in place for at least 60 seconds
  3. References
    1. Lin in Herbert (2015) EM:Rap 15(2): 6-7
    2. Rosenberg (2011) Ann Emerg Med 57(4): 375-7 +PMID: 20817349 [PubMed]

VII. Technique: Improvised Skin Closure Strips and Tissue Adhesive

  1. Patient bites on a Tongue blade to maintain positioning and alignment as described above
  2. Surface of teeth is dried (see above)
  3. Apply skin closure strips (typically used for wound closure, e.g. steri-strips)
    1. Strips should extend over the anterior surface, from adjacent stable teeth and across the affected teeth
  4. Apply Tissue Adhesive, drop by drop, in a controlled manner, along the skin closure strip
  5. References
    1. Warrington (2022) Crit Dec Emerg Med 36(4): 25

VIII. Technique: Other methods

  1. Suture wrapped around adjacent teeth
  2. Sutured to Gingiva

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