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ISSN 0975-8437 INTERNATIONAL JOURNAL OF DENTAL CLINICS 2011:3(1):107-108

INTERNATIONAL JOURNAL OF DENTAL CLINICS VOLUME 3 ISSUE 1 JANUARY-MARCH 2011 107

Reattachment of Anterior Teeth Fragments with Two Different Treatment

Techniques: Report of Two CasesAbhishek Agrawal, Narendra.U.Manwar, Manoj.G. Chandak

AbstractCoronal fractures of the anterior teeth are a common form of dental trauma. Reattachment of the

tooth fragment is one of the options for managing coronal tooth fractures when the tooth fragment is

available and there is minimal violation of the biological width. This article reports management of two

coronal tooth fracture cases that were successfully treated using tooth fragment reattachment withdifferent treatment modality.Key Words: Fragment Reattachment;Band Pinching Technique;Fiber Reinforced Post.

Received on: 10/12/2010 Accepted on:10/01/2011

Introduction

Crown fractures have beendocumented to account for up to 92% of all

traumatic injuries to the permanent

dentition.(1) Dental trauma often has a severeimpact on the social and psychological well-

being of a patient.(2) Coronal fractures of

permanent incisors represent 18-22% of alltrauma to dental hard tissues, 28-44% being

simple (enamel and dentin) and 11-15%

complex (enamel, dentin and pulp). Of these

96% involve maxillary central

incisors.(2)Traumatized anterior teeth requirequick functional and aesthetic repair.(3)

The treatment modalities vary from

simple reattachment of fracture fragment tocomplex interdisciplinary approach. Here we

are reporting two such cases that weresuccessfully treated using tooth fragment

reattachment with different treatment modality.

Case 1

A 23 years old male patient reported

to the Department of Conservative Dentistry,

Sharad Pawar Dental College and Hospital,

India following trauma to mandibular rightlateral incisor due to fall on ground. On

intraoral examination Ellis Class III fracture

was seen with crown portion of 42, whichextended from cervical 3rd of crown on labial

side to 2mm subgingivally on the lingual

aspect (Fig 1a). The fracture fragment was

removed atraumatically and stored in normal

saline. Single visit root canal treatment withsectional obturation was done. Gingival flap

was raised as the fracture line was below

subgingival level on the lingual aspect. Troughwas prepared in the fractured crown fragment

then the fracture crown fragment was

reattached with remaining tooth portion by

suitable fibre post with the help of dual core

composite. At the end flap was repositionedand sutured and post-operative instructions

were given to the patient. The patient was

recalled for regular check up to one year(Fig1b).

Figure 1a Figure 1b

Case 2

A 24 years old male patient reported

to the department of Conservative Dentistryand Endodontics, Sharad Pawar Dental College

and Hospital, India following trauma in upper

anterior teeth due to fall from bike. On

intraoral examination Ellis Class III fracturewas seen with 11 which extended verticallyfrom incisal edge to cement-enamel junction

(Fig 2a). On radiographic examination, fracture

extension was confirmed and treatment plan

was decided. Band Pinching Technique wasselected. In the same visit, orthodontic band

was pinched and cemented with Glass inomer

cement on 11. Root Canal Treatment wasstarted after rubber dam application and

completed in single sitting with sectional

obturation. A suitable fibre post was selected

and checked for proper fit and cemented with

dual core composite. Post-operativeinstructions were given. And Patient was kept

under medication. Patient was recalled for

regular check up to 1 year [Fig 2b].

Figure 2a Figure 2b

CASE REPORT

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Discussion

Traumatic injuries involving tooth

fracture can be treated by reattachment of the

tooth fragment using an adhesive system

(acting as dental super glue).(1) The reattachedtooth is restored to its original form, contour

and margins and tends to be more compatible

with the gingiva. The psychological traumacaused to the individual due loss of aesthetics

can be managed by this procedure

successfully.(4)

In the present cases reattachment of

the fractured fragment were possible due toadvancements in dentin bonding technology

and fiber post systems. As the fractured

fragments were intact, use of natural toothsubstance clearly eliminated problems of

differential wear of restorative material,

unmatched shades and difficulty of contour andtexture reproduction associated with other

restorative techniques.(5, 6)Band Pinching was introduced by

Louis I. Grossman in 1988. It acts as a splint.

Fracture reattachment by band pinching and

fiber post is simple, economical and less timeconsuming and provides excellent results.

Factor influencing the extent and feasibility of

such repair include the site of fracture, size offractured remnants, periodontal status, pulpal

involvement, maturity of root formation,

biological width invasion, occlusion, time and

resources of the patient.(7, 8)Extensive damage of the tooth

structure and missing fragment warrantsreinforcement using fiber posts.(2) Tooth

colored fiber posts have several advantages.They are more aesthetic when bonded to tooth

tissue, modulus of elasticity similar to that of

dentin and less chances of fracture.(2)Historically cast metal post and core were used

for fracture reattachment.(2) The newer variety

of non-metallic posts is made of either ceramic

or fiber reinforced materials like carbon, quartz

or glass in an epoxy matrix.(2) By using glassfiber post with composite core and with recent

advances in adhesive techniques and materials

one can create a Monobloc, a multi-layeredstructure with no inherent weak inter-layerinterfaces.(2)

Trope et al in 1985 showed that

endodontically treated teeth can be reinforcedwith the use of resin composite restoration. The

flowable composite reinforces the tooth, helps

in achieving higher bond strengths and

minimizes the inclusion of air voids.(8) With

the materials available today, in conjunction

with an appropriate technique, aesthetic results

can be achieved with predictable outcomes.

Conclusion

Reattachment of a tooth fragment is aviable technique that restores function and

aesthetics with a very conservative approach in

single visit and can be considered whentreating patients with coronal fractures of the

anterior teeth, especially in younger patients.Acknowledgement: Dr. Pradnya Nikhade, Dr. AjaySaxena, Dept. of Conservative Dentistry, SharadPawar Dental College, India.Authors Affiliations: 1. Dr. Abhishek Agrawal,B.D.S, Post Graduate Student, 2. Dr. Narendra.U.Manwar, M.D.S, Professor, 3. Dr. Manoj.G.Chandak,M.D.S, Professor & H.O.D, Dept. of Conservative

Dentistry, Sharad Pawar Dental College, Maharashtra,India.

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4. Misra P, Misra N, Gupta K, Jain R. Immediatereattachment of fractured tooth segmentA casereport. Indian Journal of Public Health Research

& Development2010;1(2):77-8.

5. RJ H. Tooth fragment reattachment-an estheticalternativ? Report of a case. J Indian Sot PedoPrev Dent 2003;21(3):118-9.

6. Saha SG, Saha MK. Management of a FracturedTooth by Fragment Reattachment A Case Report.International Journal of Dental Clinics2010;2(2):43-7.

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Esthetics. Medical Journal Armed Forces India2008; 64(4):387-8.

Address for CorrespondenceDr. Abhishek Agrawal,B.D.S,Post Graduate Student,Dept. of Conservative Dentistry & Endodontics,

Sharad Pawar Dental College & Hospital,Maharashtra 442004, India.E-mail: agrawalabhi24@gmail.com

Source of Funding: Nil Conflict of Interest: NIL