Fragment Reattachment Research Articles

Reattachment of Fractured Maxillary Central Incisor with Fibre Post

Abstract Traumatic dental injuries leave dental practitioners with severe therapeutic problems. Traumatic dental injuries with a prevalence of 25% among school children and 33% among adults are a public health problem that can have a negative influence on the quality of life. In cases of trauma to the facial region, the incidence of maxillary central incisors is 37%, followed by that of lateral incisors (16%). Traumatic injuries to teeth can be uncomplicated crown or crown-root fractures or complicated crown or crown-root fractures. Various treatment options may be employed for the management of complicated crown-root fractures of teeth. The reattachment of tooth fragments has been a preferable alternative to the restoration of the tooth. Reattachment provides a better aesthetic result in less time, i.e. regarding the original tooth shape colour texture translucency and occlusal contacts which is both very satisfying for the patient as well as the practitioner. The purpose of this case report is to evaluate the long-term prognosis of a maxillary central incisor with complicated crown-root fracture managed by reattachment of the fragment with fibre post.

Biologic approach for fragment reattachment: a case report

Crown fracture is most reported dental injury in maxillary anterior region with uncomplicated crown fractures in anterior region are most involved in adolescents and children. A 10-year-old boy reported to the Department of Paediatric and Preventive Dentistry with a chief complaint of fractured upper left front tooth region and gave history of fall 2 hours back and he was carrying a fractured fragment along with him. Clinical and radiographical examinations revealed Ellis class II fracture in maxillary left anterior region. After considering all other treatment options fractured fragment re-attachment with light cure composite resin was finalized as a treatment option.

Comparing fracture resistance on bovine incisors restored by tooth fragment reattachment versus direct composite restoration techniques.

Anterior teeth are prone to traumatic dental injuries (TDIs). Although a number of techniques ranging from original tooth fragment reattachment (TFR) to direct composite restoration (DCR) can be used to restore uncomplicated crown fractures, there is no consensus on which method is best. The purpose of this study was to investigate the fracture resistance of bovine incisors restored by two different techniques (TFR and DCR) in three different fracture models. Sixty extracted bovine lower incisors were randomly divided into three groups (n = 20). Angle, oblique, or transverse sections of all the teeth in a group were prepared by using a disk. The cut surfaces were scanned, and the cross-sectional areas (CSA) of the enamel and dentin were measured. Half the teeth in each group were restored by DCR (n = 10) and the other half by TFR (n = 10). The forces required to fracture the restored teeth were then measured using a Universal testing machine, and the fracture modes were analyzed (cohesive, adhesive, or mixed). No statistically significant differences between the TFR and DCR restorations were detected for total and enamel CSAs in any of the restoration shapes (p > .067). The fracture forces required to break DCR angle and transverse restorations were significantly greater than for the corresponding shapes restored with TFR (p < .033). However, the difference in the forces needed to fracture oblique section restorations by DCR or TFR was not statistically significant (p = .239), despite a similar trend (143.4 ± 51 N and 120.9 ± 25 N, respectively). This study revealed that a greater force is required to fracture teeth restored by the DCR than by the TFR technique, especially for a transverse section. This demonstrates that restoring a fractured tooth provides a superior outcome compared to reattaching the fractured fragment.

Crown Fragment Reattachment by the Minimal Intervention Approach for Coronal Tooth Fractures: A Case Series

Crown Fragment Reattachment by the Minimal Intervention Approach for Coronal Tooth Fractures: A Case Series

Fragment Reattachment: A 4-Year Case Report of an Uncomplicated Dental Fracture.

This case report aims to describe a detailed clinical protocol to restore two maxillary central incisors utilizing the crown fragment reattachment technique with adhesive systems and composite resin material. A long-term successful outcome was achieved after 4 years of follow up. Patient presented to the clinic with fracture of the maxillary central incisors. A comprehensive intraoral and radiographic examination revealed that both teeth had extended crown fracture with no pulpal exposure (Class II, Ellis and Davis). Teeth fragments were thoroughly cleaned and inspected before being repositioned. Both fragments were in excellent condition with almost no parts missing. Therefore, the proposed treatment was the fragment reattachment technique. After verifying the position and adaptation fractured fragments, a flowable composite was used to perform the reattachment procedure under rubber dam isolation. With current advancements in Adhesive Dentistry, tooth fragment reattachment, if present in good condition, is considered more conservative option that restores the morphological, esthetic and functional aspects. Although one tooth showed signs of irreversible pulpitis, and needed root-canal treatment 2 weeks after the restoration, the 4-year follow-up visits confirmed the success of the restorative treatment based on clinical and radiographic evaluations. The patient showed good function and esthetic outcomes after four years of follow-up.

Fragment reattachment in situ for complicated crown-root fracture in children permanent anterior: a case report

Fragment reattachment in situ for complicated crown-root fracture in children permanent anterior: a case report

A computational model to assess the effectiveness of adhesive materials in restoration of crown-root fractures

Fragment reattachment for crown root fractures has become a routinely employed treatment modality with the advancements in adhesive dentistry. Among the majority of documented dental trauma cases, this specific fracture type is one of the most prevalent and difficult fracture kinds. Due to its complexity, these fracture kinds are often not computationally modelled. Moreover, there is a lack of literature to understand the effect of different adhesive materials, used to re-attach this particular fracture, on traumatic injuries. In our work, 3D models of the permanent maxillary central incisor tooth were developed using cone beam computed tomography image of a patient. This model was systematically modified to represent a prominent crown root fracture and subsequently re-attached computationally using three different adhesives. A biting force and a traumatic load were applied, and the induced stresses were studied across the healthy and treated tooth models and compared for three different adhesives used for re-attachment of fractured fragments. Tooth reattached with resin adhesive performed better in all the loading conditions that were considered in the study as compared to flowable composite and resin cement.

Comparative evaluation of three materials used for fragment reattachment in uncomplicated crown fracture-An in vitro study using bovine teeth.

The recommended treatment for uncomplicated crown fractures is bonding the fractured fragment or the fragment reattachment. A paucity was identified regarding the studies comparing the efficacy of micro-hybrid and nanohybrid composites in fragment reattachment. Hence, the present study aimed to evaluate and compare three materials for bonding of fragments rehydrated by humidification in teeth with uncomplicated crown fractures. Eighty mandibular bovine incisors with similar dimensions and free of any structural deformities were fractured similar to the technique followed in previous studies. Fracture was simulated, fragments, and stumps were coded, stumps were stored in artificial saliva and the fragments were dehydrated at room temperature and pressure. They were randomly assigned to Group-1 (no rehydration), Group-2 (rehydrated and bonded by flowable nanohybrid composite-3M Filtek Supreme Syringe Flowable Composite Resin-A2, Sao Paulo, Brazil), Group-3 (rehydrated and bonded by flowable micro-hybrid composite- Ruby Flow, InciDental, England, United Kingdom), and Group-4 (rehydrated and bonded by light-cured Glass-Ionomer-Cement-Voco Ionoseal, Cuxhaven, Germany). The samples were subjected to a universal testing machine to evaluate the force required to fracture the bonded fragments. The highest median value of the force required to fracture was recorded for Group 2 (208.4 N) followed by Group 3 (195.2). The force required to fracture the bonded fragments was lowest in Group 4 (67.2 N) which was lower than the negative control (131.4 N). The differences between the observations in Groups 2 and 3 were not found to be statistically significant. The nano and micro-hybrid composites showed greater force required to fracture than fragments bonded by LC-GIC. Dehydrated fragments bonded using nanocomposites performed better than rehydrated fragments bonded by using LC-GIC.

A Case Report of Different Management Protocols for Uncomplicated Crown Fracture in Young Permanent Teeth; Fragment Reattachment vs. Resin Restoration

Introduction: An uncomplicated crown fracture (enamel-dentin fracture) is the most clinically reported traumatic injury. Many techniques have been reviewed to manage this traumatic injury. The literature has no consensus on the best strategy to establish optimal biological, functional, and esthetical success. Objective: This clinical case reports different management of uncomplicated crown fractures in young permanent teeth that were successfully treated using both tooth fragment reattachment and composite build-up. Case Report: A 9-year-old female presented as an emergency patient with immature fractured upper central incisors. She hit her mouth into a solid wall and broke her front teeth during playing. Upon parental advice, the fragments were stored in a container of milk since the incident. For dental management, two treatment approaches were used. Conclusion: After a two-year follow-up, the treatment is considered successful and the traumatized teeth are vital, functional and presented with a complete root development.

Tooth fragment reattachment: A case series and literature review of a biological restoration for traumatic dental injuries

Tooth fragment reattachment: A case series and literature review of a biological restoration for traumatic dental injuries

Reattachment of Fractured Maxillary Central Incisor Crown Using Fiber Post: A Case Report.

&#x0D; ABSTRACT: Dental fractures comprise the most frequent form of traumatic dental injury and often require an immediate procedure for their treatment. Among the treatments, the restoration of fractured teeth by reattachment of the tooth fragment to its tooth remnant is a viable clinical procedure to treat tooth fracture due to trauma because it is considered a highly conservative technique.

Effect of Adhesive Materials in Re-Attachment of Crown and Crown–Root Fractures of Permanent Maxillary Anterior Tooth: A Computational Study

Traumatic dental injuries (TDI) are frequent among individuals of all ages, with a prevalence ranging from 12–22%, with crown and crown–root fractures being the most common. Fragment reattachment using light-cured nanocomposites is the recommended method for the management of these fractures. Though there are several clinical studies that have assessed the efficacy of such materials, an in-silico characterization of the effects of traumatic forces on the re-attached fragments has never been performed. Hence, this study aimed to evaluate the efficacy of various adhesive materials in crown and crown–root reattachments through computational modelling. A full-scale permanent maxillary anterior tooth model was developed by segmenting 3D scanned cone beam computed tomography (CBCT) images of the pulp, root, and enamel precisely. The full-scale 3D tooth model was then subjected to a novel numerical cutting operation to describe the crown and crown–root fractures. The fractured tooth models were then filled computationally with three commonly used filler (or adhesive) materials, namely flowable composite, resin cement, and resin adhesive, and subjected to masticatory and traumatic loading conditions. The flowable composite demonstrated a statistically significant difference and the lowest produced stresses when subjected to masticatory loading. Resin cement demonstrated reduced stress values for crown–root fractures that were masticatory loaded after being reattached using adhesive materials. During traumatic loading, resin cement demonstrated lower displacements and stress values across both fractures. The novel findings reported in this study are anticipated to assist dentists in selecting the most appropriate adhesive materials that induce the least stress on the reattached tooth when subjected to second trauma, for both crown and crown–root fractures.

Fragment reattachment or direct restoration? An in vitro study.

The fracture resistance of teeth subjected to fragment reattachment may improve when the technique is performed using intermediate materials. The aim of this study was to evaluate the influence of different bonding materials, including pre-heated composite resin, on the fracture resistance of teeth subjected to the reattachment technique compared with a direct composite resin restoration. After simulating a tooth fracture, each specimen was reattached by using one of the following intermediate materials (n=15): G0, negative control (sound teeth); G1, Z100; G2, pre-heated Z100; G3, Filtek Z350 XT; G4, pre-heated Filtek Z350 XT; G5, Filtek Z350 XT Flow; and G6, RelyX Veneer. In G7, direct class IV restorations were performed using Filtek Z350 XT composite resin. The fracture resistance was evaluated using a universal testing machine under a compressive load of 1 mm/min. One-way analysis of variance (ANOVA) and the post hoc Tukey test (5%) were conducted. G0 showed the highest fracture resistance, and this was statistically different from the other experimental groups (p < .05) except for G2 and G4, in which the fragments were bonded using pre-heated resins. A statistically significant difference was found between groups G1 and G6 (one-way ANOVA, p=.04). For G1 and G2, a significant difference was found between bonding with and without pre-heating (p < .05). This difference was not observed in G3 and G4 (p > .05). No statistically significant difference was found between the reattached and directly restored groups (t-test, p=.53). The tooth reattachment technique using pre-heated composite resin showed fracture resistance values similar to those of the sound tooth group. No difference was found between the fragment reattachment and direct composite resin techniques.

FRACTURED TOOTH FRAGMENT REATTACHMENT: A CASE REPORT.

Coronal fractures of the anterior teeth are a common form of dental trauma. Traumatic injuries of teeth involve varying degrees of damage to the supporting soft tissues or the teeth itself. Recent developments in restorative material, placement techniques, preparation designs, and an adhesive protocol allow clinicians to predictably restore fractured teeth. Among the various treatment options, reattachment of a crown fragment is a conservative treatment that should be considered for crown fractures of anterior teeth. Reattachment of fractured fragment is indeed a cost-effective conservative treatment. This case report discusses management of coronal tooth fracture case that were successfully treated using tooth fragment reattachment using bre-reinforced post

Clinical Outcomes of Surgical Crown Reattachment as Treatment for Complicated Crown-Root Fractures: A Retrospective Study.

This retrospective study evaluated the clinical outcomes of surgical crown reattachment in the treatment of complicated crown-root fractures in permanent teeth in 35 patients. Treatments were defined as follows: surgical crown reattachment combined with internal fixation with a fiberreinforced core post, ostectomy, and reattachment of the original crown fragment. Patients were examined to record the periodontal pocket depth (PD), marginal bone loss, tooth migration, and coronal fragment looseness or loss. In most cases, the fracture lines on the palatal aspect were located below the alveolar crest. About 20% to 30% of teeth had periodontal pockets ≥ 3 mm present at least 1 year after surgery. Significant PD differences were observed between the traumatized teeth and adjacent untraumatized teeth at 6 months. The available evidence suggests that surgical crown reattachment is a feasible and effective technique for managing complicated crown-root fractures in permanent teeth.

Reattachment of Anterior Fractured Tooth Fragment

Introduction: Fractures of anterior tooth can sufficiently compromise the esthetics and functionality of the tooth and hinders future treatment plans. As such, treatment without delay is always desired by the patients. The prognosis of the tooth is crucial for the success of the treatment. A conservative and an optimal treatment modality which is preferred by clinicians is reattachment of the fractured segment to its primary site. Case Report: A 24-year-old male patient reported to our department with the chief complaint of broken tooth in the upper front tooth region. Considering the degree of fracture, the biological and esthetic aspects, we planned reattachment w.r.t 21,22. Root canal therapy and glass fibre reinforced composite post was planned followed by crown lengthening and reattachment of both the teeth. Results: The patient was followed up for one year and showed satisfactory results. Conclusion: This report highlights a case of coronal tooth fracture of a 24-year-old male that was effectively managed by tooth fragment reattachment procedure.

Aesthetic Rehabilitation of Anterior Fractured Teeth with Partial Veneer: A Case Report

A variety of approaches can be employed to restore dentinal enamel fracture such as reattachment of the tooth fragment, direct composite restorations and indirect veneers. Thus, ceramic partial veneers or ceramic fragments are the most suitable option due to the increasing interest in minimally invasive dentistry and their superior optical behavior. They are considered as an innovative ultra-conservative approach that covers only the fractured part of the tooth surface without any preparation. Clinical protocol was however delicate. Bonding procedures must be highly respected and sectional veneer must be positioned carefully and checked regularly.Nowadays, Ceramic partial veneers are becoming a more popular approach but there are still concerns about the fracture strength and the survival rate of such restorations. This following report discusses the case of a patient presenting a fractured incisor that was rehabilitated using a ceramic partial veneer.

Comparative evaluation of impact strength of natural tooth and two different fragment reattachment technique

Background: The reattached fragments are prone to re-fracture if another traumatic episode occurs or under non-physiological use of the restored teeth. There is a scarcity of literature regarding the management of uncomplicated crown fracture reattachment following a further fracture Therefore, concerns have been directed towards the strength of reattachment of the fractured teeth. Hence the aim of the in-vitro study was to evaluate &amp; compare the impact strength of reattached fragments with composite resin &amp; polyethylene fiber impregnated in composite resin with that of the natural tooth. Methodology: Total samples of 42 teeth were collected and indicated for extraction. They were cleaned ultrasonically and later stored in a 0.9% saline solution. The samples were divided into three groups of 14 samples each. The fracture was induced by disk, only Ellis class II fractured teeth were included in the study. Group 1 (control group) sound tooth: Directly checked for impact strength. Group 2: Reattachment of the fractured fragment using composite resin. Group 3: Reattachment using polyethylene fiber impregnated in composite resin with minimal preparation. All samples were thermocycled between 5°C - 55°C for 500 cycles with 30 seconds dwell time and tested in an ‘impact testing machine’.

Evaluation of two rehydration protocols for fractured tooth fragments for characteristics of penetration of resin tags using confocal laser scanning microscopy.

Fragment reattachment is the recommended treatment modality in uncomplicated crown fractures. There is a paucity of literature regarding the mechanisms responsible for increased resistance to fracture after fragment rehydration in such cases. Hence, the aim of this proof-of-concept study was to decipher the microscopic changes in the penetration characteristics of resin in tooth fragments after different rehydration protocols. Sixty bovine incisors free of structural deformities were fractured as per a standard protocol and the fragments were stored in saline at 4°C. They were randomly allocated into three groups (n=20)-Group 1: negative-control, no-rehydration, Group 2: rehydration by immersion in distilled water for 15 min, Group 3: rehydration by humidification for 15 min. They were subjected to the "experimental bonding protocol" using an eighth-generation bonding agent mixed with rhodamine-B dye. The samples were subjected to decalcification and sectioned into cubical blocks (2 × 2 × 2 mm3 ). They were embedded in paraffin wax, sectioned by an ultramicrotome and evaluated by using a confocal laser scanning microscope. The depths and width of the resin tags were assessed by image analysis software, and the number of tags was counted manually by blinded evaluators. Statistical analysis was done with Stata-14. The depth of penetration of the resin tags was greatest in Group 2 (927.81 ± 280.38 μm) followed by Group 3 (902.03 ± 371.85 μm) and Group 1 (287.74 ± 124.80 μm). Similarly, the width of the penetrated resin tags was greatest in Group 2 (58.29 ± 21.15), followed by Group 3 (35.53 ± 22.15) and Group 1 (23.89 ± 6.88). The number of resin tags in the majority of the samples in Group 1 had less than 25 tags (65%), whereas there were more than 25 tags in Group 2 (70%) and Group 3 (75%). These differences were statistically significant (p < .05). The resin penetration, as observed by the number of tags and their depth and width, was significantly affected by the rehydration of the fragments. The fragments rehydrated in the distilled water had greater penetration of resin tags than those rehydrated in a humidification chamber.

Reattachment of coronal tooth fragments: Aesthetic management of a complicated anterior maxillary crown fracture

Abstract The trauma of anterior teeth is a frequent occurrence in young patients. Reattachment of fractured fragments is one of the various treatment modalities proposed in anterior tooth coronal fractures. The reattachment of fractured fragments grants the advantage of immediate aesthetic rehabilitation and restoration of function, which is a relatively rapid and less arduous procedure. The manuscript presents a case report depicting the management of a complicated crown root fracture of anterior maxillary teeth first treated endodontically, followed by reattachment of the same fragment with a cast post-reinforcement. Reattachment of fractured coronal tooth fragments is a feasible restorative option, rapidly restoring the function and aesthetics of the tooth by a conservative and inexpensive approach.