Kore P.R, Shah M, Doshi Y, Bajaj M

Transcription

1 Case Report Fractured Fragment Reattachment - A Second Chance Kore P.R, Shah M, Doshi Y, Bajaj M Kore P.R, Shah M, Doshi Y, Bajaj M. Fractured Fragment Reattachment - A Second Chance. J Periodontal Med Clin Pract 2015; 02: Affiliation 1. Dr. Prashant Ramchandra Kore (P.G student in dept of Periodontics at Pandit Deendayal Upadhayay Dental college, Kaegaon,Solapur) 2. Dr. Mona Shah (Head of department in Dept of Periodontics at Pandit Deendayal Upadhayay Dental college,kaegaon,solapur) 3. Dr. Yogesh Doshi (Reader in Dept of Periodontics at Pandit Deendayal Upadhayay Dental college, Kaegaon, Solapur) 4. Dr. Monica Bajaj (Senior lecturer in Dept of Periodontics at Pandit Deendayal Upadhayay Dental college, Kaegaon, Solapur) Corresponding Author: Dr. Prashant R. Kore Pandit Deendayal Upadhayay Dental college & hospital,kaegaon,solapur. P.NO ID : drprashantkore@gmail.com ABSTRACT: Anterior crown fractures are day after day sort of injury that for the largest part affects offspring & teenagers. Reattachment of a fractured fragment to the remaining tooth can grant access to superior & extended everlasting aesthetics.it also improved functions and stirring psychological retort. It is more quickly & abridged quantity of complex procedure. This article describes a clinical case of reattachment of fractured anterior teeth & demonstrates how aesthetic appearance can be satisfactorily restored without wear to sound structure of tooth. Key words: Fractured fragment, composite, etched, aesthetics, reattachment,biologic width. AIM: Dental injuries are the most common injuries leading to tooth loss. Uncomplicated & complicated 1 crown fracture is the most common. Teeth most commonly affected are maxillary incisors; attributable to their anterior position & protrusion caused by eruptive patterns. The aim of this article is to emphasize more on preservation of natural tooth 109

2 especially in youth who are more prone for dental injuries. INTRODUCTION: Dental trauma is on a rise in children & teenagers because of an increase in participation in sports & dangerous activities, increased accidents, etc. A number of treatment options have been used in the past for restorations of a fractured tooth. But these restorations have not promoted adequate long term aesthetics & also required a significant tooth reduction during preparation. With the development fragment. An informed consent was made. The fractured fragments were removed under local anesthesia (Lignox 2%, Warren Pharma Maharashtra India), cleaned & stored in normal saline. Since the pulp was clinically exposed endodontic therapy was done (Fig 2). Full thickness flap was reflected on buccal& palatal sides, using internal bevel gingivectomy (Fig 3). The fracture line was then exposed by ostectomy on the palatal surface maintaining the biologic width (Fig 3) The of adhesive dentistry came the concept of Tooth fragments were dried & acid etched using 37.5% Fragment Reattachment making it possible for the phosphoric acid (Solo Etch Medicept U. K) for 15 dentist to use patient's own intact tooth fragment to restore the fractured tooth by reattaching the fragment back to the tooth. Many techniques have been suggested to restore the fractured tooth. One way to treat a fractured tooth is to reattach the tooth fragment to its remnant using a composite resin first [1 2] described by Chosack and Eidelman in CASE REPORT: A 24yrs male patient reported to Dept with history of road trauma accident since 1 day. The patient complains of broken teeth and pain in upper front region of jaw. On examination it was noticed that 11, seconds (Fig 4). Bonding agent (Bond plus NT Medicept U. K) was applied & cured for 20 seconds. Pulp chamber of the fragments was filled with flowable composite (Flow Plus Medicept U. K) & cured for 40 seconds (QHL 75 Dentsply Caulk USA). 2mm of gutta-percha was removed to make space for composite material. This acted as an anchor to bond the fragment to the root. Under isolated conditions the fragments were approximated. The composite flash was removed. It was then light cured for 60 seconds from all sides. The composite was then polished using polishing disc (Sof-Lex Finishing & Polishing System 3M 21 had fractured with the fracture line extending ESPE USA) the area was irrigated to remove any below cemento-enamel junction & fragments were still attached to the gingival tissue. He also had laceration & cut injuries on his upper lip. Radio graphically the tooth did not show any vertical or horizontal fracture along the middle third & apical third of root surface (Fig 1). The fracture line extended from crown to cervical third of root in an oblique direction along the palatal surface of tooth # 11 & 21. It was decided to reattach the fractured debris. The flap was then approximated & sutured using 3-0 silk suture (Centisilk, Centenial India) (Fig.5 & 6). Care was taken that the fracture lines were completely supragingival. The teeth were then splinted with composite resin for 3 weeks. Suture removal was done after 1 week. 110

3 Osteotomy done 111

4 DISCUSSION: Maxillary central incisors are most vulnerable to injury, sustaining approximately 80% of all dental injuries, followed by the maxillary lateral & 2. Enamel beveling- this technique has claimed to improve fragment retention. This technique also has good short term aesthetics. 3. V-shaped internal enamel groove- A commonly [3] mandibular incisors. reported technique in literature is, placement of a V- Management of crown root fractures includes range of options like extraction, implants & post core. Although post core was a viable option it had its disadvantages. Post is implicated in vertical root shaped internal enamel groove which is then restored with resin composite. Clinically this technique is difficult to perform due to the limited enamel thickness of anterior teeth. [4] fracture as well as in root perforations. The 4. Internal dentin groove- Performed in pulp less technique of reattaching a tooth fragment was first [2] described by Chosack&Eidelman in Tennery was the first to report fractured fragment r e a t t a c h m e n t u s i n g a c i d e t c h e d technique.whenever possible, reattachment of fractured tooth segment is one of the best techniques for the restoration of a fractured anterior tooth. It is aesthetically more predictable for translucency, opalescence, fluorescence, teeth, where part of the pulp chamber is filled in resin composite. Procedure compromises aesthetics, as the internal resin composite can modify the shades of teeth. 5. External chamfer Here the fragment attachment is done prior to tooth preparation. This method has the advantage that the precise fit between the fragments is not lost (a disadvantage of above mentioned methods). Chamfer placement has been [5] characterizations & texture of the surface. performed on buccal, lingual or circumferentially. Management of crown root fractures often involves a multidisciplinary approach involving endodontic, 6. Over contour - Clinicians use this technique extensively but is less reported in literature. After [6] periodontal & prosthetic therapy. Presence of bonding the fragment, a superficial preparation vital pulp is one of the indications for single visit endodontic therapy and so single sitting endodontic therapy was done. The fragments was stored in [7] saline, changed weekly to prevent dehydration. Osteoctomy was done to remove bone & maintain ideal biologic width. Violation of biologic width can cause further gingival recession & an [8] unaesthetic appearance. Many techniques are described in literature for fractured fragment about 0.3 mm deep is placed on the buccal surface using a cylindrical diamond finishing bur extending about 2.5 mm coronally and apically from the fracture line. This area is then treated with a thin composite layer. This technique is useful when the fracture line is still evident after reattachment. However, this technique may compromise long term aesthetics. Also use of fiber post is been suggested for [9] [10] reattachment. These include fractured fragment reattachment. Considering 1. Simple reattachment - Reattaching the fragments various techniques described, we bonded the with no additional preparation. fractured fragment by placing composite in the pulp 112

5 chamber & root canal. The advantage of this 4. Kvinnsland I, Oswald RJ, Halse A, technique is that it gives adequate bulk of Gronningsaeter AG. A clinical and composite to prevent breakage; there is no need to roentgenological study of 55 cases of root modify the fractured fragments & ensures better perforation. IntEndod J 1989;22: adaptability. 5. Hegde RJ. Tooth fragment reattachment--an CONCLUSION: esthetic alternative: report of a case. J Indian Thus reattachment of the fractured tooth fragment SocPedodPrevDent 2003; 21: is the most conservative & biological method of 6. Trope M, Chivian N., Sigurdsson A., Vann restoring fractured anterior tooth. It can also be WF. Traumatic Injuries.In: Cohen S. & used to treat fractured teeth successfully following Burns RC, editor. Text Book of Pathways of trauma. The procedure provides best aesthetic Pulp, 8th ed.california: Mosby; 2002.p. results with minimal intervention. It also provides a second chance for the natural tooth. Care has to be 7. LehlG,LuthraR.Reattachment of fractured taken in maintaining biologic width for success of fragments of maxillary central incisorssuch cases. report of a case. J Indian SocPedodPrev Dent 2004; 22:54-5. REFERENCES: 8. Spear FM, Cooney JP. Restorative 1. Dietschi D, Jacoby T, Dietschi JM, Schatz interrelationship. In: Newman, Takei, JP. Treatment of traumatic injuries in the Klokkevold,Carranza, editor. Text Book of front teeth: restorative aspects in crown Clinical Periodontology, 10th ed.california: fractures. Pract Periodontics Aesthet Dent Saunders; 2000.p ; 12: Reis A, Francci C, Loguercio AD, Carrilho 2. Chosack A, Eidelman E. Rehabilitation of a MR, RodriquesFilho LE. Reattachmentof fracture incisor using the patient's natural anterior fractured teeth: fracture strength crown: Case report. J Dent child 1964; using different techniques. Oper Den 2001; 71: : Reis A, Loguercio AD, Kraul A, Matson E. 10.Anil kumar. S &Jyothi K. Reattachment of Reattachment of fractured teeth: a review of Fractured Tooth Using Self Etching literature regarding techniques and adhesive and Aesthetic Fiber Post. Journal of materials. Oper Dent 2004; 29: Dental Sciences & Research 2010; 1: Competing interest / Conflict of interest The author(s) have no competing interests for financial support, publication of this research, patents and royalties through this collaborative research. All authors were equally involved in discussed research work. There is no financial conflict with the subject matter discussed in the manuscript. Source of support: NIL Copyright 2014 JPMCP. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 113