|Year : 2018 | Volume
| Issue : 2 | Page : 117-126
Laboratory and clinical evaluation of uncomplicated fragment reattachment using pinholes
Talat M Beltagy
Department of Pedodontics, Faculty of Dentistry, Kafrelsheikh University, Kafrelsheikh, Egypt
|Date of Submission||04-Mar-2018|
|Date of Acceptance||26-Apr-2018|
|Date of Web Publication||25-Jun-2018|
Talat M Beltagy
Department of Pedodontics, Faculty of Dentistry, Kafrelsheikh University, Kafrelsheikh
Source of Support: None, Conflict of Interest: None
To evaluate laboratory and clinically the uncomplicated fragment reattachment using pinholes.
Materials and Methods
A total of 40 extracted human intact upper permanent central incisors with close similarity were selected and randomly divided into four groups (n = 10) according to the technique of reattachment. The incisal third of 30 specimens were sectioned horizontally. Group I: pinholes, group II: internal dentinal groove, group III: simple reattachment, and group IV (control group): intact teeth. Each fragment was reattached to its sectioned tooth using adhesive bond and resin cement. All specimens were tested for fracture strength under standard conditions in an Instron testing machine. The clinical study was performed on 20 patients, aged 8–16 years, presented with uncomplicated fragments of fractured upper central incisors, and divided into two groups (10 patients each). Group I: pinholes and group II: internal dentinal groove. All patients were followed-up clinically and radiographically at 3, 6, 12, and 18 months. Data were analyzed using one-way analysis of variance and post-hoc test with the significant level P less than 0.05.
The laboratory study showed that the control group recorded the high strength value followed by pinholes, internal groove, and simple reattachment and the difference was statistically significant. However, the clinical results showed no significant differences between the two techniques.
It was concluded that the pinholes technique had only a significant effect on fragment reattachment success in the in-vitro study.
Keywords: coronal tooth fracture, fragment reattachment techniques, tooth fragment
|How to cite this article:|
Beltagy TM. Laboratory and clinical evaluation of uncomplicated fragment reattachment using pinholes. Tanta Dent J 2018;15:117-26
|How to cite this URL:|
Beltagy TM. Laboratory and clinical evaluation of uncomplicated fragment reattachment using pinholes. Tanta Dent J [serial online] 2018 [cited 2018 Nov 15];15:117-26. Available from: http://www.tmj.eg.net/text.asp?2018/15/2/117/235131
| Introduction|| |
The coronal fracture of the anterior teeth is the most frequent form of traumatic dental injury affecting mainly children and adolescents, especially the youngest (8–11 years), and the upper central incisors are the most commonly affected due to their vulnerable situation in the dental arch . Several factors can influence the management of crown fractures, including the extent of the fracture, fracture pattern and tooth restorability, a patient's age, soft tissue condition, absence/presence of tooth fragment, the condition of reattachment, esthetic expectations, occlusion, economics, and prognosis ,.
The coronal fractures are classified according to WHO into uncomplicated crown fractures, such as enamel and dentin fractures and complicated crown fractures that associated with pulp and/or periodontal involvement . The uncomplicated and complicated crown fractures in children's teeth caused by trauma represent ~ 28–44 and 11–15%, respectively .
Various treatment options have been developed to restore the uncomplicated crown fractures, such as veneers , or jacket crowns; however, such treatments are more destructive and harmful to the pulp . The development of resin composite and bonding systems can provide a more conservative approach . Despite the advanced technology in adhesives and restorative techniques, still, no restorative material can reproduce the natural dental structures, functional demands, and esthetic hue . Therefore, when a fractured fragment is available, it is the first restorative option that should be performed immediately ,.
The original fragment reattachment is a vital important technique for restoring coronal fracture. It overcomes the disadvantages of full-coverage or resin restorations . The technique is fast, simple to use, minimally invasive, less time-consuming, and low-cost. It improves the emotional discomforts and incisal function. Likewise, it maintains the original anatomic form of the tooth, the occlusal alignment, natural characteristics of wear, surface texture, translucence, and shape and provides perfect, long-lasting esthetics ,. Therefore, tooth fragment reattachment can be considered the best decision to restore the coronal fracture in patients younger than 18–20 years that overcome any prosthetic replacement .
Several techniques have been proposed for the management of uncomplicated fragment reattachments, such as circumferential bevel , labial chamfer placement ,, internal dentinal groove, v-shaped enamel notch, and a circumferential or lingual composite overcontour ,, the use of dentin pin (biopins) , vertical groove technique , or bonding without additional preparation .
The literature reviews of evidence-based demonstrated that the design and dental materials play a significant role in fracture strength, and the recorded results vary from high strength value, with the use of internal dentinal groove, and composite resin overcontouring ,, while the labial chamfer and lingual overcontour  recorded about 50%. Other investigators have failed to illustrate a significant difference between the other techniques used ,. Many published data reported that both material and technique used for fragments reattachment may have a significant effect on the fracture strength of the restored teeth .
In fact, the in-vitro results from fragment reattachment studies have shown that the additional preparation to the fragment and/or tooth remnant can improve the bonding strength between them ,. Thus, further investigations are required to evaluate the effects of new techniques and adhesives introduced for the clinical use. Therefore, the current study aimed to evaluate laboratory and clinically the uncomplicated fragment reattachment using pinholes. The null-hypotheses suggest that there will be no difference between the effectiveness of different techniques on fragment reattachment.
| Materials and Methods|| |
The current study had two parts (laboratory and clinical parts). The laboratory part evaluated the fracture strength of three different techniques (pinholes, internal dentinal groove, and simple reattachment). The clinical part evaluated the effect of pinholes technique in the fragment reattachment on the survival of the restored tooth.
The study samples comprised 40 intact human maxillary central incisors freshly extracted for therapeutic reasons. The teeth were decontaminated in a buffered aqueous solution of formaldehyde for 2 h and then were cleaned from the calculus and soft tissues with an ultrasonic scaler. Specimens with intact incisal edges and closed apices were selected for close similarity in mesiodistal and buccolingual widths using a digital caliper for the measurement (IOS, USA). Under optical magnification (×4), the teeth were inspected for incipient caries, microcracks, or any other structural defect, then stored in a sterile saline at 4°C and to be used within 3 months of collection ,.
The labial surface of each crown was measured carefully by the digital caliper and divided into three equal horizontal thirds using a marker. The specimens were embedded perpendicular to standard molds of auto-polymerizing acrylic resin, leaving the anatomical crowns exposed [Figure 1]. Specimens were randomly divided into four groups (n = 10/group) according to the technique of reattachment; group I: pinholes, group II: internal dentinal groove, group III: simple reattachment, and group VI (control group): sound teeth.
|Figure 1: The labial surface of a specimens crown was divided into three transversal thirds using a digital caliper (a–c). Acrylic molded specimen within the metallic cylinder (d).|
Click here to view
The junction of the incisal and middle thirds of the crowns of the three groups was sectioned off horizontally through the long axis of the specimens with a diamond disc under a cooling system, eliciting an Ellis class-II fracture ,,,.
Fragments were cleaned and disinfected using mechanical and chemical techniques. Polishing paste, sodium hypochlorite (NaOCl), and 70% alcohol have been used to remove the protein coating from the fragments. The fragments were kept moist in deionized water for no longer than 48 h before bonding to avoid their dehydration ,,.
Group I: a pinhole (1.5 mm depth and width) was prepared bilaterally within the dentin's fragment, 1 mm away from the dentino-enamel junction using #4 round carbide bur with a high-speed under a cooling system. The pinholes were connected together with a shallow dentinal groove.
Group II: an internal dentinal groove of 1 mm depth and width was prepared within the fragment with #2 round carbide bur with a high-speed handpiece under a cooling system .
Group III: simple fragment reattachment without an additional preparation [Figure 2].
|Figure 2: Incisal fragments showing the used three different reattachment techniques; pinholes (a), the internal dentinal groove (b), and simple fragment reattachment (c).|
Click here to view
Both surfaces were etched using 37% phosphoric acid gel (Super-etch, SDI) for 30 s, then thoroughly rinsed off and air dried. Two coats of the adhesive resin (Adper Single Bond 2; 3M ESPE) were applied to the etched surfaces and gently air thinned for a 3–5 s without light-activation to avoid the misfit of the bonded parts . A thin coat of self-adhesive resin cement (RelyX Unicem; 3M ESPE) was applied to both surfaces; the fragment was carefully repositioned on the tooth remnant under pressure. The excess cement was removed and light-cured from both aspects for 60 s using curing-light (Demetron Optilux 400; Kerr, USA) while pressing the fragment against the matching specimen part.
Group IV (control group): sound specimens without sectioning.
All specimens were restored for 2 weeks at 100% humidity and at 37°C and then were placed in separate mesh bags and thermocycled together in distilled water for 1000 cycles between 5 and 55°C at a dwell and transfer time of 15 and 10 s, respectively . The specimens were positioned in the jig adapted in an Instron testing device (Instron, High Wycombe, UK) at Department of Dental Biomaterials, Faculty of Dentistry, Tanta University (Tanta, Egypt). Force was applied in a labio-palatal direction using a 0.5 mm thick stainless steel rod at 90° angle in the center of the incisal third of the specimen with a crosshead speed of 0.5 mm/min ,, [Figure 3]. The load required to detach each specimen's fragment was recorded in kilogram forcing units (kgf) .
|Figure 3: Metal assembly used to hold a specimen at an angle of 90° (a). A mounted specimen ready for testing of fragment strength in an Instron testing machine (b).|
Click here to view
A clinical prospective study was performed between 2012 and 2016 on 20 children patients of both sexes aged 8–16 years (mean: 12.6 ± 2.3 years) who presented at the Department of Pedodontics, Faculty of Dentistry, Tanta University with uncomplicated fragments of fractured upper central incisors following a traumatic dental injury.
All children' parents were thoroughly informed about the purpose and procedures of the study, and written consents were obtained, in addition to the ascents obtained from the children above 8 years. The protocol of this study was approved by the Research Ethics Committee, Faculty of Dentistry, Tanta University.
The inclusion criteria were that the patient (i) had uncomplicated fractured crown that involved enamel and dentin (Ellis class II); (ii) did not have any systemic disease, periodontal pathology, and caries of the tooth remnant; (iii) had no previous restoration to a fractured tooth or history of tooth fractured; and (iv) was able to come back for regular recall examinations .
All fractured teeth were checked for vitality tests (Parkell Products Inc., Farmingdale, New York, USA), pulp exposure, and any periodontal changes following the dental trauma. The fractured tooth, fragment margins, and condition were examined by trans-illumination to rule out the presence of enamel cracks. For each patient, a preoperative periapical radiograph was taken to evaluate the root fracture, apex maturation, and periapical area. The patients were divided randomly into two study groups (n=10) according to the reattachment technique.
Group I: pinholes group
The fragment was cleaned, disinfected, and placed in deionized water for 30 min before reattachment procedure. It was assembled to check the close fit and to detect any missing parts. The pinholes with the connecting shallow dentinal groove were prepared, as discussed in the in-vitro study. Each patient was treated under local anesthesia and cotton rolls isolation. The fractured tooth was separated from the adjacent teeth with a celluloid strip during the reattachment procedure. The technical steps of reattachment were similar to the group I in the in-vitro study [Figure 4], [Figure 5], [Figure 6]. The restored tooth was finished, polished with rubber abrasive and a series of Soflex discs (3M ESPE Dental Products, St. Paul, Minnesota, USA). The occlusion was carefully checked and granulated fine and extra-fine diamond burs (Heico Switzerland Products) were used for any occlusal adjustments. All patients were instructed to maintain good oral hygiene and recalled for clinical and radiographic evaluation at 3, 6, 12, and 18 months.
|Figure 4: Preoperative photograph showing the uncomplicated coronal fracture of upper permanent incisors (a and b). The pinholes with a shallow connecting groove were prepared in the fragment of upper right central incisor (c). The tooth after fragment reattachment and composite restoration of left central incisor (d and e).|
Click here to view
|Figure 5: Uncomplicated coronal fracture of traumatized upper right central incisor (a). The fragment with pinholes preparation (b). The case after reattachment procedure (c).|
Click here to view
|Figure 6: Frontal view uncomplicated coronal fractures of upper right central incisor (a). The fractured fragment with pinholes preparation (b, c). The case after reattachment procedure (d).|
Click here to view
Group II: internal dentinal groove
An internal dentinal groove of 1-mm depth and width was prepared within the fragment as mentioned before. All technical steps of reattachment were similar to group II in the in-vitro study [Figure 7].
|Figure 7: Preoperative photograph showing uncomplicated coronal fractures of upper central incisors (a). The right central was endodontically treated and the fragment repositioned but not included in the study (b, c). The internal dentinal groove was prepared in the other fragment (e, f). The patient after fragment reattachment (g).|
Click here to view
All teeth were examined for fragment stability, the presence of abscess, gingival swelling, tooth mobility, sinus tract formation/fistula, sensitivity to percussion and pulp vitality test . The pulp test was carried out at the recall time after treatment . The color harmony between the fragment and the tooth remnant was evaluated using Cvar and Ryge's  modified rating system which has three scores: (i) α: there is no color mismatch, shade and/or translucency between the restoration and the adjacent tooth (ii) Bravo: there is a slight color mismatch, shade and/or translucency, and (iii) Charlie: there is an obvious color mismatch, shade, and/or translucency. Color harmony immediately scored postreattachment and during recall time and it was scored on images that were obtained using an 18-MP digital camera (EOS 600D, Canon, Tokyo, Japan) at an illumination of 5000K ± 10% .
A periapical radiograph was used to examine: Pulp canal obliteration, intactness of the lamina dura, fracture of the root or the alveolar bone, external root resorption, ankylosis, and apical pathology for each tooth . The restored teeth were scored according to the stage of root development using the method of Moorrees et al.  which was modified by the formula of Andreasen and Pedersen : R (1/4 − 3/4): root length (1/4, 1/2, or 3/4), Rc: root length complete, A (1/2): apex half-closed, and Ac: apical closure complete.
Statistical analysis was performed using SPSS software, version 19 (IBM, Chicago, Illinois, USA). The fracture strength was presented as the range, mean, and SD. The mean values of fracture strength for the tested groups were compared using one-way analysis of variance, and the least significant difference test was used as post-hoc test to compare between each two groups. The level of significance was adopted at P less than 0.05.
| Results|| |
[Table 1] showed that control sound group recorded the highest fracture strength value followed by pinholes, the internal dentinal groove, and simple reattachment group and the differences were significant (P < 0.05).
All restored teeth with fragment reattachment were assessed clinically and radiographically for 18 months. In both groups, none of the signs and symptoms of sensitivity to percussion, loss of pulp vitality, abscess/swelling, draining sinus/fistula, and mobility were reported.
Radiographically, pulp canal obliteration, loss of lamina dura, pathologic root resorption, ankylosis, failure of the formation of a closed apex, and apical changes were not observed in both groups [Figure 8], [Figure 9], [Figure 10]. All patients had 100% success. Fragment stability showed that refracturing of the fragment in one (10%) patient of pinholes group at 18 months follow-up and two (20%) patients in internal groove group; one of them was refractured at 12 months and another at 18 months of follow-up [Table 2]. The difference was not statistically significant (P > 0.05).
α Scores for color harmony were recorded 50 and 60% at the baseline for pinholes and internal group, respectively, which increased to 100% at 9 months. Charlie score was not observed [Table 3] and [Figure 11] and [Figure 12].
|Figure 8: Postoperative periapical radiograph showing fragments reattachment of upper central incisors; one with pinholes (right) and the other with the internal groove, 3/4 roots length were formed with the apices halves-closed (A/2) (a). Root lengths (Rc) and the apical closure (Ac) were completed during the recall time (b and c).|
Click here to view
|Figure 9: Preoperative radiograph showing the uncomplicated coronal fracture of upper right central and uncomplicated fracture of the other central (a). Endodontic treatment with fragment reattachment of left central (b) not included in the study, and fragment reattachment with internal groove of right central (c).|
Click here to view
|Figure 10: Preoperative periapical radiograph showing the uncomplicated coronal fracture of upper right central incisor (a); fragment reattachment with pinholes (b).|
Click here to view
| Discussion|| |
In-vitro results of the current study support rejection of the null hypothesis that there was no difference between the tooth fragment reattachment techniques.
The uncomplicated coronal fracture is most common among children and teenagers resulting from accidental trauma or sports injuries. When the fractured fragment is still available, repositioning, and bonding it immediately to the tooth remains is the first restorative option that should be performed ,.
Tooth fragment reattachment should be considered, especially in children having teeth with uncompleted roots because the vital dental tissues were preserved during dental development ,. Although this method is convenient and very simple, the treated tooth will still be more susceptible and vulnerable to repeated trauma. Therefore, it requires maintaining a clean and dry field, good selection of proper techniques, high-quality adhesive systems, and materials for the respective clinical situation .
Several factors play an important role in the survival of the reattached fragment. Among these factors are the fragment stored media, type adhesive material used, use of materials to protect the dentin-pulp complex, flow of cement or resin composite, and the technique used for the fragment reattachment ,,. However, some of the studies have recorded that the resin materials have no positive influence on the fracture resistance of the reattached fragment ,.
One of the important factors that have a significant influence on fragment reattachment strength is the preparation design. Some of the studies reported that the fragment reattachment strength was lower than that of the sound tooth, and additional preparations to the tooth remnant and/or fragment were recommended , as they improve the bonding strength between them. Various techniques have been proposed, but the most commonly used one is the internal dentinal groove that restores about 97.2% of the fractured fragment . So this technique in this study was used for comparison in the clinical part.
Although the laboratory part of the study may help in the prediction of clinical outcomes and behavior of the restoration, the in-vitro results cannot be extrapolated and may be affected, as they always lack the clinical environmental condition that the restoration could be subjected to a long time. Therefore, in this study, both laboratory and clinical evaluation of pinholes technique in fragment reattachment would be the true judgmental tests .
To simulate the uncomplicated Ellis class II coronal fracture in this study, one-third of each specimen was sectioned horizontally, and the fragments were kept moist in deionized water before reattachment to maintain a proper hydration, superior bond strength ,, and inhibit the fragment discoloration . The labial aspect of each specimen was selected for force application to simulate the real traumatic hard objects. The center of the incisal thirds was the point for force application which was very carefully controlled to maintain the same distance of fulcrum to all specimens .
In the current study, the control sound group had the highest fracture strength followed by pinholes and internal dentinal group, while simple reattachment was the lowest, and the difference was significant.
Placement of pinholes with a connecting shallow groove may provide high fracture strength than the internal dentinal groove. This may be explained by the increase in surface area of adhesion, as the fracture strength is directly proportional to the surface area . Also, the greater the involvement of internal resins within preparation is, the better the retention and fracture strength, and the distribution of force are ,. The horizontal resin bar with the vertical resin slots in pinholes design act as an opponent to the labial compressive force, while in simple reattachment, the stress always concentrated on the fracture line . The results of the current study were in close agreement with the studies of Srilatha et al. , Loguercio et al. , Kumer et al. , and Abdulkhayum et al.  who concluded that the fragments reattachment with internal groove technique showed high fracture strength than simple reattachment which was in accordance with the findings of the current study.
The clinical evaluation of this study reported that the restorations success rate was 90% and 80% for pinholes and internal groove group, respectively, while the radiographic evaluation showed 100% for both groups.
Electric pulp test was carried out at the recall time after treatment to exclude any false response of the chocked traumatized tooth . In this study, all restored teeth had no clinical signs and symptoms during the recall time. At the last follow-up period, the survival rate of the restored teeth with pinholes and internal grooves techniques were 90.0 and 80.0%, respectively, and the difference was not significant. As children have restricted control of incisive function, more were exposed to repeated trauma and traumatic situations and misuse of physiologic tooth function; therefore, the risk of the fragment debonding is high. This may explain the fragment refractured in both groups of the clinical study ,.
In this study, bravo color disharmony may be due to the fragments kept dry with the patients for about 2–3 days before reattachment ,. α score was dramatically increased from 50 and 60% baseline to 100% at 9 months for pinholes and internal groove group, respectively, as most of the coronal fragments retrieve occurs at the time of trauma. This finding is in agreement with the findings of Simonsen , Toshihiro and Rintaro , and Yilmaz et al.  who demonstrate that the fractured fragment may regain some of the translucency and original color as a result of the intraoral water absorption.
In both groups, the restored teeth had no clinical signs or symptoms during the recall time. These findings are in agreement with previous results of Simonsen , Diangelis et al. , Chu et al. , and Rappelli et al. .
Radiographically, there was no delay in root development was observed in the treated teeth having open apices. This agrees with the previous results of Robertson et al.  and Yalmez et al.  who observed complete root development in restoring teeth having open apices, but without concomitant luxation injury.
This indicated that the uncomplicated fragment reattachment using proper design, acid etchant, and a high-quality adhesive system with resin cement may provide pulpal protection against the infection, thus avoiding any pulpal or pathological complications , demonstrating satisfactory clinical and radiographical results.
There were some limitations for this study including; possible debonding of the fragment, color mismatch for a period of time  because of incomplete fragment rehydration with breakdown of the collagen fibers , and demarcated fracture line was noticed in few cases .
Although the use of this technique in fragment reattachment is reasonably simple, fast and conservative approach with good function and esthetic results, further research is highly recommended in both the in-vitro test and for evaluating the long-term clinical success of reattached fragment.
| Conclusion|| |
The in-vitro results concluded that pinholes technique showed the highest fragment strength as compared to the other used technique. The in-vivo results demonstrated a good esthetic and functional performance technique. Therefore, pinholes design can be considered an acceptable alternative technique in tooth fragment reattachment of uncomplicated coronal fracture.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Dietschi D, Jacoby T, Dietschi JM, Schatz JP. Treatment of traumatic injuries in the front teeth: restorative aspects in crown fractures. Pract Periodontics Aesthet Dent 2000; 12:751–758.
Olsburgh S, Jacoby T, Krejci I. Crown fractures in the permanent dentition: pulpal and restorative considerations. Dent Traumatol 2002; 18:103–115.
Macedo GV, Diaz PI, De O Fernandes CA, Ritter AV. Reattachment of anterior teeth fragments: a conservative approach. J Esthet Restor Dent 2008; 20:5–20.
Zuhal K, Semra OE, Hüseyin K. Traumatic injuries of the permanent incisors in children in southern Turkey: a retrospective study. Dent Traumatol 2005; 21:20–25.
Andreasen FM, Daugaard-Jensen J, Munskgaard EC. Reinforcement of bonded crown fractured incisors with porcelain veneers. Endod Dent Traumatol 1991; 7:78–83.
Salameh Z, Sorrentino R, Ounsi HF, Sadig W, Atiyeh F, Ferrari M. The effect of different full-coverage crown systems on fracture resistance and failure pattern of endodontically treated maxillary incisors restored with and without glass fiber posts. J Endod 2008; 34:842–846.
Pusman E, Cehreli ZC, Altay N, Unver B, Saracbasi O, Ozgun G. Fracture resistance of tooth fragment reattachment: effects of different preparation techniques and adhesive materials. Dent Traumatol 2010; 26:9–15.
Terry DA. Adhesive reattachment of a tooth fragment: the biological restoration. Pract Proced Aesthet Dent 2003; 15:403–409.
Reis A, Loguercio AD, Kraul A, Matson E. Reattachment of fractured teeth: a review of literature regarding techniques and materials. Oper Dent 2004; 29:226–233.
Maia EA, Baratieri LN, de Andrada MA, Monteiro SJr, de Araújo EMJr. Tooth fragment reattachment: fundamentals of the technique and two case reports. Quintessence Int 2003; 34:99–107.
Vaz VT, Presoto CD, Jordão KC, Jordão KF, Paleari AG, Dantas AA, et al
. Fragment reattachment after atypical crown fracture in maxillary central incisor. Case Rep Dent 2014; 2014:231603.
Alvares I, Sensi LG, Araujo EMJr, Araujo E. Silicone index: an alternative approach for tooth fragment reattachment. J Esthet Restor Dent 2007; 19:240–245.
Mendes L, Laxe L, Passos L. Ten-year follow-up of a fragment reattachment to an anterior tooth: a conservative approach. Case Rep Dent 2017; 2017:2106245
Amir E, Bar-Gil B, Sarnat H. Restoration of fractured immature maxillary central incisors using the crown fragments. Pediatr Dent 1996; 8:285–288.
Davis MJ, Roth J, Levi M. Marginal integrity of adhesive fracture restorations: Chamfer versus bevel. Quintessence Int Dent Dig 1983; 14:1135–1146.
Diangelis AJ, Jungbluth M. Reattaching fractured tooth segments: an esthetic alternative. J Am Dent Assoc 1992; 123:58–63.
Stellini E, Stomaci D, Stomaci M, Petrone N, Favero L. Fracture strength of tooth fragment reattachments with postpone bevel and overcontour reconstruction. Dent Traumatol 2008; 24:283–288.
Nogueira LC, Tavano KT, Ferraz NK, Glória JC, Botelho AM. Biological restoration of a fractured anterior tooth with the use of dentine pin (Biopins). Case Rep Dent 2015; 2015:138474.
Karre D, Kumar duddu M, Swathi S, Bin Mohsin A, Bharadwaj B, Barshaik S. Conservative vertical groove technique for tooth rehabilitation: 3-year follow-up. Case Rep Dent 2018; 2018:2012578.
Reis A, Francci C, Loguercio AD, Carrilho MR, Rodrigues Filho LE. Re-attachment of anterior fractured teeth: fracture strength using different techniques. Oper Dent 2001; 26:287–294.
Srilatha, Josh S, Chhasatia N, Rani PJ, Mathur E. Reattachment of fractured anterior teeth-determining fracture strength using different techniques: an in vitro
study. J Contemp Dent Pract 2012; 13:61–65.
Munksgaard EC, Hojtved L, Jorgensen EH, Andreasen JO, Andreasen FM. Enamel-dentin crown fractures bonded with various bonding agents. Endod Dent Traumatol 1991; 7:73–77.
Worthington RB, Murchison DF, Vandewalle KS. Incisal edge reattachment: the effect of preparation utilization and design. Quintessence Int 1999; 30:637–643.
Reis A, Kraul A, Francci C, de Assis TG, Crivelli DD, Oda M, et al
. Re-attachment of anterior fractured teeth: fracture strength using different materials. Oper Dent 2002; 27:621–627.
VamsiKrishna R, Madhusudhana K, Swaroopkumarreddy A, Lavanya A, Suneelkumar C, Kiranmayi G. Shear bond strength evaluation of adhesive and tooth preparation combinations used in reattachment of fractured teeth: an ex-vivo study. J Indian Soc Pedod Prev Dent 2015; 33:40–43.
] [Full text]
Chazine M, Sedda M, Ounsi HF, Paragliola R, Ferrari M, Grandini S. Evaluation of the fracture resistance of reattached incisal fragments using different materials and techniques. Dent Traumatol 2011; 27:15–18.
Kovacs M, Păcurar M, Pop M, Blanka P, Bukhari C. Fracture resistance of tooth fragments reattached with different techniques. An in vitro
study. Rom J Oral Rehabil 2012; 4:36–41.
Davaria AR, Sadghibe M. Influence of different bonding agents and composite resins on fracture resistance of reattached incisal tooth fragment. J Dent Shiraz Univ Med Sci 2014; 15:6–14.
Capp CI, Roda MI, Tamaki R, Castanho GM, Camargo MA, de Cara AA. Reattachment of rehydrated dental fragment using two techniques. Dent Traumatol 2009; 25:95–99.
Chu FS, Yim TM, Wei SY. Clinical considerations for reattachment of tooth fragments. Quintessence Int 2000; 31:385–391.
Loguercio AD, Mengarda J, Amaral R, Kraul A, Reis A. Effect of fractured or sectioned fragments on the fracture strength of different reattachment techniques. Oper Dent 2004; 29:295–300.
Yilmaz Y, Guler C, Sahin H, Eyuboglu O. Evaluation of tooth-fragment reattachment: a clinical and laboratory study. Dent Traumatol 2010; 26:308–314.
Roberts G, Longhurst P. Oral and dental trauma in children and adolescents
. New York, NY: Oxford; 1996.
Cvar JF, Ryge G. Reprint of criteria for the clinical evaluation of dental restorative materials. Clin Oral Invest 2005; 9:215–232.
Moorreess CF, Fanning EA, Hunt EEJr. Age variation of formation for ten permanent teeth. J Dent Res 1963; 42:1490–1502.
Andreasen FM, Pedersen BV. Prognosis of luxated permanent teeth: the development of pulp necrosis. Endod Dent Traumatol 1985; 1:207–220.
Prabhakar AR, Yavagal CM, Limaye NS, Nadig B. Effect of storage media on fracture resistance of reattached tooth fragments using G-aenial Universal Flo. J Conserv Dent 2016; 19:250–253.
] [Full text]
Rokaya ME, Beshr K, Mahram AH, Pedir SS, Baroudi K. Evaluation of extraradicular diffusion of hydrogen peroxide during intracoronal bleaching using different bleaching agents. Int J Dent 2015; 2015:493795.
De Santis R, Prisco D, Nazhat SN, Riccitiello F, Ambrosio L, Rengo S, et al
. Mechanical strength of tooth fragment reattachment. J Biomed Mater Res 2001; 55:629–636.
Rajput A, Talwar S, Ataide I, Verma M, Wadhawan N. Complicated crown-root fracture treated using reattachment procedure: a single visit technique. Case Rep Dent 2011; 2011:401678.
Farik B, Munksgaard EC, Andreasen JO, Kreiborg S. Drying and rewetting anterior crown fragments prior to bonding. Endod Dent Traumatol 1999; 15:113–116.
Van Noort R, Noroozi S, Howard IC, Cardew G. A critique of bond strength measurements. J Dent 1989; 17:61–67.
Badami AA, Dunne SM, Scheer B. An in vitro
investigation into the shear bond strengths of two dentine bonding agents used in the reattachment of incisal edge fragments. Endod Dent Traumatol 1995; 11:129–135.
Pavone AF, Ghassemian M, Mancini M, Condò R, Cerroni L, Arcuri C, et al
. Autogenous tooth fragment adhesive reattachment for a complicated crown root fracture: two interdisciplinary case reports. Case Rep Dent 2016; 2016:9352129.
Kumar S, Maria R. Determining the fracture strength of the reattached fragment of anterior teeth: an in vitro
study. J Dental Allied Sci 2013; 2:16–20.
Abdulkhayum A, Munjal S, Babaji P, Chaurasia V, Munjal S, Lau H, et al
evaluation of fracture strength recovery of reattached anterior fractured tooth fragment using different re-attachment techniques. J Clin Diagn Res 2014; 8:208–211.
Baratieri LN, Monteiro SJ, Andrada MA, Vieira LC, Cardoso AC, Ritter AV. Estética: Restaurações Adesivas Diretas em Dentes Anteriores Fraturados
. São Paulo, Brazil: Livraria Editora Santos; 1995.
Andreasen FM, Norén JG, Andreasen JO, Engelhardtsen S, Lindh-Strömberg U. Long-term survival of fragment bonding in the treatment of fractured crowns: a multicenter clinical study. Quintessence Int 1995; 26:669–681.
Simonsen RJ. Restoration of a fractured central incisor using original tooth fragment. J Am Dent Assoc 1982; 105:646–648.
Toshihiro K, Rintaro T. Rehydration of crown fragment 1 year after reattachment: a case report. Dent Traumatol 2005; 21:297–300.
Rappelli G, Massaccesi C, Putignano A. Clinical procedures for the immediate reattachment of a tooth fragment. Dent Traumatol 2002; 18:281–284.
Robertson A, Andreasen FM, Andreasen JO, Noren JG. Long-term prognosis of crown-fractured permanent incisors. The effect of stage of root development and associated luxation injury. Int J Paediatr Dent 2000; 10:191–199.
Lise DP, Cardoso Vieira LC, Araújo É×, Lopes GC. Tooth fragment reattachment: the natural restoration. Oper Dent 2012; 37:584–590.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12]
[Table 1], [Table 2], [Table 3]