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http://www.journal-imab-bg.org REATTACHMENT OF FRACTURED PERMANENT Ani BelchevaDepartment of Pediatric Dentistry, Faculty of Dental Medicine,Medical University, Plovdiv, Bulgaria SUMMARY: time passed by. The clinicians find it difficult because ofthe small patient’s age, need of high esthetics in the front In this review article the method of reattaching Key words: reattachment, crown fractures, permanentteeth INTRODUCTION Trauma to the permanent teeth is rather commonevent among schoolchildren. Crown fracture present almostanterior incisors are most often affected (80% central Reconstruction of crown fractures has developedthrough the years. Elaboration in the field of adhesiveinvasive approach and achieve esthetic and functionaladhesive materials creates new perspectives inreconstruction of fractured teeth (6, 36). The aim of this review article is to propose themethod reattachment of the original tooth fragment forreconstructing crown fractures of permanent incisors. Chosack and Eildeman describe for the first time in1964 reattachment of tooth fragment after trauma of 12 years Andreasen FM et al. make a detailed description ofthe clinical protocol when treating uncomplicated and complicated crown fractures by reattachment (3). Theauthors apply the so cold GLUMA protocol for reattachingof 76 permanent teeth of schoolchildren. There are many studies published at late 80-s and 90-s describing successful clinical cases with reattachedbeveling (27), others describe resources for pulp protection · Advantages Reattachment should be first choice whenreconstructing fractured teeth and the fragment is available.This method has a number of advantages shown in clinicaland experimental studies. esthetics, as it uses the original tooth’s shape, color, Reattachment of tooth fragment of anterior teeth is Occlusal forces, generated at protrusive movementsof the mandible are extremely destructive to the relationtooth fragment – bonding agent (14). That is why manyauthors consider placement of porcelain or compositeteeth to values close to the intact teeth (14, 26, and 32). Reattachment of tooth fragment is possible on itspresence after the trauma and the fragment is intact with The successful reattachment depends on fragment’sdehydrated the poor tooth’s strength will be. Improvementof tooth’s resistance can be achieved by fragment DOI: 10.5272/jimab.14-2-2008.97 ISSN: 1312-773X (Online) http://www.journal-imab-bg.org significantly decreases its fracture resistance. At the sameDentin’s dehydration causes collapse of collagen fibers and A lasting dehydration of tooth’s fragment can causeoriginal tooth’s color will be. In most cases dehydrated In a contemporary experimental study of Capp et al.is shown that wetness necessary for correct functioning ofthe adhesive mechanism is more critical for the dentin thanfor the enamel. Dentin removing before reattachmentfragments dehydrated for 48 hours. Same authors commentreturn of share bond strength after only 30 minutes of Besides fragment’s rehydration another importantcondition is its adaptation to the tooth’s remnant. reattachment (25). According to Basuttil and Fung, when thechild’s age shows immature development of the fracturedtooth’s gingival margins, the application of more · Techniques for preparation and adhesive materials reach that of the intact teeth (4). Another statement saysperformed by Farik, Worthington and Reis. Authors propose different preparation techniques of the fragment and theresistance (8). Besides the great amount of publications (5, 9, and33), presenting different approaches for preparation of thelasting result of some of the preparations. The contemporary29), alloy reattachment of fractured fragment to acquirecharacteristic of non invasive method of treatment with good increase tooth’s strength. Fractured teeth reattachedthose beveled 45-degrees. Worthington et al. (36) show According to Reis et al. Tooth reattachment withoutof fragment to the tooth. That’s why they prepare chamferafter reattachment and fill it with resin (3). It’s also a method Kanca and Baratieri et al. Use dentin bonding systems All -(3M Dental, USA) (6,22) respectively, other authors applyso cold “sandwich technique” (5). Another alternative is theanhydride in combination with 3 – n-butyl borate (4-META). http://www.journal-imab-bg.org (6, 24). Andreasen FM et al. (4) pointed out that materialoutstand the functional loading. Andreasen FM et al. In spite the conflicting results addition of compositematerial is important it cases when the adaptation betweenfragment and tooth is not sufficient and when theconnection line is too visible but the patient insists for better Sometimes the fracture comprises enormous part ofthe dentin and full polymerization is difficult to achieve (30).In these cases chemically polymerized or double polymerizedmaterials are preferred Dean et al (14) and Reis et al. (30)and chemically polymerized composite materials forreattachment of fractured fragments. Some authors · Prognosis provide for. There is a lack of enough clinical long lastingstudies. The clinical trail of Andreasen et al. (3) for lasting and 25% retention after 2, 5 and 7 years respectively. Inadhesive build up and reattachment of tooth fragment Afterat application of fragment reattachment. Another prospectiveacid etching, internal V-shaped channels, bonding agents and In a contemporary clinical study after 2 years offollow up of reattached fractured incisors of 11 childrenaged 8-13, the authors receive „satisfying” and „verysatisfying” clinical and roentgen results concerning Using the good experience of the published in thearticles there are more often scientific reports ofsuccessfully followed up clinical cases of reattachedfractured teeth without pulp involvement (1) or of CONCLUSION Crown fractures of the permanent teeth inschoolchildren are unique to a great extend and can not beeasily classified according to the way of reconstruction.Literally application of separate method is difficult and everyreconstruction. Reattachment of tooth fragment is minimalinvasive and esthetic method. The approach is conservativeto the dental clinicians’ different opportunities for estheticand functional restorations that are economically effectiveis the fact that all the alternative methods as direct adhesiveresin reconstruction, veneers and crowns can be performed çúáåí ôðàãìåíò, Ñòîìàòîëîã 21 2. Alvares I, et al. Silicone index: an 3. Andreasen FM, Noren JG,study. Quintessence Int 1995; 26: 669- 4. Andreasen FM, Sternhardt U,crown fracture. An experimental study REFERENCE 5. Baratieri LN, Monteiro S Jr,Caldeira de Andrada M. The 6. Baratieri LN, Ritter AV, Monteiro http://www.journal-imab-bg.org Address for correspondence: Dr. Ani Beltcheva, PhD Department of Pediatric Dentistry, Faculty of Dental Medicine, Medical University, Plovdiv, Bulgaria Å-mail: abeltcheva@yahoo.com S Jr, et al. Tooth fragment reattachment:Periodontics Aesthet Dent 1998; 10: 7. Basuttil NA, Fung DE. Tooth 8. Borssen E, Holm AK. Traumatic 9. Burke FJT. Reattachment of 10. Burke FJT. 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