Reattachment of a Fractured Crown Fragment of the Maxillary Central Incisor : a Case Report- Juniper Publishers
Juniper Publishers-Open Access Journal of Dentistry & Oral Health
Abstract
The Most Common traumatic dental injury is the
uncomplicated crown fracture of the maxillary central incisor. Various
reports have been presented about reattachment of the crown fragment,
and literature reviews have cited that reattachment using an adhesive
bonding agent is the best way of treating these injuries if the fragment
is available, perfectlyadapted and properly stored. The present
casereport describes an uncomplicated crown fracture of the maxillary
right central incisor in a young patient who has 11 years old. The crown
fragment was successfully re attached to the tooth using an
acid-etchand adhesive bonding resin technique. After 1 years of
following-up, the reattached fragment presents satisfying esthetics and
excellent function.
Keywords: Uncomplicated crown fracture; Reattachment; Adhesive bonding resinIntroduction
The traumatic dental injuries are becoming more
common, mainly because of an increase in the participation of children
and teenagers in dangerous sports and activities [1]. Because of its
position in the arch, maxillary incisors are the most common teeth
involved in dental trauma, and it has been estimated that about one
quarter of the population under the age of 18 sustain traumatic injury
in the form of anterior crown fracture. It is a tragic experience for
the patient who requires immediate attention, not only because of damage
to the dentition but also because of psychologic effect of the trauma.
Aesthetical and functional rehabilitation of crown
fractures is one of the greatest challenges for the dentist. When the
coronal fragment is available and completely recovered intact, the
reattachment of the original tooth fragment appears to be the most
conservative treatment approach.
This case report describes the reattachment of a
fractured crown fragment of the maxillary central incisor utilizing an
ultra-conservative preparation technique with one year of successfully
following-up.
Case Report
11 year-old male patient presented to the Department
of Pediatric Dentistry and Prevention of Rabat University, with a
traumatic injury sustained when he had a bicycle accident 12 hours prior
to his attendance. Past medical history was reviewed and there was no
remarkable report. A complete history of the incident was taken.
The initial clinical examination did not reveal any
soft tissue injury and no pathologic findings were noted during the
investigation of the temporomandibular joint and potentially affected
osseous structures. Intraoral examination revealed that right maxillary
central crown was broken, without involving pulpal tissue. Intraoral
periapical radiographic investigation confirms the clinical observation
with an intact periodontal ligament space. The fragment was examined and
checked from all sides. It was in good condition and it fit reasonably
well with the remaining tooth structure. Based on the clinical and
radiographic findings, a diagnosis of uncomplicated crown fracture was
made.
After discussing with the patient and his father the
available treatment options, we opted for the reattachment of the crown
fragment by using an acid-etch and adhesive bonding resin technique. The
fracture site and the fragment were acid etched with 37% phosphoric
acid for 20s and rinsed thoroughly with air-water spray. Excess water
was removed with a brief jet of air and the adhesive was applied to both
surfaces. The fragment was positioned in its original place and light
cured for 10s from
various directions. Finishing and polishing of the restoration
were carried out and the occlusion was checked. The esthetic
result was excellent and the repair was barely visible. A week
later, the patient was called for a follow-up appointment. The
patient reported that he had a little sensitivity to cold for about
12 h after the treatment, which disappeared after that.
One year later, the patient was called for control to check the
vitality of the tooth. The tooth was vital and the reattached crown
fragment presents satisfying esthetics and excellent function.
Discussion
The reattachment of natural tooth fragment is aesthetic
and minimally invasive restorative alternative for the fractured
anterior tooth. Compared with other restorative techniquessuch
as flowable composite, dual cure orresin modified glass ionomers,
the reattachment of fractured fragments can offer several
advantages comprising preserve maximal natural tooth structure,
better esthetics, less time consuming procedure and a positive
emotional and social response from the patient for preservation
of natural tooth structure. A large number of publications
demonstrat a variety of techniques for this procedure, from
simple reattachment depending solely on micromechanical
bonding to various preparation techniques of the tooth and
the fragment. A study carried out in 1999 by Worthington et al.
compared the fracture resistance of reattachment fragments
using simple reattachment, circumferential internal bevels and
facial internal bevels together with lingual external bevels [2].
The results showed that in all groups the fracture resistance was
restored up to one half that of intact controls for crown fractures
and one third for root fractures [3]. This was in agreement
with a study carried out in 1986 by Dean et al, who found that
placement of a circumferential bevel does not increase retention
[4]. A number of advantages have been cited in favor of tooth fragment reattachment. It is a conservative approach which does
not preclude the use of other types of restorations later on should
it fail. Among the earliest causes of Traumatic Dental Injuries
described in the literature are increased overjet with protrusion
and inadequate lip coverage [5,6]. Prevention of dental injuries
is essential because of its frequency and consequences. It’s
obtained by studying their aetiology, their risk factors and by
using intra-oral protection during the practice of a contact
sport [7]. The treatment described in the present case report
is reasonably simple, while restoring function and esthetics
with a very conservative technique. The crown fragment was
reattached by using an acid-etch with 37% phosphoric acid and
adhesive bonding resin (3M) technique because the fragment
was available, perfectly adapted and properly stored. In a
recipient of milk. The storage environment is a factor of success
of our technique with milk preference; it prevents desiccation of
the crown fragment and provides better aesthetic results [8-18].
Conclusion
The reattachment of the intact fractured segment can
be considered as an ultraconservative method for aesthetic rehabilitation. This is why it is necessary to educate the population
to preserve the fractured segment and demand immediate
dental treatment. The adhesive bonding resin technique can
be used effectively to restore fractured teeth; presumably with
sufficient strength but long-term follow up is essential to predict
the durability of the tooth-adhesive-fragment complex and the
vitality of the tooth (Figure 1-8).
For more Open Access Journals in Juniper Publishers please click on: https://juniperpublishers.com
For more articles in Open Access Journal of Dentistry & Oral Health please click on:
Comments
Post a Comment