Fragment Reattachment Of Traumatized Upper Central Incisor: Four-year Clinical Evaluation

Objectives: The objective of this study was to evaluate the long term success of fragment reattachment for severely traumatized upper central incisor using combined micro and macro-retention. Methods: A 28-year old female patient was referred to the Department of Conservative Dentistry complaining from fractured upper central incisor. On the treatment day, under infiltration anesthesia the fractured fragments were removed. Using rubber dam isolation, Canal was prepared and filled using cold lateral compaction and non-eugenol resin sealer (Roeko seal, Roeko; OH, USA). Gingival flap was reflected and bone osteotomy was performed 1mm below the fracture line. Size 5 Para post (Coltene/Whaledent; Altstatten, Switzerland) was cemented using glass-ionomer cement. The labial enamel fragment and the dentin of the exposed root were etched (30 and 15s respectively), rinsed (20s) and gently dried. One coat of self-priming adhesive (Excite, Ivoclar/ Vivadent; Schaan, Liechtenstein) was applied (10s), dried (5s) and light-cured (20s). Resin composite (Tetric Ceram, Ivoclar/Vivadent; Schaan, Liechtenstein) was incrementally applied and was light cured (40s each). After restoration completion, the flap was repositioned and sutured. The patient was instructed to perform restrict oral hygiene measures and recall visits were scheduled regularly up to four years. Results: Decrease in average pocket depth from 8mm to 3mm labially and from 6mm to 2mm palataly was recorded all over the evaluation period. A slight bone resorption started at the 3-month follow up period and no further radiographic changes was noticed. The composite restoration was satisfactory. Conclusions: Fragment reattachment of severely traumatized upper central incisor using both micro and macro-retention was proved to be a successful technique up to 4-years clinical evaluation period.

The authors would like to thank Professor Mokhtar N. Ibrahim, Department of Operative Dentistry, Ain Shams University, for his advice during the course of this study.