Management of a Subgingivally Fractured Central Incisor by Re-attachment Using a Fiber Post

Abstract

Reattachment of a fractured fragment to the remaining tooth is challenging but one of the best treatment protocol in regards to aesthetics, function as well as patients acceptance. This case report presents a 20 years old male with an oblique complicated crown fracture of maxillary left central incisor tooth. The procedure used to repair the fracture regarding this case included flap surgery with endodontic treatment. The root canal was filled with a root canal sealer and gutta-percha. After root canal obturation, fragments were reattached with duel cure composite resin using a glass fibre post. After 12 months evaluation, clinical and radiographic examinations showed a stable reattachment, good aesthetics and healthy periodontium.

Fragment reattachment after complicated crown‐root fractures of anterior teeth: A systematic review

“…Tooth mobility and percussion tests were used as diagnostic tests in six 13,15,22,25,28,29 and two articles, 13,29 respectively. In ten of the included articles, only a single straight angled pre‐operative intra‐oral periapical (IOPA) radiograph was taken for the assessment of the extent of fracture 10,12–15,22–25,27 . In addition to an IOPA, an orthopantomograph (OPG) 29 and a soft tissue radiograph 26 were taken in one article each.…”

“…The attached coronal fragment was removed in all cases and rehydrated using a storage medium. Saline was used as a storage medium in six of the articles, 12,15,23,26,28,29 while distilled water was used in five of the articles 10,13,22,25,27 . In one article, the fragment was stored in frozen distilled water for 6 hours and then thawed at room temperature in water for 30 minutes prior to reattachment 16 .…”

“…With regard to the exposure of the fracture, the following procedures were done: mucoperiosteal flap surgery in eight articles, 10,14–16,24,26,28,29 mucoperiosteal flap surgery with osteoplasty and osteotomy in five articles, 10,15,16,28,29 and only gingivectomy in four articles 12,15,23,25 . However in three articles, exposure of the fracture was not done 13,22,27 …”

“…With rapid advances in adhesive dentistry, fragment reattachment is another treatment option that is being increasingly considered for management of these cases 8,9 . It has various advantages as it re‐establishes the aesthetic, morphological and functional aspect of the tooth immediately, the achievement of lifelike translucency, incisal edge wear rate similar to that of the adjacent teeth, preservation of identical occlusal contacts, less chair‐side time, and a positive psychological response 10 . In addition, it is a minimally invasive, cost‐effective procedure, which restores the function, aesthetics, and phonetics immediately.…”

“…A recent systematic review reported that fragment reattachment could be a practical alternative treatment option to conventional composite restoration in uncomplicated crown fractures 11 . Numerous case reports and case series describe successful outcomes after coronal reattachment in complicated CRF of anterior teeth 10,12–16 . Various techniques and different materials have been used for reattachment to date.…”