Reattaching fragments, why?
An article by Simone Grandini and Giulio Pavolucci
From a clinical case by Giulio Pavolucci
Dental traumas in pediatric patients are very frequent; dentists must be prepared to treat these young patients, offering them the best solution with the minimum tissue sacrifice.
In case of crown fracture, the fragment (if available) must be reattached with adhesive techniques; otherwise the first choice is a direct restoration. Prosthetic solutions must be delayed if possible, especially in young patients.
The reattachment procedure is very simple and reliable, and is described step by step using a case report of an Ellis class II fracture.
This 9 years old young patient, came to our attention in emergency; our first concern was to be sure that the trauma was consequence of a simple accident. The kid was playing at school with some other children and fell, breaking his 1.1 tooth. Unfortunately he was able to find only a part of the fragment; we decided to reattach it and to complete the tooth with a direct composite restoration. When available, and in good conditions, the fragment must be used, because is the most effective and bio-compatible material we can use.
The white spot on the papilla between 1.1 and 1.2 is due to H2O2 used at school to disinfect.
Occlusal view showing pulp exposure, so this is a III class fracture according to Ellis. The pulp was not bleeding and the tooth was both asintomatic and vital, so we decided to not to perform an endodontic treatment.
Rubber dam isolation is always imperative in order to perform an adhesive procedure.
Enamel etching and self-etch adhesive application on the partial fragment. The fragment was only disinfected with 0.2% chlorhexidine; no cleaning or beveling procedures were applied, in order to mantein the fitting.
For the same reasons, even the margin of the tooth was not prepared.Enamel etching and self-etch adhesive were applied.
The fragment was repositioned using a thin layer of flowable composite.
Both margins (buccal and palatal) were beveled in order to improve the fracture resistence.
The missing part of the tooth was restored directly in composite; the first layer of palatal and interproximal enamel was made with an high translucency resin, that allowed us to handle the incisal characterizations.
All the dentinal body was made with A2 dentin resin, trying to imitate the natural structure of the mamelons.
A translucent mass was layered between the mamelons, than an opaque A2 mass was applied to create the incisal halo, and in the end a thin layer of enamel.
Finishing procedures with a diamond bur.
After polishing and rubber dam removal.
At the control visit ( 14 days later ), the restoration is well integrated, we can appreciate a good colour match and a natural aspect of the incisal third.