DENTAL TRAUMA: Biological approach for management of anterior Tooth Trauma: Triple case report

Uncomplicated and complicated crown fracture is the most common traumatic dental injury to permanent teeth, and the teeth most commonly affected by trauma are the maxillary incisors, with a reported share of 96% of all the crown fractures (80% central incisors and 16% lateral incisors).

This is attributable to their anterior position and protrusion caused by the eruptive pattern. This kind of injury mainly affects children and adolescents, with boys considered as being at a higher risk than girls mainly because of an increase in the participation of children in dangerous sports and activities. In the past, fractured teeth were restored using acrylic resin or complex ceramic restorations associated with metals.

These restorations did not promote adequate long-term esthetics and also required a significant tooth reduction during preparation. Because of difficulty in obtaining good retention, there were few attempts to reattach fractured fragments of the teeth.

Chosack and Eildeman published the first case report on reattachment of a fractured incisor fragment in 1964 in which complicated tooth fracture was managed by endodontic treatment followed by a cast post and core. The post and core were fitted to the prepared tooth fragment and then cemented to the remaining tooth structure.

Recently, with the advancement in the materials and bonding techniques, this new method of retaining fractured tooth segment is gaining popularity. Various techniques have been suggested to achieve the desired goal.

This includes various methods employed to improve adhesion between the fractured and the remaining segments, using a circumferential bevel before reattaching, placing a chamfer at the fracture line after bonding, using a V-shaped enamel notch, placing an internal groove or a superficial overcontour over the fracture line.