Clinical procedures for the reattachment of a fractured tooth segement

Objective: To outline the clinical procedures for reattachment of a fractured tooth segment following a complicated tooth fracture. Methods: Trauma had occurred the previous day before presentation. The fractured segment was partially retained. Clinical and radiographic examination showed no periodontal disease or alveolar bone injury. There was exaggerated response to vitality test. A diagnosis of complicated crown fracture was made. The treatment chosen was root canal treatment and fracture reattachment. The fractured segment was completely detached. The remaining tooth was isolated with rubber dam, the radicular pulp extirpated, working length determined and canal prepared to size 80. Irrigation was carried out using sodium hypochlorite, and normal saline, canal dried with paper points and obturated with gutta perch cones using the lateral compaction technique. A screw post and core was placed, the fractured segment was tried in to establish fit. The fit was good. The tooth was etched with 35% phosphoric acid for 30 seconds after which it was rinsed with water and air dried. Adhesive bonding agent was applied with a micro-brush rubbing for 20-30 seconds to give time for the bonding agent to penetrate into the dentinal tubules and to form a correct hybrid layer. It was then polymerized for 20 seconds. The fragment was treated the same way as the tooth; the cavity within the fragment was filled with a self polymerizing composite. They were then luted with a thin layer of enamel composite to cover the fractured line, polished and finished. Result: Patient was satisfied with aestethic, he felt the restoration was part of himself and not a foreign body. Conclusion: Although, reattachment is more advocated for uncomplicated crown fracture, the first case of reattachment involved luting the dental fragment to an endodontic post. Reattachment is a good technique; it is aesthetically more predictable.