Tooth Fragment Reattachment for a Fractured Anterior Tooth
Luiz N. Baratieri, CD, MS, PhD
This study describes the fractured tooth fragment reattachment when the fracture is severe and involves the biological width. Upon reviewing this study, the reader should have an enhanced understanding of the:
- Principles of the reattachment process
- Clinical implementation
- Advantages of reattachment, particularly for young patients
Fractures of the anterior teeth can be transverse, oblique, or longitudinal. The tooth fragment may be completely separated from its original site, or it may be retained in position by the junctional epithelium and connective tissue or even by the tooth remnant itself, as is the case in incomplete fractures.
Treatment options for fractured anterior teeth depend on factors such as fracture extension, pulpal involvement, periodontal involvement, aesthetic compromise, and functional compromise. The treatment may involve simple maintenance without restoration or may require extraction of the tooth remnant and placement of an osseointegrated implant or fixed prosthesis. The biocompatibility of current advanced adhesive technology (eg, the total acid etch technique—enamel/dentin/pulp—and the current resin adhesives) allows the application of solutions in direct contact with the pulpal tissue and the periodontal ligament, as required in the reattachment of fractured tooth fragments. The treatment options provided by these advanced adhesive systems include:
The case presented exemplifies an invasion of biological width due to a fracture of an anterior tooth of a young patient. In such cases, the compromise is generally limited to only one surface of the tooth, often restricted to no more than a small extension on that surface. Correction of biological width involves only the invaded area, applying a localized osteotomy that does not extend to the adjacent teeth, the proximal areas, or the palatal aspect of the tooth involved. However, this procedure is possible only in patients with adequate plaque control, who demonstrate low risk of periodontal disease. In addition, tooth fractures in such patients must cause only a localized invasion of the biological width, and must not reach the infraosseous level.
In cases where the biological width has been invaded without infraosseous compromise, apicoplasty is another treatment alternative. It seeks to reposition the fracture margin (to be involved at restoration) on a level that is more coronal and compatible with the biological width. A new periodontal protection is formed at the apical region that has undergone surgery, reinstating the histophysiological balance between structures. Advantages of these conservative approaches include aesthetics and a minimal surgical trauma. Utilized in combination with recent advancement in adhesive technology, this treatment represents a useful alternative for the restoration of fractured teeth in the anterior region.
*Professor, Operative Dentistry, CCS/STM, Federal University of Santa Catarina, Florianopolis, Brazil
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