II. Indications
III. Mechanism
- Secure tooth with temporary splint to adjacent teeth
IV. Preparation
- Dental Anesthesia
- Dry the teeth
- Place a cotton pledget or dental sponge in the recess or vestibule between the lip and teeth
- Consider oxygen via Nasal Cannula to facilitate drying
- Tooth Alignment
V. Technique: Coe-Pak Splint
- Mix and form Coe-Pak periodontal paste
- Mix equal parts of catalyst and base on an impermeable disposable surface
- Mix for 30-60 seconds
- Place in a basin of sterile water
- Soak Coe-Pak to allow for manipulation (Coe-Pak sticks to any dry surface)
- Wet gloves thoroughly
- Remove Coe-Pak from water and roll and mold with gloved fingers
- Splint should be wide enough to cover three teeth
- Splint should be tall enough to cover Gingiva and enamel (but not past biting surface)
- Mix equal parts of catalyst and base on an impermeable disposable surface
- Apply Coe-Pak to teeth
- Dry teeth well (Coe-Pak requires a dry surface)
- Apply formed Coe-Pak splint to the facial (outer) surface of the teeth
- Include at least one tooth (preferably two) to either side of the avulsed or luxated tooth
- Splint should be applied to both the Gingival and enamel surface (may irritate Gingiva)
- Splint should not extend past or over the Occlusal (biting) surface
- Apply the splint firmly to the teeth and Gingiva to ensure adhesion
- Work the paste into the spaces between the teeth
- Coe-Pak splint may also be applied to the tooth oral (inner) surface
- Typically not needed if the facial surface splint is well applied
- Resources
- Dental Box: Stabilizing Teeth
VI. Technique: Improvised Metal Splint with Tissue Adhesive
- Prepare splint material
- Obtain the thin metal ridge from an N-95 respiratory mask (or other Splinting material)
- Trim the metal strip to cover 3 teeth (the affected tooth and one to either side)
- Round the edges of the metal strip to eliminate sharp edges
- Apply Tissue Adhesive (n-butyl-2-cryanoacrylate)
- Apply Tissue Adhesive to the edges of the affected tooth, securing it to the adjacent teeth
- Apply Tissue Adhesive to the both the metal strip and the surface of the three teeth (region of splint)
- Firmly apply the metal strip to the three teeth and hold in place for at least 60 seconds
- References
- Lin in Herbert (2015) EM:Rap 15(2): 6-7
- Rosenberg (2011) Ann Emerg Med 57(4): 375-7 +PMID: 20817349 [PubMed]
VII. Technique: Improvised Skin Closure Strips and Tissue Adhesive
- Patient bites on a Tongue blade to maintain positioning and alignment as described above
- Surface of teeth is dried (see above)
- Apply skin closure strips (typically used for wound closure, e.g. steri-strips)
- Strips should extend over the anterior surface, from adjacent stable teeth and across the affected teeth
- Apply Tissue Adhesive, drop by drop, in a controlled manner, along the skin closure strip
- References
- Warrington (2022) Crit Dec Emerg Med 36(4): 25