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.
- 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.
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