bonding broken tooth fragments figure 1A 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.

bonding broken tooth fragments figure 2Technique

  1. First a putty index was made with the broken fragments in position.
  2. Generous bevel was placed on the enamel. This helped to increase the enamel surface area for better bond strength.
  3. The putty index was used to orient the fragments to correct location.
  4. Composite restoration with total etch technique using a fourth generation bonding agent was completed.
  5. 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; bonding broken tooth fragments figure 3however, 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


Post a Comment

Comments

Commenter's Profile Image Jody
April 12th, 2012
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.
Commenter's Profile Image Mike Weisbrod
April 13th, 2012
Did you use a body or dentin shade to mask the fracture line?
Commenter's Profile Image Vivek Mehta
April 13th, 2012
@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
Commenter's Profile Image Vivek Mehta
April 13th, 2012
@ 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.
Commenter's Profile Image Arnie Mirza
April 14th, 2012
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.
Commenter's Profile Image Vivek Mehta
April 15th, 2012
@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.
Commenter's Profile Image Arnie Mirza
April 15th, 2012
I appologize for not having the reference. That fractured tooth was prepared for a crown later on.
Commenter's Profile Image Anu Wadivkar
April 18th, 2012
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 ?
Commenter's Profile Image Vivek Mehta
April 18th, 2012
@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.
Commenter's Profile Image Esha Gupta
January 10th, 2013
my 10 year old brother broke his front teeth last night, can they be repaired? the fragments have been lost
Commenter's Profile Image Vivek Mehta
January 10th, 2013
Esha: Sorry to hear about your brother's situation. Yes even if the fragments are lost the teeth can still be repaired.
Commenter's Profile Image Dr. Daniel N. Uditsky
June 13th, 2013
Congratulations to the author on a well written article and an excellent result. I have done many similar cases over my 44 year career. The advent of bonded composite resin has allowed me to restore many similar cases with excellent esthetics and (mostly) long term results. I use a technique similar to Dr. Mirza's. For additonal retention, I will put pot holes in the tooth and the fractureds segements using a 1/4 or 1/2 round bur after I clean everything with a slurry of pumice and water. Instead of a flowable resin, I prefer Insure clear dual cure resin cement (or a similar product).
Commenter's Profile Image Ilhaam S.
July 26th, 2013
Thank you for sharing your case and the wonderful write-up. I have had several , successful similar cases treated the same way but with palatal undercuts (using a small Inverted cone bur) for additional retention.
Commenter's Profile Image J Denton
December 9th, 2013
I read this article when you wrote it and had a chance to put it into practice today. Patient kept the tooth in milk and it broke this morning. She was on medicaid and could not afford a crown. Turned out very esthetic and she left very happy. Thank you.
Commenter's Profile Image Maureen
May 27th, 2014
My 8 year old daughter broken her front tooth almost to the pulp in a trampoline collision with her cousins head. This was just two weeks ago. I looked all over but could not find the broken piece. Her cousin apparently had a lump on his head that just released the tooth. Crazy and disgusting, I know. In the meantime I had my daughter's tooth bonded. I should receive the tooth in the mail shortly, it is being sent in gauze soaked in milk in a zip-lock bag. If the tooth is not dried out is it be possible to bond it back?