Management of Anterior Teeth Fracture With Preservation of Fractured Fragment-Two Case Reports

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MANAGEMENT OF ANTERIOR TEETH FRACTURE WITH PRESERVATION OF

FRACTURED FRAGMENT-TWO CASE REPORTS
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International Journal of Innovative Research in Dental Sciences
Vol. 1, Issue 4, December 2016
MANAGEMENT OF ANTERIOR TEETH

FRACTURE WITH PRESERVATION OF
FRACTURED FRAGMENT-TWO CASE
REPORTS
Dr. Tirthankar Bhaumik 1, Dr. DebolinaChowdhury2, Dr. U K Das3, Dr. Priti Desai4
1 Post Graduate Trainee, Department of Conservative Dentistry &Endodontics, Guru Nanak Institute of Dental sciences
& Research, Panihati, Kolkata-114, West Bengal, India.
2 Post Graduate Trainee, Department of Conservative Dentistry &Endodontics, Guru Nanak Institute of Dental sciences
& Research, Panihati, Kolkata-114, West Bengal, India.
3 Professor and Head of the Department, Department of Conservative Dentistry &Endodontics, Guru Nanak Institute
of Dental sciences & Research,Panihati, Kolkata-114, West Bengal, India.
4 Professor, Department of Conservative Dentistry & Endodontics, Guru Nanak Institute of Dental sciences & Research,
Panihati, Kolkata-114, West Bengal, India.
ABSTRACT: Incidence of traumatic dental injuries is quite high and is more common in permanent dentition than
primary dentition. Among all type of injuries, crown fractures are most common in which approximately 58.6% are in
adults.1,2 The most frequent causes of these injuries are falls, sport activities, cycling, joy rides, machine operations,
violence and road traffic accidents. Predisposing factors of dental trauma could be related to the person’s anatomic
features like increased over jet, inadequate lip coverage of the upper anterior teeth etc. Crown fractures can occur at
incisal third, middle third or gingival third where fractures extending below the cemento-enamel junction requires a
multidisciplinary treatment approach. Conventional approaches to rehabilitating fractured anterior teeth include
composite/ceramic restorations and endodontic treatment followed by post-core-supported prosthetic restorations.
Sometimes fracture fragment has been proposed as a favourable crown repair material due to its same biologic origin
superior morphology, conservation of structure, and patient acceptance. It also helps in maintaining the isolation of
operative field during the endodontic and operative procedures.
Keywords: Traumatic dental injury, anterior teeth fracture, fracture fragment reattachment.
INTRODUCTION
Dental trauma and associated fracture of toothoften has a severe impact on the social and psychological wellbeing of a
patient. This condition requires immediate attention/consideration for re-establishingboth esthetics and functionality.
Dental trauma primarily leads to fracture of the anterior teeth, specifically the upper incisors, because of their vulnerable
location in the mouth. In cases of road traffic accidents, domestic violence, and sports injuries, multiple and/or
complicated tooth fractures may be observed.Coronal fractures of permanent incisors represent 18-22% of all trauma to
dental hard tissues and in 96% situation upper incisors get affected. Out of all such cases 28-44% involve enamel and/or
dentin and 11-15%, involve enamel, dentin and pulp.3The proportion of tooth injury varies from 4% to 33%depending
on the sex and age of children.4,5,6 Various case reports have suggested that during first two decades of life, usually around
8-12 years, dental injuries are maximum in occurrence and that 70% of such injuries involve the maxillary central incisors
followed by maxillary lateral incisors and mandibular incisors.7-10 Depending on age, the incidence is higher in males
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than in females with ratio of approximately 3:1.A study of 84 treated permanent incisors with root fracture found that
17% of the fractures occurred in the apical third, 56% in the middle third, 27% in the cervical third, and 29% in the
crown, involving enamel and dentin.11
Various techniques have been adopted to restore the fractured teeth. Early techniques include acrylic jacket crowns,
orthodontic bands, pin retained resin, porcelain, bonded crown and composite resin. Tennery in 1988 was the first to
report the re-attachment of a fractured fragment using acid-etch technique.12 Subsequently, Starkey and Simonsen have
reported similar cases.8,13 Tooth fragment reattachment offers a conservative and cost effective restorative option that has
been shown to be an acceptable alternative to the restoration of the fractured tooth with resin-based composite or full-
coverage crown.
Reattachment of a fragment to the fractured tooth can provide good and long-lasting esthetics, wear similar to adjacent
and opposing tooth; color matching; preservation of incisal translucency; maintenance of original tooth contours;
economical; preservation of occlusal contacts; color stability of enamel and positive emotional and bettersocial
acceptance and reponse from patients.
Resin based restorative materials are frequently used in restoration of the fractured teeth. Because of the poor mechanical
resistance of these materials, different approaches have been developed to strengthen resistance of composite resin, such
as fiber posts. Tooth-coloredfiber posts were introduced in the 1990’s and has several advantages, such as esthetics, bond
to tooth structure and has modulus of elasticity similar to that of dentin.
This article aims to discuss the considerations for fracture fragment reattachmenttechnique and to present two clinical
case reports of fracture involving enamel, dentin and pulp treated with reattachment of fracture fragment.
CASE REPORT
Case 1:
A 25-year-old female patient reported to the Department of Conservative Dentistry & Endodontics, Guru Nanak Institute
of Dental Sciences & Research, Kolkata following fractureof upper both central incisors and upper left lateral incisor
with fragment mobility and pain following an injury from fall at home stairs two days back.(Fig. 1) The patient’s medical
history was not contributory or inhibitory. No apparent injury was found to the soft tissues in the extra oral and intra oral
examination. Clinical and radiographic examination revealed that there was an oblique fracture in the cervical third region
of the right maxillary incisor and horizontal fracture at cervical level of left maxillary central incisor and left maxillary
lateral incisor involving enamel and dentin with exposure of the pulp and the fractured fragment was loosely attached to
the tooth.
Fig. 1
50
CASE 2:
A 15-year-old boy reported to the Out-Patient Department of Conservative Dentistry & Endodontics, Guru
Nanak Institute of Dental Sciences & Research, Kolkata with fractured upper right central incisor with mobility and pain
after experiencing a fall during playing a day before.(Fig. 2) Medical history was not contributory. Clinical and
radiological examination revealed cervical level fracture of right maxillary central incisor with no soft tissue or associated
facial bone injury.
Fig. 2
MANAGEMENT
In both the cases, the fracture fragments were repositioned end to end and then stabilized by orthodontic wire
fixed in place with light cure composite resin.(Fig.3 and 4)Single sitting root canal treatment was carried out in the
fractured teeth through the access cavitypreparedpalatally after achieving local anesthesia. Barbed broach, Hyflex CM
file system, sodium hypochlorite irrigant, gutta – percha cones and sealers were the instruments and materials used in the
procedure.( Fig. 5 to 10)
Post space is prepared in all the root canal treated fractured teeth keeping the apical 3mm apical guttapercha seal
intact.(Fig. 11 and 12) Glassfibre posts for the all the affected teeth were selected, checked for tug back trimmed 1mm
short of access opening and then cemented to the tooth structure using light cure composite resin restorative
material(Paracore- Coltene).( Fig 13 to 18)
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Fig. 3(Case 1) Fig. 4(Case 2)
Fig. 5( Case 1) Fig. 6( Case 2)
52
Fig.9( Case 2) Fig. 10( Case 2)
53
Fig. 15( Case 10 Fig. 16( Case 2)
Fig. 17( Case 1) Fig. 18(Case 2)
DISCUSSION
Factors influencing the treatment modalities of coronal fractures include Site of fracture, Size of fractured remnant. ,
Periodontal status, Pulpal involvement, Maturity of root formation, Biological width invasion, Occlusion. Depending
on these factors various treatment options are Reattachment of fractured fragment, Composite restoration, Ceramic/
metal-ceramic restoration, Cast restoration
Various studies regarding the incidence of dental trauma, especially in the pediatric and adolescent populations, have
made it clear that this injury is of significant nature and effects up to one third of patients in this age group. Studies have
54
reported estimates that about one out of every four persons under age of 18 will sustain a traumatic dental injury in the
form of an anterior crown fracture.13
The most common etiological factors of crown-root fractures are falls, violent fights, automobile and bicycle accidents.
In anterior teeth crown-root fracture is caused by direct trauma while in posterior teeth it is caused by indirect trauma.
Fracture lines seen in crown fractures can be single or multiple. Most commonly seen running in horizontal direction. A
rare type of injury is a vertical fracture of crown-root running along the long axis of the tooth or deviating in a mesial or
distal aspect.14
Multiple approaches have already been established for fractures of teeth like orthodontic extrusion, forced surgical
extrusion and periodontal crown lengthening procedures to expose the fracture site followed by restoring the lost tooth
structure by prefabricated or custom cast post and core build up with, composite resin or prosthodontic restoration. 15 But
each of the method has its inherent drawbacks like, excessive forces in orthodontic extrusion can lead to pain, failure of
the tooth to move, root damage, tilting of the abutment and subsequent impaction of the root being extruded. The custom
or prefabricated post and core have hazards like possibility of root perforation during the post space preparation, induced
stresses and the risk of fracture during the placement of the post and wedging effects of the tapered posts. 16 Moreoverthese
approaches are elaborate and time consuming and not so very cost effective.
As the reattachment procedure, does not preclude any future treatment so whenever an intact fragment is available,
reattachment of fractured fragment should be considered as a viable first treatment option. Liew too described the
prognosis of this procedure as it can act as ‘a short to medium term temporary restoration which has the potential for
indefinite service’.13 Therefore, the narrated approach was opted.
In these cases Hyflex CM file system was adopted as it is flexible, efficient but less aggressive when cutting and produces
less vibration during canal preparation. This file system was preferred as there was a chance of detachment of fracture
fragments during preparation and also there was curvature in roots of affected teeth.
Fiber Post was the preferred choice over cast post as it facilitates the preservation of fracture fragment. It does not require
ferrule preparation and these fibre post are bonded rather than luted which reinforces the stabilization of fracture
fragment.Glass fiber post was selected out of all the fiber post systems for its better mechanical and physical properties.
The behaviour of a glass fiber post-restored tooth is similar to that of a natural tooth, since it produces an appropriate
stress distribution, they have the best biomechanical performance.17
CONCLUSION
Developments in restorative materials and dentin bonding systems have provided the opportunity to use tooth fragments
in the treatment of dental trauma. Further, the reattachment technique provided protection of the original tooth structure,
as well as positive social and psychological effects on patients. Tooth fragment reattachment procedure offers an
ultraconservative, safe, fast and aesthetically pleasing result when the fractured fragment is available.
REFERENCES
1. Marcenes W, Al Beiruti N, Tayfour D, Issa S. Epidemiology of dental injuries to the permanent incisors of 9-
12-year-old schoolchildren in Damascus, Syria. Endod Dent Traumatol 1999; 15:117-23.
2. Zaleckiene, Peciuliene, Brukiene, Drukteinis.Traumatic dental injuries: etiology, prevalence and possible
outcomes,Stomatologija, Baltic Dental and Maxillofacial Journal; 2014, 16: 7-14.
3. Divakar HD, Nayak M, Shetty R. Changing concepts in fracture reattachment of teeth-A case series.
Endodontology 2007;2:27-35.
4. Vitale MC, Caprioglio C, Martignone A, Marchesi U, Botticelli A. Combined technique with polyethylene fibers
and composite resins in restoration of traumatized anterior teeth. Dental Traumatology 2004;20(3):172-7.
5. Misra P, Misra N, Gupta K, Jain R. Immediate reattachment of fractured tooth segment–A case report. Indian
Journal of Public Health Research & Development2010;1(2):77-8.
6. Bakland L K (2002) Endodontic considerations in dental trauma, In:Endodontics, 5thed, Ingle JI, Bakland LK
eds, BC Decker, Hamilton, 795-843.
7. Simonsen RJ (1982) Restoration of a fractured central incisor using original tooth fragment. J Am Dent Assoc
105,646-648.
55
8. Galea H (1984) An investigation of dental injuries treated in an acute care general hospital. J Am Dent Assoc
109, 434-438.
9. Oztan MD, Sonat B (2001) Repair of untreated horizontal root fractures: two case reports. Dent Tramatol 17,
240-243.
10. Welbury R, Kinirons MJ, Day P, Humphreys K, Gregg TA (2002). Outcomes for root fractured permanent
incisors: a retrospective study. Pediatr Dent 24,98-102.
11. Tennery N.T.: The fractured tooth reunited using the acid etch bonding technique. Tex Dent J 1988; 96: 16 - 17.
12. Starkey P.E.: Reattachment of a fractured fragment to a tooth. J Ind Dent Assoc 1979; 58: 37 - 38.
13. Liew VP. Reattachment of original tooth fragment to a fractured crown- case report. Australian Dental Journal
1988;33(1): 47-50.
14. Andreasen JO, Andreasen FM, Crown-root fractures. In Andreasen. JO Andreasen FM (Eds). Textbook and
color atlas of traumatic injuries to the teeth 1994;3:257-77.
15. Grossman Y, Aravz-Dutari J, Chogle SM, Blatz B, Sadan A. A conservative approach for the management of
a crown-root fracture. Quintessence Int. 2006 Nov-Dec;37(10):753–759.
16. Brown GJ, Welburry RR. Root extrusion a practical solution in complicated crown-root incisor fractures. Br
Dent J. 2000 Nov;Sep;189:477–478.
17. Bessone, l. & Fernandez b. E. Jr. Evaluation of different post systems: finite element method. Int. J.
Odontostomat.,4(3):229-236, 2010.
18. Onay EO et al. Effect of adhesive system type and root region on the push out bond strength of glass-fibre posts
to radicular dentine. IntEndod J, 2010;43:259-268.
19. Goracci C et al. Evaluation of the adhesion of fibre post to intraradicular dentin. Oper Dent,2005;30-5:627-635.
20. Stockton LW, Williams PT. Retention and shear bond strength of two post systems. Oper Dent 1999;24:210-6.
21. Cornier CJ et al. in vitro comparison of the fracture resistance and failure mode of fibre , ceramic, and
conventional post system at various stages of restoration. J Prosthodont 2001;10:26-36.
22. Naumann M et al. Self Adhesive Cements as Core Build-ups For One-stage Post-endodontic Restorations?
IntEndod J 2011; 44:195-202.
23. Vanessa TorracaPeraroVaz et al. Fragment Reattachment after Atypical Crown Fracture in Maxillary Central
Incisor- a case report.Case Reports in Dentistry 2014, Article ID 231603, 4 pages.
24. S.Saha, MK Saha, Management of a Fractured Tooth By Fragment Reattachment- A Case Report IJDC 2010:2
(2): 43-47
Biography
Dr.Tirthankar Bhaumik is presently Post Graduate Trainee in the Department of Conservative Dentistry &Endodontics,
Guru Nanak Institute of Dental sciences & Research, Panihati, Kolkata-114, West Bengal, India.
Email: drtirthankar.bhaumik@gmail.com
56
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MANAGEMENT OF ANTERIOR TEETH FRACTURE WITH PRESERVATION OF

Article · January 2017

The user has requested enhancement of the downloaded file.

MANAGEMENT OF ANTERIOR TEETH

Fig. 3(Case 1) Fig. 4(Case 2)

Fig. 5( Case 1) Fig. 6( Case 2)

Fig. 7( Case 1) Fig. 8( Case 1)

Fig.9( Case 2) Fig. 10( Case 2)

Fig. 11( Case 1) Fig. 12( Case 2)

Fig. 13( Case 1) Fig. 14( Case 1)

Fig. 15( Case 10 Fig. 16( Case 2)

Fig. 17( Case 1) Fig. 18(Case 2)

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