REGULAR ISSUE Mandlik et al. _______________________________________________________________________________________________________ IIOAB-India Mandlik et al. IIOABJ; Vol. 4: Issue 4; 2013: 10–14 10 www.iioab.org www.iioab.webs.com DENTAL SCIENCE SALVAGING FRACTURED MAXILLARY INCISORS BY REATTACHMENT: CASE REPORTS Jyoti Mandlik 1* , Nitin Shah 1 , Paras Gupta 2 1 Department of Conservative Dentistry and Endodontics, Bharati Vidyapeeth Deemed University’s Dental College and Hospital, Pune, Maharashtra, INDIA 2 Department of Conservative Dentistry and Endodontics, Uttaranchal Dental and Medical Research Institute, Dehradun, Uttarakhand, INDIA ABSTRACT *Corresponding author: Email: drjyoti8@gmail.com; Tel: +91- 9421385056 [I] INTRODUCTION The treatment of complicated crown-root fractures in many cases is compromised by fracture lines that are well below the gingival margin or crestal bone. After root canal obturation, proper isolation for a dry operative field is critical to the successful restoration of traumatized teeth. In this respect, a wide range of treatment options have been advocated for fractured permanent teeth including; orthodontic extrusion [1]; osteotomy/osteoplasty [2]; intentional replantation [3]; re- attachment of fragments [4] and the last option being, extraction if nothing else is possible. Re-attachment of a tooth fragment should be preferable to restoring fractured teeth. Besides being a more conservative procedure, there are several advantages to this, such as obtaining esthetics in a single appointment, obtaining a healthy periodontal attachment and maintaining the original tooth contour and translucence [5,6,7]. The present case reports describe the re-attachment of the original fractured tooth fragments with resin luting cement. In one of the cases a glass fiber post, was also used. [II] CASE DESCRIPTION 2.1. Case 1 A 21 year old male patient was referred to the department of Endodontics, with the complaint of a fractured maxillary right central incisor due to a fall on the sportsfield. He complained of pain during mouth closure and bleeding from the gums at the fracture site. Patient’s medical history was non-contributory. Extra-oral examination showed no significant abnormality. Intra-oral examination revealed crown fracture of 11, classified as an unfavorable (plane of the fracture angle extended cervically in a labial to lingual direction with no lingual support to the applied forces) [8]; complicated crown fracture (oblique fracture with fracture line extending subgingivally on the palatal aspect, but without involving the biological width). The fractured coronal segment was highly mobile. Neither laceration nor alveolar bone fracture was evident. Patient had mild pain during examination. Background: Dental trauma most commonly results in anterior crown fractures. Salvaging such fractured teeth is often a clinical challenge. The development of adhesive dentistry has allowed dentists to reattach the broken segment of the fractured tooth. The reattachment technique offers many advantages such as achieving esthetics, less time consuming etc. Aim: To evaluate different techniques of reattachment, as a treatment modality for fractured maxillary incisors. Case description: The first case report presents a 21 years old male patient with fractured maxillary right central incisor. The treatment carried out included root canal treatment, electrocautery to expose the palatal margin of the root and reattachment of the fractured segment, using resin luting cement. The second case report presents a 24 years old male patient with fractured maxillary right central incisor. Similar treatment as in the first case was followed, with the addition of a fiber-post placement in the root canal before the reattachment of the fragment. At recall visit after 12 months, a stable reattachment was observed in both the cases with good esthetics and periodontal health. Discussion: Treatment of fractured anterior teeth is challenging. Continuous research in adhesive materials has led to the development of innovative techniques like reattachment of fractured segments that offer advantages over routine restorative procedures like composite build-ups, onlays and crowns. The techniques described for the two cases here allow successful reattachment of the broken segments to the fractured teeth, achieving desirable esthetic results. Conclusion: Reattachment resulted in a successful outcome, giving good esthetics and function at a comparatively low cost to the patient. Clinical significance: Reattachment of a tooth fragment is a viable technique that restores function and esthetics, with a very conservative approach. Received on: 11t h -Dec-2012 Revised on: 04 th -May-2013 Accepted on: 23 rd – May-2013 Published on: 10 th –Aug-2013 Dental trauma; Crown fractures; Fiber-post; Resin luting cement; Fragment reattachment KEY WORDS CASE REPORT OPEN ACCESS ISSN: 0976-3104 ISSN: 0976-3104