Tooth Fragment Research Articles

Aesthetic rehabilitation of a complex crown-root fracture by fragment reattachment with a fiber-reinforced post: A case report

Complex crown-root fractures are characterized by the involvement of both crown and root with pulp exposure. They pose aesthetic, functional, and psychological problems for the patient. Furthermore, they can pose technical difficulties for the practitioner. The purpose of this case report is to describe the management of a complex crown-root fracture of the right upper central incisor with subgingival limit by reattaching the tooth fragment with fiber-reinforced post. We considered a coronal elongation (gingivectomy and osteoplasty) to recreate the biological space and to expose the limit of the fracture line to guarantee the quality of the bond.

Evaluation of Fracture Resistance of Reattached Tooth Fragments Restored Using Fiber-reinforced Composites: A Systematic Review.

This systematic review examined the current literature to evaluate the fracture resistance of the tooth fragments reattached using fiber-reinforced composites (FRC). An electronic search was performed on Scopus, PubMed, and Web of Science databases according to specific inclusion and exclusion criteria to identify relevant articles to be included until January 2023. Articles with full text available in the English language for randomized control studies, observational studies, retrospective studies, and in vitro studies conducted on permanent human teeth were selected. The risk of bias was assessed in all studies using the OHAT tool. Out of 16 search results, seven in vitro studies with a total of 415 samples were included in the review. Three studies reported that reinforcement using rigid FRC posts improves fracture resistance of reattached anterior teeth, three studies reported that reinforcement using flexible fiber bundles enhances the fracture strength of reattached posterior teeth and one study reported that the use of flexible polyethylene fibers improves fracture resistance in molars with reattached cusps. Within the limitations of the studies included in the review, there is low-quality evidence that reinforcement of reattached fragments using FRC posts or fibers improves fracture resistance. The reattached fractured fragments may be susceptible to re-fracture. The use of FRC to reinforce the resin composite used for reattachment may enhance the bond strength and increase resistance to fracture. How to cite this article: Albar NHM. Evaluation of Fracture Resistance of Reattached Tooth Fragments Restored Using Fiber-reinforced Composites: A Systematic Review. J Contemp Dent Pract 2024;25(6):605-615.

Management of Complicated Crown Root Fracture Using Chamfer Reattachment Technique

Abstract The reattachment of the tooth fragment is one of the viable treatment options if the original intact tooth fragment is available following dental trauma. The reattachment of the remaining fractured tooth can provide better aesthetics, improved function and generate a positive psychological response amongst patients. This case report consists of three cases of crown root fracture that was successfully treated using tooth fragment reattachment technique.

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.

Biomechanical characteristics of maxillary anterior incisor, conventional immediate implantation and socket shield technique — A finite element analysis and case report

BackgroundTo prevent the absorption and collapse of the labial bone plate of the anterior teeth, immediate implantation and socket shield technique have been increasingly applied to anterior dental aesthetic implant restoration. ObjectiveTo provide a biomechanical basis for implant restoration of maxillary anterior teeth, finite element analysis was used to investigate the stress peak and distribution in different anatomical sites of natural teeth, conventional immediate implantation and socket shield technique. MethodsThree maxillary finite element models were established, including a maxillary incisor as a natural tooth, a conventional immediate implantation and a socket shield technique. A mechanical load of 100 N was applied to simulate and analyze the biomechanical behavior of the root, periodontal ligament (PDL), implant and surrounding bone interface. ResultsThe stress distribution of the natural tooth was relatively uniform under load. The maximum von Mises stress of the root, periodontal ligament, cortical bone and cancellous bone were 20.14 MPa, 2.473 MPa, 19.48 MPa and 5.068 MPa, respectively. When the conventional immediate implantation was loaded, the stress was mainly concentrated around the neck of implant. Maximum stress on the surface of the implant was 102 MPa, the cortical bone was 16.13 MPa, and the cancellous bone was 18.29 MPa. When the implantation with socket shield technique was loaded, the stress distribution of the implant was similar to that of immediate implantation. Maximum stress on the surface of the implant was 100.5 MPa, the cortical bone was 23.11 MPa, the cancellous bone was 21.66 MPa, the remaining tooth fragment was 29.42 MPa and the periodontal ligament of the tooth fragment was 1.131 MPa. Conclusions1. Under static loading, both socket shield technology and conventional immediate implantation can support the esthetic restoration of anterior teeth biomechanically. 2.Under short-term follow-up, both immediate implant and socket shield technology achieved satisfactory clinical results, including bone healing and patient satisfaction. 3.The stress distribution is mainly located on the buccal bone surface of the implant and is associated with resorption of the buccal bone plate after implant replacement in both socket shield technology and conventional immediate implantation. 4.The presence of retained root fragment had an impact on the bone graft gap. In immediate implantation, the peak stress was located in the cortical bone near the implant position, while in socket shield technology, the peak stress was at the neck of the cortical bone corresponding to the retained root fragment.

Effect of temperature on rehydration and fracture resistance of reattached tooth fragments after crown fracture: An in vitro study.

Uncomplicated crown fractures of maxillary anterior teeth are common dental injuries, and the bonding of fractured fragments is recommended for management. Rehydration of fragments improves bonding and fracture resistance. Therefore, the aim of this study was to compare the fracture resistance of the reattached tooth fragment of the incisor crown after rehydration using either a steamer or a humidifier. Bovine teeth were used as a model. Fractured fragments were divided into three groups: Group I (no rehydration), Group II (rehydration by humidifier), and Group III (rehydration by steamer). Fragments were reattached using a standard bonding protocol. Fracture resistance was tested using a universal testing machine. Statistical analysis was performed using analysis of variance and Chi-square tests. The force required to fracture the reattached fragments was significantly higher in Group II (humidifier) compared to Group I (no rehydration) (P = 0.005). Group III (steamer) had a force value similar to Group I, indicating no significant improvement in fracture resistance with steamer rehydration. The temperature inside the steam-based chamber reached an average of 95.7°C with 95% humidity, whereas the conventional humidification chamber had an average temperature of 39.2°C and 84% humidity. Within the limitations of the present study, the rehydration protocol using a steam-based chamber was found to have a significantly lower force required to fracture the reattached fragments as compared to humidifier-based chamber. This was not significantly different from the fragments which were reattached without rehydration.

Management of complicated crown fracture with an aberrantly placed tooth fragment - a case report and review of the literature

Management of complicated crown fracture with an aberrantly placed tooth fragment - a case report and review of the literature

Comparative Evaluation of the Effect of Various Storage Media on the Fracture Resistance of the Reattached Tooth Fragment: An Observational Study.

Traumatic injuries are the most disruptive and distressing emergencies and pose a challenge for dental professionals because many different treatment protocols are currently available. They also affect the social and psychological well-being of children. A multidisciplinary approach is involved in the management of traumatic dental injuries to maintain function and esthetics. The aim of this study was to evaluate the fracture resistance of a reattached tooth fragment kept in four storage media, namely Hank's balanced salt solution (HBSS), Tooth Mousse, ginger honey, and probiotic yogurt, for 1, 6, and 24 hours. The study consisted of 84 intact maxillary central incisors. All the teeth were stored in distilled water until used and were embedded in acrylic molds, 1 mm below the cervical end. The teeth were then sectioned to simulate an uncomplicated crown fracture (Ellis class II fracture), and all the teeth were randomly divided into four groups of 21 each. The teeth were then reattached using Tetric N Universal bonding agent and Tetric N Flow flowable composite. Fracture resistance was assessed using a universal testing machine. Statistical analysis was done using a one-way analysis of variance (ANOVA) test and a post hoc Tukey test. The results showed that fracture resistance was highest in the Tooth Mousse group at 6 and 24 hours. Ginger honey exhibited the highest fracture resistance at 1 hour, whereas the probiotic yogurt group showed the lowest values. It was concluded that Tooth Mousse was the best storage medium for storing tooth fragments. Ginger honey can also be used as an alternative storage medium as it is easily available and inexpensive. Naik S, Murry JN, Sharma S, et al. Comparative Evaluation of the Effect of Various Storage Media on the Fracture Resistance of the Reattached Tooth Fragment: An Observational Study. Int J Clin Pediatr Dent 2024;17(6):665-672.

An assessment of Brazilian dentists' knowledge about tooth fragment reattachment: A cross-sectional study.

Crown fractures are common traumatic dental injuries and tooth fragment reattachment is a viable option for restoring a fractured tooth. The aim of this study was to assess the knowledge and experience of dentists in the Federal District regarding the tooth fragment reattachment technique for enamel and dentin fractures. For the cross-sectional observational study, an electronic form was designed with objective and self-report questions for dentists. The data were analyzed using descriptive statistics, with their absolute and relative frequencies. For the analysis of categorical variables, the nonparametric chi-squared or Fisher exact association tests were used in the statistical software R (version 4.2.1). A total of 416 dentists participated in the study (58.9% female and 41.1% male). Of these, 70% declared they knew about fragment reattachment, but only 42.3% reported previous experience with this procedure. The most common storage medium used for the fractured fragment was milk (78.1%), and the bonding material used for reattachment was light-cured composite resin (86.3%). A majority (66.3%) reported that for a patient with enamel and dentin fracture, with the crown fragment in good condition, they would choose to do the reattachment. Dentists demonstrated that they had adequate knowledge about the tooth fragment technique, although many did not have previous experience with this procedure.

Identifying and documenting osseous trauma from shark attacks by post mortem CT examination and autopsy.

A 15-year-old male was attacked by a large white shark while surfing. CT examination revealed an above-knee amputation of the right lower extremity with stripping of soft tissues from the groin distally. 3-dimensional volume rendering did not show any fragments of shark teeth but did reveal linear gouges, areas of shaving of cortical bone and an inverted 'V'-shaped defect at the distal margin of the femoral shaft. At autopsy these injuries were confirmed in addition to areas with fine parallel cross-striations matching the marginal serrations of the teeth of a white shark. Thus, while post mortem CT with 3-dimensional reconstruction at high resolution can show the nature and number of the bony injuries following shark attack, it is complimented by pathological examination which may find fine parallel grooves from teeth serrations. Post mortem 3-dimensional volume rendering may also help to find or exclude fragments of teeth, and silicone casting may provide a permanent record of bone lesions.

Analyzing the Impact of Different Bonding Protocol Strategies to Improve the Fracture Resistance of Uncomplicated Crown Fractures on Tooth Fracture Reattachment in Permanent Anterior Teeth: An In-vitro Study.

Objective This study aims to analyze three different bonding protocol strategies in determining the fracture resistance on the reattachment of fragments in permanent anterior teeth. Methodology This study evaluated the ability of three bonding methods (Group A, total-etch technique; Group B, selective-etch technique; and Group C, self-etch technique) to enhance the fracture resistance of reattached tooth fragments. Sixty permanent maxillary central incisors were chosen, segmented at 3 mm from the incisal edge, and randomly distributed among the three groups. Tooth fragments were stored for 24 hours in GC Tooth Mousse (GC Corporation, Tokyo, Japan), and then reattachment was done using respective bonding techniques. Fracture resistance was gauged using a universal testing machine. Results The mean fracture resistance values were as follows: total-etch (419.5995 N), selective-etch (359.1448 N), and self-etch (192.0887 N). One-way analysis of variance (ANOVA) and post hoc Tukey tests revealed a statistically significant difference between the groups. It was inferred that the total-etch technique exhibited the highest fracture resistance, while the self-etch technique resulted in the lowest fracture resistance (P < 0.05). Conclusions The choice of bonding technique for reattaching tooth fragments should be made based on clinical context and patient needs. Total-etch provided the highest fracture resistance, but selective etch can be preferred for anterior teeth with lower occlusal loads to prevent sensitivity.The self-etch technique may not provide sufficient strength and should be used cautiously. More clinical studies are required to validate these findings and guide clinical decision-making in traumatic dental injury management.

Socket-shield Technique and immediate implant placement for ridge preservation in the aesthetic region: a 1-year clinical and tomographic follow-up

Objective: To describe the clinical, radiographic and tomographic aspects, as well as complications, success, aesthetic and functional results of an implant placed using the “socket shield” technique. Case Details: Represents a 46-year-old patient, with increased mobility of the crown in the bucco-palatal direction, with indication for extraction replaced by immediate implant. Atraumatic extraction, socket preservation technique and immediate implant placement were performed. The socket-shield technique was designed for placing implants to protect the oral bone and achieve adequate aesthetics. The buccal fragment of the tooth was kept fixed and the implant was placed in contact with the tooth fragment. Cone Bean computed tomography showed bone formation in the buccal aspect 1 year later, and demonstrated stability of the peri-implant bone tissue and replacement of the root remnant by bone. The clinical appearance demonstrated maintenance of peri-implant soft tissues and good aesthetics without gingival retraction. Final considerations: One-year follow-up shows adequate healing and healthy peri-implant tissue, suggesting that the socket-shield technique with immediate implant placement can be an excellent alternative for preserving the vestibular cortex and implant placement, especially in the aesthetic area.

Management of dental trauma: re-attachment workflows. Guidelines and case studies

Dental trauma presents in a number of different ways and the outcome of treatment of trauma is equally varied, and can be dependent on the mode of management at the acute presentation. Pulpal vitality, retention of the periodontal ligament, discolouration factors, apical maturity, mobility and recession are just some of the follow-up complications that can be influenced not only by the nature of the injury, but also the method of immediate management. This report of two cases of broken incisors highlights the use of adhesive techniques and a knowledge of hue, chroma and opacity to re-attach tooth fragments in an aesthetic zone trauma. The cases also highlight the variance of outcome based on the nature of the trauma and the injury sustained. CPD/Clinical Relevance: To highlight the relevance of trauma management, the techniques available and the variation in outcome with treatment.

Barodontalgias, dental and orofacial barotraumas: a survey in Swiss divers and caisson workers.

Changing ambient pressure can lead to medical conditions in body cavities filled with air. Intraoral pain elicited by changes in pressure is referred to as barodontalgia. Dental barotraumas are defined as pressure-induced damages of teeth and restorations. The pathophysiologic background so far is not completely clear. The present study deals with dental and orofacial symptoms which can occur as a result of pressure variations. With the aid of cantonal administrations, diving associations, and tunnel construction firms, 520 pressure-exposed individuals (499 scuba/ professional divers, 21 caisson workers operating at excess pressure) were questioned regarding dental problems. A personal interview was conducted with affected individuals. Problems in the dental area were experienced by 15% of all respondents. Toothaches were suffered by 10.2% of the participants. Tooth injuries occurred in 6.3% of all interviewees (26 fractured amalgam restorations, 4 crown fractures, 3 losses of tooth fragments). A proportion of 11.3% among the respondents complained about temporomandibular joint problems or mucosal irritations (for example aphthae) related to the mouthpieces. Barotraumas outside the dental area were incurred by 31.9% of the divers. Of these, 69.9% concerned the ears and 65.6% occurred during the descent. Based on the results obtained from the survey and taking into account the current literature, recommendations for the prevention of barotraumas in divers and caisson workers were prepared. Diagnostic exclusion of dental pathologies and avoidance of retentive reconstruction materials are important factors for the prevention of barodontalgias and dental barotraumas.

Comparative Evaluation of Fracture Resistance and Microleakage of Tooth Fragment Reattachment with Different Pretreatment Conditions: An In Vitro Study

Comparative Evaluation of Fracture Resistance and Microleakage of Tooth Fragment Reattachment with Different Pretreatment Conditions: An In Vitro Study

Determination of Material and Fracture Properties of a Case-Hardened Planet Gear and Its Homogenisation Method to Obtain the Damage Mechanism Caused by Fragment Ingestion.

Before a new type of engine is introduced into civil aviation, it must comply with various safety regulations. These regulations include the analysis of secondary damage caused by the re-ingestion of a tooth fragment. The purpose is to prevent crack propagation through the gear rim, which would lead to catastrophic failure. In this context, identification of the initial crack location is crucial to determine the crack propagation path. Therefore, this paper presents a technique to determine and validate a constitutive material model and fracture locus for case-hardened spur gears. As the modelling of the surface-hardened layer is computationally intensive, it is necessary to homogenise the model. This paper comprehensively reviews and discusses the associated effects and errors. To determine the plastic behaviour of the case-hardened external gear (30CrNiMo8) and the nitrided internal gear (35CrAlNi7-10), the widely acknowledged Johnson-Cook material model is implemented using compression and Vickers indenter tests to define the necessary parameters. The fracture locus implementation is also based on the Johnson-Cook method and an axial shift of the fracture locus based on the hardness profile of the spur gears is determined by quasi-static pulsator tests. For validation, a project-specific gearbox test rig is used, enabling consistent ingestion of defined fragments. In addition, to check the likelihood of a tooth flank crack and to validate the results, a simplified ingestion experiment is performed.

Adhesion of tooth fragment after trauma: effect of adhesion strategy and storage in the rescue box.

This study aims to investigate the impact of storage conditions for crown fragments (specifically, whether they were stored within a tooth rescue box or in tap water) on their adhesion to fractured teeth when subjected to two different adhesive systems (namely, total etch and self etch). Sixty maxillary premolars were sectioned to obtain tooth fragments. These fragments were stored briefly (2 hours) and reattached in the following groups: Group 1 (fragments stored in tooth rescue box and reattached with etch and rinse (E&R) technique), Group 2 (fragments stored in tap water and reattached with E&R technique), Group 3 (fragments stored in tooth rescue box and reattached with self-etch (SE) technique), and Group 4 (fragments stored in tap water and reattached SE technique). After reattachment, the bonded tooth fragments underwent thermal cycling (500 cycles, 5-55 °C) and bond strength testing using a universal testing machine. Two-way Analysis of Variance (ANOVA) and Tukey's tests were used for bond strength comparison (p ≤ 0.05). A two-parameter Weibull distribution was conducted to evaluate the reliability of the storage medium and adhesion modality on bond strength. The results showed that measured shear bond values (MPa ± Standard deviation (SD); arranged in descending order) for each group were: Group 2 (Tap water/E&R = 6.5 ± 2.1), Group 1 (Rescue box/E&R = 6.0 ± 2.5), Group 4 (Tap water/E&R = 5.1 ± 2.8), and Group 3 (Rescue box/SE = 3.6 ± 3.2). Significant differences were found only between Groups 2 and 3 (p = 0.002). In conclusion, storing crown fragments in a tooth rescue box did not significantly affect the shear bond strength of the restored tooth. However, fragments reattached using the self-etch technique showed comparable shear bond strength but a higher rate of adhesive failures compared to the E&R technique.

PLLA Membranes Enriched with Chitosan/DCPA: Innovative Approach to Bone Tissue Engineering.

Bone tissue engineering has been very promising. The use of scaffolds of synthetic and natural materials is an alternative to combine the advantages of both types of materials. This study aimed to evaluate electrospun polymeric matrices of pure PLLA or associated with 5% or 10% of chitosan particles loaded or not with DCPA in bone proliferation and differentiation of periodontal ligament stem cells (PDLSC). The particles and matrices were characterized by scanning electron microscopy. PDLSC were isolated from periodontal ligament fragments of human permanent teeth using the explant technique. Cell proliferation assay (Alamar Blue) was performed from 1 to 21 days of culture in clonogenic medium and Alizarin Red assay was performed after 21 days of culture in osteogenic medium. The data were analyzed using Kruskal-Wallis test, and the comparison between media was given by the Student-Newman-Keuls test (α = 0.05). On days 1 and 7 there were no statistical difference between materials regarding cell proliferation (p>0.05). The materials with 5 and 10% chitosan / DCPA showed greater proliferation than PLLA control on days 14 and 21 and the material with 10% pure chitosan was greater than the control in 21 days. Regarding the alizarin red assay, PLLA 5% chitosan, PLLA 5 and 10% chitosan / DCPA showed a greater degree of mineralization than the control and the PLLA 10% chitosan material, and they were similar to each other. We conclude that PLLA 5 and 10% chitosan / DCPA materials were able to increase both, cell proliferation and differentiation of PDLSC in bone cells. Key words:Chitosan, PLLA, polymeric matrix, electrospinning.

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.

Aesthetic dental rehabilitation of children after dental trauma to anterior teeth with pulp chamber exposure. A clinical case

Relevance. The prevalence of dental injuries in children reaches 52.3%, based on age. Currently, the number of traumas of anterior maxillary teeth tends to increase. The search and application of the most optimal treatment options for dental injuries in an aesthetic area in children remains relevant.Description of the clinical case. The article presents the treatment results of an 8-year-old boy diagnosed with S02.52 according to ICD-10: fracture of the crown of tooth 2.1 within the enamel, dentin layers with pulp involvement. Vital amputation of the crown pulp with a direct pulp capping with "Rutdent", an MTA-based product, was chosen as the tactic of dental care. A tooth fragment was attached with a composite material (using an adhesive protocol) for aesthetic rehabilitation. The function and aesthetics of the tooth were restored. The result was stable six months after the treatment.Conclusion. The popularization of various sports events can lead to an increase in the incidence of dental traumas to anterior teeth in children. A pediatric dentist should be able to apply modern methods of diagnosing acute dental trauma to make the correct diagnosis and choose the optimal treatment method. The opportunities of modern pediatric dentistry allow the restoration of all dental functions lost during trauma: anatomical, aesthetic and physiological.