Can Bonding Broken Tooth Fragments Really Work?
A 19-year-old patient named Tim presented with a crown fracture on his two central incisors. We decided to use the broken teeth fragments he brought with him to repair the fracture—the treatment was successful.
Tim was very happy to have his smile back and I was glad that we could accomplish an otherwise long complex restoration in a short emergency visit.
Published research (see references below) as well as Andreasen’s guide on dental trauma recommends that rebonding of fractured fragments is a viable treatment option.
What helped us get a favorable outcome in this case?
- The fracture had not affected the pulp.
- I was able to see Tim within hours of the accident.
- Tim had been able to bring the fractured fragments with him when he came to see me.
- He had put the fragments in a moist paper towel inside a plastic bag, so the fragments were not dehydrated.
- The fragments were a perfect fit. The pieces when put together completed the missing tooth structure in its entirety.
Technique
- First a putty index was made with the broken fragments in position.
- Generous bevel was placed on the enamel. This helped to increase the enamel surface area for better bond strength.
- The putty index was used to orient the fragments to correct location.
- Composite restoration with total etch technique using a fourth generation bonding agent was completed.
- Using the fragments made it easy to replicate the original anatomic form, color and texture in the restoration.
It’s now been 15 months and Tim hasn’t had any problems with the treatment. He also doesn’t wear the nightgaurd appliance that I recommended; however, so far his teeth have tested vital at two follow-up appointments.
References:
1. Badami V, Reddy SK. Treatment of complicated crown-root fracture in a single visit by means of rebonding. J Am Dent Assoc. 2011 Jun;142(6):646-50.
2. Macedo GV, Ritter AV. Essentials of rebonding tooth fragments for the best functional and esthetic outcomes. Pediatr Dent. 2009 Mar-Apr;31(2):110-6.
Vivek Mehta DMD, FAGD, Visiting Faculty, Spear Education. Follow him on Twitter @Mehta_DMD.
I had a patient 10 years ago that fell down some steps and broke her upper lateral incisor. Took an X-ray of her lip which was swollen and found the tooth fragment in her lip. Froze her up and removed the fragment and did this exact same thing (bonded tooth fragment back in place). Perfect match, tooth still vital and holding strong. It can work and work well in the right situation.
Did you use a body or dentin shade to mask the fracture line?
@Jody : Thank you for the comment. That was an awesome service for the patient. Any another restorative treatment at the young age of 10 would have condemned the tooth for multiple restorative treatments throughout its remaining life. I think you might like these two articles
Sargod SS, Bhat SS. A 9 year follow-up of a fractured tooth fragment reattachment. Contemp Clin Dent 2010 [cited 2012 Apr 13];1:243-5. Available from: http://www.contempclindent.org/text.asp?2010/1/4/243/76392
Macedo GV, Diaz PI, De O Fernandes CA, Ritter AV.Reattachment of anterior teeth fragments: a
J Esthet Restor Dent. 2008;20(1):5-18; discussion 19-20. pdf available at http://endoexperience.com/documents/AttachFrTooth.pdf
@ Mike W : Filtek Supreme A2 Body shade. I find in thin increments body shade is, many a times a better match then an enamel shade. I almost always do a mock up cure in the mouth to test it out. I tend to use Enamel shade for Filtek very sparingly.
I had a similar case and was done as temporary measure.I read an article recommending shaving slightly from the inside of both of the fractured area but without touching that fractured area facially.Then using a flowable resin after etching and bonding.
@Mirza : Thank you for the comment. If you have access to, or have reference info on that article I would love to read that. I am curious what was the permanent restorative treatment you chose in the case you mentioned. Again, I appreciate you taking the time.
I appologize for not having the reference. That fractured tooth was prepared for a crown later on.
Great work!!!What post treatment instructions did you give Tim with regards to biting into food items ( hard and soft). Also did you and do you modify the teeth in protrusive to lighten contact ?
@Anu Wadivkar : Good Questions. Thank you for the compliments!!
Post op instructions: “Avoid using the front teeth to directly bite into anything that is harder than an apple”
Occlusal adjustment: I tried to make sure there was even contact on all 4 incisors in protrusive movement. So in other words I made sure there were areas of contact on other teeth to share the load.
my 10 year old brother broke his front teeth last night, can they be repaired? the fragments have been lost
Esha:
Sorry to hear about your brother’s situation. Yes even if the fragments are lost the teeth can still be repaired.