Effect of Adhesive Materials in Re-Attachment of Crown and Crown–Root Fractures of Permanent Maxillary Anterior Tooth: A Computational Study

Abstract

Traumatic dental injuries (TDI) are frequent among individuals of all ages, with a prevalence ranging from 12–22%, with crown and crown–root fractures being the most common. Fragment reattachment using light-cured nanocomposites is the recommended method for the management of these fractures. Though there are several clinical studies that have assessed the efficacy of such materials, an in-silico characterization of the effects of traumatic forces on the re-attached fragments has never been performed. Hence, this study aimed to evaluate the efficacy of various adhesive materials in crown and crown–root reattachments through computational modelling. A full-scale permanent maxillary anterior tooth model was developed by segmenting 3D scanned cone beam computed tomography (CBCT) images of the pulp, root, and enamel precisely. The full-scale 3D tooth model was then subjected to a novel numerical cutting operation to describe the crown and crown–root fractures. The fractured tooth models were then filled computationally with three commonly used filler (or adhesive) materials, namely flowable composite, resin cement, and resin adhesive, and subjected to masticatory and traumatic loading conditions. The flowable composite demonstrated a statistically significant difference and the lowest produced stresses when subjected to masticatory loading. Resin cement demonstrated reduced stress values for crown–root fractures that were masticatory loaded after being reattached using adhesive materials. During traumatic loading, resin cement demonstrated lower displacements and stress values across both fractures. The novel findings reported in this study are anticipated to assist dentists in selecting the most appropriate adhesive materials that induce the least stress on the reattached tooth when subjected to second trauma, for both crown and crown–root fractures.

Development of patient-specific finite element model for study of composite dental implants

“…Due to the prevalence of frontal and incisal injuries [45], traumatic load was applied in the study. Since the maxilla are encased in skull, the upper surface of maxilla was constrained in all degrees of freedom A load of 10 MPa was applied to the natural crown of the central incisor and the porcelain crown of the implant to simulate the effects of a traumatic load, in line with previous literature [4]. Figure 4 shows the amount and location of pressure and constraint being applied that were used in this study.…”

“…Finite element analysis using patient based models have been able to address this aspect in past. Recently, Garg et al [4], performed the computational analysis of reattachment of fractured tooth using adhesive material (flowable composite, resin cement, and resin adhesive) on realistic tooth model. In their study they simulated the re-attachment of the fractured incisor tooth by using different composite based adhesive materials and measured the stress under different loading conditions.…”

Reattachment of Fractured Tooth: A Comprehensive Review

“…Pusman et al state that the intermediate material and the bonding adhesive have an impact on the reattached tooth’s fracture strength [ 2 ]. Garg et al found that a flowable composite shows better results than resin cement in fracture reattachment [ 38 ].…”