Reattachment of rehydrated dental fragment using two techniques

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.

Analyzing the Impact of Different Bonding Protocol Strategies to Improve the Fracture Resistance of Uncomplicated Crown Fractures on Tooth Fracture Reattachment in Permanent Anterior Teeth: An In-vitro Study

Objective This study aims to analyze three different bonding protocol strategies in determining the fracture resistance on the reattachment of fragments in permanent anterior teeth. Methodology This study evaluated the ability of three bonding methods (Group A, total-etch technique; Group B, selective-etch technique; and Group C, self-etch technique) to enhance the fracture resistance of reattached tooth fragments. Sixty permanent maxillary central incisors were chosen, segmented at 3 mm from the incisal edge, and randomly distributed among the three groups. Tooth fragments were stored for 24 hours in GC Tooth Mousse (GC Corporation, Tokyo, Japan), and then reattachment was done using respective bonding techniques. Fracture resistance was gauged using a universal testing machine. Results The mean fracture resistance values were as follows: total-etch (419.5995 N), selective-etch (359.1448 N), and self-etch (192.0887 N). One-way analysis of variance (ANOVA) and post hoc Tukey tests revealed a statistically significant difference between the groups. It was inferred that the total-etch technique exhibited the highest fracture resistance, while the self-etch technique resulted in the lowest fracture resistance (P < 0.05). Conclusions The choice of bonding technique for reattaching tooth fragments should be made based on clinical context and patient needs. Total-etch provided the highest fracture resistance, but selective etch can be preferred for anterior teeth with lower occlusal loads to prevent sensitivity. The self-etch technique may not provide sufficient strength and should be used cautiously. More clinical studies are required to validate these findings and guide clinical decision-making in traumatic dental injury management.

Evaluation of two rehydration protocols for fractured tooth fragments for characteristics of penetration of resin tags using confocal laser scanning microscopy

BACKGROUND

Fragment reattachment is the recommended treatment modality in uncomplicated crown fractures. There is a paucity of literature regarding the mechanisms responsible for increased resistance to fracture after fragment rehydration in such cases. Hence, the aim of this proof-of-concept study was to decipher the microscopic changes in the penetration characteristics of resin in tooth fragments after different rehydration protocols.

MATERIAL AND METHODS

Sixty bovine incisors free of structural deformities were fractured as per a standard protocol and the fragments were stored in saline at 4°C. They were randomly allocated into three groups (n = 20)-Group 1: negative-control, no-rehydration, Group 2: rehydration by immersion in distilled water for 15 min, Group 3: rehydration by humidification for 15 min. They were subjected to the "experimental bonding protocol" using an eighth-generation bonding agent mixed with rhodamine-B dye. The samples were subjected to decalcification and sectioned into cubical blocks (2 × 2 × 2 mm3 ). They were embedded in paraffin wax, sectioned by an ultramicrotome and evaluated by using a confocal laser scanning microscope. The depths and width of the resin tags were assessed by image analysis software, and the number of tags was counted manually by blinded evaluators. Statistical analysis was done with Stata-14.

RESULTS

The depth of penetration of the resin tags was greatest in Group 2 (927.81 ± 280.38 μm) followed by Group 3 (902.03 ± 371.85 μm) and Group 1 (287.74 ± 124.80 μm). Similarly, the width of the penetrated resin tags was greatest in Group 2 (58.29 ± 21.15), followed by Group 3 (35.53 ± 22.15) and Group 1 (23.89 ± 6.88). The number of resin tags in the majority of the samples in Group 1 had less than 25 tags (65%), whereas there were more than 25 tags in Group 2 (70%) and Group 3 (75%). These differences were statistically significant (p < .05).

CONCLUSION

The resin penetration, as observed by the number of tags and their depth and width, was significantly affected by the rehydration of the fragments. The fragments rehydrated in the distilled water had greater penetration of resin tags than those rehydrated in a humidification chamber.

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.

Fracture Resistance of Reattached Hydrated Fragment of Fractured Incisors

Background and objectives

Fragment reattachment procedure provides conservative treatment option when an intact fractured fragment is available. Rewetting of fractured fragment before reattaching has shown better bond strength of attached fragment. Therefore, fracture resistance of reattached fractured fragment with hydration and without hydration was evaluated and compared.

Materials and methods

Ellis class II fracture was induced in selected and coded 60 extracted maxillary central incisors using a custom-made-wise and assigned into group I and group II (without hydration and with hydration) and both the groups were further divided into two groups (1 week and 3 months). In group I, fractured fragments were reattached after bench-drying for 24 hours. In group II, fractured fragments were reattached after hydrating for 1 hour following bench-drying for 24 hours. Composite (Filtek Z350 XT, Universal Restorative, 3M ESPE) was used to reattach the fractured fragments. Reattached fractured fragments were stored in artificial saliva for 1 week and 3 months and subjected to fracture resistance test using Universal Testing Machine. The data obtained were tabulated and statistically analyzed.

Results

Fracture resistance in hydration samples was higher than without hydration at the end of 1 week and 3 months statistically. Fracture resistance of fractured fragment at the end of 3 months was higher in both with hydration and without hydration but was not significant with hydration.

Conclusion

Hydration of fractured fragment before reattachment procedure has shown better fracture resistance and improved further after storing in artificial saliva for 3 months.

How to cite this article

Suresh M, Mallikarjun SB, Babu G, et al. Fracture Resistance of Reattached Hydrated Fragment of Fractured Incisors. Int J Clin Pediatr Dent 2020;13(5):476-480.

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.

Fragment reattachment after complicated crown-root fractures of anterior teeth: A systematic review

BACKGROUND/AIM

Fragment reattachment is a procedure that can immediately restore form and function in crown-root fracture cases and is considered a minimally invasive and cost-effective treatment option. The aim of this systematic review was to analyze the methods used and the outcome of fragment reattachment for complicated crown-root fractures of anterior teeth.

MATERIALS AND METHODS

Five electronic databases (PubMed, Web of Science, Embase, Scopus, and Google Scholar) were searched for English language articles regarding fragment reattachment after complicated crown-root fractures of anterior teeth.

RESULTS

Twelve case reports and two case series were selected for this review after applying the inclusion and exclusion criteria. In eleven articles, the fracture line was exposed prior to reattachment. Root canal treatment was performed in all cases except one, where conservative pulp treatment was done prior to reattachment. A post was used as part of the restoration in 85% of the cases. Additional fragment preparation was done in 42% of the cases in the form of beveling and groove formation. Adhesive strategies used to reattach the coronal fragments were total-etch, self-etch, or self-cure adhesive. Intermediate materials used for reattachment were resin cement, glass-ionomer cement, composite and self-adhesive cement. Treatment outcomes were favorable in all the included articles and the follow-up period ranged from three months to seven years.

CONCLUSION

Fragment reattachment after complicated crown-root fractures of anterior teeth can be considered as a viable treatment option if the clinical conditions are favorable.

Reattachment of fractured teeth using a multimode adhesive: Effect of different rewetting solutions and immersion time

BACKGROUND/AIMS

Following coronal tooth fracture, keeping the fragment hydrated is of the utmost importance in the tooth fragment bonding technique. The aim of this study was to evaluate the effects of different immersion times in different storage media on multimode adhesive bonding between reattached fragments and teeth.

MATERIALS AND METHODS

A total of 195 bovine incisors were fractured and randomized into the following storage groups (n = 15): G0-control group (sound tooth); GA-saline solution: for 1 hour (A1) or 24 hours (A2); GB-artificial saliva: for 1 hour (B1) or 24 hours (B2); GC-coconut water: for 1 hour (C1) or 24 hours (C2); GD-tap water: for 1 hour (D1) or 24 hours (D2); GE-milk: for 1 hour (E1) or 24 hours (E2); GF-dry (dehydration): for 1 hour (F1) or 24 hours (F2). Tooth fragments were then reattached using a multimode adhesive in a self-mode technique with a flowable resin composite. Fracture resistance was evaluated in a universal testing machine under a compressive load (1 mm/min). The data were submitted to two-way analysis of variance and the post hoc Tukey test (5%).

RESULTS

The group submitted to the dehydration factor (GF) exhibited a mean value of 599.1 ± 144.2 N, while those submitted to all hydration protocols (GA, GB, GC, GD, GE) exhibited a mean value of 751.8 ± 285.4 N. Dehydration significantly affected the fracture strength values (P = .005). No significant interaction between the rewetting solutions was observed (P > .05).

CONCLUSIONS

Hydration of the tooth fragment increased fracture resistance, regardless of the storage solution and/or immersion time.

Comparative evaluation of fracture resistance using two rehydration protocols for fragment reattachment in uncomplicated crown fractures

BACKGROUND/AIMS

Uncomplicated crown fracture is the most common traumatic dental injury. The International Association of Dental Traumatology has recommended fragment reattachment as the best method for restoring uncomplicated crown fractures of permanent teeth. Dehydration can affect fracture resistance after reattachment. However, a standard protocol for rehydration is still lacking. Hence, the aim of this study was to design a humidification chamber and assess its efficacy for improving the rehydration of tooth fragments and increasing fracture resistance after reattachment.

MATERIALS AND METHODS

Sixty mandibular bovine incisors with similar dimensions and free of any structural deformities were fractured and randomized into five groups: Group I, Control Group (sound teeth); Group II (dehydrated for 24 hours); Group III (rehydrated in distilled water for 15 minutes); Group IV (rehydrated in a humidification chamber for 15 minutes); and Group V (restored with composite). A humidification chamber was designed and used for rehydration for 15 minutes in Group IV. Fragments in Group III were immersed in distilled water for 15 minutes. Reattachment procedures and materials remained the same in all groups. Fracture resistance was tested in a universal testing machine, and statistical analysis was done by Stata-14.

RESULTS

The Control Group with sound teeth (Group I) exhibited a maximum value of 282 ± 10.32 N, while Group II (fragment reattached without rehydration) had the least fracture resistance, 49.75 ± 5.2 N. Rehydration by means of the humidification chamber protocol (Group IV) resulted in significantly higher fracture resistance (150.54 ± 6.49 N) than in Group III (rehydration by means of immersion).

CONCLUSIONS

Fracture resistance after fragment reattachment was significantly affected by the rehydration of fragments for 15 minutes in the humidification chamber. Fragment reattachment after rehydration showed better fracture resistance than the composite restorations.

Long-term results of crown fragment reattachment techniques for fractured anterior teeth: A retrospective case-control study

OBJECTIVE

Among the techniques used by pediatric dentists for the crown fracture is the fragment reattachment. The aim of this study was to evaluate the long-term survival of the tooth reattachment in comparison to the composite restoration technique.

METHODS

The study included 67 patients aged 7-9 years (males 38/56.7%; females 29/43.3%), with noncomplicated fractures of permanent teeth. The patients were divided into two groups; group A included 32 patients (males 18/56.2%; females 14/43.8%; total number of affected tooth 36), and group B comprised 35 patients (males 20/57.1%; females 15/42.9%; 36 affected tooth). In group A patients the reattachment was conducted after the trauma, and the direct composite restoration technique was used for patients in group B. All patients were evaluated for complications and pulp status for 5 years.

RESULTS

There were no significant differences (P > 0.05) in terms of the occurrence of complications observed between groups throughout the 5-year observation period.

CONCLUSION

Both methods provide similar results over the 60 months of observation.

CLINICAL SIGNIFICANCE

Reattachment technique has shown to be a reliable treatment option that might be considered as a primary technique when the fragment is saved after the trauma.

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.

Multidisciplinary Treatment of Complicated Crown-Root Fractures: A Case Study

Traumatic dental injuries usually occur among children and adolescents, with maxillary central incisors as the most often affected teeth. Complicated crown-root fractures are particularly challenging for esthetic and functional rehabilitation and often require a multidisciplinary approach. A 21-year-old male patient came to the Dental Clinic due to fractured maxillary incisors caused by trauma during a sporting activity. Clinical examination revealed horizontal fractures of teeth 7, 8, and 9, initiating in the labial cervical third and extending subgingivally on the palate, with exposed pulp tissues. On provisional repositioning and splinting the fragments, root canal treatment was performed. Definitive repositioning was accomplished by raising a full-thickness gingival flap, using fiber-reinforced composite posts, by an endodontist and an oral surgeon. Reattachment was accomplished under surgical conditions to ensure precise positioning of fragments by exposing the palatal aspect of the fracture lines and providing a dry operating field. Definitive composite resin veneers were performed after seven days.

Effect of storage media on fracture resistance of reattached tooth fragments using G-aenial Universal Flo

Background:

Over a period of the past few years’ episodes of dental trauma more commonly coronal fractures of anterior teeth are being increasingly reported in children. Fragment reattachment can be considered as a valid treatment option in such situations. However, ideal medium for storage of fragments before reattachment needs to be explored.

Aim:

To compare the fracture resistance of incisor tooth fragments stored in four storage media: Dry air, milk, coconut water, or egg white before reattaching them with G-aenial Universal Flo.

Materials and Methods:

Forty-eight freshly extracted maxillary incisors were divided into four groups. Teeth were then sectioned, and fragments were stored in dry air (Group I), milk (Group II), coconut water (Group III), and egg white (Group IV). The fragments were reattached using simple reattachment technique and tested on the Universal Testing Machine. Statistical analysis was performed using one-way analysis of variance and post hoc Tukey's test.

Results:

There was statistically significant difference (P < 0.05) in fracture resistance values between the groups. The highest fracture resistance value was demonstrated by Group II, whereas least fracture resistance values were observed in Group IV.

Conclusion:

Along with milk, coconut water being tested for the first time can be considered a viable alternative.

Management of crown root fracture by interdisciplinary approach

Fracture of tooth after trauma is distressing to a person because of the discomfort and pain due to pulpal injury. Crown root fractures of anterior teeth cause concomitant periodontal injury and there will be concern about appearance, and aesthetics. Management of pulpal and periodontal tissue relieves pain and restoration of tooth form regains patients confidence. Restoration of fractured tooth will be accepted readily if it is minimally invasive, less expensive, and aesthetically acceptable. Reattachment is an option for restoration of anterior teeth compared to other artificial replacements because of its appearance as natural. This method is favourable when the fractured fragment is intact and available. Utilization of pulp space for retention of fragment is achieved by the insertion of a dentine bonding post. This case report describes a case of tooth reattachment after trauma in which the pulp space is utilized to bond a fiber-reinforced post for retention after periodontal tissue management.

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.

Clinical management of a complicated crown-root fracture using autogenous tooth fragment: A biological restorative approach

Trauma resulting in crown-root fracture is one of the most challenging fracture types. However, biologic width involvement should be carefully evaluated. Reattachment of tooth fragment to a fractured tooth remains as the treatment of choice because of its simplicity, natural esthetics, and conservation of tooth structure. The reattachment procedure using composite resin should be considered if the subgingival fracture can be exposed to provide isolation. This report presents a case of complicated crown-root fracture of permanent maxillay left central incisor, involving the biologic width in a 10-year-old girl. The traumatized tooth was treated endodontically. Access to the subgingival margins was gained by orthodontic extrusion followed by gingivectomy. The fractured fragment was reattached using bonding system and composite resin.

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.

Tooth fragment reattachment: the natural restoration

The aim of this manuscript was to discuss some important considerations about tooth fragment reattachment and report the success of a clinical case in which a tooth fragment and direct composite resin were used to restore a fractured anterior tooth. Clinical and radiographic examination 12 months after trauma showed good esthetics and periodontal health.

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.

Effect of storage environment on the bond strength of reattachment of crown fragments to fractured teeth

Aim:

The aim of this study was to examine various storage environments for storing fragments before being bonded to the remaining teeth and also estimate the required force to fracture the restored teeth.

Materials and Methods:

Sixty mandibular incisor teeth were fractured on the incisal one-third and were divided into five groups of 12 each to be stored in normal saline, water, milk, saliva and dry environments for 24 hours. All the fractured parts in each group were bonded to their relevant apical parts by an etch and rinse bonding system and a flowable composite resin. The fracture resistance was measured by a universal testing machine, and the results were analyzed using one-way ANOVA and Tukey statistical tests.

Results:

The results revealed that the difference among the five groups was statistically significant (P<0.001). Tukey tests showed that the force required for fracturing fragments kept in the milk and saliva environments were significantly higher than those for the normal saline, water and dry environments (P<0.05 ).

Conclusions:

It was concluded that keeping the fractured parts in milk and saliva environments can increase the required force for fracturing teeth more than the other environments.

Clinical management of a fractured anterior tooth with reattachment technique: a case report with an 8-year follow up

Fracture of anterior teeth is a relatively common outcome of trauma to the teeth. If the fractured teeth fragments are recovered by the patient and brought to the dental office within reasonable time, the fragments may be reattached to the remaining tooth structure. This article presents a case of a 15-year-old male patient with fractured left maxillary lateral incisor. The fragment reattachment was performed using dual-cured composite resin cement and the treatment outcomes of an 8-year follow up were presented. The technique described in this case report for reattachment of the fractured fragments is simple, while restoring providing long-lasting esthetics and improved function with a very conservative approach.

Alternative treatment procedure in the case of fractured abutment of adhesive bridge: a clinical report

In this case report, an alternative approach was presented for treatment of coronal fracture including pulp of maxillary central incisor, one of the abutments of an adhesive bridge, by using fiber post and tooth's own fractured component. The patient was referred to our clinic with the complaint of pain from the upper right central incisor and mobility of the adhesive bridge in maxillary anterior segment. It was realized that, the upper right central incisor, one of the abutments of the adhesive bridge, had been fractured at middle thirds of the crown including the pulp chamber. After dismounting the adhesive bridge and completion of the root canal treatment, a fiber post was placed into the fractured tooth. The fractured component, adherent to adhesive bridge retainer, was concorded to the fiber post. The whole structure was cemented with adhesive resin. A 1-mm-wide groove was made along the fracture line and restored with composite resin. The patient was evaluated clinically and radiographically at 12 and 30 months after the treatment.

CLINICAL SIGNIFICANCE

Adhesive cementation of fractured component by supporting the remaining tooth structure with a fiber post is an inexpensive and conservative treatment alternative when the fractured component is compatible with the remaining tooth structure in cases of tooth fractures including the pulp chamber at anterior segment.

Evaluation of tooth-fragment reattachment: a clinical and laboratory study

PURPOSE

To evaluate the restoration of fractured teeth by reattaching tooth fragment to its tooth remnant in a group of children and adolescents, and to compare the results with those of a laboratory study.

MATERIALS AND METHODS

The clinical study was conducted on 43 fractured incisors: 22 uncomplicated crown fractures (Group A) and 21 complicated crown fractures (Group B). The 43 incisal fragments: 23 were kept dry for 47 h and 20 were kept wet for 24 h by the patients before they were reattached. The fragments were kept in 0.9% saline solution for 30 min before reattachment. The fragments in Group A were reattached using a dentin bonding agent, a flowable and a hybrid resin composite, whereas the fragments in Group B were reattached to the tooth remnant after a pulpotomy was performed. The laboratory study was conducted on 56 extracted incisors. Teeth were divided equally into four groups: Group I - Uncomplicated crown fracture + wet medium; Group II - Uncomplicated crown fracture + dry medium; Group III - Complicated crown fracture + wet medium, and Group IV - Complicated crown fracture + dry medium. The fragments were then reattached in a manner that was similar to that used in the clinical study. The restored teeth were then re-fractured. All data were analyzed statistically.

RESULTS

In the clinical study, the restored teeth were followed up for 2 years. Neither the type of trauma nor the storage medium had any significant effect on the survival, color, and bond strength of the restored teeth when assessed in the clinical and laboratory study. The color disharmony that was encountered initially in restored teeth resolved significantly on its own accord within 12 months after reattachment of the fragment.

CONCLUSION

Fragment reattachment can be used to treat fractured teeth successfully in children and adolescents.

Reattachment of anterior fractured teeth: effect of materials and techniques on impact strength

BACKGROUND/AIM

The reattachment of dental fragments, as a conservative treatment, should be the first choice to restore fractured teeth. Therefore, the aim of this study was to evaluate the effect of different materials and reattachment techniques on impact strength of bovine incisors.

MATERIAL AND METHODS

Standardized fragments were obtained when 80 crowns were sectioned 12 mm from the incisal edge. Teeth were mounted in PVC rings, embedded in acrylic resin and polyether to simulate bone support and periodontal ligament. Specimens were distributed in nine groups (n = 10), according to the reattachment technique (Direct bonding or Circumferential chamfer); the adhesive system (Single Bond or Clearfil SE Bond); and the intermediated material (Filtek Z350 Flow or Rely X CRA). Sound teeth composed the control group. Circumferential chamfer was prepared after the bonding of the fragment by means of a spherical point and filled with the composite Filtek Z250. The impact strength was evaluated in a universal testing machine Instron. A compressive load was applied at a crosshead speed of 500 mm min(-1) on the buccal surface, 2 mm from the incisal edge. Data were submitted to anova and Ryan-Einot-Gabriel-Welsch Multiple Range test (5%).

RESULTS

Mean value of impact strength for control group was 64.8 Kgf. The fragment reattachment using Circumferential chamfer was significantly superior to Direct Bonding. The use of Single Bond significantly increased the impact strength when compared to the use of Clearfil SE. There was no significant difference among Rely X and Filtek X350 Flow.

CONCLUSION

No technique or material, when individually considered, was capable of achieving the mechanical strength of the sound teeth; however, the association of reattachment technique Circumferential chamfer with bonding system Single Bond could approximate the immediate impact strength of the restored teeth to that observed in the sound teeth.