Reattachment Procedure Research Articles

Management of complicated crown fracture in maxillary incisor using fragment reattachment - 5-year follow-up

Complicated crown-root fractures of maxillary incisors are a relatively common occurrence in cases of trauma to the facial region. Patients with such fractures are in acute pain and usually require emergency care on their first clinical visit. Pain management and restoration of function, esthetics, and phonetics should be the prime objective in handling such patients. The reattachment of fractured tooth fragments is a relatively simple procedure that provides natural esthetics and conservation of tooth structure. This case report describes such a reattachment procedure in a complicated crown-root fracture and its success at 5 years of follow-up.

Repairing the Irredeemable Fragment Reattachment of a Complicated Crown-root Fracture with Fiber Post

Coronal fracture of the anterior teeth is a commonly occurring dental trauma often seen in young individuals. Such fractures can be conservatively managed with fragment reattachment procedure when the fragment is available and preserved in correct storage media. Due to advancements in adhesive dentistry, fragment reattachment is a simple, esthetic and fast treatment option. This article reports a case of fragment reattachment of a complicated crown root fracture using fibre post as an intraradicular splint.

Minimal Intervention Approach for Complicated Crown- root Fracture using Reattachment procedure: Three Years Follow-up

Crown-root fractures are commonly encountered in dental practice, and their management poses a challenge to clinicians. With the advent in adhesive dentistry, reattachment of the fractured segment became a viable restorative alternative. Reattachment is a conservative treatment option that allows for immediate restoration of function, esthetics and phonetics. This case report presents a minimal intervention approach to the management of a complicated crown root fracture. The tooth was endodontically treated followed by esthetic reattachment of the fractured fragment using composite fiber post. The patient was followed up for three years, and clinical and radiographic examinations showed a successful treatment outcome.

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.

Cost-effectiveness of upper extremity arthroplasties at orthopedic specialty hospitals

Background: Major joint/limb reattachment procedures of upper extremities (Diagnosis-related group 483, DRG-483) are increasingly utilized, while average costs have increased yearly. This study seeks to determine the influence of volume, neighborhood demographics, and orthopedic specialization on the cost of DRG-483. Methods: Utilization and cost data for DRG-483 was extracted from Centers for Medicare and Medicaid Services (CMS) inpatient charge data from 2014-2018. Neighborhood demographic data was queried as USDA Rural-Urban Commuting Area codes (RUCA) from the United States 2010 census and Esri’s ArcMap software. Orthopedic specialization ratios for each hospital (OSR = Musculoskeletal discharges/Total Discharges) was utilized to compare Orthopedic Specialty Hospitals (OSH) = OSR>0.99 and Nonspecialty Hospitals (NSH) = OSR≤0.99. The cost of DRG-483 procedures and the influence of volume, hospital demographics, and orthopedic specialization was analyzed using linear regression models. Results: OSH performed DRG-483 procedures at lower average Medicare payments (AMP) than NSH in all years studied (P<0.001), averaging 15% saved per surgery. DRG-483 volume was weakly negatively correlated with AMP, averaging $2.95 saved per discharge. Finally, population density of hospital location was inversely proportional to DRG-483 AMP with metropolitan centers performing the procedure at the lowest cost to the CMS. Conclusions: CMS payments are optimized at urban orthopedic specialty hospitals. Eliminating the AMP difference for the 222,519 DRG-483 performed at NSH would have saved CMS over 480 million dollars between 2014-2018.

Inadvertent ocular penetration during eyelid anesthesia – Case presentation and review of literature

We report a case of inadvertent ocular penetration during eyelid block with local anesthesia for blepharoptosis surgery. A 51-year-old female was planned for levator reattachment procedure for aponeurotic ptosis in the left eye. Following eyelid infiltration using a 30-G, 0.5-inch needle, a localized conjunctival chemosis with intraocular air bubble was noted in the anterior chamber. There was no diminution in vision, and whatever was visible in the posterior segment examination was within normal limits. The procedure was abandoned. After observation for 2 weeks, the patient was operated uneventfully under local anesthesia. Local anesthetic injection during eyelid infiltration may be complicated by inadvertent ocular penetration. Knowing thorough anatomy of the eyelid, using the appropriate technique and immediate identification of signs and symptoms of ocular penetration can prevent any further complications from happening.

Inadvertent intraocular injection of methylprednisolone in a patient with prior superior oblique tuck surgery

Summary Background To report inadvertent intraocular methylprednisolone injection into an eye that had previously undergone superior oblique tuck surgery. Material and methods An observational case report. Results An inadvertent intraocular penetration occurred following periorbital methylprednisolone injection, which was performed via the superonasal quadrant to relieve trochlear pain in an eye that had undergone previous superior oblique tuck procedure. There was immediate loss of vision, afferent pupillary defect, and raised intraocular pressure. Fundoscopy revealed intravitreal and subretinal methylprednisolone with retinal detachment. Immediate removal of intravitreal and subretinal methylprednisolone was performed with a retinal reattachment procedure. Postoperatively, retinal necrosis was noted in the area that was in contact with methylprednisolone. Conclusions This case highlights the risk of inadvertent intraocular penetration while injecting through a limited periorbital space that has been previously operated on.

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.

Comparative evaluation of the fracture resistance of reattched fragments using three different retentive methods: An in vitro study

: Traumatic injuries to the anterior teeth are one of the most difficult and perplexing problems faced in the paediatric dentistry. Coronal fracture of the anterior teeth is a common form of dental trauma that mainly affects the maxillary and mandibular incisors. Fragment reattachment has been the preffered technique among clinicians because it has several advantages over the composite restorations such as it is a conservative procedure, maintains original tooth contours, translucence and incisal edge wears at similar rate to adjacent teeth.: To compare and evaluate the fracture resistance of reattached fragments using three different methods.Forty sound permanent mandibular central and lateral incisor were selected and mounted in self-cure acrylic resin. The teeth were sectioned with a diamond disc 3mm short of the incisal edge and they were randomly divided into four groups (n=10). Group I – simple reattachment, group II- internal dentinal groove, group III – vertical groove with fiber reinforced post placement, group IV – overcontouring done before the reattachment procedure. The force required to fracture the specimen were recorded using an onscreen calibration tool of the universal testing machine. The results were statistically analyzed.: The results showed that group I, group II and group IV required lesser force to fracture when compared with group III.: The group restored with fiber reinforced post showed the highest value of fracture strength while the simple reattachment had the lowest value.

Immediate autogenous reattachment of fractured tooth fragment post trauma: A case report

Fractures of the anterior teeth are one of the most common forms of dental injury that occur during trauma to the head and neck region. These complications can be managed conservatively and immediately through autogenous reattachment procedures. Reattachment procedures are an immediate solution in the management of coronal fractures in which the patient’s own fractured tooth fragment is bonded back onto the remaining portion of the tooth after endodontic therapy. This technique restores proper form, function, and aesthetics of the tooth in a short duration of time and also significantly impacts the post traumatic psychological rehabilitation of the patient. The recent advances in bondable dental materials have made these reattachment procedures much more predictable. This paper describes a case report of a patient who reported with a fractured tooth post trauma to the face and was treated using endodontic therapy followed by reattachment of the fractured tooth fragment using anchorage from a fiber post.

Immediate esthetic rehabilitation of fracture vital and nonvital teeth: A noval approach

Traumas that affect the hard tissues, cause functional and esthetic disturbances which are of great relevance especially when a patient is a public figure immediate treatment in such cases is mandatory for both esthetic and psychological reasons. In the pre-adhesive era, fractured teeth were restored either with pin retained restorations or metallic post. However, with development of adhesive dentistry more conservative approach can be adapted allowing the dentists to use the patient’s own fragment to restore the fractured tooth.This procedure termed as reattachment can lead to immediate esthetic restoration. This article present the two successful conservative management of reattachment procedure.

COMPARATIVE EVALUATION OF FRACTURE RESISTANCE OF REATTACHED FRACTURED FRAGMENT OF ANTERIOR TEETH WITH DIFFERENT TECHNIQUES: AN IN VITRO STUDY

Introduction: Conservative restoration of fractured anterior teeth is a challenge. Today is an era of beautification; even dentistry is moving towards better appearance. Therefore we are always in search of techniques and materials, which will lead to more natural appearance of teeth.
 Aim: To assess the break strength of maxillary focal incisors subsequent to reestablishing with four reattachment procedures (simple reattachment, internal grooving, over–contour, buccal chamfer with lingual over contour). And to compare the fracture strength obtained by reattached segments and to find the best technique for restoring fractured central incisor teeth.
 Result: In current in vitro study was directed to assess the crack strength of maxillary focal incisor teeth utilizing four distinct reattachment methods. Initial four gatherings were the experimental groups and fifth one was control bunch. The force required to fracture the reattached fragment was recorded in Newton.
 Conclusion: In light of results obtained and within the limitations of the present study: None of the reattachment procedures were able to regain the fracture strength as compared to the intact teeth. When compared to an intact tooth Buccal chamfer with lingual overcontour, and overcontour group had 60% recovery of fracture strength and Fracture strength of Buccal chamfer with lingual overcontour, and over contour was better than internal groove which was better than simple reattachment group.

A novel insertion design of fiber materials for the adhesive reattachment in vertically fractured teeth.

ObjectiveThis ex vivo study aimed to evaluate the strengthening effect of different ferrule and reattachment designs with fiber and adhesive materials on vertically fractured teeth.MethodsNinety extracted single-root premolars were instrumented and divided into nine groups (two control groups and seven experimental groups; n = 10). The negative control (NC) group comprised of intact teeth, while the positive control (PC) group comprised of root canal-treated teeth. The roots of the teeth in the experimental groups were vertically fractured into two equal fragments. The fragments were reattached with one of the followings: 4-methacryloxyethyl trimellitate anhydride/methacrylate-tri-n-butyl borane (4-META/MMA-TBB) resin, 4-META/MMA-TBB + quartz fiber post, 4-META/MMA-TBB + glass fiber bundles, 4-META/MMA-TBB + quartz fiber post + 1 mm ferrule, 4-META/MMA-TBB + glass fiber bundles + 1 mm ferrule, 4-META/MMA-TBB + quartz fiber post + 2 mm ferrule, and 4-META/MMA-TBB + glass fiber bundles + 2 mm ferrule. The core build-ups were made with composite resin. The specimens were subjected to compressive loading until failure occurred. Mean load necessary to fracture each sample and the fracture types of these samples were recorded.ResultsThe highest mean fracture load was recorded in the NC group (1,036.7 N), which was not significantly higher than the PC group (989.66 N) (p > 0.05). The roots reattached with quartz fiber post demonstrated significantly less fracture strength (871.9 N) as compared to the other test and control groups (p < 0.05). There was no significant difference between the PC group and reattached fragments with different ferrule designs in terms of fracture resistance (p > 0.05).ConclusionsThe customized fiber bundles may be more suitable for reattachment of vertically fractured teeth than the rigid fiber posts. For reattachment procedures, the ferrule design may be preferred to increase the fracture strength of vertically fractured teeth.

Reattachment of Crown in Anterior Fractured Tooth-A Case Report

In dentistry, traumatic injuries are most common in the anterior teeth due to its anatomic position. The various treatment modalities have been used depending on the extent of injury on teeth and supporting structures. Esthetic concerns are the most important challenges in modern dental practice. Adhesive dentistry is an excellent approach regarding esthetics, especially for fractured anterior teeth. This case report describes the successful treatment of reattachment procedure in a 17-year-old male patient presented with a fractured maxillary left central incisor.

Knowledge, awareness and perception amongst dental practitioners towards natural tooth fragment reattachment procedures in clinical practice-A cross-sectional survey.

Reattachment of a tooth fragment is a viable alternative to restore a fractured tooth. The aim of this study was to assess the knowledge, awareness and perception of dental practitioners towards tooth fragment reattachment procedures. The cross-sectional study was conducted during 2019 and comprised dental practitioners working as general dentists or dental specialists. The subjects were asked to fill out a self-administered questionnaire. Questions related to knowledge and practice regarding fragment reattachment procedures were asked, and the responses were recorded. SPSS version 20.0 and the chi-square test were selected as the statistical tools for data analysis with significance level established at p < .05. Eight hundred and fifty-seven subjects participated in the study. Of them, 404 (47%) were general dentists and 453 (53%) were specialist dentists. Out of the 857 subjects, 231 (27%) had clinical experience of less than 5 years, 268 (31.3%) between 5 and 10 years, 190 (22%) between 10 and 20 years and 168 (19.6%) had experience of over 20 years. Of the 857 subjects, 673 (78.5%) had some knowledge about the reattachment procedure and 292 (34.1%) had performed reattachment in clinical practice. The most common storage medium used for the fractured fragment was saline. The bonding material used for reattachment was lightcured composite resin. A subsequent fracture of the reattached fragment was encountered by more than 62% of the subjects. Lack of availability of the fragment and lack of clinical training were the major reasons for clinicians not performing the procedure routinely. The attachment procedure was most often performed by both general dentists and specialist dentists with 5-10 years of clinical experience. Furthermore, the majority of the participants did not have any familiarity with the concept of biological restorations. Cross contamination was a major clinical concern for the limited clinical application of biological restorations.

Outcomes and Material Cost Comparison of Transosseous Versus Suture Anchor Fixation of the Achilles Tendon: A Retrospective Study

Insertional Achilles tendinopathy is a common pathology that may be resistant to conservative treatment requiring surgical intervention. Treatment often involves partial to complete detachment of the Achilles tendon, debridement, and reattachment. Although 50% of the tendon may be safely resected without significantly compromising strength, the addition of a lengthening procedure requires further reinforcement. We conducted a retrospective review of 43 procedures comparing outcomes of 16 single suture anchor procedures with 27 transosseous fixation procedures for reattachment of the Achilles. The suture anchor group utilized one of 2 different industry anchors while the transosseous group utilized sutures ranging in size from 2-0 to #2. Female patients contributed 67% of the procedures with 53% occurring on the left side. For each group the median preoperative pain score (scale 0-10) was 8 and the median of the lowest reported postoperative pain score was 0. The typical time to lowest postoperative pain was 10 weeks for the suture anchor group and 4 weeks for the transosseous group. Tourniquet time averaged 59.3 (12.9) minutes for the suture anchor group and 65.1 (16.4) for the transosseous group. There was a large difference in material costs between the suture anchor and transosseous groups which ranged from $364.51 to $448.51 and $99.80 to $104.00 respectively. With similar results on postoperative pain and adverse event rate to suture anchor fixation and lower material costs than anchor fixation, transosseous fixation remains a viable option for fixating the Achilles tendon to bone in treatment of insertional Achilles tendinopathy.

Biologic restoration: A successful treatment option for immediate esthetics – A case report

Crown fractures mainly in the anterior region are the most common outcome of traumatic injuries. The common cause is ascribed to falls, motor vehicle accidents, and contact sports. Out of all the dental trauma injuries, dentoalveolar trauma contributes to about 25%, which may vary from simple crown fracture of enamel and/or dentin to complicated crown root fractures. In this case report, an undergraduate dental student reported with a fractured crown due to a fall an hour earlier. The clinical and radiographic assessment leads to the diagnosis of an uncomplicated crown fracture. Fracture line was extending obliquely till the middle third of the crown involving enamel and dentin. Tooth segment adaptation was evaluated, and decision was made to attempt for reattachment procedure. The tooth was isolated using rubber dam and tooth fragment was reattached using flowable composite. Follow up period was noted for 6 months. Tooth segment reattachment is a minimally invasive procedure with immediate aesthetic and it is not time consuming. This procedure has a predicable long-term prognosis with minimal complication due to advances in adhesive technique. Various factors should be taken into consideration for maximizing the benefits. Thus, this simple procedure is an alternative to the other complex restorative procedure for restoring tooth function, form, and esthetics. Recent advances in flowable composites can be used for a much more predictable result pertaining to strength and aesthetics.

Conservative Approach for Management of Complicated Crown Facture using Tooth Fragment Reattachment Technique

The restoration of a fractured anterior tooth by fragment reattachment is biological, conservative, and the most currently acceptable treatment option. In addition, the advancements in adhesive dentistry, tooth fragment reattachment procedure has become simpler and clinically reliable. This article presents management of two cases of complicated crown fracture of maxillary incisors by reattachment of the fractured tooth segment.

Calcaneoplasty coupled with an insertional Achilles tendon reattachment procedure for the prevention of secondary calcaneal impingement: a retrospective study.

Background:Posterior heel pain may occur after an Achilles insertional rupture reattachment procedure and could be attributed to an impingement between the calcaneal tuberosity and Achilles tendon, which could be observed using postoperative magnetic resonance imaging (MRI). Moreover, such impingement, which may be associated with postoperative pain symptoms, could be relieved by calcaneoplasty.Methods:Postoperative Visual Analog Pain Scale (VAS), American Orthopedic Foot and Ankle Society (AOFAS) score, Foot Function Index (FFI), Ankle Activity Score (AAS), and Tegner score were obtained and compared between 10 patients who underwent calcaneoplasty (calcaneoplasty group) and 11 patients who did not receive calcaneoplasty (non-calcaneoplasty group). Several signs of calcaneal tuberosity impingement identified in MRI were also compared between the two groups, which included retrocalcaneal bursitis, postoperative tendinopathy, tendon calcification, bone marrow edema, increased Achilles tendon diameter, and bony spurs.Results:The VAS score was 2.00 ± 1.41 and 2.18 ± 1.83 (p = 0.803), the AOFAS score was 90.60 ± 4.22 and 81.82 ± 7.77 (p = 0.005), the FFI was 5.00 ± 2.86 and 17.18 ± 15.92 (p = 0.028), the AAS was 5.50 ± 2.55 and 5.82 ± 2.04 (p = 0.750), and the Tegner score was 4.30 ± 1.49 and 4.45 ± 1.21 (p = 0.797) in the calcaneoplasty and non-calcaneoplasty groups, respectively. The AOFAS score and FFI were significantly different between the groups. MRI findings revealed that the non-calcaneoplasty group had significant signs of calcaneal impingement compared with the calcaneoplasty group.Conclusions:Secondary calcaneal impingement due to insertional tendon enlargement may occur, and prophylactic calcaneoplasty coupled with an insertional reattachment procedure could achieve promising postoperative outcomes for patients with insertional Achilles tendon rupture.

Fracture Resistance of Reattached Hydrated Fragment of Fractured Incisors.

Background and objectivesFragment reattachment procedure provides conservative treatment option when an intact fractured fragment is available. Rewetting of fractured fragment before reattaching has shown better bond strength of attached fragment. Therefore, fracture resistance of reattached fractured fragment with hydration and without hydration was evaluated and compared.Materials and methodsEllis class II fracture was induced in selected and coded 60 extracted maxillary central incisors using a custom-made-wise and assigned into group I and group II (without hydration and with hydration) and both the groups were further divided into two groups (1 week and 3 months). In group I, fractured fragments were reattached after bench-drying for 24 hours. In group II, fractured fragments were reattached after hydrating for 1 hour following bench-drying for 24 hours. Composite (Filtek Z350 XT, Universal Restorative, 3M ESPE) was used to reattach the fractured fragments. Reattached fractured fragments were stored in artificial saliva for 1 week and 3 months and subjected to fracture resistance test using Universal Testing Machine. The data obtained were tabulated and statistically analyzed.ResultsFracture resistance in hydration samples was higher than without hydration at the end of 1 week and 3 months statistically. Fracture resistance of fractured fragment at the end of 3 months was higher in both with hydration and without hydration but was not significant with hydration.ConclusionHydration of fractured fragment before reattachment procedure has shown better fracture resistance and improved further after storing in artificial saliva for 3 months.How to cite this articleSuresh M, Mallikarjun SB, Babu G, et al. Fracture Resistance of Reattached Hydrated Fragment of Fractured Incisors. Int J Clin Pediatr Dent 2020;13(5):476–480.