Direct composite resin restoration of an anterior tooth: effect of fiber-reinforced composite substructure

The aim of the study was to determine the static load-bearing capacity of fractured incisal teeth restored with the conventional adhesive-composite technique or by using fiber reinforced composites (FRC). Upper incisal teeth were prepared by cutting the incisal part of the crown horizontally. Restorations were made by three techniques. Group A (control group) was restored by reattaching the original incisal edge to the tooth. Group B was restored using composite resin. Group C was restored with composite and FRC. Restored teeth were statically loaded until fracture. Results suggest that an incisally fractured tooth restored with a combination of composite resin and FRC-structure provide the highest load bearing capacity.     

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.     

Reattachment of a severely traumatized maxillary central incisor, one-year clinical evaluation: a case report

Traumatic fracture of anterior teeth is one of the common dilemmas facing the dentist during daily practice. Classical treatment of a fractured tooth involving the pulp includes the use of post and core with or without a crown, or extraction of the remaining part of the fractured tooth and replacement with a three-unit fixed partial denture or an implant. With the improvement of adhesive systems, reattachment of the fractured tooth fragment became possible as a mode of treatment that immediately improves the esthetic quality of the restored tooth. This article presents a clinical technique for the restoration of a fractured maxillary central incisor, by reattaching the labial enamel fragment using a metallic post and resin composite restoration. One-year clinical evaluation revealed successful results for this technique.     

A modified technique on the reattachment of permanent tooth fragments following dental trauma. Case report

Fractured anterior teeth can be restored by adhesive bonding of the fractured fragment to the remaining tooth structure. One of the major challenges for the practitioner treating traumatized anterior teeth with immediate fragment reattachment is disguising the fracture line, through the correct use of masking and restorative resins to make the restorations imperceptible to the eye as well as improve the retention of the restoration. This paper discusses a modified technique for reattaching a permanent tooth fragment following dental trauma. The initial procedure involved simple reattachment using light cured composite resin between the fragment and the remnant part of the tooth, without additional preparation. The surplus resin was spread across it in an attempt to optimize marginal seal and improve the aesthetics of the restoration. Finally, after taking into account the occlusion, the lingual surfaces of the teeth were veneered with microfilled composite to improve the retention of the reattached fragments.     

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.     

Re-attachment of anterior fractured teeth: fracture strength using different techniques

Fracture of anterior teeth by trauma is a common problem in children and teenagers. Complex metal-ceramic crowns with considerable loss of remaining sound structure are no longer necessary due to adhesive techniques, such as composite restorations and re-attachment techniques. This study compared the fracture strength of sound and restored anterior teeth using a resin composite and four re-attachment techniques. A "one bottle" adhesive system (One-Step, BISCO) and a dual cure resin cement (Duo-Link, BISCO) were applied. Thirty-five sound permanent lower central incisors were fractured by an axial load applied to the buccal area and randomly divided into five groups. The teeth were restored as follows: 1) bonded only = just bonding the fragment; 2) chamfer-group = after bonding, a chamfer was prepared on the enamel at the bonding line and filled with composite; 3) overcontour group = after bonding, a thin composite overcontour was applied on the buccal surface around the fracture line; 4) internal dentinal groove = before bonding, an internal groove was made and filled with a resin composite; 5) resin composite group = after a bevel preparation on the enamel edge, the adhesive system was applied and the fractured part of the teeth rebuilt by resin composite. Restored teeth were subjected to the same loading in the same buccal area. Fracture strength after restorative procedure was expressed as a percentage of the original fracture strength and the results analyzed by Kruskal-Wallis statistical analysis. The mean percentages of fracture strength were: Group 1: 37.09%, Group 2: 60.62%, Group 3: 97.2%, Group 4: 90.54% and Group 5: 95.8%. It was concluded that the re-attachment techniques used in Groups 3 and 4, as well as the composite restored group (Group 5), were statistically similar and reached the highest fracture resistance, similar to the fracture resistance of sound teeth.     

Intraradicular splinting of a horizontally fractured central incisor: a case report

Abstract – This case report presents the endodontic management of a horizontally fractured right incisor involving healing with granulation tissue using an intraradicular splinting technique. We also discuss the spontaneous healing of the fractured left central incisor with calcified tissue. A composite resin splint was made for all of the upper anterior teeth. The root canal of the right incisor was temporarily filled with calcium hydroxide slurry. The intraradicular splinting involved placing a file in the canal. Sealer was introduced into the canal and then a no. 110 K file was fixed in the canal with polycarboxylate cement. The tooth was asymptomatic and the composite splint was removed after 1 month. The right incisor appeared normal clinically and radiographically at the 30‐month recall. This case demonstrates that intraradicular splinting can be used to manage horizontally fractured teeth with necrotic and mobile coronal segment.     

Emergency repair followed by complete-coronal restoration of a fractured mandibular incisor.

Severely fractured anterior teeth often require immediate repair, while long-term restoration is delayed until a healing period is completed. This paper details a technique of immediate emergency repair of a fractured mandibular incisor followed by placement of a bonded composite resin complete-coronal restoration months later. Careful diagnosis, gentle handling of the freshly traumatized tooth and surrounding tissues, and ideal selection and use of the respective bonding materials are necessary to ensure eventual replication of form, function, and tooth shade when the long-term restoration is placed.     

Shear bond strength between composite resin and denture teeth: effect of tooth type and surface treatments

PURPOSE: The purpose of this study was to investigate the strength of the composite resin-denture tooth bond as affected by different tooth surface treatments. MATERIALS AND METHODS: Spectrum TPH was condensed on 112 mandibular first molar acrylic resin and composite resin denture teeth, which received seven different treatments: Four groups were treated with Prime & Bond NT adhesive, and three groups were treated with One Step adhesive. Four groups (two of each adhesive category) were treated with Composite Activator and air abrasion. In one group, AeliteFlo was used just before the condensation of Spectrum TPH. Bond strength was evaluated with a shear test device on a Monsanto testing machine. The results were evaluated statistically with two-way ANOVA and the Scheffé method. RESULTS: There was a significant interaction between denture tooth type and surface treatments. Bond strength of composite resin was greater to composite than to acrylic resin teeth when the bond was mediated only with adhesives. One Step adhesive and AeliteFlo resulted in a higher bond of composite resin to both types of teeth. Wetting tooth surfaces with Composite Activator did not increase the bond. CONCLUSION: When repairing denture teeth with composite resin and adhesives, the bond strength was higher with composite than with acrylic resin teeth, and there were differences between the adhesives used.     

Dental fracture fragment attachment: fracture model and luting agent comparisons

PURPOSE: The purpose of this study was twofold: 1. To compare two different research models for simulating a traumatic anterior tooth fracture: the blunt trauma method (standard method) and an AL2O3 sectioning method (experimental method). 2. To compare the bond strength of tooth fragments bonded with resin modified glass ionomer vs. a light cured composite resin. METHODS: Two hundred bovine incisors were used in the study and kept in plain tap water throughout. The study consisted of five basic steps: 1. Fracture of the teeth by either blunt trauma (chisel and hammer) or AL2O3 sectioning disc. 2. Luting of the fractured fragments back to the teeth using either a composite resin or resin modified glass ionomer. 3. Thermocycling of the repaired teeth. 4. Dislodging the teeth to determine the strength of repair. 5. Determination of fracture type. RESULTS: One-way ANOVA revealed a statistically significant difference in the forces required to fracture the resin modified glass ionomer and composite resin regardless of whether the teeth were originally fractured with the blunt force method (p=0.030) or the disc sectioning method (p=.001). One-way ANOVA also revealed a statistically significant difference between the forces required for fracture by blunt trauma and the disc fracture techniques with the resin modified glass ionomer group (p=0.000345). However, there was no significant difference when the two techniques were compared for the composite resin (p= 0.2941). CONCLUSIONS: 1. The resin modified glass ionomer was significantly stronger than the composite resin when both the blunt trauma and the disc fracture techniques were employed. 2. The study's results do not support substituting the ease of the AL2O3 disc for the more time-consuming blunt trauma method.     

Single-tooth replacement with a chairside prefabricated fiber-reinforced resin composite bridge: a case study

There are many fixed options for replacing a single anterior tooth, including implants; conventional full coverage; porcelain-fused-to-metal, all-ceramic, and fiber-reinforced composite designs; and minimal preparation designs that utilize lingual wing frameworks made from metal, ceramic, or fiber-reinforced composite. All of these approaches require at least two visits; however, it is possible to replace a missing anterior tooth in a single visit by using adhesive techniques with resin composite and fiber-reinforced resin composite materials. This approach has been developed and refined with a bridge created at chairside, using a prefabricated fiber-reinforced composite framework. This framework consists of a pontic substructure that is shaped to support a resin composite pontic, with one or two wings used to attach the pontic substructure to either the lingual or facial surfaces of the abutment teeth. This article describes a chairside technique for replacing a maxillary central incisor by using a prefabricated fiber-reinforced framework.     

Re-attachment of anterior fractured teeth: fracture strength using different materials

This study compared the fracture strength of two different techniques (bonded only and buccal chamfer) and different material combinations used to reattach tooth fragments. An axial load applied to the buccal area fractured 110 sound permanent lower incisors. Fifty teeth were designated for the bonded only group (no additional preparation) and 50 teeth were designated for a buccal chamfer group. For each group teeth were subdivided into five subgroups (n = 10) according to the restorative material combinations used: 1) adhesive system (A); 2) A + light cured luting cement; 3) A + dual cured luting cement; 4) A + flowable resin and 5) A + hybrid resin. In a control group (resin composite build-up), in the remaining 10 teeth, the crown portion was rebuilt with adhesive and resin composite. Restored teeth were subjected to the same loading in the same buccal area. Fracture strength after restorative procedures for all groups was expressed as a percentage of the original fracture strength and the results were analyzed by two-way ANOVA and Tukey's test for pair-wise comparison. The interaction and the material factor were not statistically significant (p = 0.140 and p = 0.943, respectively). The chamfer group showed higher fracture strength recovery (67.9%) than the bonded only group (41.1%), and both were statistically lower than the resin composite build-up (103.2%). It was concluded that the material used to reattach the fragment is less important than the chosen technique.     

In vitro tooth reattachment techniques: A systematic review

Background/Aims

Fragment reattachment is a procedure that offers advantages, such as preservation of tooth structure and maintenance of color, shape, and translucency of the original tooth. The aim of this study was to analyze the reattachment techniques used to restore anterior teeth fractured by trauma.

Materials and Methods

The PubMed, LILACS, Web of Science, Cochrane, and Scopus databases were searched in October 2016, and the search was updated in February 2017. A search of the gray literature was performed in Google Scholar and OpenGrey. Reference lists of eligible studies were evaluated to identify additional studies. Two authors assessed studies for inclusion and extracted the data. In vitro studies that evaluated permanent human teeth fractured by trauma were included.

Results

Twenty‐one studies remained after screening. The bond strength between the fragment and the crown was evaluated in 119 experimental groups. Ten different techniques were evaluated as follows: no preparation, chamfer, bevel, anchors, overcontour, internal groove, no preparation associated with chamfer after reattachment, fragment dentin removal associated with chamfer after reattachment, bevel associated with overcontour, and groove associated with shoulder. Five different materials were used to reattach the fragment: bonding system, luting composite resin, flowable composite, microhybrid composite, and nanocomposite.

Conclusion

Fragment reattachment using a technique with no preparation and an adhesive system associated with an intermediate composite with good mechanical properties can restore part of the resistance of the fractured tooth.     

A nine-year clinical case study of a resin-bonded fixed partial denture seated on the maxillary anterior teeth

PatientThis report describes the longevity of a resin-bonded fixed partial denture (RBFPD). This denture was seated on the maxillary anterior teeth with minimal tooth preparation. The RBFPD was cast from a silver–palladium alloy (Castwell M.C. 12), and the pontic was veneered with an indirect composite material (Estenia). The retainers were primed with a metal conditioner (V-Primer) and seated with a tri-n-butylborane initiated adhesive resin (Super-Bond C&B). After an observation period of eight years, a fracture occurred in the incisal edge of the central incisor abutment. The fractured area was restored with light-polymerizing composite resin and the anterior guidance was re-adjusted.DiscussionRBFPD abutment teeth with deep vertical overlap should be carefully prepared to avoid abutment tooth fracture.ConclusionThe clinical performance of the RBFPD made from a silver–palladium–copper–gold alloy was sufficient when seated with tri-n-butylborane initiated adhesive resin after surface modification using vinyl-thiol primer.Clinical significanceThe use of vinyl-thiol primer and tri-n-butylborane initiated adhesive resin is a clinically reliable bonding system for seating resin-bonded fixed partial denture (RBFPD) made from a silver–palladium–copper–gold alloy. The RBFPD, based on a reliable bonding system, can clinically function for a long time, even if the vertical overlap of the abutment teeth is excessive.     

Class IV preparations for fractured anterior teeth restored with composite resin restorations

Pediatric dentists play a major role in treating most of the anterior teeth fractures due to the fact that most patients who suffer such traumatic injuries are between the ages of seven and fourteen. Several techniques has been developed to restore the fractured incisors to the original shape and color, these include full-coverage of the traumatized tooth, or restoring the incisors with a resin. The purpose of this study is to find the ideal combination of tooth preparation and restorative material, namely, to determine if stair step chamfer preparations provide more retention in class IV restorations than the plain chamfer preparation technique when restored with a combination of a hybrid composite resin and a microfilled composite resin. This was done by comparing the shear strength values between the buccal stair-step chamfer preparation, and a modification on it (buccal and lingual stair-step chamfer preparation) and the plain chamfer preparation techniques in class IV restorations on anterior incisors using different composite resin materials. The Instron machine was used to test shear strength. One hundred and two bovine incisor teeth were freshly harvested from the slaughterhouse. The teeth were prepared and restored according to the following six groups; Plain Chamfer preparation with Tetric Ceram Composite, Plain Chamfer preparation with Renamel Composite, buccal stair-step chamfer preparation with Tetric Ceram composite, buccal stair-step chamfer preparation with Renamel composite, Buccal and lingual stair-step preparation with Tetric Ceram Composite, Buccal and lingual stair-step chamfer preparation with renamel composite. All samples were fractured using the Instron testing machine then the surface area were measured using Image-J software. Shear strength for every sample was calculated using the load numeric result from the Instron machine and the measured surface area. The Two-Factorial (AB) Analysis of Variance For Independent Samples showed that the buccal stair-step chamfer preparation showed significantly higher shear strength and fracture resistance than plain chamfer or the buccal and lingual stair-step chamfer preparation. The combination of Renamel Hybrid and Renamel Microfill composite materials showed better results than the Tetric Ceram composite when used with all three preparation techniques, but did not show a statistical significance. It was concluded that buccal stair-step preparation technique provided the ideal preparation technique with bonded composite resins in fractured anterior teeth. Only 7% of the entire sample size had an adhesion failure versus 93% that had cohesion failure. There was no significant difference in shear strength, between the restorative materials used, in conjunction with all the preparation techniques.     

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.     

Fracture resistance of tooth fragment reattachment: effects of different preparation techniques and adhesive materials

Abstract –  The purpose of this study was to evaluate and compare the bond strengths of experimentally fractured human tooth fragments reattached with different adhesive materials and retentive techniques in vitro . Uncomplicated crown fractures were obtained on intact human mandibular permanent incisors by applying perpendicular load to the buccal aspect of tooth crowns. Fractured teeth were randomly assigned into one of three reattachment protocols: (i) Simple reattachment, (ii) Overcontour preparation, and (iii) Internal dentin groove. The first and second groups were divided into 10 subgroups, and the third group into five subgroups ( n  = 10 per group) with respect to five different adhesive systems (Prime&Bond NT, Adper Single Bond II, Adper Prompt L-Pop, Clearfil S³ Bond, G Bond) used with or without a hybrid resin composite (Z250). Restored teeth were subjected to thermal cycling, and subsequently to the same loading protocol used for fracturing intact teeth. Fracture strength after reattachment procedures was recorded as a percentage of the original fracture strength. Both type of adhesive material and placement of an intermediate layer of resin composite affected the fracture resistance ( P  < 0.05). The highest fracture strength recovery was obtained using the internal dentin groove technique (54 ± 0.58%, P  < 0.05), followed by the overcontour and simple reattachment protocols (49 ± 0.58% and 32 ± 0.82%, respectively, P  < 0.05). Ultramorphological evaluation of bonded specimens revealed voids and microcracks along the adhesive interface, which might contribute to postadhesive failure.     

Chairside prefabricated fiber-reinforced resin composite fixed partial dentures.

The introduction of pre-impregnated fiber-reinforced resin composites has provided the dental profession with the opportunity to fabricate and deliver adhesive, esthetic, and metal-free tooth replacements. Utilizing this technology, a prefabricated fiber-reinforced resin composite fixed partial denture prototype that allows rapid, cost-effective, and noninvasive fixed tooth replacement for single anterior teeth has been developed. Ideal situations for this type of service include: a fixed replacement following tooth loss from trauma; a fixed tooth replacement in medically compromised patients who cannot sit for extended periods of time or have local anesthesia; periodontally compromised abutments; a fixed space maintainer following orthodontic movement; and a fixed provisional during the post implant healing phase prior to loading. This article describes the framework construction and placement protocol for the prefabricated fiber-reinforced resin composite fixed partial denture.     

Performance of techniques used for re-attachment of endodontically treated crown fractured teeth

OBJECTIVES: The aim of this study was to compare the fracture strength of three techniques used to re-attach tooth fragments in sound and endodontically treated fractured teeth with or without fiber post placement. MATERIAL AND METHODS: Ninety human lower incisors were randomly divided into three groups of 30 teeth each. In group A teeth were not subjected to endodontic treatment; while teeth from groups B and C were endodontically treated and the pulp chamber restored with a composite resin. All teeth were fractured by an axial load applied to the buccal area in order to obtain tooth fragments. Teeth from each group were then divided into three subgroups, according to the re-attachment technique: bonded-only, buccal-chamfer and circumferential chamfer. Before the re-attachment procedures, fiber posts were placed in teeth from group C using dual cure resin luting cement (Duo-Link). All teeth (groups A-C) had the fragments re-attached using a same dual cure resin luting cement. In the bonded-only group, no additional preparation was made. After re-attachment of the fragment, teeth from groups buccal and circumferential chamfer groups had a 1.0 mm depth chamfer placed in the fracture line either on buccal surface or along the buccal and lingual surfaces, respectively. Increments of microhybid composite resin (Tetric Ceram) were used in subgroups buccal chamfer and circumferential chamfer to restore the chamfer. The specimens were loaded until fracture in the same pre-determined area. The force required to detach each fragment was recorded and the data was subjected to a three-way analysis of variance where factors Group and Re-attachment technique are independent measures and Time of fracture is a repeated measure factor (first and second) and Tukey's test (alpha=0.05). RESULTS: The main factors Re-attachment technique (p=0.04) and Time of fracture (p=0.02) were statistically significant. The buccal and circumferential chamfer techniques were statistically similar (p>0.05) and superior to the bonded-only group (p<0.05). The first time of fracture was statistically superior to second time of fracture (p<0.001). CONCLUSIONS: The use of fiber post is not necessary for the reinforcement of the tooth structure in re-attachment of endodontically treated teeth. When bonding a fractured fragment, the buccal or circumferential re-attachment techniques should be preferable in comparison with the simple re-attachment without any additional preparation. None of the techniques used for re-attachment restored the fracture strength of the intact teeth.     

Biological approach for management of anterior tooth trauma: triple case report

Anterior crown fractures are a common form of injury that mainly affect children and adolescents. The position of maxillary incisors and their eruptive pattern carries a significant risk for trauma. In the pre-adhesive era, fractured teeth needed to be restored either with pin-retained inlays or cast restorations that sacrificed healthy tooth structure and were a challenge for clinicians to match with adjacent teeth. The development of adhesive dentistry has allowed dentists to use the patient's own fragment to restore the fractured tooth. Three cases are presented here with complicated crown fracture of maxillary central incisors; the reattachment of the fractured tooth segment in this case has been performed using different combinations of techniques, viz. simple reattachment, circumferential bevel and internal dentinal groove.