|Year : 2014 | Volume
| Issue : 1 | Page : 54-56
Adhesive crown fragment reattachment in anterior-fractured tooth
Josué Martos, Yassamin Mona Majzoob, Cácia Signori, Luiz Fernando Machado Silveira
Department of Semiology and Clinics, Faculty of Dentistry, University Federal of Pelotas, Pelotas, Brazil
|Date of Web Publication||20-Mar-2014|
Department of Semiology and Clinics, Faculty of Dentistry, University Federal of Pelotas, Gonçalves Chaves Street, 457, Pelotas, RS 96015-560
Source of Support: None, Conflict of Interest: None
Crown fractures of the permanent dentition comprise the most frequent form of traumatic dental injuries and often require an immediate procedure for their treatment. Reattachment of the fractured fragment to its original position is an optimal approach to esthetic and functional rehabilitation. This paper reports the case of a permanent maxillary central incisor with crown fracture treated by adhesive fragment reattachment.
Keywords: Crown fracture, dental trauma, permanent teeth, treatment
|How to cite this article:|
Martos J, Majzoob YM, Signori C, Silveira LM. Adhesive crown fragment reattachment in anterior-fractured tooth. J Res Dent 2014;2:54-6
|How to cite this URL:|
Martos J, Majzoob YM, Signori C, Silveira LM. Adhesive crown fragment reattachment in anterior-fractured tooth. J Res Dent [serial online] 2014 [cited 2019 Dec 7];2:54-6. Available from: http://www.jresdent.org/text.asp?2014/2/1/54/129080
| Introduction|| |
Fractures in anterior teeth are very frequent, particularly in children and younger individuals. ,, The level of fracture is an important factor in the determination of treatment, especially when the dentogingival complex is compromised.  Esthetic and functional rehabilitation is the primary goal of the treatment of crown fractured tooth. Actually, an alternative approach, which is becoming more attractive due to the technology of new dentin bonding agents, is fragment bonding. ,,,,,
Often the patient that suffered a crown fracture can recover the fragment, making diagnosis and the treatment facilitated. The repositioning of fractured crown fragment using the bonding fragment technique offers several advantages including the reestablishment of function, esthetics, shape, shine and surface texture, in addition to the original contour and alignment of teeth.
A clinical study revealed that fragment retention was considerably higher by using a total etch technique and dentin bonding agents and that reinforcement of the fracture line did not prolong fragment retention.  At this point, a new clinical approach has been proposed to enhance fragment retention by using a groove in the fragment, which would increase the bonding surface and thus the bonding strength. 
This paper reports a case of a permanent incisor with crown fracture treated using adhesive fragment reattachment.
| Case Report|| |
This was a case report of a 15-year-old male patient who was referred to the dental clinic, reporting a dental trauma of the maxillary right central incisor. Dental history revealed that the trauma was the result of a fall. He reported no treatment until that moment and the crown fragment it was perfectly intact and stored in water.
The intraoral and radiographic examination showed that the injury had caused a non-complicated crown fracture in the middle-third of the tooth, without pulp exposure [Figure 1]a and b. Clinical examination evidenced fracture involving only the enamel aspect [Figure 1]c with no symptoms. The crown fragment analysis showed a perfect margin adaptation of the fragment to the tooth remnant [Figure 1]d.
|Figure 1: (a) Initial clinical aspect of the traumatized maxillary incisor, (b) Initial radiographic appearance of the fractured tooth, (c) Buccal view of fractured tooth, (d) Internal details of the dental fragment|
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The position and pattern of the fracture, the occlusion (maxilo-mandibular relationship) and a tooth remnant with an intact substrate suggested that a reattachment of the fragment to its original position by using adhesives procedures was a reliable option for the case. The patient was systemically healthy, presented an overall plaque index and gingival index of below 20% and the operative area was free of visible plaque.
After dental prophylaxis and cleaning the fragment with 2% digluconate chlorhexidine, the fragment was helded with a gutta-percha stick for handling purposes. The operative field was isolated with polytetrafluorethylen strip mainly on adjacent teeth. Briefly, the crown fragment and the tooth remnant were acid etched for 30 s with 35% phosphoric acid gel, rinsed for 30 s and dried with air spray [Figure 2]a. Then, a conventional two-bottle adhesive system (Scotchbond Multi-Purpose Plus, 3M ESPE, St. Paul, MN, USA) was applied on the enamel and after juxtaposition of the fragment with the tooth, they were light-cured for 40 s buccally and 40 s lingually using halogen light-curing equipment at an intensity of 1400 mW/cm 2 (Radii LED Curing Light, SDI, Australia) [Figure 2]b and c. Excess adhesive was removed and final polishing was performed using a high-luster polishing paste (Opal L, Renfert GmbH, Hilzingen, Germany), goat-hair brushes and cotton buffs (Renfert GmbH, Hilzingen, Germany) on the external enamel surface [Figure 2]d.
|Figure 2: (a) The dental surface was acid etched, (b) A conventional two-bottle adhesive system was applied, (c) Juxtaposition of fragment with the tooth and photopolymerization, (d) Clinical view of reattachment procedures, (e) Clinical view after 4-months follow-up, (f) Radiographic follow-up 4-months|
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4 months after the adhesive procedure, good esthetic appearance and function were observed and a frontal smile view shows an imperceptible reattachment [Figure 2]e. Radiographic examination revealed the periodontal health and a normal aspect of the apex and osseous structures [Figure 2]f.
| Discussion|| |
Reattachment of the fragment to its original position is considered an excellent approach for the management of a coronoradicular fracture. ,,,,, The application of dental adhesives capable of reattaching a fragment to the remaining tooth structure appears to offer a number of advantages compared with the conventional methods for restoring fractured teeth. 
Another great benefit to the adhesive fragment reattachment technique is that it reduces the necessity of restorative procedures used to fill the tooth with composite resin. In the case of unsuccessful treatment, the composite resin restoration as an alternative can be placed in a region where the structure was preserved. 
In the present case, the location and aspect of the fracture (non-complicated crown fracture) and the presence of a balanced occlusion may have favored the clinical success. Limitations in the bonding fragment technique are attributed to detachment of the remaining dental fragment; the fragment does not recover its original color or also bonding of the remaining the fragment at the incorrect position.
The radiographic follow up is essential for viewing alterations not perceptible clinically, as an extension of the crown fractures and its proximity with the pulp tissue; root and alveolar fractures; stage of rhizogenesis and alterations of the periodontal ligament space. 
The planning of the present treatment enabled clinical success with direct adhesive fragment reattachment; however, further clinical descriptions are necessary in order to evaluate the outcomes of reattachment over the long-term.
| Conclusion|| |
The present case report shows that the reattachment of the fractured crown fragment using the bonding technique offers several advantages including the reestablishment of function and aesthetics.
| References|| |
|1.||Cetinbaº T, Yildirim G, Sönmez H. The relationship between sports activities and permanent incisor crown fractures in a group of school children aged 7-9 and 11-13 in Ankara, Turkey. Dent Traumatol 2008;24:532-6. |
|2.||Al-Khateeb S, Al-Nimri K, Alhaija EA. Factors affecting coronal fracture of anterior teeth in North Jordanian children. Dent Traumatol 2005;21:26-8. |
|3.||Kramer PF, Zembruski C, Ferreira SH, Feldens CA. Traumatic dental injuries in Brazilian preschool children. Dent Traumatol 2003;19:299-303. |
|4.||da Cruz MK, Martos J, Silveira LF, Duarte PM, Neto JB. Odontoplasty associated with clinical crown lengthening in management of extensive crown destruction. J Conserv Dent 2012;15:56-60. |
|5.||Dogan MC, Akgun EO, Yoldas HO. Adhesive tooth fragment reattachment with intentional replantation: 36-month follow-up. Dent Traumatol 2013;29:238-42. |
|6.||Olsburgh S, Jacoby T, Krejci I. Crown fractures in the permanent dentition: Pulpal and restorative considerations. Dent Traumatol 2002;18:103-15. |
|7.||Farik B, Munksgaard EC, Andreasen JO, Kreiborg S. Fractured teeth bonded with dentin adhesives with and without unfilled resin. Dent Traumatol 2002;18:66-9. |
|8.||Pagliarini A, Rubini R, Rea M, Campese M. Crown fractures: Effectiveness of current enamel-dentin adhesives in reattachment of fractured fragments. Quintessence Int 2000;31:133-6. |
|9.||Martos J, Koller CD, Silveira LF, Cesar-Neto JB. Crown fragment reattachment in anterior-fractured tooth: A five-year follow-up. Eur J Gen Dent 2012;1:112-5. |
|10.||Martos J, Marques MM, da Costa RK, Silveira LF, Nova Cruz LE. Transurgical re-attachment of coronal fragment in anterior-fractured tooth. Eur J Gen Dent 2013;2:76-9. |
|11.||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. |
|12.||Neto JB, da Cruz MK, Barbosa RP, Masotti AS, Duarte PM, Martos J. Periodontal surgery associated with odontoplasty in the esthetic functional rehabilitation of a fractured anterior tooth. Gen Dent 2010;58:e236-9. |
|13.||Andreasen JO, Andreasen FM, Andersson L, editors. Textbook and Color Atlas of Traumatic Injuries to the Teeth. 4 th ed. Copenhagen, Denmark: Blackwell Munksgaard; 2007. |
[Figure 1], [Figure 2]