Dr. Neena. I. E ABSTRACT
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. . It restores function, provides a positive psychological response, and is a relatively simple procedure.This article reports on the coronal tooth fracture involving enamel and dentin. case that was successfully treated using tooth fragment reattachment.
Coronal fractures of the anterior teeth are a common form of dental trauma that mainly affects children and adolescents. The majority of dental injuries involves the anterior teeth, especially the maxillary incisors (because of its position in the arch), whereas the mandibular central incisors and the maxillary lateral incisors are less frequently involved. Dental injuries usually affect only a single tooth; however, certain trauma types such as automobile accidents and sports injuries involve multiple tooth injuries.
One of the options for managing coronal tooth fractures, especially when there is no or minimal violation of the biological width, is the reattachment of the dental fragment when it is available. Tooth fragment reattachment offers a conservative,esthetic, and costeffective restorative option that has been shown to be an acceptable alternative to the restoration of the fractured tooth with resin-based composite or full-coverage crown. Reattachment of a fragment to the fractured tooth can provide good and long-lasting esthetics because the tooth’s original anatomic form, color, and surface texture are maintained can restore function, can result in a positive psychological response.
Fig 1 : Coronal fracture of maxillary central incisors involving enamel and dentin
Fig 2 : view of teeth fragments
Fig 3 : Reattachment of the fractured incisal edges
A 12 year old male patient reported to the Department of Pediatric and Preventive Dentistry, D.A.P.M.R.V Dental College and Hospital, Bangalore, following trauma to maxillary left central incisors. Trauma had occurred due to fall while playing 2 hours ago. The patient brought the broken crown fragment along with his Parents medical history was non contributory.
Examination revealed that the teeth had fracture involving enamel and dentin (Fig 1). Fractured portion of the teeth were intact (Fig 2) and the teeth tested positive to the electric pulp tester. No mobility of the injured teeth was recorded and surrounding tissues were healthy. A periapical radiograph showed that the root formation was complete with no extrusion. The teeth fragment was immediately maintained in normal saline during whole period prior to restoration. Following a detailed examination, the adaptation of the fragments was checked. After the placement of rubber dam, the glass ionomer cement base was given covering the exposed dentine, a circumferential V - shaped notch was placed internally in the enamel of the teeth fragments Phosphoric acid gel 37.5% was applied to the enamel on the fragment and the teeth for 20 seconds, limited to 2 mm beyond the fracture margin. Air-water spray was used to remove the acid and the surface was air dried taking care to keep the dentin slightly wet. Scotchbond adhesive system was applied to the conditioned areas. A small increment of resin composite was applied to the tooth fragment which was then reattached to its proper position. Visible light polymerization was done for 90 seconds while fragment was kept in position under pressure. The teeth were polished with polishing discs (Fig 3). Occlusion was checked and post operative instructions to the patient were given to deter from loading the anterior teeth. Clinical and radiographic examination were carried out after 1 month, 3 months, 6 months and 1year. Teeth responded positively to the electric pulp tester and the radiographs showed no periapical changes. Discussion
Traumatic injuries involving tooth fracture can be treated by reattachment of the tooth fragment using an adhesive system acting as dental super glue.The reattached tooth is restored to its original form, contour and margins and tends to be more compatible with the gingiva. The psychological trauma caused to the individual due loss of aesthetics can be managed by this procedure successfully In the present case reattachment of the fractured fragment was possible due to advancements in dentin bonding technology . As the fractured fragment was intact, use of natural tooth substance clearly eliminated problems of differential wear of restorative material, unmatched shades and difficulty of contour and texture reproduction associated with other restorative techniques.With the materials available today,in conjunction with an appropriate technique, esthetic results can be achieved with predictable outcomes. Thus, the reattachment
of a tooth fragment is a viable technique that restores function and esthetics with a very conservative approach, and it should be considered when treating patients with coronal fractures of the anterior teeth, especially younger patients. CONCLUSION
A suitable reinforcing restoration for endodontically treated teeth is of utmost importance for the success of the treatment and to avoid tooth fracture with repeated trauma. Reattachment of original tooth fragment, with the improved adhesive protocol and reinforcement technique is a simple conservative approach to provide immediate natural esthetics and functional rehabilitation. REFERENCE
- Reattachment of anterior teeth fragments:a conservative approach georgia v. macedo, patricia i. diaz, carlos augusto de o. fernandes, andré v. ritter, , journal compilation © 2008, blackwell publishing.
- Reattachment of anterior teeth fragments with two different treatment techniques: report of two cases abhishek agrawal, narendra.u.manwar, manoj.g. chandak .International journal of dental clinics volume 3 issue 1 january-march 2011.
- Starkey P.E.: Reattachment of a fractured fragment to a tooth.J Ind Dent Assoc 1979; 58: 37 - 38.
- Simonsen R.J.: Restoration of a fractured central incisor using original teeth. J Am Dent Assoc 1982; 105: 646 – 648.
- Burke F.J.T.: Reattachment of a fractured central incisor tooth.fragment. Br Dent J 1991; 170: 223 - 225.