Year : 2005 | Volume
: 23 | Issue : 1 | Page : 42--43
Biological aspects of tooth fragment reattachment in immature incisors
N Kalra, P Rai
Department of Dentistry, University College of Medical Sciences, G.T.B. Hospital, New Delhi, India
Tooth fragment reattachment is a relatively new technique and there are many aspects which still need to be explored. Reported here is a case of enamel and dentin fracture of 11 and 21. There was a very thin layer of dentin clinically over the pulp chamber and the root apices were immature. The reattachment procedure was modified slightly. The initial joint was made with protective calcium hydroxide and glass ionomer cement on the approximating surfaces. The further reattachment was accomplished using composites and acid etch technique. This was done for pulpal protection. After six months, reattachment was intact and successful with no staining, sensitivity or pain. The radiographs revealed root completion of the immature incisors. The reattachment procedure proved to be biologically superior in addition to its esthetic value and psychological advantage.
|How to cite this article:|
Kalra N, Rai P. Biological aspects of tooth fragment reattachment in immature incisors.J Indian Soc Pedod Prev Dent 2005;23:42-43
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Kalra N, Rai P. Biological aspects of tooth fragment reattachment in immature incisors. J Indian Soc Pedod Prev Dent [serial online] 2005 [cited 2020 Jul 10 ];23:42-43
Available from: http://www.jisppd.com/text.asp?2005/23/1/42/16027
Children are more prone to trauma of anterior teeth. Prevalence of trauma to maxillary central incisors is generally 37 percent. A traumatic injury associated with fracture of anterior teeth is an unfortunate incident for a young patient and parents. This is specially important if the root formation is not complete. Such cases require immediate care not only because of psycho-social effects but also to protect vitality of the tooth so that root formation and growth can occur to its full potential.
One of the many techniques employed, is composite resin reattachment done immediately which is extremely satisfying and well appreciated. The repair needs to be followed with pulpal treatment immediately or at a later stage if necessary. A crucial aspect which must be remembered at this stage is the preservation of the traumatized pulp, as the remaining pulp will help in root completion in a young tooth.
Tennery, Starkey, Simonsen were the early workers on the subject of "tooth fragment reattachment". Composite resins with the acid etch technique have proved a real boon in reattachment procedures. The earlier treatment of fractured segment was to build them with composites but quite often there was the complaint of non-satisfactory colour matching, sensitivity, and poor translucency. Another common complaint with composite restoration was fast incisal edge wear of the composite surface. Reattachment of fragments takes care of the above stated drawbacks to a great extent. Another important advantage with tooth fragment reattachment is the psychological comfort of the child.
Reported here is the case of a 7 year old patient with history of fall at home and sustained fracture [Figure 1] of 11 and 21 (Ellis Class-ll). Intra oral periapical radiograph revealed a large pulp chamber with a very thin layer of dentine covering it. The root apices had not developed completely and presented a funnel shaped apex. Radiologically they appeared to be early Nolla stage 8 [Figure 2]. The teeth tested positive to electrical pulp testing. The teeth were not mobile and the adjacent mucosa was gently bruised. The fractured portion of the teeth were intact.
The fractured segments were hydrated in normal saline. The teeth were isolated with rubber dam. A reverse bevel and minimal undercuts were placed on and along the fracture line circumferentially. The same was repeated on the fractured segment. In order to protect the pulp a layer of calcium hydroxide was applied on the dentin. Glass ionomer cement was used to unite the two fragments. The enamel was freed of any remnant of glass ionomer cement. Acid etch technique and incremental application of composite resin was done to splint the segments labially and palatally. Final finishing was done using discs and polishing kits. Occlusal evaluation was satisfactory. The child was advised not to use the front teeth for biting and was put on a recall schedule. The repaired segments were pleasing aesthetically [Figure 3] and provided excellent psychological comfort to the patient and her mother.
On further follow-up, the teeth were asymptomatic. Favourable outcome was noticed on the intra-oral peri-apical radiograph [Figure 4], it was seen that a progress in root growth with some gain in length. Apical area also seemed to have matured (Nolla stage 9).
Tooth fracture reattachment procedure is a treatment of choice and holds a bright future as a treatment modality. It appears to be the ultimate in conservative pediatric dentistry. The colour, texture, shade and translucency is natural and hence extremely satisfying. In the present case, the highlights of the clinical procedure was the biological activity of the well protected pulp (since the approximating surfaces of the segments were free from any kind of acid etching). The later radiograph shows the developed root and closed apices of 11 and 21 much to the delight of the treating dentist.
|1||Tennery NT. The fractured tooth reunited using the acid etch bonding technique. Tex Dent J 1988;96:16-7.|
|2||Starkey PE. Reattachment of a fractured fragment to a tooth. J Ind Dent Assoc 1979;58:37-8.|
|3||Simonsen RJ. Restoration of a fractured central incisor using original teeth. J Am Dent Assoc 1982;105:646-8.|
|4||Damle SG. Textbook of pediatric dentistry. 2nd Ed. Arya Publishing House 2002. p. 331-2.|