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 Table of Contents  
CASE REPORT
Year : 2020  |  Volume : 1  |  Issue : 1  |  Page : 19-22

Reattachment an immediate esthetic protocol


Department of Conservative and Endodontics, Pacific Dental College, Udaipur, Rajasthan, India

Date of Submission21-Nov-2020
Date of Acceptance09-Dec-2020
Date of Web Publication31-Dec-2020

Correspondence Address:
Prashant Purandhar Shetty
Department of Conservative and Endodontics, Pacific Dental College and Hospital, Udaipur - 313 024, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpcdoh.jpcdoh_2_20

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  Abstract 


The immediate fragment reattachment is a conservative treatment which allows the restoration of the original dental anatomy thus rehabilitating function and esthetics in a shortest time available. Dentists are confronted with managing dental trauma and restoring fractured teeth on a regular basis. Hence, the technique that speed and simplify treatment, restore esthetics and improve long-term success rate are therefore of potential value and should be considered. Fracture reattachment possess challenging conservative and economically viable procedure within a single visit. This article discusses fragment reattachment technique and presents clinical case of coronal fracture involving enamel, dentin, and pulp.

Keywords: Composite resins, conservative treatment, reattachment, tooth fracture, traumatic injuries


How to cite this article:
Bapna P, Jain D, Udhani B, Shetty PP. Reattachment an immediate esthetic protocol. J Prim Care Dent Oral Health 2020;1:19-22

How to cite this URL:
Bapna P, Jain D, Udhani B, Shetty PP. Reattachment an immediate esthetic protocol. J Prim Care Dent Oral Health [serial online] 2020 [cited 2021 Oct 23];1:19-22. Available from: http://www.jpcdoh.org/text.asp?2020/1/1/19/305892




  Introduction Top


Crown fracture has been documented to account up to 90% of all traumatic injuries to the permanent dentition. Many epidemiologic studies show that most dental injuries involve just one tooth and maxillary incisors are the most commonly affected.[1],[2] It has been reported males are more frequently affected than females, particularly in the maxillary incisors.[3] An alternating treatment option for restoring fractured incisors is using bonding agent for the chipped fragment onto the natural crown. The first published case of reattaching a fractured incisor fragment was reported in 1964 by Chosack and Eidelma[4] when clinicians described a case of rehabilitation of a fractured incisor using the patient's original tooth. After these, many articles have been published regarding a variety of preparation designs and materials for reattachment. Dental injuries usually affect only a single tooth; however, certain trauma types such as automobile accidents and sports injuries involve multiple tooth injuries.[5] A number of techniques have been developed to restore the fractured crown. Early techniques include stainless steel crowns, basket crowns, orthodontic bands, pins, pin retained resin, porcelain bonded crowns, and composite resin.[6]

Some of the advantages from reattachment of fractured tooth fragment are:

  1. Conservation of tooth material
  2. Color matching
  3. Preservation of incisal translucency
  4. Good esthetics
  5. Maintenance of original tooth contours
  6. Economical
  7. Preservation of occlusal contacts
  8. Color stability of enamel
  9. Positive emotional and social responses from patients.


Disadvantages of fragment reattachment are:

  1. It may result in a change in color due to inadequate rehydration of the fragment; and
  2. It carries the possibility of detachment of the fragment.


The objective of this case report is to present the reconstruction of a traumatized and fractured right maxillary central incisor by building a composite resin core with a glass fiber post.


  Case Report Top


A 40-year-old male patient reported to the department of conservative dentistry and endodontics of pacific dental college with a chief complaint of a fractured left maxillary central incisor because of trauma sustained during fall [Figure 1]. He did not have swelling or hemorrhage in the related area, and his medical history was noncontributory. Radiographic examination of the tooth revealed fracture line involving the enamel, dentin, and pulp [Figure 2]. The patient was immensely concerned about the immediate restoration of esthetics. Hence, we decided to restore esthetics immediately by reattaching the original crown fragment after ruling out periodontal damage, root fracture, and bony fracture. The fractured segment was removed atraumatically [Figure 3]. To prevent dehydration, the original fragment was kept in Hanks balanced salt solution till the completion of root canal treatment and post preparation. After completing the endodontic treatment followed by sectional obturation [Figure 4], postspace preparation was done both in the coronal fragment as well as in the root canal for proper retention of the fractured fragment assembly. Glass fiber post was selected as the patient was concerned more about his esthetics. After etching, the adherent surface of the fractured fragment was attached to the glass fiber post, and subsequently, the whole assembly was then cemented to the root portion with flowable composite resin [Figure 5]. The restoration was light cured, finished, polished, and checked for proper contact [Figure 6]. The entire treatment procedure was completed in one sitting.
Figure 1: Fractured tooth in relation with #21

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Figure 2: Radiographic examination of #21 reveals involving enamel, dentine, and pulp

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Figure 3: Fractured crown with #21

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Figure 4: Radiographic view of sectional obturation of #21

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Figure 5: Radiographic view of glass fiber post and then cementation of the root portion with flowable composite resin with #21

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Figure 6: Completed treatment with #21

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  Discussion Top


Traumatized anterior teeth require quick repair for both functional and aesthetic needs. By using the original tooth fragment to restore a fractured tooth, it is possible to achieve very good aesthetics. Traumatic injuries involving tooth fracture can be treated by reattachment of the tooth fragment using a dentine adhesive system to provide what is considered to the most conservative to restoration. Factors influencing the extent and feasibility of such repairs include the site of the fracture, size of fractured remnants, periodontal status, pulpal involvement, maturity of root formation, biological width invasion, occlusion, and time. The composite reinforcement technique, together with this light-transmitting post, had been widely used to functionally and esthetically restore compromised root-filled teeth.[7] Restoration with a post after endodontic treatment provides retention of a core to support the coronal restoration, especially with extensive tooth loss. Conventionally, these posts have been cast or machined from metals and can be grouped as active or passive posts.[8] Active posts derive their primary retention directly from the root dentine by the use of threads. Passive posts rely primarily on luting cement for their retention. The advantages of using the original tooth fragment over other materials include better color match, morphology, translucency, patient acceptance, and economical.[9]

It is acknowledged that the placement of traditional metal posts weakens the roots and leads to root fracture, or may lead to caries that may cause irreversible failure and extraction of tooth in some cases.[10] The reattachment of the crown fragment to a fractured tooth can be considered as the most conservative treatment and could be the first choice for crown fractures of anterior biological width invasion, occlusion, time, and resources of the patient. If the fracture involves 2/3 or more of the crown, a postreattachment is more commonly used.[11] However, this technique is not without limitations. First, the resistance to fracture gained after reattachment is only 50%–60% that of the intact tooth.

Second, the success of reattachment also depends on how dehydrated the fragment is, because the longer the fragment remains dehydrated, the lesser will be the fracture strength of the tooth; however, strength can be reinstituted by hydrating the fragment. Prolonged dehydration may present esthetic problems, like lighter tonality than the tooth remnant.[12] Return to original color may take time or may not occur at all. With remarkable advancement of the adhesive systems and resin composites, reattachment procedures are no longer a temporary/provisional restoration, but rather a permanent restorative treatment providing favorable prognosis.[13],[14] In the present case, the fragment was maintained in the oral cavity since the accident, which avoided desiccation and color change. Our case was followed up for 6 months without noticeable color change of the crown or periapical radiological changes. The patient continued with the reattached fragment as a permanent restoration.


  Conclusions Top


Reattachment technique is the most conservative and biological method of restoring a fractured anterior tooth. Reattaching a tooth fragment with newer adhesive materials may be successfully used to restore fractured teeth with adequate strength, but long-term followup is necessary in order to predict the durability of the tooth-adhesive-fragment complex and the vitality of the tooth. This procedure helps us to preserve maximal natural tooth structure. Patient cooperation and understanding of the limitations of the treatment are of utmost importance for good prognosis. This procedure helps us to preserve maximal natural tooth structure. The need of the day is to educate the public to preserve the fractured segment and seek immediate dental treatment.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Shulman JD, Peterson J. The association between incisor trauma and occlusal characteristics in individuals 8-50 years of age. Dent Traumatol 2004;20:67-74.  Back to cited text no. 1
    
2.
Calişkan MK, Türkün M. Clinical investigation of traumatic injuries of permanent incisors in Izmir, Turkey. Endod Dent Traumatol 1995;11:210-3.  Back to cited text no. 2
    
3.
Rappelli G, Massaccesi C, Putignano A. Clinical procedures for the immediate reattachment of a tooth fragment. Dent Traumatol 2002;18:281-4.  Back to cited text no. 3
    
4.
Chosack A, Eidelma NE. Rehabilitation of a fractured incisor using the patient's natural crown – Case report. J Dent Child 1964;71:19-21.  Back to cited text no. 4
    
5.
Andearsen JO, Andreasen F, Andersson L. Textbook and Color Atlas of Traumatic Injuries of the Teeth. 3rd ed.. St. Louis (MO): Mosby; 1994.  Back to cited text no. 5
    
6.
Toshihiro K, Rintaro T. Rehydration of crown fragment 1 year after reattachment: A case report. Dent Traumatol 2005;21:297-300.  Back to cited text no. 6
    
7.
Wadhwani CP. A single visit, multidisciplinary approach to the management of traumatic tooth crown fracture. Br Dent J 2000;188:593-8.  Back to cited text no. 7
    
8.
Pasini S, Bardellini E, Keller E, Conti G, Flocchini P, Majorana A. Surgical removal and immediate reattachment of coronal fragment embedded in lip. Dent Traumatol 2006;22:165-8.  Back to cited text no. 8
    
9.
Ricketts DN, Tait CM, Higgins AJ. Post and core systems, refinements to tooth preparation and cementation. Br Dent J 2005;198:533-41.  Back to cited text no. 9
    
10.
Shetty PP, Metgud S, Jain A, Dhillon G, Astekar M. A conservative single visit reattachment of fractured crown fragment. Clin Pract 2012;2:e70.  Back to cited text no. 10
    
11.
Shetty PP, Patel A, Metgud S, Shah H. Reattachment an immediate emergency protocol: A case report. Indian J Dent Sci 2015;7:74-6.  Back to cited text no. 11
    
12.
Thapak G, Ashtha A, Arora A. Fractured tooth reattachment: A series of two case reports. 2019;31:117-20.  Back to cited text no. 12
    
13.
Choudhary A, Garg R, Bhalla A, Khatri RK. Tooth fragment reattachment: An esthetic, biological restoration. J Nat Sci Biol Med 2015;6:205-7.  Back to cited text no. 13
    
14.
AlQhtani FA. Reattachment of a dehydrated tooth fragment using retentive holes. Cureus 2020;12:e6640.  Back to cited text no. 14
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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