Tooth Fragment Reattachment
Dr. Nuha El-kadiki
(lecturer in Conservative Dentistry and Endodontic Department ,Faculty of
Dentistry ,University Of Benghazi )
Introduction:
Tooth fragment bonding is an excellent treatment option in
dealing with a traumatic injuries of the anterior teeth. 1
an immediate attachment of the incisal edge is a
conservative, simple and aesthetic alternative. Moreover
also restores the function and provide a positive
psychological response. 2
1. F Shirani MR Malekipour V Sakhaei Manesh F Aghaei: Hydration and Dehydration Periods of Crown Fragments Prior to
Reattachment.
2. RICCARDO TONINI An Innovative Method for Fragment Reattachment after Complicated Crown Fracture
Introduction:
Rewetting The tooth fragment has been shown to increase
restoration durability. 1
The fragment bonding technique was first reported as a
temporary treatment for crown fractures.1 ,Since then,
tremendous development has occurred in terms of both the
materials used and in the treatment procedure itself.
1. F Shirani MR Malekipour V Sakhaei Manesh F Aghaei: Hydration and Dehydration Periods of Crown Fragments Prior to
Reattachment.
2. RICCARDO TONINI An Innovative Method for Fragment Reattachment after Complicated Crown Fracture
Introduction:
long term follow up is necessary in order to predict the
durability of the tooth-adhesive-fragment complex and the
vitality of the tooth.
This procedure helps us to preserve maximal natural tooth
structure.
Patient cooperation and understanding of the limitations of
the treatment is of utmost importance for good prognosis.
1. F Shirani MR Malekipour V Sakhaei Manesh F Aghaei: Hydration and Dehydration Periods of Crown Fragments Prior to
Reattachment.
2. RICCARDO TONINI An Innovative Method for Fragment Reattachment after Complicated Crown Fracture
Introduction:
The need of the day is
to educate the
population to preserve
fractured segment and
seek immediate dental
treatment.
ADVANTAGES OF THIS TECHNIQUE :
It is a realistic, conservative, and cost effective approach.
The procedure provides a long-lasting esthetics((because the
tooth’s original anatomic form, color, and surface texture are
maintained). and restores function.
provides a positive psychological response.
restoration of the tooth with minimal sacrifice of the remaining
tooth structure.
long-term wear than when direct composite is used
Factors affecting this technique;
Extent of fracture (biological width violation, endodontic
involvement, alveolar bone fracture).
Pattern of fracture and restorability of fractured tooth (associated
root fracture).
Secondary trauma injuries (soft tissue status),
Presence/absence of fractured tooth fragment and its condition for
use (fit between fragment and the remaining tooth structure),
Factors affecting this technique;
Occlusion, esthetics, finances.
Patient cooperation and understanding of the limitations of the
treatment is of utmost importance for good prognosis.
Conclusion:
Rewetting The tooth
fragment has been
shown to increase
restoration
durability
• Reis have shown that a simple
reattachment with no further preparation
of the fragment or tooth was able to
restore only 37.1% of the intact tooth’s
fracture resistance,
• whereas a buccal chamfer recovered
60.6% of that fracture resistance;
bonding with an over contour and
placement of an internal groove nearly
restored the intact tooth fracture
strength, recovering 97.2 and 90.5% of
it, respectively.
• In cases of complicated fractures, when
endodontic therapy is required, the
space provided by the pulp chamber can
be used as an inner reinforcement, thus
avoiding further preparation of the
fractured tooth.
Precautions taken after such treatment:
Fabrication of a mouth guard .
Patient education about treatment limitations may enhance
clinical success as reattachment failures may occur with
new trauma or parafunctional habits.
Steps taken during the procedure
Dentist must dip the dental fragment in a vessel with water
immediacy.
Instruct the patient about the advantages and disadvantages
offered by the procedure.
Analyze clinically and radiographically the remaining tooth
structure(root fracture, pulp exposure, amount of exposed
dentin, pulp condition)
Analyze the fragment regarding degree of dehydration and
degree .
Steps taken during the procedure
Isolation of the operative field.
Fragment attached using gutta percha rod or sticky wax just to
hold it.
Cleaning of the dental fragment and coronal remnant with
pumice-water slurry.
Cleaning of the exposed dentin with 3% H2O2 for 10 seconds.
Protection of the exposed dentin with a CAOH liner.
Acid etching for 1 min for both fragment and the coronal
remnant.
Steps taken during the procedure
Washing for 40 seconds by air/water spray.
Application for adhesive resin to etched enamel on both
fragment and coronal remnant.
Proper seating of the fragment before polymerization of the
resin.
Union line evaluated few days after reattachment. If clearly
seeen with deterioration in esthetics.
Line can be masked by a small chamfer then will be veneered
with a microfilled resin.
Case
reports
Case 1:
• Patient details:
Name : A.M.A
Age: 12years.
Sex: male.
Occupation: student.
Martial status: single
Medical history: Patient is fit and well.
Dental history :No previous dental history.
Case 1:
• Patient details:
Chief complain : patient complained of a sever continuous
throbbing pain , which was not relieved by analgesia .
On examination : the two central incisors were tender to
percussion, no swelling or mobility.
Case 1:
Patient details:
On taken x-ray :Clinical and radiographic examination
revealed a complicated oblique crown fracture. Without
root fracture or any involvement to soft tissue.
The patient bring the fractured segments and have
instructed the patient to put them in normal saline or
milk to avoid over dryness
Case 1:
• After endodontic therapy the treatment options were
presented to the patient. After some deliberation about
the advantages, disadvantages, prognosis, and cost of
every treatment option, the patient and the patient’s
mother opted to have the tooth fragment reattached.
.Fragments
Rubber dam isolation—
.frontal view
Phosphoric acid-etching Application of bonding
.of the tooth agent on the tooth
Phosphoric acid-etching of the
.fragment
Application of bonding agent on
.the fragment
year follow up 1
Immediate treatment
year follow up 4
Case 2:
Conclusion:
Reattachment technique is a conservative, less time consuming
and biological method of restoring a fractured anterior tooth.
It could be the first choice for crown fractures of anterior teeth.
More research has to be done to determine whether the treatment
should be carried out immediately or during a second
appointment. Furthermore, the effect that different periods of dry
storage may have on the fragment is also a matter of uncertainty.
Summary :
Patient cooperation and understanding of the limitations of the
treatment is of utmost importance for good prognosis.
but long term follows up is necessary in order to predict the
durability of the tooth-adhesive-fragment complex.
