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 Table of Contents  
CASE REPORT
Year : 2016  |  Volume : 7  |  Issue : 2  |  Page : 124-127

Fragment reattachment of a complicated crown-root fracture in primary maxillary central Incisor and 1 year follow-up


Department of Paedodontics and Preventive Dentistry, UCMS (Delhi University) and GTB Hospital, New Delhi, India

Date of Web Publication19-May-2016

Correspondence Address:
Namita Kalra
Department of Paedodontics and Preventive Dentistry, UCMS (Delhi University) and GTB Hospital, New Delhi - 110 095
India
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DOI: 10.4103/0976-433X.182669

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  Abstract 

Coronal fracture of anterior teeth is a common form of dental trauma that affects children and adolescents. It is a tragic experience, which requires immediate attention and quick functional and esthetic repair. The major challenge for the clinician for managing such type of dental injuries is to re-establish the natural esthetics of the traumatized anterior tooth. Traditionally, such injuries have been restored with composite resins. They have the primary disadvantage of color mismatch and variable wear. Therefore, if a broken fragment is available, the restoration of the tooth using its own fragment should be the first treatment of choice. This clinical report describes reattachment of tooth fragment of complicated crown-root fracture of a deciduous maxillary central incisor in a 4-year-old child following trauma.

Keywords: Crown-root fracture, reattachment, tooth fragment


How to cite this article:
Khatri A, Kumar S, Kalra N, Tyagi R. Fragment reattachment of a complicated crown-root fracture in primary maxillary central Incisor and 1 year follow-up. SRM J Res Dent Sci 2016;7:124-7

How to cite this URL:
Khatri A, Kumar S, Kalra N, Tyagi R. Fragment reattachment of a complicated crown-root fracture in primary maxillary central Incisor and 1 year follow-up. SRM J Res Dent Sci [serial online] 2016 [cited 2020 Oct 25];7:124-7. Available from: https://www.srmjrds.in/text.asp?2016/7/2/124/182669


  Introduction Top


Anterior teeth trauma of a young patient is a tragic experience, which requires immediate attention not only because of damage to dentition but also because of the psychological impact it may have on the patient and parents.[1] Coronal fractures of the anterior teeth are a common form of dental trauma that affects children and adolescents.[2],[3] The average incidence reported in literature ranges from 4% to 46% with 11-30% in primary dentition and 6-29% in the permanent dentition.[4] Of these traumatic injuries, the incidence reported for crown-root fracture comprises 5% of traumatic injuries affecting the permanent dentition and 2% in primary dentition.[5] The major challenge for the clinician for managing such type of dental injuries is to re-establish the natural esthetics of the traumatized anterior tooth. Traditionally such injuries have been restored with composite resins. They have the primary disadvantage of color mismatch and variable wear. Therefore, if a broken fragment is available, the restoration of the tooth using its own fragment has been suggested as an alternative.[6] Such biological restoration provides excellent results regarding surface smoothness and esthetics.[7]

This clinical report describes reattachment of tooth fragment of a deciduous maxillary central incisor in a 4-year-old child with extensive fracture involving pulp following trauma.


  Case Report Top


A 4-year-old male child reported to the Department of Paedodontics and Preventive Dentistry, University College of Medical Science and GTB Hospital, Delhi with the chief complaint of broken upper front tooth, following trauma 2 days ago which occurred due to fall during some sport activity. There was no relevant medical history. Extra-orally, no sign of swelling, laceration, or active bleeding was found. Intraoral examination revealed a crown-root fracture of right deciduous maxillary central incisor involving enamel, dentin with pulp exposure [Figure 1]. The tooth was splitted into large labial firm segment and a small mobile labio-lingual fragment which was hanging in soft tissue. A small mesial tooth fragment was missing. There was mild associated soft tissue injury and no bony injury. A periapical radiographic examination revealed no associated pathology, resorption of root and no damage to the permanent tooth bud [Figure 2].
Figure 1: Preoperative frontal view

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Figure 2: Preoperative intraoral periapical radiograph

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After obtaining parental consent, the fractured tooth fragment was carefully removed under local anesthesia taking care not to cause any damage to either the fragment or the remaining tooth. Extracted fragment revealed the involvement of small root portion along with palatal crown fragment [Figure 3]. The adaptation of the fragment was checked. The fractured fragment was stored in normal saline.
Figure 3: Fractured tooth fragment

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Pulp therapy was done for the fractured tooth and obturated with metapex [Figure 4]. The entrance of root canal was sealed with a glass ionomer cement plug. The pulp chamber dentin and enamel were etched with a 37% phosphoric acid gel, rinsed, and coated with (Prime and Bond NT, Dentsply Caulk, Milford DE, USA) 5th generation bonding agent and light cured. The fractured surface of the fragment was treated with 37% phosphoric acid gel for 30 s followed by delicate rinsing and application of bonding agent and light cured. Composite resin (Ceram–X Mono Dentsply DETREYGmbh, Konstanz, Germany) Shade M2 was applied to the fragment and the tooth surface. The fractured segment was then accurately placed on the tooth. When the original position had been re-established excess resin was removed, and the area was light cured for 40 s, making sure that no displacement of the fragment occurred before resin polymerization was complete. A small mesial portion of tooth surface was built up with composite to give full anatomy of the tooth. Finishing and polishing were done [Figure 5]. The occlusion was carefully checked and adjusted. The repaired area could hardly be differentiated, and the esthetical result was excellent. The patient was given instructions to avoid exerting heavy function on this tooth and to follow oral hygiene instructions.
Figure 4: Post endodontic intraoral periapical radiograph

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Figure 5: Postoperative frontal view

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On the subsequent follow-up visits at 1, 3, 6, and 12 months postoperatively clinical, as well as radiographic (intraoral periapical) evaluation was done, and tooth has been found to be asymptomatic [Figure 6].
Figure 6: One-year follow-up (frontal view and intraoral periapical radiograph)

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  Discussion Top


Trauma to anterior teeth is relatively common among young children and teenagers. Most dental injuries occur between 2 and 3 years and between 8 and 12 years of age. They are more common in boys than in girls because of their active involvement in extracurricular activities.[8],[9],[10] By the end of 5 years, about one-third of boys and one-fourth of girls have experienced traumatic injury to their teeth.[11] The most common causes of trauma in early life are fall because children are developing their mobility skills while later other cause may include automobile accidents, protruding incisors, chronic seizure disorders, and child abuse.[12]

In the primary dentition, luxation injuries are more common than tooth fractures due to the spongy nature of the bone and to the lower root/crown ratio in comparison to that of the permanent dentition.[12] However in this case, it was a complicated crown-root fracture of the right deciduous maxillary central incisor.

Various treatment options suggested for managing trauma to primary tooth range from direct resin restoration to the extraction of the deciduous tooth followed by space maintaining appliances. However, the major consequence of early loss of maxillary primary incisors is most likely the delayed eruption of permanent successors as reparative bone and dense connective tissue covers the site. This would lead to adverse consequences like unattractive appearance, development of deleterious habits such as tongue thrust, forward resting posture of the tongue and also the improper pronunciation of frictative sounds, such as “s” and “f.”[13] Hence, the primary teeth should be restored provided it is not damaging the permanent successor.

Reattachment is a way to restore the natural shape, contour, translucency, surface texture, occlusal alignment, and color of the fragment along with a positive emotional and social response from the patient to the preservation of natural tooth structure, and it is also an economical and a conservative procedure.[14],[15],[16],[17],[18],[19] So, whenever the fracture fragment is available reattachment should be the first choice of treatment.[6],[20] This technique offers several advantages over conventional composite restorations. Reattachment of a fragment to the fractured tooth can provide good and long-lasting esthetics as the tooth's original form, color, and surface texture are maintained.[21]

The success of reattachment depends on certain factors like the site of fracture, size of fractured remnants, periodontal status, pulpal involvement, occlusion, the material used for reattachment, and prognosis.[22]

Although evidence-based literature shows that materials do not play an important role in fracture strength recovery, the advantage of reattachment of fractured fragments include immediate esthetics, more reliable outline form, possibility of maintaining the occlusal function, absence of differential wear, lowered economic burden, and excellent time resource management.[18] Moreover, the patient's self-esteem remains positive due to maintaining the natural appearance of his teeth.

An advantage of the incisal edge reattachment procedure is that it does not preclude any future treatment and therefore, in cases where the fragment is available represents a viable first treatment option. Andreasen and Andreasen state that the reattachment procedure may importantly serve as a transitional treatment alternative for preteens or teenage patients to postpone definitive treatment until an age where gingival margin contours are relatively stable.[23]

The clinician must consider that a dry and clean working field and proper use of bonding protocols and bonding materials are the key to achieve success in adhesive dentistry. Reattachment failures occur as a result of new trauma or parafunctional habits, so fabrication of a mouth guard and patient education about treatment limitations enhance clinical success.[24]


  Conclusion Top


Thus, along with the materials available today and an appropriate technique, esthetic results can be achieved with a predictable outcome. Thus, the reattachment of a tooth fragment is a viable technique that restores function and esthetics with a very conservative approach, and it should be considered when treating patients with coronal fractures of the anterior teeth, especially younger patients.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Vishwanath B, Faizudin U, Jayadev M, Shravani S. Reattachment of coronal tooth fragment: Regaining back to normal. Case Rep Dent 2013;2013:286186.  Back to cited text no. 1
    
2.
Dietschi D, Jacoby T, Dietschi JM, Schatz JP. Treatment of traumatic injuries in the front teeth: Restorative aspects in crown fractures. Pract Periodontics Aesthet Dent 2000;12:751-8.  Back to cited text no. 2
    
3.
Hamilton FA, Hill FJ, Holloway PJ. An investigation of dento-alveolar trauma and its treatment in an adolescent population. Part 1: The prevalence and incidence of injuries and the extent and adequacy of treatment received. Br Dent J 1997;182:91-5.  Back to cited text no. 3
    
4.
Tandon S. Textbook of pedodontics. In: Pediatric Considerations for Oral Surgery: Oral and Maxillofacial Injuries in Children. 2nd ed. India: Paras Publishing; 2008. p. 562-3.  Back to cited text no. 4
    
5.
Andreasen JO, Andreasen FM, editors. Crown root fractures. In: Textbook and Color Atlas of Traumatic Injuries of Teeth. 3rd ed. Copenhagen: Munksgaard; 1994. p. 257-77.  Back to cited text no. 5
    
6.
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7.
Corrêa-Faria P, Alcântara CE, Caldas-Diniz MV, Botelho AM, Tavano KT. “Biological restoration”: Root canal and coronal reconstruction. J Esthet Restor Dent 2010;22:168-77.  Back to cited text no. 7
    
8.
American Academy on Pediatric Dentistry Council on Clinical Affairs. Guideline on management of acute dental trauma. Pediatr Dent 2008-2009;30(7 Suppl):175-83.  Back to cited text no. 8
    
9.
Santos Filho PC, Quagliatto PS, Simamoto PC Jr, Soares CJ. Dental trauma: Restorative procedures using composite resin and mouthguards for prevention. J Contemp Dent Pract 2007;8:89-95.  Back to cited text no. 9
    
10.
Forsberg CM, Tedestam G. Etiological and predisposing factors related to traumatic injuries to permanent teeth. Swed Dent J 1993;17:183-90.  Back to cited text no. 10
    
11.
Andreasen JO, Andreasen FM. Textbook and Color Atlas of Traumatic Injuries of Teeth. 3rd ed. Copenhagen: Munksgaard; 1994.  Back to cited text no. 11
    
12.
Pinkham JR. Pediatric dentistry: Infancy through adolescence. In: Introduction to Dental Trauma: Managing Traumatic Injuries in the Primary Dentition. 4th ed. Amsterdam: Elsevier; 2005. p. 236-37.  Back to cited text no. 12
    
13.
Mcdonald DR, Avery JA. Dentistry for the child and adolescent. In: Managing the Developing Occlusion. 9th ed. Missouri: Mosby; 2011. p. 558.  Back to cited text no. 13
    
14.
Simonsen RJ. Traumatic fracture restoration: An alternative use of the acid etch technique. Quintessence Int Dent Dig 1979;10:15-22.  Back to cited text no. 14
    
15.
Baratieri LN, Monteiro Júnior S, Cardoso AC, de Melo Filho JC. Coronal fracture with invasion of the biologic width: A case report. Quintessence Int 1993;24:85-91.  Back to cited text no. 15
    
16.
Santos J, Bianchi J. Restoration of severely damaged teeth with resin bonding systems: Case reports. Quintessence Int 1991;22:611-5.  Back to cited text no. 16
    
17.
Trushkowsky RD. Esthetic, biologic and restorative considerations in coronal segment reattachment for a fractured tooth: A clinical report. J Prosthet Dent 1998;79:115-9.  Back to cited text no. 17
    
18.
Chu FC, Yim TM, Wei SH. Clinical considerations for reattachment of tooth fragments. Quintessence Int 2000;31:385-91.  Back to cited text no. 18
    
19.
Arapostathis K, Arhakis A, Kalfas S. A modified technique on the reattachment of permanent tooth fragments following dental trauma. Case report. J Clin Pediatr Dent 2005;30:29-34.  Back to cited text no. 19
    
20.
Belchema A. Reattachment of fractured permanent incisors in school children (review). J IMAB 2008;14:96-9.  Back to cited text no. 20
    
21.
Reis A, Loguercio AD, Kraul A, Matson E. Reattachment of fractured teeth: A review of literature regarding techniques and materials. Oper Dent 2004;29:226-33.  Back to cited text no. 21
    
22.
Wadhwani CP. A single visit, multidisciplinary approach to the management of traumatic tooth crown fracture. Br Dent J 2000;188:593-8.  Back to cited text no. 22
    
23.
Andreasen JO, Andreasen FM. Textbook and Color Atlas of Traumatic Injuries of Teeth 3rd ed. Copenhagen: Munksgaard; 1994. p. 240.  Back to cited text no. 23
    
24.
Andreasen FM, Norén JG, Andreasen JO, Engelhardtsen S, Lindh-Strömberg U. Long-term survival of fragment bonding in the treatment of fractured crowns: A multicenter clinical study. Quintessence Int 1995;26:669-81.  Back to cited text no. 24
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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