Fracture resistance of re-attached coronal fragments--influence of different adhesive materials and bevel preparation

An assessment of Brazilian dentists' knowledge about tooth fragment reattachment: A cross-sectional study

BACKGROUND/AIM

Crown fractures are common traumatic dental injuries and tooth fragment reattachment is a viable option for restoring a fractured tooth. The aim of this study was to assess the knowledge and experience of dentists in the Federal District regarding the tooth fragment reattachment technique for enamel and dentin fractures.

MATERIALS AND METHODS

For the cross-sectional observational study, an electronic form was designed with objective and self-report questions for dentists. The data were analyzed using descriptive statistics, with their absolute and relative frequencies. For the analysis of categorical variables, the nonparametric chi-squared or Fisher exact association tests were used in the statistical software R (version 4.2.1).

RESULTS

A total of 416 dentists participated in the study (58.9% female and 41.1% male). Of these, 70% declared they knew about fragment reattachment, but only 42.3% reported previous experience with this procedure. The most common storage medium used for the fractured fragment was milk (78.1%), and the bonding material used for reattachment was light-cured composite resin (86.3%). A majority (66.3%) reported that for a patient with enamel and dentin fracture, with the crown fragment in good condition, they would choose to do the reattachment.

CONCLUSION

Dentists demonstrated that they had adequate knowledge about the tooth fragment technique, although many did not have previous experience with this procedure.

The risk of bonded fragment loss in crown-fractured anterior teeth managed by fragment reattachment: a systematic review and meta-analysis

PURPOSE

To identify the factors affecting the risk of bonded fragment loss in crown-fractured anterior teeth managed by fragment reattachment.

METHODS

The study protocol followed the best practices of evidence-based medicine and was registered in PROSPERO. A comprehensive literature search was performed electronically in six databases (PubMed, Embase, SCOPUS, Web-of-Science, Lilacs, and Cochrane) on 18-09-2023. It was saved in EndNote-online and duplicates were removed. Selection of articles was performed in two stages, followed by data-extraction, risk of bias assessment, data-analysis, and meta-analysis. The quality of evidence for the outcomes was assessed by the GRADE-approach.

RESULTS

The study included six articles that had similar selection protocols with variations in duration from trauma to treatment and the observation period. Only one study employed pre-attachment fragment preparation and three performed post-attachment reinforcements. Overall loss of fragment was 20% (95%CI-13,30%). When the risk ratio for loss of restoration or fragment was compared, it was found to be 2.21 (95%CI-1.52,3.21) in uncomplicated crown fractures, 2.54 (95%CI-1.35,4.79) in complicated crown fractures. The risk of bias was found to be low in two and moderate in four studies. Grade of evidence for all the outcomes was very low.

CONCLUSION

Fragment loss was lowest in uncomplicated crown fractures where reinforcement had been performed, and highest when bonding was done in complicated crown fractures without reinforcement. The risk of fragment loss was higher than the loss of composite restorations.

Effect of temperature on rehydration and fracture resistance of reattached tooth fragments after crown fracture: An in vitro study

BACKGROUND

Uncomplicated crown fractures of maxillary anterior teeth are common dental injuries, and the bonding of fractured fragments is recommended for management. Rehydration of fragments improves bonding and fracture resistance. Therefore, the aim of this study was to compare the fracture resistance of the reattached tooth fragment of the incisor crown after rehydration using either a steamer or a humidifier.

MATERIALS AND METHODS

Bovine teeth were used as a model. Fractured fragments were divided into three groups: Group I (no rehydration), Group II (rehydration by humidifier), and Group III (rehydration by steamer). Fragments were reattached using a standard bonding protocol. Fracture resistance was tested using a universal testing machine. Statistical analysis was performed using analysis of variance and Chi-square tests.

RESULTS

The force required to fracture the reattached fragments was significantly higher in Group II (humidifier) compared to Group I (no rehydration) (P = 0.005). Group III (steamer) had a force value similar to Group I, indicating no significant improvement in fracture resistance with steamer rehydration. The temperature inside the steam-based chamber reached an average of 95.7°C with 95% humidity, whereas the conventional humidification chamber had an average temperature of 39.2°C and 84% humidity.

CONCLUSION

Within the limitations of the present study, the rehydration protocol using a steam-based chamber was found to have a significantly lower force required to fracture the reattached fragments as compared to humidifier-based chamber. This was not significantly different from the fragments which were reattached without rehydration.

Comparing fracture resistance on bovine incisors restored by tooth fragment reattachment versus direct composite restoration techniques

BACKGROUND/AIM

Anterior teeth are prone to traumatic dental injuries (TDIs). Although a number of techniques ranging from original tooth fragment reattachment (TFR) to direct composite restoration (DCR) can be used to restore uncomplicated crown fractures, there is no consensus on which method is best. The purpose of this study was to investigate the fracture resistance of bovine incisors restored by two different techniques (TFR and DCR) in three different fracture models.

MATERIALS AND METHODS

Sixty extracted bovine lower incisors were randomly divided into three groups (n = 20). Angle, oblique, or transverse sections of all the teeth in a group were prepared by using a disk. The cut surfaces were scanned, and the cross-sectional areas (CSA) of the enamel and dentin were measured. Half the teeth in each group were restored by DCR (n = 10) and the other half by TFR (n = 10). The forces required to fracture the restored teeth were then measured using a Universal testing machine, and the fracture modes were analyzed (cohesive, adhesive, or mixed).

RESULTS

No statistically significant differences between the TFR and DCR restorations were detected for total and enamel CSAs in any of the restoration shapes (p > .067). The fracture forces required to break DCR angle and transverse restorations were significantly greater than for the corresponding shapes restored with TFR (p < .033). However, the difference in the forces needed to fracture oblique section restorations by DCR or TFR was not statistically significant (p = .239), despite a similar trend (143.4 ± 51 N and 120.9 ± 25 N, respectively).

CONCLUSION

This study revealed that a greater force is required to fracture teeth restored by the DCR than by the TFR technique, especially for a transverse section. This demonstrates that restoring a fractured tooth provides a superior outcome compared to reattaching the fractured fragment.

Comparative Evaluation of the Effect of Various Storage Media on the Fracture Resistance of the Reattached Tooth Fragment: An Observational Study

Background

Traumatic injuries are the most disruptive and distressing emergencies and pose a challenge for dental professionals because many different treatment protocols are currently available. They also affect the social and psychological well-being of children. A multidisciplinary approach is involved in the management of traumatic dental injuries to maintain function and esthetics. The aim of this study was to evaluate the fracture resistance of a reattached tooth fragment kept in four storage media, namely Hank's balanced salt solution (HBSS), Tooth Mousse, ginger honey, and probiotic yogurt, for 1, 6, and 24 hours.

Materials and methods

The study consisted of 84 intact maxillary central incisors. All the teeth were stored in distilled water until used and were embedded in acrylic molds, 1 mm below the cervical end. The teeth were then sectioned to simulate an uncomplicated crown fracture (Ellis class II fracture), and all the teeth were randomly divided into four groups of 21 each. The teeth were then reattached using Tetric N Universal bonding agent and Tetric N Flow flowable composite. Fracture resistance was assessed using a universal testing machine. Statistical analysis was done using a one-way analysis of variance (ANOVA) test and a post hoc Tukey test.

Results

The results showed that fracture resistance was highest in the Tooth Mousse group at 6 and 24 hours. Ginger honey exhibited the highest fracture resistance at 1 hour, whereas the probiotic yogurt group showed the lowest values.

Conclusion

It was concluded that Tooth Mousse was the best storage medium for storing tooth fragments. Ginger honey can also be used as an alternative storage medium as it is easily available and inexpensive.

How to cite this article

Naik S, Murry JN, Sharma S, et al. Comparative Evaluation of the Effect of Various Storage Media on the Fracture Resistance of the Reattached Tooth Fragment: An Observational Study. Int J Clin Pediatr Dent 2024;17(6):665-672.

Reattachment of Fractured Tooth: A Comprehensive Review

Dental trauma is one of the most prevalent problems encountered in clinical practice. Traumatic injuries involving fractures of the anterior tooth are one of the most common problems among children and adolescents. There is a physical and social impact on patients' quality of life due to traumatic dental injuries (TDIs). Children and adolescents frequently present with a crown fracture that necessitates immediate intervention. Clinicians need to be aware of various treatment modalities for TDIs and have to address these injuries immediately. Due to advances in adhesive technologies, fragment reattachment is the treatment of choice when the fragment is available and well stored. The purpose of this article is to cover various techniques for reattaching fractured fragments and the most current developments in adhesive systems for this purpose.

Management of Complex Crown Fractures: A Case Series

Maxillary teeth are most vulnerable to fracture due to trauma. An effective treatment plan for an anterior teeth fracture not only improves function and appearance but also benefits the patient psychologically. The reattachment of the fragmented tooth is one of the best treatment methods for such condition. It is considered as a better treatment option because it is uncomplicated, aesthetic, and preserves the dental structure. To achieve a positive prognosis, patient cooperation and awareness about the treatment are essential. This article includes three case reports that illustrate the management of complex maxillary anterior teeth fractures wherein the reattachment of the fractured tooth segments was undertaken.

Survival analysis of fragment reattachments and direct composite restorations in permanent teeth after dental traumatic injuries

BACKGROUND/AIM

In case of crown fractures after traumatic dental injuries, the affected teeth can be restored either with reattachment of the fractured fragment or with a direct composite restoration. So far, longevity data for reattachments and direct composite restorations with regard to different failure types (pulp necrosis and infection, restoration loss) are scarce. Therefore, the aim of this retrospective study was to evaluate the restorative and biological survival of reattached fragments and composite restorations after crown fractures in permanent teeth.

MATERIAL AND METHODS

Dental records of patients treated between 2000 and 2018 were retrospectively analysed regarding the restoration (reattachment or direct composite restorations) of teeth with crown fractures. Survival (no further intervention) and restorative and/or biological failure of all restored teeth were recorded. Statistical analysis was performed using Kaplan-Meier statistics, and the mean annual failure rates for two and 5 years were calculated. Furthermore, the effect of potential risk factors on survival was assessed. Log-rank tests and univariate Cox regression models (likelihood ratio tests) were used to assess the univariate effect of all variables of interest. Variables with a p-value ≤.10 were included in a multivariate Cox regression model with shared frailty (p < .05).

RESULTS

Overall, 164 patients with 235 teeth (uncomplicated crown fracture: N = 201, complicated crown fracture: N = 34) were included (1.6 ± 2.5 years observation time). Of these, 59 teeth were restored with reattachment of the fragment and 176 with a composite restoration. Overall, composite restorations had a significantly higher survival rate than reattachments (p = .002). The cumulative survival after 2 years was 42.9% and 65.0% for teeth treated with a reattachment (mAFR = 34.5%) and a composite restoration (mAFR = 19.3%), respectively. When differentiating between failure types, restoration failure and pulp necrosis were significantly more frequently detected in reattached crown fractures compared to composite restorations (restorative failure: p = .001; biological failure: p = .036). In the multivariate Cox regression model, the variable jaw and luxation significantly influenced the survival when the tooth was restored with a composite restoration. The survival was not influenced by the fracture type.

CONCLUSIONS

Restorative and biological failures were more frequently detected when the tooth was restored with a reattached fragment compared to a direct composite restoration. Both, restoration failure and pulp necrosis with infection should be considered as frequent complications after restoration of crown-fractured teeth which emphasizes the necessity of regular and short follow-up intervals throughout the first 2 years.

Complicated Crown Fracture of Permanent Incisors: A Conservative Treatment Case Report and a Narrative Review

Dental trauma may have a severe impact on the social and psychological wellbeing of a patient. Most cases of dental injuries involve anterior teeth, especially the maxillary upper incisors. Crown fractures, with or without pulp exposure, are the most common trauma in permanent dentition. There are many methods of management, in which the initial state of the pulp, the time since the injury, and the presence of an accompanying injury play a key role. This case report aimed at showing a possible conservative treatment after complicated tooth fracture that consisted of partial pulpotomy followed by adhesive reattachment of the tooth fragment using a technique based on heated resin composite. Such a specific procedure represents a conservative approach to traumatic coronal lesions, providing a suitable opportunity to maintain the tooth vitality, aesthetics, and function. Indeed, reattachment of tooth fragment using a composite/adhesive is a simple technique to achieve excellent results in terms of aesthetic and function.

Multidisciplinary Approach to Complicated Crown-root Fracture Treatment: A Case Report

Treatment of complicated crown-root fractures is one of the most challenging within the various types of dental trauma and requires a multidisciplinary approach. This paper reports the complicated crown-root fracture of a maxillary right central incisor, in which there was esthetic, functional, and biologic (endodontic and biologic width invasion) involvement. A 15-year-old male patient presented to the dental clinic one month after suffering trauma with a complicated crown-root fracture on tooth 8. The patient had previously undergone endodontic treatment and was sent to have periodontal surgery to reestablish the biological width on the palatal surface. Following the surgery, a fiberglass post was cemented, and the fragment was reattached. This approach allows the exposure of the cervical margin, adequate isolation, and subsequent fragment reattachment in the same clinical appointment. Fragment reattachment is a viable approach as it is a simple and conservative procedure that restores the natural esthetic of the tooth and has superior resistance compared to a composite restoration. The patient's cooperation in understanding the limitations of the treatment and maintaining adequate oral hygiene are very important to achieving a good prognosis of the case. After a 2-year clinical and radiographic follow-up period, the clinical protocol was found to be successful, and the tooth remained functional, esthetically favorable and asymptomatic.

Comparative evaluation of the force required to fracture coronal segments reattached using different methods

BACKGROUND/AIM

Anterior teeth are prone to traumatic injuries. Their management is necessary in order to maintain the pulp and esthetics. Various methods have been reported for fragment reattachment of fractured teeth but there is no consensus on which is the best technique. The aim of this study was to compare the force required to fracture reattached fragments using polyethylene fibers in vertical grooves on the external surface of teeth, fiber-reinforced composite post and circumferential chamfer.

MATERIAL AND METHODS

Forty-eight extracted maxillary central incisors were sectioned using a disk and randomly divided into 4 groups (n = 12): Group 1: control group, Group 2: reattachment followed by placement of two external vertical grooves on the labial surface and restored with polyethylene fibers and hybrid composite, Group 3: reattachment followed by two external vertical grooves and filled with fiber posts and composite, and Group 4: reattachment followed by circumferential chamfer at the fracture line and restored with composite. The forces required to fracture the reattached fragments were measured using a Universal testing machine. Data were analyzed using the Kruskal-Wallis test. Pairwise multiple comparison procedure was done using the Student-Newman-Keuls Method.

RESULTS

The highest values for force required to fracture were observed in the fiber post group and the lowest in the Ribbond group (p < .05). The fiber post group had significantly different results compared to the Ribbond and Chamfer preparation groups (p < .05). However, the difference of rank between the fiber post and control groups was not significantly different (p > .05).

CONCLUSION

The force required to fracture the fiber post group was closest to that of intact teeth followed by the chamfer and Ribbond groups, respectively.

Minimal intervention treatment of crown-root fracture in a mature permanent tooth by MTA pulpotomy and Fragment Reattachment: A Case Report

Treatment of crown-root fracture can be complicated, time-consuming and expensive. This paper presents a treatment approach that minimises intra-operatory intervention and preserves the biologic tissue. A 15-year-old boy reported for treatment of an oblique crown fracture in the left permanent maxillary central incisor (#21, Fédération Dentaire Internationale) with mature root apices. The treatment presented an endodontic, periodontal and restorative challenge as the crown fracture exposed the pulp and extended subgingivally. The patient also had accompanying generalised enamel hypoplasia due to dental fluorosis (grade 3 Deans Fluorosis index), making the aesthetic rehabilitation difficult. The case was managed by preserving the vital pulp by MTA pulpotomy, followed by the adhesive bonding of autogenous crown fragment. A three-year follow-up revealed healthy vital pulp tissue and retained bonded fragment with acceptable aesthetics and periodontal health.

Influence of different tooth preparation and bonding techniques on the fracture resistance of tooth fragment reattachment

Purpose

comparing the influence of different tooth preparation and bonding techniques on the fracture resistance of tooth fragment reattachment.

Materials and method

Ninety bovine central incisors were selected. Fifteen teeth act as a control (Group A). Experimental specimens were sectioned at the mesial-incisal proximal edge 3 mm from the incisal edge in a labio-lingual direction at 25degree inclination apically. Experimental specimens were then divided into five groups according to the tooth reattachment techniques utilized; Group B: no tooth preparation + Cured bond + Flowable composite; Group C: no tooth preparation + Uncured bond + Flowable composite; Group D: Bevel + bond + Flowable composite; Group E: Over-contouring + bond + Nanohybrid composite; Group F: Over-contouring + bond + Flowable composite. Specimens were subjected to thermocycling between 5 °C and 55 °C for 500 cycles with 30 sec. dwell time. Fracture strength was evaluated using universal testing machine. Data was analyzed using One-way ANOVA.

Results

There was a statistically significant difference between Group A and all the experimental groups, p < .001. Group E showed the highest statistically significant fracture resistance mean value compared to other experimental groups, while the lowest mean value was found in Group B.

Conclusion

Though, none of the tested techniques resulted in fracture resistance similar to that of intact teeth, over-contouring technique with nanohybrid composite application showed better performances compared to the other techniques tested in the current study. Bonding plus flowable resin composite application with no additional tooth preparation and placement of a bevel are not suggested due to the low fracture strength achieved.

Effect of chamfer design on load capacity of reattached incisors

OBJECTIVE

This study aimed to evaluate the effect of different chamfer preparations on the load capacity of reattached fractured incisors under lingual loading.

METHODS

Eighty #8 typodonts were randomly assigned to four groups (n = 20 each). They were sectioned to simulate crown fracture, and reattached with a self-etch adhesive and a resin composite. The preparation for each group was: (1) no chamfer; (2) buccal chamfer; (3) lingual chamfer; and (4) circumferential chamfer. Forty-eight human lower incisors were grouped and prepared similarly (n = 12 each). These teeth were tested for their load capacity under a lingual load on a universal testing machine. Finite element models were used to examine the stresses on the reattached surfaces to help interpret the experimental results.

RESULTS

The buccal chamfer did not increase the load capacity when compared with the no-chamfer group. Lingual and circumferential chamfers respectively increased the fracture load by 36.9% and 32.3% in typodonts, and 78.5% and 33.3% in human incisors. The increase was statistically significant (p < 0.05). A higher fracture load tended to be accompanied by a larger area of deflected cohesive fracture. Finite element analysis showed that lingual and circumferential chamfers reduced the fracture-causing tensile stress at the lingual margin of the reattachment interface by approximately 70% and 60%, respectively, in human upper incisors.

SIGNIFICANCE

It was the joint design, and not the size of the bond area, that affected the load capacity of reattached incisors. Among the preparations considered, only those with a lingual chamfer could increase the load capacity of reattached incisors under a lingual load.

Reinsertion of a fractured clinical crown as a biological restoration after dental trauma

This clinical report describes the rehabilitation procedure of an upper central tooth with a coronal fracture without compromising the root. The treatment plan consisted of the reinsertion of the fractured fragment as a definitive cemented biological restoration. Due to the deficient remnant, a fiber-reinforced composite post was used. The objective of this clinical case was to report the biological behavior of the enamel and dentin of a biological restoration after dental trauma. Patient satisfaction with the treatment was achieved by continuing with the same tooth and biomimetizing the fracture line with conventional composites. Controls were conducted, and 1 year after dental trauma, no color changes in dental tissues and no inflammation in periodontal and soft tissues were observed.

Comparative Evaluation of Fracture Resistance of Incisor Fragments Using Simple, Bevel, Internal Groove Preparation Designs and Reattached with Nanocomposites: An In Vitro Study

Aim:

The aim of this in vitro study was to evaluate the fracture resistance of anterior crown fragments using three different preparation designs and reattached using two different nanocomposites.

Materials and Methods:

A total of 120 sound human permanent incisors were selected and divided into six groups. The teeth were sectioned and reattached using different preparatory designs and nanocomposites. Group A (simple reattachment with G-aenial Universal Flo), Group A2 (bevel preparation reattached with G-aenial Universal Flo), Group A3 (internal groove preparation reattached with G-aenial Universal Flo), Group B1 (simple reattachment with Polofil NHT Flow), Group B2 (bevel preparation reattached with Polofil NHT Flow), and Group B3 (internal groove preparation reattached with Polofil NHT Flow). The teeth were sectioned and reattached using different preparatory designs and nanocomposites. These teeth were then subjected to thermocycling, and fracture resistance of the reattached fragments was recorded using Instron machine.

Results:

Group A3 showed the highest fracture resistance. The least fracture resistance was seen in Group B1.

Conclusion:

The fracture resistance of reattached incisor fragments depends mainly on the preparation design incorporated and also the material used to restore. Fragments where internal groove preparatory design was done and reattached with G-aenial Universal Flo, showed greater fracture resistance. Simple reattachment preparatory design showed the least fracture resistance, and hence must be avoided.

Effect of Casein Phosphopeptide-Amorphous Calcium Phosphate on Fracture Resistance of Reattached Tooth Fragments Using Conventional and Self-Adhesive Bioactive Flowable Composite

Objectives  The present study aimed to investigate the effect of casein phosphopeptide–amorphous calcium phosphate (CPP-ACP) complex and the type of flowable composite (conventional or self-adhesive bioactive) on the fracture resistance of fractured incisors restored through reattachment technique.

Materials and Methods  In this experimental in vitro study, 60 extracted bovine central mandibular incisors were randomly divided into six groups ( n = 10) according to the reattachment technique. Their incisal edges were cut off to represent an enamel–dentin fracture. The fragment edges were reattached as follows: Group 1—selective etching and bonding followed by conventional flowable composite; Group 2—selective etching and bonding followed by bioactive flowable composite; Group 3 was like Group 2 but without applying bonding; Groups 4, 5, and 6 were similar to Groups 1, 2, and 3, respectively, but both tooth fragments were pretreated with CPP-ACP-containing paste for 3 minutes. Fracture resistance was assessed by a universal testing machine.

Statistical Analysis  Data were analyzed by SPSS—Statistical Package for the Social Sciences—software using one-way analysis of variance and Tukey post-hoc tests (α= 0.05).

Results  The highest and lowest fracture resistance was recorded in Groups 5 (15.96 MPa) and Group 6 (1.95 MPa), respectively, being significantly different from the other groups. The mean fracture resistance of Groups 3 and 6 was significantly lower than the other groups ( p < 0.05). However, Groups 1, 2, and 4 showed no difference in fracture resistance.

Conclusion  Bioactive composite was not superior to conventional composite for fragment reattachment, but using it in self-adhesive mode reduced the fracture strength significantly. Yet, pretreatment with CPP-ACP, followed by application of adhesive, improved the fracture resistance of bioactive composite.

Management of Complicated Crown-Root Fracture by Extra-Oral Fragment Reattachment and Intentional Reimplantation with 2 Years Review

Trauma with an accompanying fracture to the anterior teeth gives an agonizing experience for a young individual due to the physical disfigurement and the psychological impact that is imposed on them. This paper reports a case of complicated crown-root fracture in a young child that was treated by extra-oral fragment reattachment followed by the intentional reimplantation. The tooth was endodontically-treated followed by the placement of fiber-reinforced composite post. The fragments were reattached extra orally following an atraumatic extraction. The tooth was then reimplanted back into the socket followed by splinting. Clinical results were successful after 2 years. This case report demonstrates the importance of modifying a treatment protocol to maintain esthetics up to the completion of the developmental period.

Long-term Follow-up of Complicated Crown Fracture With Fragment Reattachment: Two Case Reports

Two cases of complicated crown fracture of the maxillary incisors were restored using the fragment reattachment technique. Root canal treatment was performed, and the fractured fragment was bonded to the tooth structure using a dentin adhesive system and a flowable composite resin, followed by the insertion of a fiber post using dual-cured resin cement. Reattached fragments have shown reliable prognosis without inflammatory signs around bonded junctions after long-term follow-up.

Influence of Storage Media and Duration of Fragment in the Media on the Bond Strength of the Reattached Tooth Fragment

Introduction

Fracture of anterior teeth is the most frequent type of injury in the permanent dentition. Composite materials have made possible the use of adhesive materials and techniques, but storage of fragment in the media can enhance the bond strength. The purpose was to evaluate the influence of storage media and duration of the fragment in the media on the bond strength of the reattached fragment of teeth.

Materials and methods

A total of 104 permanent maxillary central incisors were included. Samples were divided into four groups of 26 teeth each, further divided into eight groups of 13 teeth each and sectioned 3 mm apical to the incisal edge and stored in four storage media—tap water, artificial saliva, sodium fluoride, and Tooth Mousse at 12 and 24 hours. The bond strength was measured by universal strength testing machine.

Results

Tooth Mousse showed statistically significant difference (p-value 0.001) compared with sodium fluoride, artificial saliva, and tap water when stored in both 12 and 24 hours’ duration.

Conclusion

Tooth Mousse was a better storage media when compared with sodium fluoride, artificial saliva, and tap water.

Clinical significance

Tooth Mousse can be considered as a best storage media for fragment reattachment.

How to cite this article: Jalannavar P, Tavargeri A. Influence of Storage Media and Duration of Fragment in the Media on the Bond Strength of the Reattached Tooth Fragment. Int J Clin Pediatr Dent 2018;11(2):83-88.

Fracture resistance of reattached fragments using three different techniques with emphasis on vertical grooves and fiber-reinforced composite post: A novel technique

Background:

The aim of this study was to evaluate and compare relatively less explored fragment reattachment methods following traumatic injury.

Materials and Methods:

Eighty sound permanent maxillary incisors were selected and mounted in acrylic blocks. Teeth were sectioned using the diamond disc and randomly divided into 4 groups (n = 20), Group A, B, C, D. In Group A, after reattachment with composite, a 1 mm-depth circumferential chamfer was placed in the fracture line using a diamond disc bur and filled with composite. In Group B, two vertical grooves 1 mm deep, 1 mm wide, and 4 mm length were placed on the labial surface perpendicular to the fracture line and filled with two fiber-reinforced composite (FRC) posts and composite. In Group C, dentin is removed from the fragment and filled with composite. In Group D, the teeth were intact which served as control group. The force required to fracture the reattached teeth were recorded in Newton's using an onscreen calibration tool of the universal testing machine.

Results:

Teeth in Groups A, B, C required lesser force to fracture when compared with the teeth of the Group D. When compared to Group D, Group A showed a fracture resistance of 36%, Group B 62%, and Group C 32%.

Conclusion:

This study proves that reattachment by vertical grooves with FRC posts showed highest fracture resistance and it is the most preferred method. So far no attempt has been made to reattach fractured fragment using vertical grooves and reinforcing with FRC posts.

Clinical Performance and Epidemiologic Aspects of Fractured Anterior Teeth Restored with a Composite Resin: A Two-Year Clinical Study

PURPOSE

To investigate the etiologic factors, effect of age and gender on dental trauma, and to evaluate the performance of composite resin on the fractured crown of permanent anterior teeth.

MATERIALS AND METHODS

Over a 2-year period, 73 permanent teeth from 51 patients with dental trauma were treated with direct composite resin restoration. Informed consent and standardized trauma forms were completed by the patient; teeth were restored with a submicron hybrid composite resin (Spectrum TPH) and respective adhesive system (Prime&Bond NT). Sixty-nine teeth were directly restored without fiber posts, while four were treated with fiber posts. Two experienced clinicians, besides the operator, evaluated each restoration at 6-, 12-, and 24-month follow-ups according to US Public Health Service (USPHS) criteria for the following characteristics: anatomical form, marginal adaptation, color match, marginal discoloration, surface roughness, and caries. Data were analyzed using the Wilcoxon Signed Rank, Kruskal-Wallis, Mann-Whitney U, and Siegel and Castellan tests.

RESULTS

A total of 73 traumatized teeth in 51 patients aged from 14 to 64 years (mean age 25.47 ± 14.058 years) were assessed according to the Ellis classification and restored over a 2-year period. Crown fractures were more common in the maxilla (84.9%) and caused by falls (58.8%). At the end of 24 months, a total of ten restorations were lost. The survival rate after 24 months was 82.14%. There were statistically significant differences in marginal adaptation between the 6-, 12-, and 24-month follow-ups. Although changes in marginal discoloration over time were not significant (p = 0.194), changes in color match were significant (p = 0.029).

CONCLUSION

Within the limitations of this study, direct composite restorations were accepted as clinically satisfactory.

The Coronal Tooth Fractures: Preliminary Evaluation of a Three-Year Follow-Up of the Anterior Teeth Direct Fragment Reattachment Technique Without Additional Preparation

Objective:

The aim of this research is to describe and to analyse the long-term results and the clinical steps of direct fragment reattachment technique with no additional tooth preparation, used to treat crown fracture. This technique achieves the clinical success, combining satisfactory aesthetic and functional results with a minimally invasive approach.

Methods:

The 3 years follow-up included 9 patients (5 males, 4 females) with coronal fracture. In all the cases the fragment was available and intact. The authors illustrate the adhesive procedure used. Under local anaesthesia and after positioning the rubber dam, both the tooth and the fragment surface were etched, rinsed and applied by the adhesive system in order to obtain the retention of the fractured part to the tooth without additional tooth preparation or resin cement.

Results:

The statistical analysis shows the good performances of direct fragment reattachment technique. After 36 months, in 22.2% of the cases, the detachment was observed of the bonded fragment and in 11.1% of patients, complications were recorded.

Conclusion:

Our clinical experience shows how the ultra-conservative procedure used is fast, easy and offers a long term predictability; it also allows good functional and aesthetic outcomes.

Influence of Root Canal Posts on the Reattachment of Fragments to Endodontically Treated Fractured Incisors: An in vitro Experimental Comparison

OBJECTIVE

The aim of this study was to establish the benefits of inserting a fiberglass post when bonding tooth fragments after complicated coronal fractures.

METHODS

Thirty bovine incisors were randomly assigned to three groups: a control group of intact teeth (A), and two experimental groups (B and C). Coronal fragments were cut from the teeth in groups B and C, which then underwent root canal treatment, inserting posts in the teeth in group C. The coronal fragments were bonded to the teeth in both experimental groups using the same materials and technique, then the specimens were submitted to mechanical loading until fracture.

RESULTS

The specimens in the experimental groups had a lower resistance to mechanical loading than the intact teeth. The mean failure load was: 352.77 (SD ± 62.22) N in group A, 151.04 (SD ± 45.76) N in group B, and 168.61 (SD ± 33.59) N in group C. The difference between group A and the other two groups was statistically significant (analysis of variance test: p < 0.0001), whereas there was no statistically significant difference in the force needed to fracture the teeth in groups B and C (Tukey's test: p = 0.34). When the failure mode under loading was examined, the fractures in group C never involved new tooth substance beneath the adhesion interface, whereas in group B, this was only true in one in two cases.

CONCLUSIONS

Inserting a post does not significantly improve the strength of restored teeth, but it may result in a more favorable fracture mode.

CLINICAL SIGNIFICANCE

Within the limitations of this in vitro study, reattaching the fragment of a fractured tooth does not seem to restore the tooth to its original load resistance. The findings of this study indicate that inserting a fiberglass post for reinforcement purposes in fractured teeth undergoing root canal treatment is unable to significantly improve their load-bearing capacity by comparison with teeth repaired without inserting a post. However, the results of the present study suggest that inserting a post may result in a more favorable fracture mode in the event of further trauma.

Multidisciplinary Management of Complicated Crown-Root Fracture of an Anterior Tooth Undergoing Apexification

The purpose of this case report was to present the multidisciplinary management of a subgingival crown-root fracture of a patient undergoing apexification treatment. A 12-year-old male patient was referred to the pediatric dentistry clinic with an extensive tooth fracture of the right permanent maxillary lateral incisor. Clinical and radiographic examinations revealed the presence of a complicated crown-root fracture, which had elongated to the buccal subgingival area. The dental history disclosed that the apexification procedure had been started to be performed after his first trauma experience and he had neglected his appointment. The coronal fragment was gently extracted; endodontic treatment was performed; flap surgery was performed to make the fracture line visible. The coronal fragment was reattached to the root fragment with a dual-cure luting composite. A fiber post was stabilized and the access cavity of the tooth was restored with composite resin. At the end of the 24th month, the tooth was asymptomatic, functionally, esthetically acceptable and had no periapical pathology. It is important for the patients undergoing apexification treatment to keep their appointments because of the fracture risk. Restoration of the fractured tooth by preparing retention grooves and a bonding fiber-reinforced post are effective and necessary approaches for successful management.

Tooth fragment reattachment: a case report

The aim of this article is to present a case report for the multidisciplinary treatment of anterior tooth fractures with invasion of the biologic width and pulpectomy. Successful esthetic and functional results were achieved by bonding the crown fragment, without any form of preparation or the utilization of intracanal posts.

In vitro fracture resistance of mandibular incisors restored with modified partial-coverage ceramic restorations

BACKGROUND/AIM

The aim of this in vitro study was to investigate the impact fracture resistance of anterior teeth that had been fractured and restored with modified partial-coverage ceramics using the edge-up technique.

MATERIAL AND METHODS

A total of 178 extracted human mandibular central and lateral incisors were included in this study. The incisors were randomly divided into two groups. Group 1 (n = 89) teeth were cleaved and restored with modified partial-coverage ceramics using the edge-up technique; Group 2 (n = 89) consisted of intact teeth that served as control. Impact strength was tested in a modified impact testing machine (pendulum type), and the severity of crown fracture after fracture resistance test was registered.

RESULTS

Impact strength was insignificantly lower in restored teeth (median 5.39 and range 0.81-14.12 kJ m(-2) ) than in intact teeth (median 5.45 and range 0.31-16.47 kJ m(-2) ), although no statistically significant differences were observed. Regarding the severity of crown fracture, restored teeth showed a lower rate of severe fractures (20.22%) compared to intact teeth (25.84%), but no statistically significant differences were observed.

CONCLUSIONS

Restoration of cleaved mandibular incisors with modified partial-coverage ceramics using the edge-up technique shows fracture resistance and severity of crown fracture following traumatism similar to intact teeth. In this way, this technique can be used successfully for the treatment of fractured anterior teeth.

Utilization of different management concepts in fractured tooth fragment reattachment: a report of three cases

Traumatic injuries of teeth involve varying degrees of damage to the supporting soft tissues or the teeth itself. A very common injury to the permanent dentition affecting children and adolescents during their growing years is the anterior crown fracture. Recent developments in restorative material, placement techniques, preparation designs, and an adhesive protocol allow clinicians to predictably restore fractured teeth. With the advent of adhesive dentistry the process of fragment reattachment has become simplifed and more reliable. This procedure provides an improved function, is relatively faster to perform and at the same time provides long lasting esthetics. This paper discusses various innovative techniques of fracture reattachment depending on the complexity of the case.

Preservation of coronal tooth fragments prior to reattachment

BACKGROUND

Reattachment of the tooth fragment is a well-accepted treatment option in dealing with crown fractures. Hydration of the fragment is an important aspect in this treatment. The present study evaluated the effect of storing fragments in different storage media prior to reattachment.

METHODS

Sixty bovine incisors were randomly divided into five groups. The teeth were fractured and the fragments were dried for 48 hours and then immersed in one of the four experimental media (distilled water, milk, egg white, or 50% dextrose solution) for 2 hours. Tooth fragments in the control group were kept dry. The apical segments of the fractured teeth were stored in physiological saline. Fragments were reattached and force was applied on the labial side of the teeth at a 1 mm/min rate until failure.

RESULTS

One-way ANOVA indicated that the storage medium affects bond strength (p = 0.002). Multiple comparison tests showed that the teeth preserved in the 50% dextrose solution and the egg white exhibited significantly higher bond strengths compared to the control group (p < 0.05).

CONCLUSIONS

Preservation of the fractured tooth fragment in egg white or hypertonic solutions results in a higher strength of the bond between the restoration and the tooth as compared to storage in water or dried conditions.

Prevalence and treatment demand after traumatic dental injury in South Brazilian schoolchildren

BACKGROUND

Evaluation of the frequency and need for treatment of dental trauma is critical for both planning and establishing dental services and preventive programs.

AIM

This cross-sectional study evaluated the prevalence of dental trauma, need for treatment and factors associated with dental visits after an injury.

SUBJECTS AND METHODS

A multistage sample of children aged 8-12 years, from 20 private and public schools in Pelotas/Southern Brazil, was considered. Socioeconomic information was collected from parents, and data regarding traumatic events were obtained from the children. Clinical examinations were conducted using validated criteria. Descriptive analysis and logistic regression were used to assess the factors associated with search for treatment after injury.

RESULTS

A total of 1210 children were included, 153 (12.6%, 95% CI 10.8-14.6) of whom suffered dental trauma, with a total of 175 traumatized teeth. The most frequently observed type of injury was enamel fracture, affecting 129 (73.7%) teeth, of which 107 did not require restorative treatment. A total of 68 (38.8%) teeth required care, of which 24 (13.7%) received treatment. Of the children who recalled the trauma, 39 (36.5%) sought treatment, which was significantly associated with both higher maternal education (OR 2.75; 95% CI 1.18-6.41) and trauma severity (OR 7.71; 95% CI 3.17-18.75).

CONCLUSIONS

The prevalence of traumatic injuries was relatively high in this population. Although most of the traumatized teeth did not require treatment, dental care was neglected, as most of the children were not taken to a dentist for evaluation. Also, there was a considerable demand for treatment, most of them of low complexity. Special attention should be given to children whose mothers have completed fewer years of education, as the mother's level of education was an important predictor of evaluation by a dentist after injury.

Tooth fragment reattachment technique on a pluri traumatized tooth

This case report describes and analyses a tooth fragment reattachment technique used to resolve crown fractures of the anterior teeth. This treatment allows a conservative approach to traumatic coronal lesions offering a better possibility of maintaining aesthetics and function. The authors have illustrated here a clinical case of a fractured incisor. This case is characterized by several traumas on the same tooth that required different therapeutic solutions. We used an easy and ultra-conservative technique without any tooth preparation in the first and third traumatic injuries. In the second trauma, a direct restoration of the fractured tooth was performed. The adhesive reattachment is a simple system to achieve good aesthetic and functional results.Our clinical experiences demonstrated that, when tooth and fragment margins are intact, the reattachment technique without any tooth preparation is a simple and predictable procedure. Quality of adhesion is shown by the retention of the reattached fragment in the second trauma that caused only partial enamel fractures.

Hydration and Dehydration Periods of Crown Fragments Prior to Reattachment

Introduction

Tooth fragment bonding is an excellent treatment option in dealing with traumatic injuries of the anterior teeth. Rewetting the tooth fragment has been shown to increase restoration durability. The present study examined the effect various dry and wet storage periods had on the reattached fragment's bond to the tooth.

Materials and Methods

One hundred and eight human mandibular incisors were fractured and assigned to undergo a dehydration period of 30 minutes, six hours, 24 hours, or three days before the rewetting procedure. After fracturing the teeth and drying the fragments, each of the specimens was assigned to one of the three main groups (A, B, or C) intended to evaluate the effect of different rehydration periods. Groups A and B underwent a 30-minute and a 24-hour rewetting period, respectively. Group C served as a control (without a rewetting stage). Tooth fragments were then reattached and prepared for the strength test. Force was applied on the lingual side of the tooth at a 1 mm/min rate until failure.

Results

The mean loads (N) required to fracture the restored teeth were as follows: 204.43 ± 33.48 N, 322.59 ± 34.62 N, and 253.25 ± 29.05 N for groups A, B, and C, respectively. Two-way analysis of variance (p&lt;0.05) showed that rehydration and dehydration periods as well as their interaction caused significant differences in the strength of the final restoration. Multiple comparison tests showed that, in general, significant differences were not seen among different dehydration times prior to the rewetting stage (p&gt;0.05), except in the case of the 30-minute dehydrated specimens (p&lt;0.05).

Conclusion

Compared to a 30-minute period, a 24-hour rehydration of the tooth fragment before treatment seems to salvage enough moisture to result in an increase in reattachment strength.

A conservative approach toward restoration of fractured anterior tooth

Reattachment of the fractured anterior tooth is a highly conservative and aesthetic treatment that has gained popularity in the recent past. Presented here is one such case in which a combination of external enamel bevel and internal dentinal groove has been used to enhance the bonding between the fractured fragment and the remaining tooth. The treatment was found to be successful both functionally and aesthetically at the 18-month follow-up.

Adhesive tooth fragment reattachment with intentional replantation: 36-month follow-up

Crown-root fracture is one of the most challenging fracture types in dental traumatology literature. Aesthetic and functional rehabilitation is the primary goal of the treatment of crown-root-fractured tooth. For this purpose, reattachment of the fragment to its original position is a good choice. This paper reports a case of an adhesive fragment reattachment of a complicated crown-root fracture with intentional replantation in a 9-year-old girl patient and 36-month follow-up.

Shear bond strength of restorations applied to un-complicated crown fractures: an in vitro study

BACKGROUND

Study was designed to evaluate shear bond strengths of different restorative techniques of uncomplicated enamel-dentin fractures in permanent incisors.

MATERIAL AND METHODS

Forty human mandibular incisors were divided into four groups. One-third of their anatomical crowns from the incisal edges were cut off in three groups, representing an uncomplicated enamel-dentin fracture. Intact teeth in group 1 were used as control. In group 2, edge fragments were reattached by flowable composite (Filltek Flowable Supreme XT). In group 3, teeth were restored with universal resin composite (Filtek Z 250). In group 4, pre-impregnated glass fiber sheet (everStickNet) was positioned onto fractured surface, and then restorations were completed with resin composite. Three-step etch-and-rinse adhesive system (Adper Scotchbond Multi Purpose) was used in all test groups. Shear bond strengths of all samples were determined in universal testing machine, and data were analyzed with Kruskal-Wallis followed by Mann-Whitney U tests. Failure types were observed by light microscope.

RESULTS

Shear bond strength of sound teeth was significantly higher than those of restored teeth (P < 0.05). Mean shear bond strengths of the reattached teeth were lower than the other two restoration types; however, differences were not statistically significant (P > 0.05).

CONCLUSIONS

Load-bearing capacity of restored teeth was not as high as sound teeth in the uncomplicated crown fracture. However, shear bond strength of different types of restorations seems close to each other.

Fracture resistance of microhybrid composite, nano composite and fibre-reinforced composite used for incisal edge restoration

Traumatized anterior teeth need quick, aesthetic and functional repair. Along with aesthetics, the physical properties of restorative material should also be considered for long-lasting restoration. Fibre reinforcement has been tried as a newer technique to improve the physical properties of composite materials. Hence, this study was carried out to evaluate the fracture resistance of microhybrid composite, nano composite and fibre-reinforced composite used for restoration of incisal edge of fractured maxillary central incisors. Extracted permanent maxillary central incisors were randomly divided into four groups of 10 samples each: control group with intact teeth (Group A), microhybrid composite (Esthet X; Dentsply/Caulk, Milford, DE, USA) (group B), nano composite (Ceram X; Dentsply/Caulk) (group C) and microhybrid composite reinforced with polyethylene fibre - flowable composite unit [(Ribbond THM; Ribbond Inc., Seattle, WA, USA; Esthet X flow; Dentsply/Caulk)] (group D). The fracture resistance was measured under universal testing machine at a speed of 1mmmin(-1) with the loading tip of 2mm diameter. The samples were further evaluated for mode of fracture under stereomicroscope at 3.5× magnification. The data were analysed using one-way anova and Tukey's test for fracture resistance. Group A and group D exhibited significantly higher fracture resistance than group B and group C. No significant difference was found between group B and group C as well as between group A and group D. Fisher's exact test for the mode of fracture revealed no statistical significance. It was concluded that fibre reinforcement of composite could be an alternative technique for restoration of fractured anterior teeth for better aesthetics and longevity of the restoration.