Management of an uncomplicated crown fracture by reattaching the fractured fragment—Case report

Coronal fractures of the anterior teeth are common sequelae of traumatic dental injuries. Reattachment of fractured tooth fragments using dental adhesive techniques offers some advantages, including restoration of the function, esthetics, shape, texture, and brightness of the surface. The present report describes a clinical case of reattachment with a 4‐year clinical and radiographic follow up in a permanent maxillary central incisor with an uncomplicated crown fracture. Fragment reattachment is a conservative procedure, preserving esthetics and functionality, and it can provide an immediate positive emotional response from the patient.     

Combined technique with glass‐fibre‐reinforced composite post and original fragment in restoration of traumatized anterior teeth – a case report

Abstract – Dentoalveolar trauma is frequently encountered by dental practitioners. In some instances, saving a child’s traumatized permanent teeth can create difficulties for the child, the parents and the dentist. Reattachment of a crown fragment is a conservative treatment that should be considered for crown fractures of anterior teeth. This case describes the clinical reattachment of an original tooth fragment. A 10‐year‐old male presented at the Department of Pediatric Dentistry with a complex crown fracture of the left maxillary central incisor 1 day after the trauma occurred. Following endodontic treatment, a glass‐fibre‐reinforced composite root canal post (FRC Postec^®; Ivoclar Vivadent AG, Schaan, Liechtenstein) was inserted to increase retention and distribute stress along the root. The dental restoration was completed using the original fragment and a dual‐cured resin composite (Variolink^® II; Ivoclar Vivadent AG). Clinical and radiographic examinations at 1‐year recall showed the glass‐fibre‐reinforced composite root canal post and restoration to be in place, indicating the success of the treatment in maintaining the fractured tooth. Thus, we conclude that reattachment of a tooth fragment using a dual‐cured resin composite and a glass‐fibre‐reinforced composite root canal post is an alternative method for the rehabilitation of fractured teeth that offers satisfactory aesthetic and functional outcomes.     

Reattachment of anterior teeth fragments using a modified Simonsen’s technique after dental trauma: report of a case

Abstract – This is a case report of a 9‐year‐old boy with complicated crown fractures of two traumatized teeth: left maxillary central and lateral incisors. The central incisor presented a small pulpal exposure of approximately 1 mm and the lateral incisor had an ulcerated and exposed pulp. Endodontic management included direct pulp capping, partial pulpotomy, and restorative management including reattachment of the teeth fragments using a modified Simonsen’s technique. The reattached fragments were assessed clinically and radiographically at 12 months. The teeth remained vital, there were no color changes, and the restorations had an acceptable appearance.     

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.     

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

Abstract – 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.     

Rehydration of crown fragment 1 year after reattachment: a case report

Abstract –  The reattachment of the crown fragment to a fractured tooth is a conservative treatment that should be considered for patients with crown fractures of anterior teeth. This case report describes the reattachment of crown fragment that is discolored because of dehydration. After 1 month, the fragment had regained some of the original color and translucency. After 1 year, the reattached fragment had satisfying esthetics and excellent function. The reattachment of the crown fragment should be done even if the crown fragment is discolored.     

Reattachment of fractured fragments of maxillary central incisors--report of a case

Reattachment of the original tooth fragment to the fractured tooth helps in maintaining the tooth's colour, wear resistance, morphology and translucency in the restoration. This paper describes the reattachment of fractured fragments using metallic post and core in case of a 12 year old patients who suffered a complicated facture of maxillary central incisors.     

Effect of fractured or sectioned fragments on the fracture strength of different reattachment techniques

This study evaluated the effect of fractured or sectioned fragments on the fracture strength recovery of four techniques used for reattachment and resin composite buildups. Ninety-one sound, permanent lower central incisors were used. Half the teeth were fractured in the incisal-proximal edge; the other half had the incisal-proximal edge sectioned by a diamond saw. Teeth from each half were randomly divided into five techniques: 1) bonded only; 2) chamfer; 3) over-contour; 4) internal dentinal groove and 5) resin composite buildup. An adhesive system and dual cure resin cement were employed for the reattachment. Restored teeth were subjected to load in a specific point on the buccal surface. Based on the fracture strength of sound teeth, a fracture strength recovery was calculated for each tooth. A one-way ANOVA and Tukey's test (alpha=0.05) were used to evaluate differences between the techniques for each method of obtaining fragments. The fracture strength recovery of similar techniques was evaluated by a Student t-test (alpha=0.05). No differences could be detected among reattachment techniques when fragments were obtained by sectioning. In groups where the fragments were fractured, Techniques 3 and 4 showed the highest fracture strength recovery. The resin composite buildup provided fracture strength recovery similar to intact teeth regardless the way fragments were obtained.     

恒前牙断冠粘接的临床及实验研究

目的探讨修复年轻恒前牙冠折的简便过渡性方法。方法临床上共对59颗冠折患牙的牙冠进行粘接，按粘接模式分为3组。其中A组（内部倒凹＋唇侧洞斜面）14颗，B组（内部倒凹＋舌侧排溢道）14颗，C组（内部倒凹＋舌侧排溢道＋唇侧洞斜面）31颗。选择21颗上颌中切牙的离体牙，按临床研究中的3种粘接模式分为3组，每组7颗，进行悬臂梁模型实验，探讨能够承受最大力值的粘接模式。结果临床研究显示，59颗断冠粘接的冠折牙齿有3颗脱落，其中2颗为B粘接模式，1颗为A粘接模式，均为二次外伤所致；其余56颗牙齿观察时间平均为28．3个月，断冠粘接后的牙齿均完好。实验研究显示，A、C粘接模式所能承受的力值明显大于B粘接模式（F=5．161,P=0．017），是目前临床上采取的主要方法。结论“内部倒凹＋舌侧排溢道＋唇侧洞斜面”以及“内部倒凹＋唇侧洞斜面”的粘接模式，为前牙外伤断冠粘接的最佳方式，它能较好地恢复冠折牙的外观、形态及功能，是一种适合于临床恒前牙冠折的、简便的过渡性修复方法。     

Shear bond strengths of tooth fragments reattached or restored

This study investigated the shear bond strengths of sectioned human mandibular incisor edge fragments reattached using luting cements, bonding agents or restored with composite resins. Seventy teeth were randomly distributed among six experimental groups and a control group. Leaving half of the anatomic crowns exposed, the teeth were embedded in self-cure acrylic resins with the exposed part then sectioned. The fragments in groups 1-4 were bonded to their respective teeth using Clearfil Liner Bond 2V, Scotch Bond Multi Purpose Plus, Panavia-F and 3M Opal Luting cement. The 5th and 6th groups were restored with composite resins (Silux 3M and Clearfil AP-X) using their bonding agents (Single Bond and Clearfil SE Bond). The results indicated that reattachment of fractured incisal fragments by using new generation bonding agents was effective against shear stresses, comparable with the intact teeth. Instead of restoration with composite resins therefore reattachment of a fractured fragment might be more preferable in cases of dental trauma.     

Retrieval and reattachment of an elusive tooth fragment

Traumatic dental injuries of uncomplicated nature are a common finding and upper central incisors are the most commonly affected teeth. Sometimes, the fractured fragment or the tooth gets embedded in the surrounding soft tissues and is often missed. There are few case reports regarding the retrieval and reattachment of tooth fragment. This report presents the case of an 8-year-old girl who came with the chief complaint of pain, irritation, and tingling sensation in the lower lip since one year when her upper central incisors got fractured due to trauma along with lip laceration. A soft tissue radiograph of lower lip revealed the presence of fractured tooth fragment which was then surgically removed and reattached to one of the fractured incisors. The patient was found to be asymptomatic after the procedure. This report further highlights the importance of proper radiographic diagnosis along with clinical examination immediately after trauma in order to prevent any complications in future.     

Reattachment of complicated tooth fracture: An alternative approach

Trauma to the anterior teeth is relatively a common occurrence. There are several treatment modalities for such condition, one of which is reattachment of fractured fragment itself. Reattachment of fractured fragment provides immediate treatment with better esthetics, restoration of function, and is a faster and less complicated procedure. Reattachment of tooth fragment should be the first choice and is a viable alternative to conventional approaches because of simplicity, natural esthetics, and conservation of tooth structure. Patient cooperation and understanding of the limitations of the treatment is of utmost importance for good prognosis. The present case report describes management of a complicated fracture of maxillary right central incisor treated endodontically, followed by reattachment of the same fragment. Reattachment of fractured tooth fragments offers a viable restorative alternative, immediately restores tooth function for the clinician because it restores tooth function and esthetics with the use of a very conservative and cost-effective approach.     

Treatment of oblique crown fractures in maxillary premolars using adhesive tooth fragment reattachment: 19 years of follow up

Abstract – This report presents an oblique crown fracture in the maxillary right premolars of an adolescent because of fall, which was treated using adhesive tooth fragment reattachment. The impact of the mandible base to the floor caused minor fractures in multiple teeth, severe fracture of teeth 14 and 15, and condylar fractures. The fragments of teeth 43, 45, 46, and 16 were lost at the site of accident. The condylar fractures were managed with a non‐surgical conservative approach combining mandibular immobilization and stabilization of temporomandibular joints with maxillomandibular fixation using acrylic splints. After 3 months, the interocclusal splints were removed, and the patient was referred for dental care. Teeth 14 and 15 presented complicated oblique crown fractures causing separation of the buccal and palatal fragments, which were in place, attached to the gingival tissue. Tooth 15 presented chronic hyperplastic pulpits. The fragments were banded for stabilization during the endodontic treatment, and the bands served as matrix for adhesive tooth fragment reattachment. The other fractured teeth received direct composite resin restorations. After 8 years, tooth 16 developed pulp necrosis and was treated endodontically and restored with composite resin. Clinical and radiographic examination 19 years after trauma showed a good adaptation of the tooth fragment/composite resin restoration, good periodontal health, no signs of root resorption, and intact lamina dura.     

儿童前牙冠折断端再接修复

目的：观察儿童前牙冠折断端即刻再接修复的临床疗效。方法：14例冠折上前牙用双重固化树脂粘接系统进行断端即刻再接修复，临床观察1年。结果：经过1年观察，再接断牙牙冠牢固，牙龈组织健康，外形恢复良好，牙冠颜色无明显改变，咬合关系正常。结论：前牙冠折再接修复疗效可靠。     

年轻恒前牙冠折断再接的临床观察

选择2006-02～2007-11来我院儿科就诊的32颗年轻恒前牙冠折的病例,采用日本可乐丽公司生产的帕娜碧亚F双固化粘接材料、3M纳米树脂、3M siglebond-2粘接剂进行自体断冠再接.通过半年至2年的观察,有2颗再接牙冠脱落,其余再接牙冠固位良好,形态美观.断冠再接术是一种简便的、适合于年轻恒前牙冠折的过渡性治疗方法.     

Multidisciplinary approach to the rehabilitation of a crown-root fracture with original fragment for immediate esthetics: a case report with 4-year follow-up

Abstract –  Dental practitioners frequently encounter dentoalveolar traumas. According to the severity of the trauma, a large spectrum of complications such as isolated tooth fracture, dentoalveolar fracture or fracture at maxillofacial region may occur. If the isolated tooth fracture occurs particularly at anterior region, the rehabilitation should satisfy both esthetic and functional problems. An unrestorable tooth should be extracted and this leads to more complex treatments such as implant or conventional prosthetic rehabilitations, which will restore the function, but impair the esthetics. Recently, powerful new generation dual-cured resin composites have been produced for reattachment of original fractured fragments. In this case, we presented treatment of oblique crown-root fracture of a maxillary central tooth from enamel-cement junction by the reattachment technique. We used dual cured resin composite (Panavia F^®) and a self-tapping screw-post (Dentatus^®) for reattaching the crown fragment. Orthodontic treatment was applied for intruding and leveling the tooth. Four years after treatment, the tooth exhibited good esthetics, good periodontal health and normal function. However, minimal relapse occurred in spite of orthodontic treatment. In conclusion, the reattachment technique is an alternative method, which offers satisfactory esthetic and functional rehabilitation of the fractured teeth.     

A case report of reattachment of fractured root fragment and resin-composite reinforcement in a compromised endodontically treated root

Abstract – The composite reinforcement technique has been used clinically to salvage damaged root-filled teeth compromised by caries, trauma, developmental abnormalities, internal resorption and iatrogenic causes. This clinical case report describes the use of the technique to reattach a fractured fragment in a compromised endodontically treated root besides reinforcing it for continued function in the mouth. Factors of clinical importance related to this additional application; including reattachment of tooth fragments, post crown retention, coronal microleakage and fracture resistance and strength, are also briefly discussed.     

Treatment of crown fractured incisors with laminate veneer restorations. An experimental study

Abstract A method is described by which crown fractured incisors are restored with cast ceramic (Dicor) laminate veneers after initial treatment with either reattachment of the original crown fragment with a dentin bonding agent, with a composite resin build-up or no treatment (i.e. the veneer alone is used to restore the incisal edge). In order to elucidate the effect of the fragment/composite-tooth bonding interface on fracture strength of the restored teeth, the fracture strengths of the various treatment groups were compared to that of intact teeth supplied with Dicor laminate veneers. In an experimental investigation using central and lateral incisors from sheep, it was found that fracture strength (16.6 ±4.2 MPa) equal to that of intact incisors (16.1 ± 2.6 MPa) could be achieved using laminate veneers made of porcelain on fractured teeth whose crown fragments were reattached using a dentin bonding agent (5). In the present investigation, using the same experimental model but using cast ceramic (Dicor) laminate veneers, the fracture strength of the restored incisors was significantly increased (21.0 ± 3.7 MPa), exceeding that of intact teeth. The fracture strength of intact teeth was also exceeded in veneered incisors which were initially restored with a conventional composite resin build-up (20.2±5.6 MPa). However, the greatest fracture strength (28.2 ±8.9 MPa) was achieved when a Dicor laminate veneer alone was used to restore the fractured ineisal edge. The strength was equivalent to that of intact teeth supplied with Dicor veneers (26.7 ± 6.3 MPa). While fracture strengths of teeth which were initially restored by fragment reattachment and then supplied with veneers exceeded that of intact teeth when veneer preparation was limited to enamel, they were reduced to the half of (hat of intact teeth (i.e. the same strength as teeth initially restored by fragment reattachment and no veneering) if the preparation extended into dentin. In the present experimental model, ii would appear that laminate veneers alone might be used to restore lost incisal edges of crown fractured anterior teeth.     

Reattachment of anterior teeth fragments: a conservative approach

Coronal fractures of the anterior teeth are a common form of dental trauma that mainly affects children and adolescents. One of the options for managing coronal tooth fractures when the tooth fragment is available and there is no or minimal violation of the biological width is the reattachment of the dental fragment. Reattachment of fractured tooth fragments can provide good and long-lasting esthetics (because the tooth's original anatomic form, color, and surface texture are maintained). It also restores function, provides a positive psychological response, and is a relatively simple procedure. Patient cooperation and understanding of the limitations of the treatment is of utmost importance for good prognosis. This article reports on two coronal tooth fracture cases that were successfully treated using tooth fragment reattachment. CLINICAL SIGNIFICANCE: Reattachment of fractured tooth fragments offers a viable restorative option for the clinician because ot restores tooth function and esthetics with the use of a very conservative and cost-effective approach.     

玻璃纤维桩与双固化树脂型水门汀在外伤恒前牙冠折牙再接术中的应用

目的：观察玻璃纤维桩与双固化树脂型水门汀在成人外伤恒前牙冠折断牙再接术中的临床应用效果及可行性。方法：对冠折的折断牙片保留完整的35个恒前牙采用玻璃纤维桩及双固化树脂型水门汀进行自体牙断冠再接,进行1-2年的追踪观察。结果：断牙再接术1-2年的保存率为100％。结论：应用玻璃纤维桩及树脂型水门汀进行自体牙断冠再接,短期疗效肯定。