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 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.     

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.     

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.     

断冠再接术治疗外伤恒前牙冠折的疗效观察

目的 观察断冠再接术治疗恒前牙外伤冠折的临床效果。方法 对外伤冠折断片保留完整的38颗恒前牙冠折患者，运用牙釉质-牙本质粘结剂和光固化复合树脂使自体断冠复位再接，进行3年的临床回顾性观察。结果 断冠再接术2年的保存率为94．74％，3年的保存率为92．01％。结论 断冠再接术是一中、短期的暂时修复的好方法，是治疗18岁以下冠折患者首选的方法。     

Reattachment of a fractured maxillary tooth: a case report.

A 14-year-old male patient reported with a horizontal fracture of almost the entire crown of a maxillary incisor, extending subgingivally at the palatal side. After root canal therapy and electrosurgery, the tooth fragment was reattached using a total-etch dentin-bonding system and a hybrid composite. Due to enamel cracks and the necessity for more retention, the labial surfaces of the teeth were veneered with a micro-filled composite. The clinical situation of the reattached teeth was confirmed successful by radiographic and photographic assessment after 1, 3, 6, and 12 months. The restoration of an anterior tooth with original tooth fragment in young patients has advantages over conventional composite or prosthetic restorations. However, reattached teeth with fracture extending subgingivally, require long-term follow-up.     

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

Abstract – 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.     

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.     

An evaluation of various materials and tooth preparation designs used for reattachment of fractured incisors

Abstract – Background/Aim: The present study was undertaken to evaluate and compare the fracture strength of various restorative materials and designs used in the reattachment of anterior fractured teeth. Materials and method: Sound human maxillary central incisors were selected for the study. These teeth were fractured using universal testing machine so as to obtain Ellis class II fracture with intact fragment. The fractured fragment was reattached to the tooth using three restorative materials namely, bonding agent, resin luting cement and nano‐composite, and designs incorporated were simply bonding the fragment to the tooth and other one included a chamfer along the fractured line. The reattached teeth were again fractured and the mean fracture strength values recorded. Results and Conclusion: A combination of nano‐composite (best material) and chamfer preparation (best design) gave the highest mean fracture strength values.     

Tooth fragment reattachment techniques—A systematic review

Background/Aim

Several strategies have been developed for tooth fragment reattachment following fracture. Although many techniques have been reported, there is no consensus on which one has the best results in terms of the bond strength between the fragment and the dentin over time. The aim of this study was to assess the currently reported tooth fragment reattachment techniques for fractured crowns of anterior teeth.

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 cross‐checked to identify additional studies; gray literature and ongoing trials were investigated. Two authors assessed studies to determine inclusion and undertook data extraction. Case reports/series of three or more cases, cross‐sectional studies, cohort studies, and in vivo clinical trials in all languages were included.

Results

Five articles remained after screening. These studies predominantly reported on fragment reattachment with composite resin and resin cement. There was little consistency among the studies in regard to the technique used for tooth fragment reattachment and length of the follow‐up period.

Conclusions

According to the evidence found in the studies included in this review, simple tooth fragment reattachment was the preferred reattachment technique. An increase in the bond strength between tooth fragment and dentin was observed when an intermediate material was used. Further investigation is needed, using standard follow‐up periods and larger samples.     

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.     

Multidiciplinary treatment of complicated subgingivally fractured permanent central incisors: two case reports

Abstract – Subgingival crown fractures with pulp exposure in permanent teeth present both endodontic and restorative problems with unfavorable prognosis. Numerous restorative techniques such as resin composite restorations with and without pins, crowns and reattachment of the fractured dental fragment could be listed as the treatment options. There are several successful cases in the literature where advantages of less microleakage and proper gingival biocompatibility in cases with reattachment of the tooth fragment were reported. Two cases of palatinal subgingival crown fractures are reported. Both had been restored by reattachment of the fragment and composite with the help of the flap surgery. Follow up visits (Case 1 for 4 years and Case 2 for 1 year) revealed satisfactory esthetics and function.     

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.     

玻璃纤维桩和复合树脂直接修复儿童冠折上前牙的临床评价

目的：应用玻璃纤维桩和复合树脂直接修复儿童冠折上前牙,随访2年并评价其临床效果。方法：对37例45颗儿童冠折上前牙行完善的根管治疗后,应用玻璃纤维桩与复合树脂直接进行修复,定期复查,评价其临床效果。结果：随访期内未见纤维桩折断、根折、及根尖周病变,仅1颗出现桩的脱粘结导致桩和树脂脱落。树脂的边缘渗漏、继发龋、表面着色、树脂折裂或部分脱落偶有发生,经处理均达病人满意。结论：对于根管治疗后儿童冠折前牙,应用玻璃纤维桩和复合树脂直接进行修复是成功而有效的过渡性治疗方法,可在短期内最大限度保存牙体组织,降低根折风险。     

Bonding of enamel-dentin crown fractures with GLUMA® and resin

Abstract A procedure is described whereby enamel-dentin fragments can be bonded to the remaining tooth substance. The tooth and tooth fragment are conditioned with EDTA and GLUMA® and then bonded together with a light-cured composite resin. Results based on the restoration of 76 complicated and uncomplicated crown fractures of permanent incisors with up to 2 years' observation indicate that teeth bonded with GLUMA® can withstand normal chewing forces. Long-term studies on the retention of bonded fragments, color stability and pulpal reaction to bonding are now in progress.     

Immediate fixed temporization with a natural tooth crown pontic following failure of replantation

Extracted teeth can be bonded directly to adjacent teeth utilizing a prefabricated composite resin framework reinforced with polyethylene fiber as a noninvasive long-term provisional tooth replacement. This immediate provisional restoration allow for exact repositioning of the coronal part of the extracted tooth in its original intraoral three-dimensional position and thus relieves the apprehension of the patient caused by the sudden loss of an anterior tooth.     

Compomers, reattachment method expand restoration capabilities.

The purpose of this article is to review one new material and one new technique being used in restorative dentistry today. Compomers, new fluoride-releasing resin restorative materials, are compared to conventional glass ionomers in terms of classification, physical properties, and clinical usage. Compomers are not true glass ionomer materials since the acid/base setting reaction, charactheristic of conventional glass ionomers, does not occur. As a consequence, their physical properties of translucency, coefficient of thermal expansion, and strength more closely resemble composite resins than conventional glass ionomers. These differences in physical properties have clinical implications in their usage. In terms of new techniques, clinical and laboratory data now exist to support the method of reattachment of fractured tooth fragments using only dentin bonding agents, in cases where the tooth fragment is available. This method can restore up to 50 percent of the original strength of intact teeth. The technique advocates the use of acid etching and enamel and dentin bonding, without any tooth preparation. In vitro studies have achieved total (100 percent) restoration of intact teeth by bonding a porcelain veneer to the tooth after the reattachment.     

Castable Ceramic Veneers

The use of laboratory fabricated veneers for restoration of discolored or malformed anterior teeth is becoming a widely used dental technique. Etched castable ceramic veneers are an alternative to etched procelain veneers for the esthetic treatment of anterior teeth. The use of an intraenamel tooth preparation along with composite resin dual-cure cements has provided the success with this technique.     

Seven-year clinical evaluation of painful cracked teeth restored with a direct composite restoration

The purpose of this study was to investigate long-term clinical effectiveness of treating painful cracked teeth with a direct bonded composite resin restoration. The hypothesis tested was that cracked teeth treated with or without cuspal coverage showed the same performance. Forty-one patients attended a dental practice with a painful cracked tooth that was restored with a direct composite resin restoration. Twenty teeth were restored without and 21 with cuspal coverage. After 7 years, 40 teeth could be evaluated. Three teeth without cuspal coverage needed an endodontic treatment, of which 2 failed as a result of fracture. No significant differences were found for tooth or pulp survival. Three more repairable restoration failures were recorded. Mean annual failure rate of restorations without cuspal coverage was 6%; no failures in restorations with cuspal coverage occurred (P = .009). A direct bonded composite resin restoration can be a successful treatment for a cracked tooth.     

Reattachment using a fragment from an extracted tooth to treat complicated coronal fracture

Abstract –  Reattachment of fragment is the preferred alternative to restore the fractured teeth, offering several advantages. Partial pulpotomy has demonstrated satisfactory results as a conservative treatment for pulp exposures because of trauma. This study reports a case in which the treatment of a complicated coronal fracture was accomplished by partial pulpotomy and reattachment of a dental fragment obtained from an extracted tooth using composite resin. The results show the feasibility of the conservative pulp therapy and the restorative approach.