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 Table of Contents  
CASE REPORT
Year : 2018  |  Volume : 30  |  Issue : 1  |  Page : 88-94

Tooth reattachment: Reincarnating the originals


Department of Conservative Dentistry and Endodontics, Mansarovar Dental College, Bhopal, Madhya Pradesh, India

Date of Web Publication4-Jun-2018

Correspondence Address:
Dr. Indra Gupta
E-7/449, Arera Colony, Bhopal - 462 016, Madhya Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/endo.endo_58_17

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  Abstract 

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

How to cite this URL:
Gupta I, Khullar A, Mishra N, Ghosh S. Tooth reattachment: Reincarnating the originals. Endodontology [serial online] 2018 [cited 2018 Dec 15];30:88-94. Available from: http://www.endodontologyonweb.org/text.asp?2018/30/1/88/233742


  Introduction Top


Among all the traumatic injuries of permanent dentition, crown fractures have been documented to account for up to 92%.[1] Dental trauma mostly leaves a major impact on the social and psychological well-being of a patient.[2] Children and adolescents are mainly affected by coronal fractures of anterior teeth.[3],[4] The most common dental injuries involve the maxillary incisors.[5] Traumatized anterior teeth need immediate functional and esthetic repair.[6]

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.[7],[8],[9]

Following is a case series of reattachments depicting various treatment modalities.


  Case Reports Top


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].
Figure 1: Preoperative extraoral image showing bruises and scars

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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.
Figure 2: Intraoral image (labial view)

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Figure 3: Preoperative intraoral images

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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.


Treatment done

The fragments were brought in approximation anatomically and splinted to each other and the neighboring teeth as well using composite [Figure 5].
Figure 5: Interdental splinting using composite

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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].
Figure 6: Working length radiograph

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Figure 7: Sectional obturation

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Figure 8: Postplacement

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Figure 9: Access cavity filling with composite

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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].
Figure 10: Preoperative photograph

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Figure 11: Preoperative intraoral periapical

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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].
Figure 12: Fractured fragment

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Figure 13: Image after gutta percha removal

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Figure 14: Postplacement with flap retraction

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Figure 15: Reattachment of fragment and luting of post

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Figure 16: Suture placement after composite veneering

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Figure 17: Postoperative intraoral periapical

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Figure 18: Follow-up photograph

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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].
Figure 19: Pre operative image

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Figure 20: Preoperative intraoral periapical

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Treatment

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.
Figure 21: Postoperative photographs

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Figure 22: Post operative radiograph

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Figure 23: Postoperative intraoral periapical

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  Discussion Top


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.[10]

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.[11]

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.[12]

The friction bond of postplacement in addition to bonding provides retention to the coronal portion and assists in preventing dislodgement by nonaxial forces.[13]

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.[10]

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.
Figure 24: Follow-up photograph after 1 month

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Figure 25: Follow-up intraoral periapical after 2 months

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Figure 26: Follow-up photograph after 2 months

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  Conclusion Top


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

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Rappelli G, Massaccesi C, Putignano A. Clinical procedures for the immediate reattachment of a tooth fragment. Dent Traumatol 2002;18:281-4.  Back to cited text no. 1
[PUBMED]    
2.
Divakar HD, Nayak M, Shetty R. Changing concepts in fracture reattachment of teeth-A case series. Endodontology 2007;2:27-35.  Back to cited text no. 2
    
3.
Dietschi D, Jacoby T, Dietschi JM, Schatz JP. Treatment of traumatic injuries in the front teeth: Restorative aspects in crown fractures. Pract Periodontics Aesthet Dent 2000;12:751-8.  Back to cited text no. 3
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4.
Hamilton FA, Hill FJ, Holloway PJ. An investigation of dento-alveolar trauma and its treatment in an adolescent population. Part 1: The prevalence and incidence of injuries and the extent and adequacy of treatment received. Br Dent J 1997;182:91-5.  Back to cited text no. 4
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5.
Andreasen JO, Andreasen FM, editors. Classification, etiology and epidemiology of traumatic dental injuries. In: Textbook and Color Atlas of Traumatic Injuries to the Teeth. 3rd ed. Copenhagen: Munksgaard; 1993. p. 151-77.  Back to cited text no. 5
    
6.
Simonsen RJ, Osborne JW, Lamsen RL. Restoration of a fractured central incisor using original teeth. J Am Dent Assoc 1982;105:646-8.  Back to cited text no. 6
    
7.
Olsburgh S, Jacoby T, Krejci I. Crown fractures in the permanent dentition: Pulpal and restorative considerations. Dent Traumatol 2002;18:103-15.  Back to cited text no. 7
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8.
Reis A, Francci C, Loguercio AD, Carrilho MR, Rodriques Filho LE. Re-attachment of anterior fractured teeth: Fracture strength using different techniques. Oper Dent 2001;26:287-94.  Back to cited text no. 8
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9.
Andreasen FM, Norén JG, Andreasen JO, Engelhardtsen S, Lindh-Strömberg U. Long-term survival of fragment bonding in the treatment of fractured crowns: A multicenter clinical study. Quintessence Int 1995;26:669-81.  Back to cited text no. 9
    
10.
Munksgaard EC, Højtved L, Jørgensen EH, Andreasen JO, Andreasen FM. Enamel-dentin crown fractures bonded with various bonding agents. Endod Dent Traumatol 1991;7:73-7.  Back to cited text no. 10
    
11.
Lokesh P, Kala M. Management of mid-root fracture using MTA and fiber post to reinforce crown – A case report. Indian Dent Res Rev 2008;3:32-6.  Back to cited text no. 11
    
12.
Lui JL. A case report of reattachment of fractured root fragment and resin-composite reinforcement in a compromised endodontically treated root. Dent Traumatol 2001;17:227-30.  Back to cited text no. 12
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13.
Pasini S, Bardellini E, Keller E, Conti G, Flocchini P, Majorana A, et al. Surgical removal and immediate reattachment of coronal fragment embedded in lip. Dent Traumatol 2006;22:165-8.  Back to cited text no. 13
    


    Figures

  [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]



 

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Abstract
Introduction
Case Reports
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