Attach the detached to preserve the existing natural tooth by the man-made base

Ashish Jain; Umrana Faizuddin; P Shanti Priya; Sarika Akula

doi:10.4103/jorr.jorr_14_20

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CASE REPORT

Year : 2021 | Volume : 13 | Issue : 1 | Page : 50-52

Attach the detached to preserve the existing natural tooth by the man-made base

Ashish Jain, Umrana Faizuddin, P Shanti Priya, Sarika Akula
Department of Conservative Dentistry and Endodontics, Panineeya Institute of Dental Sciences, Hyderabad, Telangana, India

Date of Submission	01-May-2020
Date of Decision	19-Jun-2020
Date of Acceptance	25-Jun-2020
Date of Web Publication	15-Feb-2021

Correspondence Address:
Sarika Akula
Panineeya Institute of Dental Sciences, VR Colony, Kamala Nagar, Dilsukhnagar, Hyderabad - 500 060, Telangana
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/jorr.jorr_14_20

Abstract

Traumatic dental injuries are most commonly seen in children and teenagers, especially in the anterior teeth. The ultimate goal of any dental treatment is to reestablish the lost tooth form and function. Numerous procedures have been proposed in the past in which there was considerable loss of remaining sound tooth structure. However, with recent technologies, the minimally invasive procedure is dominating. One such procedure is to reattach the fractured fragment to reestablish the biological form and function of the tooth. Thus, in this section, two case reports on managing complicated crown fractures were discussed, where restoration of anterior teeth with the available tooth fragment was supported with fiber post. As this procedure helps to provide life like appearance of the tooth by restoring anatomy and esthetics, it even adds to psychological stability of the patient.

Keywords: Complicated crown fracture, fiber post, fractured tooth fragment, internal grooving

How to cite this article:
Jain A, Faizuddin U, Priya P S, Akula S. Attach the detached to preserve the existing natural tooth by the man-made base. J Oral Res Rev 2021;13:50-2

How to cite this URL:
Jain A, Faizuddin U, Priya P S, Akula S. Attach the detached to preserve the existing natural tooth by the man-made base. J Oral Res Rev [serial online] 2021 [cited 2021 Jun 21];13:50-2. Available from: https://www.jorr.org/text.asp?2021/13/1/50/309429

Introduction

In this modern Cenozoic era, esthetics of dentofacial complex Has got a major role. The traumatic injuries of oral region make up 5% of all injuries, where injuries of permanent dentition account for 5%–29%.^[1] Crown fractures and crown root fractures account for 26%–76% and 0.3%, respectively. Of the entire dentition, anterior teeth are commonly affected because of their position and angulation in dental arch.^[2]

Based on extent of fracture line, it can be either uncomplicated (28%–44%) or complicated fracture (11%–15%).^[3] The first case of fracture reattachment was done by Tennery using the acid etching technique. Reattachment is a procedure where tooth is replaced back to its original position with/without the support of fiber posts. It helps in maintaining the esthetics of patient as same tooth of the individual is repositioned back.^[4]

Case Reports

Case report 1

A 22-year-old male patient has reported to the department of conservative dentistry and endodontics with a history of trauma and severe pain for 1 day. Clinical examination revealed crown fracture with mobility of fractured fragment and radiograph shown fracture involving pulp. The mobile segment was extracted and stored in saline. The examination revealed a complicated oblique crown fracture without violation of biological width. Immediately, root canal treatment was initiated. Chemo-mechanical preparation was done up to F3 finishing file (Protaper gold-Dentsply Sirona) and obturated. Post space preparation was done using Pesso reamer size 3. Later appropriate Fiber post size 0 (RelyX™ Unicem-3M ESPE) was selected and placed into the canal using resin cement (multilink N-Ivoclar Vivadent). After post placement, fractured fragment was approximated. Internal grooving was done on fragment surface using diamond fissured bur followed by etching, rinsing and it was reattached using resin luting agent (multilink N-Ivoclar Vivadent) [Figure 1]. One-year follow-up showed promising results [Figure 2]a.

Figure 1: (a) Radiograph showing fracture line involving pulp, (b) Preoperative picture, (c) Extracted fracture fragment, (d) Fiber post placement, (e) Placement of groove, (f) Postoperative

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Figure 2: (a) Postoperative and follow-up of the first case, (b) Postoperative and follow.up of the second case

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Case report 2

A 21-year-old female patient has reported with a history of trauma on the day of presentation. On examination, crown fracture with mobile fractured segment was observed. The fractured fragment was removed and stored in saline. Immediate root canal treatment was initiated, bio mechanical preparation done using rotary up to F3 finishing file followed by circumferential filling. Obturation was done using 6% 30 gutta percha points and accessory cones. Post space preparation and fiber post placement was done. After fiber post placement, small internal groove was placed using round diamond bur within the palatal aspect of dentin (bulky side) at the fractured interface. Then etching of fractured enamel was done for 30 s and dentin conditioning for 10 s using 37% phosphoric acid gel followed by rinsing and drying using cotton pellets. After application of bonding agent, the prepared fragment was left uncured. The same is followed for the remaining tooth structure. Then resin composite cement was applied into the groove of fragment and fitted against the intact tooth and cured for 40 s buccally lingually [Figure 3]. Finishing and polishing was done. Follow up was done [Figure 2]b

Figure 3: (a) Preoperative photograph, (b) Radiograph showing post space preparation, (c) Extracted fracture fragment, (d) Fiber post placement, (e) Placement of groove, (f) Repositioning of the fragment

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Discussion

Management of dental traumatic injuries is a multidisciplinary approach, which helps in proper healing of tissues and provides adequate function and esthetics. In the past, in case of crown fractures, reattachment procedure was considered a provisional treatment option, but with the latest innovations, this technique offered favorable prognosis.^[5],[6]

New adhesive technologies helped in restoring natural tooth fragment, where it maintains original tooth color, contact and contour, and retain the incisal translucency.^[7],[8] It is a time saving, conservative procedure and add psychological benefits to patients. According to Sarapultseva and Sarapultsev, reattachment technique is a primary procedure when the fragment is saved after trauma.^[9]

In case of reattachment, the extent of fracture line has a pivotal role. If it extends below the alveolar crest, to bring the fracture line within the biological limits, orthodontic extrusion and surgical extrusion has to be done. If the fracture line is located above the alveolar crest, but deep subgingivally violating the biological width, then gingivectomy has to be done. But there was no requirement of these procedures in the mentioned case reports as the fracture line was not encroaching the biological width.^[10]

According to Reis et al. (2001), simple reattachment recovers 37.1% of fracture resistance of the intact tooth, buccal chamfer recovers 60.6%, over-contour 97.2% and internal groove 90.5%.^[11] In overcontouring, greater extension of material on the surface provides better force distribution but hampers the esthetic appearance. Hence, in these case reports, internal grooving has been chosen. In case of internal grooving, resin flows into the groove and forms internal resin bar that acts as an opponent to the compression load applied on the surface and is responsible for better mechanical results. It doesn't alter the precise fit between the fractured tooth fragment and the remaining tooth. This helps to minimize the composite and enamel interface.^[12],[13]

In this case report, fiber post has been used, as glass fibers have elastic modulus similar to dentin. This helps in unidirectional flexion of the post and uniform distribution of the stress. Besides, it requires minimal tooth preparation, less chair-side time. In cases of untoward consequences, they can be easily retrieved.^[14]

Hydration of fracture fragment plays an important role as it helps to retain the tooth color and also increases the bond strength of the tooth. The time limit for dehydrated fragment is not clear in the literature. It has been said that it takes 48 h for complete rehydration of fragment, so fragment needs to be attached the next day. In the above two cases, fracture fragment was always in hydrated state.^[15],[16]

With the recent advances in adhesive techniques and materials, the monoblock effect is created which is a multilayered structure with no inherent weak inter-layer interfaces. According to Trope et al. in 1985, the use of flowable resin composite restoration not only reinforces the tooth but also helps in achieving higher bond strength of the fractured segments. The flowable composite also minimizes inclusion of air voids, decreases microleakage and reinforces the root strength.^{[17],[18],[19]}

Conclusion

Considering the high incidence of dental fractures as a result of trauma, the working knowledge of dentist regarding treatment possibilities is essential. Reattachment should be performed when the fragment is available as it shows predictable esthetic results.

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.

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