|Year : 2018 | Volume
| Issue : 1 | Page : 88-94
Tooth reattachment: Reincarnating the originals
Indra Gupta, Apoorva Khullar, Niharika Mishra, Surabhi Ghosh
Department of Conservative Dentistry and Endodontics, Mansarovar Dental College, Bhopal, Madhya Pradesh, India
|Date of Web Publication||4-Jun-2018|
Dr. Indra Gupta
E-7/449, Arera Colony, Bhopal - 462 016, Madhya Pradesh
Source of Support: None, Conflict of Interest: None
The following article comprises three cases of coronal fracture of anterior teeth depicting various treatment modalities, including endodontic treatment of the tooth followed by post placement and reattachment of the fragment to reciprocate the original form and function. Furthermore, we have tried to reattach a fragment without interfering with the vitality of the tooth to let the injured pulp heal naturally and the results are encouraging.
Keywords: Fiber post, reattachment, vitality
|How to cite this article:|
Gupta I, Khullar A, Mishra N, Ghosh S. Tooth reattachment: Reincarnating the originals. Endodontology 2018;30:88-94
| Introduction|| |
Among all the traumatic injuries of permanent dentition, crown fractures have been documented to account for up to 92%. Dental trauma mostly leaves a major impact on the social and psychological well-being of a patient. Children and adolescents are mainly affected by coronal fractures of anterior teeth., The most common dental injuries involve the maxillary incisors. Traumatized anterior teeth need immediate functional and esthetic repair.
Various factors determine the management of coronal fractures (biological width violation, involvement of pulp, vitality of tooth, and alveolar bone fracture), extent and pattern of fracture and restorability of fractured tooth (associated root fracture), soft-tissue injuries, presence/absence of fractured tooth fragment and its status for use (approximation of fragment and the remaining tooth structure), esthetics, occlusion, finances, and prognosis.,,
Following is a case series of reattachments depicting various treatment modalities.
| Case Reports|| |
Case report 1
A 22-year-old patient presented, after sustaining a complicated crown fracture to her maxillary left central incisor during a road accident [Figure 1].
The intraoral examination revealed Ellis Class III fracture of the maxillary left central incisor (21) [Figure 2]. The fractured segment of the tooth was seen palatally attached [Figure 3] and separated labially.
Cone-beam computed tomography was done for a more definitive diagnosis, which reported: [Figure 4]
|Figure 4: Cone-beam computed tomography image showing radiolucent line extending from distal surface of crown involving the coronal structure to end 2 mm below the cementoenamel junction on the palatal aspect|
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- Thin radiolucent line seen extending from distal surface of crown involving the coronal structure to end 2 mm below the cementoenamel junction on the palatal aspect.
The fragments were brought in approximation anatomically and splinted to each other and the neighboring teeth as well using composite [Figure 5].
Following administration of local anesthesia (lignocaine 2%), access cavity was prepared followed by endodontic treatment of the tooth using a step back technique with copious irrigation. Sectional obturation was done using AH26 sealer [Figure 6] and [Figure 7]. Postspace was prepared and corresponding fiber post was selected. Dual cure resin was placed in the canal [Figure 8] to attach the post. The access cavity was restored with light cure composite [Figure 9].
Case report 2
A 28-year-old patient presented after sustaining a crown fracture to her maxillary right central incisor during a road accident [Figure 10]. The patient's medical history was noncontributory. Intraoral examination revealed upper central incisor (11) with horizontal fracture line running labial to palatal direction subgingivally and improper endodontic treatment [Figure 11].
The fractured fragment was removed and preserved in saline to prevent dehydration [Figure 12]. Old restorative material was removed, and gutta-percha (GP) removal was done with the help of GP solvent followed by endodontic retreatment [Figure 13]. Postplacement steps were followed as above [Figure 14]. Core buildup was done. An opening was made in the coronal fractured fragment to gain proper alignment with the post [Figure 15]. Flap was reflected to gain proper access to fracture line to reposition the fragment [Figure 16]. The fractured fragment was then bonded to the tooth using composite, and final composite veneering was done [Figure 17] and [Figure 18].
Case report 3
A 23-year-old patient called up at the department after sustaining a complicated crown fracture to his maxillary right central incisor after a fall at home which was in very close proximity to the college, and hence, the case was reported within 10 min.
A comprehensive history was taken to rule out any other injury. The patient's medical history was noncontributory. Intraoral examination revealed oblique fracture of upper central incisor (11) with exposed pulp, oozing blood [Figure 19], and the fracture line running labial to palatal direction supragingivally. Left central incisor (21)was luxated and depressed in the socket [Figure 20].
The two fragments were carefully brought in approximation and splinted using composite [Figure 21]. The maxillary left central incisor was placed back in the socket using patient's earlier photographs as a reference [Figure 22]. The fractured fragments were splinted to each other and to the neighboring teeth as well with the help of Gaenial ™ GC [Figure 23]. No endodontic treatment was performed.
| Discussion|| |
The present cases described the reattachment of tooth fragment as an alternative to the composite buildup for regaining the esthetics and function of fractured teeth.
The initial splinting was done to anatomically reposition the fragments together. By virtue of the newer bonding agents, such restorations show good survival rates, with failure often only resulting from subsequent trauma.
Proper bonding of posts reduces the wedging effect within the root canal, needs less dentin removal to accommodate a shorter and thinner post, and minimizes susceptibility to tooth fracture.
The site of fracture, extent of fracture, periodontal status, endodontic involvement, maturity of root formation, biological width, occlusion, time, and resource of the patient predict the feasibility of such repairs.
The friction bond of postplacement in addition to bonding provides retention to the coronal portion and assists in preventing dislodgement by nonaxial forces.
Adhesive posts have been used for its potential of increased retention. It is more flexible and has modulus of elasticity similar to dentin. It distributes forces evenly along the root when used with resin cement.
We have recently tried reattachment of the fractured fragment without any endodontic treatment to maintain the tooth vitality in the last case depicted above, and we are following it at regular intervals [Figure 24], [Figure 25], [Figure 26] and evaluating it for further results.
| Conclusion|| |
It can be concluded from the case report that fracture reattachment is a conservative and esthetic alternative for treatment of the complicated crown fracture. The long-term prognosis is still obscure, but it is an immediate technique of esthetic rehabilitation in the management of traumatized tooth.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12], [Figure 13], [Figure 14], [Figure 15], [Figure 16], [Figure 17], [Figure 18], [Figure 19], [Figure 20], [Figure 21], [Figure 22], [Figure 23], [Figure 24], [Figure 25], [Figure 26]