Sir, I read with interest the research summary in September's edition of the BDJ entitled 'Primary care dentists' experience of treating avulsed permanent teeth'1 and also the research paper itself.2

The study reported that 39% of respondents had replanted an avulsed tooth before, and that this most often took place in a primary care setting. It is interesting and perhaps unsurprising to note that the vast majority of respondents reported following the British Society of Paediatric Dentistry (BSPD) guidelines on Treatment of avulsed permanent teeth in children.3

The BSPD guidelines recommend that a composite-wire type splint is placed to stabilise replanted avulsed teeth, which is sensible given the availability of these materials. The International Association of Dental Traumatology guidelines4 also recommend the placement of a splint, but advise that there is currently no evidence base for the best type of splint to use.

Although the materials for composite-wire splints are readily available, they can be somewhat tricky to place, especially in a field contaminated with blood from a traumatic injury, and the wire has to be stabilised whilst all composite elements are polymerised. A more stress-free alternative may be to splint using orthodontic brackets. The benefit here is that each bracket can be placed individually before the wire is secured, and anecdotally they are much easier to remove and to keep clean. Importantly, the wire can be easily removed and replaced to allow accurate appraisal of tooth mobility and vitality at subsequent review. Naturally they require the availability of orthodontic brackets and modules; however, a small number of these could be obtained relatively cheaply and stored as part of a 'trauma pack' kept handy for this very reason. Indeed, working in secondary care, bracket-wire type splints are the first choice for adult and paediatric patients having undergone dental trauma.

I would also direct colleagues to the very intuitive Dental Trauma Guide (www.dentaltraumaguide.org) which is useful as an evidence-based guide to managing all types of trauma to primary and secondary teeth.