* denotes required field

Your Name: *

FIRST NAME

 LAST NAME

Gender: *

Personal Email: *

This will be your username

Password: *

Display Name: *

This will be what others see in social areas of the site.

Address: *

STREET ADDRESS (LINE 1) *

 

STREET ADDRESS (LINE 2)

 

CITY *

STATE *

ZIP *

 

 

Phone Number:

School/University: *

Graduation Date: *

Date of Birth: *

ASDA Membership No:



ABOUT SSL CERTIFICATES

Username

 

Password

Hi returning User! please login with Facebook credentials where Facebook Username is same as THENEXTDDS Username.

Username

 

Password

 
Case Study
Comments (0)

Tooth Fragment Reattachment for a Fractured Anterior Tooth

Case Presentation

Learning Objectives:

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 

  

Related Reading:

  1. Andreasen JO, Ravn JJ. Epidemiology of traumatic dental injuries to primary and permanent teeth in a Danish population sample. Int J Oral Surg 1972;1(5):235-239.
  2. Davis GT, Knott SC. Dental trauma in Australia. Austral Dent J 1984;29(4):217-221.
  3. Garcia-Godoy F, Dipres FM, Lora IM, Vidal ED. Traumatic dental injuries in children from private and public schools. Community Dent Oral Epidemiol 1986;14(5):287-290.
  4. Baratieri LN, Monteiro S Jr, Andrada MAC, et al. Esthetic-Direct Adhesive Restorations on Fractured Anterior Teeth. Carol Stream, IL: Quintessence Publishing, 1997. In press.
  5. Chain MC, Cox CF. Characterization of the cell healing sequence in exposed monkey pulps when capped with various adhesive systems. J Dent Res 1996;75(special issue):280(Abstract No. 2102).
  6. Cox CF, White KC. Biocompatibility of amalgam on exposed pulps employing a biological seal. J Dent Res 1992;71(special issue):187(Abstract No. 656).
  7. Cox CF. Biocompatibility of dental materials in the absence of bacterial infection. Oper Dent 1987;12(4):146-152.
  8. Cox CF, Subay RK, Suzuki S, et al. Biocompatibility of various dental materials: Pulp healing with a surface seal. Int J Periodont Rest Dent 1996;16(3):240-251.
  9. Cox CF, Keall CL, Keal HJ, et al. Biocompatibility of surface-sealed dental materials against exposed pulps. J Prosthet Dent 1987;57(1):1-8.
  10. Cox CF, Suzuki S. Re-evaluating pulp protection: Calcium hydroxide liners vs. cohesive hybridization. J Am Dent Assoc 1994;125(7):823-831.
  11. Cox CF, Bergenholtz G, Heys DR, et al. Pulp capping of dental pulp mechanically exposed to oral microflora: A 1-2 year observation of wound healing in the monkey. J Oral Pathol 1985;
  12. 14(2):156-168.
  13. Cox CF, Bergenholtz G, Fitzgerald M, et al. Capping of the dental pulp mechanically exposed to the oral microflora — A 5 week observation of wound healing in the monkey. J Oral Pathol 1982;11(4):327-339.
  14. Cox CF, Suzuki S, Suzuki SH. Biocompatibility of dental adhesives. J Calif Dent Assoc 1995;23(8):35-41.
  15. Kanca J III. Replacement of a fractured incisor fragment over pulpal exposure: A case report. Quint Int 1993;24(2):81-84.
  16. Kanca J III. Replacement of a fractured incisor fragment over pulpal exposure: A long-term case report. Quint Int 1996;27(12):829-832.
  17. Kimura T, Shinkai K, Iwatumi F, et al. Conservative restorations of traumatic fracture teeth with pulp exposure. Nippon Dent Un 1995;29:37.
  18. Matsuo T, Nakanishi T, Shimizu H, Ebisu S. A clinical study of direct pulp capping applied to carious-exposed pulps. J Endodont 1996;22(10):551-556.
  19. Onoe N. Study on adhesive bonding systems as a direct pulp capping agent. Japan J Conserv Dent 1994;37:429-466.
  20. Gargiulo AW, Wentz FM, Orban B. Dimensions and relations of the dentogingival junction in humans. J Periodontol 1961;32:261-267.
  21. Kaba AJ, Maréchax SC. A fourteen-year follow-up study of traumatic injuries to the permanent dentition. J Dent Child 1989;56:417-425.
  22. Andreasen JO, Andreasen FM. Essentials of Traumatic Injuries to the Teeth. Copenhagen, Denmark: Munksgaard, 1990.
  23. Amir E, Bar-Gil B, Sarnat H. Restoration of fractured immature maxillary central incisors using the crown fragments. Pediatr Dent 1986;8(4):285-288.
  24. Baratieri LN, Monteiro S Jr, Caldeira de Andrada MA. Tooth fragment reattachment: Case reports. Quint Int 1990;21(4):261-270.
  25. Burke FJ. Reattachment of a fractured central incisor tooth fragment. Brit Dent J 1991;17(6):223-225.
  26. Dean JA, Avery DR, Swartz ML. Attachment of anterior tooth fragments. Pediatr Dent 1986;8(3):139-143.
  27. Simonsen RJ. Traumatic fracture restoration: An alternative use of the acid etch technique. Quint Int 1979;10(2):15-22.
  28. Simonsen RJ. Restoration of a fractured central incisor using original tooth fragment. J Am Dent Assoc 1982;105(4):646-648.
  29. Swift EJ Jr, Perdigao J, Heymann HO. Bonding to enamel and dentin. A brief history and state of the art, 1995. Quint Int 1995;26(2):95-110.
  30. Rosenberg MM. Tratamento periodontal e protético para casos avançados. São Paulo, Brazil: Quintessence Publishing, 1992.
Have a case study of your own? Submit it to us!
Sorry, your current access level does not permit you to view this page.