International Journal of Pedodontic Rehabilitation

: 2020  |  Volume : 5  |  Issue : 2  |  Page : 68--70

Maintaining the original anatomy of the uncomplicated crown fracture using natural tooth structure: Three case reports

Olcay Ozdemir1, Levent Demiriz2,  
1 Department of Pedodontics, Faculty of Dentistry, Zonguldak Bülent Ecevit University, Zonguldak, Turkey
2 Private Dental Clinic, Zonguldak, Turkey

Correspondence Address:
Olcay Ozdemir
Department of Pedodontics, Faculty of Dentistry, Zonguldak Bulent Ecevit University, Zonguldak


Epidemiological researches have shown that dental traumatic injuries were widespread in the population and are a frequent pathology among children and teenagers. Crown fractures in an early age population are considered a real and serious public health problem owing to the high prevalence and leading serious problems that can affect the social relationship. The most common dental trauma is the uncomplicated crown fracture. Recent developments in restorative materials and adhesive techniques allow clinician to predictably restore fractured teeth. If the original tooth fragment is retained following trauma, the natural tooth structures can be reattached using adhesive protocols to ensure reliable strength, durability, and aesthetic. This report series aimed to present the treatments of traumatized maxillary central incisors, in three different cases, with reattachment of natural tooth structures.

How to cite this article:
Ozdemir O, Demiriz L. Maintaining the original anatomy of the uncomplicated crown fracture using natural tooth structure: Three case reports.Int J Pedod Rehabil 2020;5:68-70

How to cite this URL:
Ozdemir O, Demiriz L. Maintaining the original anatomy of the uncomplicated crown fracture using natural tooth structure: Three case reports. Int J Pedod Rehabil [serial online] 2020 [cited 2021 Nov 27 ];5:68-70
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Full Text


Dentoalveolar traumatic injuries are a real and serious public health problem because of the high prevalence. The global prevalence ratio is suggesting that males are 34%–52% more likely to develop traumatic dental injuries than females.[1] Crown fractures for permanent teeth are the most common type, representing 65%–75% of all such dental traumatic injuries.[2],[3] The maxillary central incisors are the most commonly affected teeth, followed by the maxillary lateral incisors.[4] Subsequently, anterior crown fractures may lead to discomfort and serious psychological problems that may affect the social relationship.

During the last century, clinicians utilized a variety of procedures such as pin-retained resin, orthodontic bands, modified three-quarter crowns, full coverage gold with bonded porcelain, porcelain jacket crowns, porcelain-bonded crowns, and porcelain inlays for the restoration of the fractured crown.[5],[6],[7] In addition to that treatment options, the more conservative treatment procedure can be applied such as reattaching the fractured part or restoration with suitable composite resins.[8],[9] Reattachment technique can be used in case of uncomplicated or complicated coronal fracture.[10],[11]

This report series aims to present the treatments of traumatized maxillary central incisors, in three different cases, with reattachment of natural tooth structures.

 Case Reports

There were three cases referred to the Faculty of Dentistry, Department of Pedodontics with coronal fractured maxillary central incisors. The patients had brought the fractured fragments from the area of injury to the clinic in different ways and time intervals. No alterations in the dentoalveolar tissues were observed in the radiographic and clinical examination. The treatment plans were formulated to reattach the fragments of the teeth. The parents read the information and give consent for child's treatment.

Case 1

A 9-year-old boy applied to the clinic at trauma day for tooth #11 [Figure 1]a. The patient had placed the fractured fragment in water [Figure 1]b. The fragment had normal translucency.{Figure 1}

Case 2

An 11-year-old boy applied to the clinic at trauma day for tooth #21 [Figure 2]a. The patient had placed the fractured fragment in a handkerchief [Figure 2]b. The fragment had acceptable translucency.{Figure 2}

Case 3

A 10-year old boy applied to the clinic the next day after trauma for tooth #21 [Figure 3]a. The patient had placed the fractured fragment in a handkerchief [Figure 3]b. The fragment part was dehydrated and lost its translucency.{Figure 3}

On the fractured edges of the teeth fragment, an intra-enamel circumferential bevel was applied. The edges were etched with a 37% phosphoric acid for 15 s and rinsed thoroughly with water, the teeth were dried, and dentin-bonding agent (Scotchbond Multi-Purpose, 3M ESPE, 3M Dental Products, St. Paul, MN, USA) was applied and light-cured as per the manufacturer's instruction. The fractured fragments were placed into the proper position of the teeth, and light-cure composite resin material (Filtek™ Z250, 3M ESPE, 3M Dental Products, St. Paul, MN, USA) was applied and photopolymerized for 20 s (Elipar Freelight 2, 3M EPSE, 3M Dental Products, St. Paul, MN, USA). After the procedure, the surfaces were polished with rubber polishing points and discs (Soft-Lex; 3M ESPE, 3M Dental Products, St. Paul, MN, USA). The reattached fragments had acceptable esthetic and function [Figure 1]c, [Figure 2]c, [Figure 3]c. There was no functional failure in the 1-year follow-up, and the patients were recalled for further follow-ups.


The main goal of restorative dentistry is maintaining the anatomical contours, long-term functional integrity, and esthetics. With the development of adhesive systems and composites, reattaching of the original tooth fragment provides a better prognosis. The procedure is cheap, has short chair-time, long-term success, creates an ideal aesthetic result, improves function, and can easily be accepted by the patient.

The original tooth fragment can be attached using different techniques. The fragment can be placed in the proper position only with bonding agents or bonding agents with the intermediate composite application.[12] In comprehensive research about tooth fragment reattachment by Pusman et al., it concluded that regardless of the adhesive technique employed, reattachment of fragments with an intermediate resin composite layer significantly increased the fracture strength recovery.[8] Besides, some studies recommend some preparation of the remaining tooth or fragment using dentin grooves, chamfers, and/or bevels.[13],[14],[15] There was no failure occurred such as debonding in the 1-year follow-up of all three cases which bevel applied and reattached with a dentin-bonding agent and an intermediate resin composite layer. Clinical trials and case reports of the long-term follow-up have reported that reattachment with developed bonding agents or adhesive luting systems may achieve esthetic and functional success for up to 7 years.[16]

Color change and lower fracture strength may occur with dehydration of the fragment. Appropriate rehydration of the fragment has the capability of restoring both color and strength.[17],[18] In this case report, no pathology occurred during the 1-year follow-up also of the dehydrated tooth structure. However, perfect color matching was not completely achieved, but it was acceptable.

The prognosis and acceptable esthetic results of the clinical follow-ups we have presented have shown that the restorations which are performed with the use of original tooth fragment can be successful in the long term. However, long-term follow-up is essential to predict the durability of the tooth-adhesive-fragment complex and the vitality of the tooth.

As a result, reattaching fragments with dentin-bonding adhesives can be used to restore fractured teeth as a treatment alternative, presumably with sufficient strength. This is a very conservative treatment that allows the restoration to maintain the original dental anatomy, thus rehabilitating function, and esthetics in a short time, by preserving dental tissues.

Declaration of patient consent

The authors certify that they had obtained all appropriate patient consent forms. In the form, the patients have given their consent for their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.


1Petti S, Glendor U, Andersson L. World traumatic dental injury prevalence and incidence, a meta-analysis-One billion living people have had traumatic dental injuries. Dent Traumatol 2018;34:71-86.
2Robertson A, Robertson S, Norén JG. A retrospective evaluation of traumatized permanent teeth. Int J Paediatr Dent 1997;7:217-26.
3Levin L, Day PF, Hicks L, O'Connell A, Fouad AF, Bourguignon C, et al. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: General introduction. Dent Traumatol 2020;36:309-13.
4Lam R. Epidemiology and outcomes of traumatic dental injuries: A review of the literature. Aust Dent J 2016;61 Suppl 1:4-20.
5Andreasen JO, Andreasen FM. Essentials of Traumatic Injuries to the Teeth: A Step-bystep Treatment Guide. 2nd ed. Copenhagen, Denmark: Munksgaard and Mosby; 2000.
6Camp JH. Diagnosis and management of sports-related injuries to the teeth. Dent Clin North Am 1991;35:733-56.
7Cavalleri G, Zerman N. Traumatic crown fractures in permanent incisors with immature roots: A follow-up study. Endod Dent Traumatol 1995;11:294-6.
8Pusman E, Cehreli ZC, Altay N, Unver B, Saracbasi O, Ozgun G. Fracture resistance of tooth fragment reattachment: Effects of different preparation techniques and adhesive materials. Dent Traumatol 2010;26:9-15.
9Villat C, Machtou P, Naulin-Ifi C. Multidisciplinary approach to the immediate esthetic repair and long-term treatment of an oblique crown-root fracture. Dent Traumatol 2004;20:56-60.
10Kanca J 3rd. Replacement of a fractured incisor fragment over pulpal exposure: A case report. Quintessence Int 1993;24:81-4.
11Liew VP. Re-attachment of original tooth fragment to a fractured crown. Case report. Aust Dent J 1988;33:47-50.
12Garcia FCP, Poubel DLN, Almeida JCF, Toledo IP, Poi WR, Guerra ENS, et al. Tooth fragment reattachment techniques-A systematic review. Dent Traumatol 2018;34:135-43.
13Brambilla GP, Cavallè E. Fractured incisors: A judicious restorative approach–part 1. Int Dent J 2007;57:13-8.
14Reis A, Francci C, Loguercio AD, Carrilho MR, Rodriques Filho LE. Re-attachment of anterior fractured teeth: Fracture strength using different techniques. Oper Dent 2001;26:287-94.
15Chazine M, Sedda M, Ounsi HF, Paragliola R, Ferrari M, Grandini S. Evaluation of the fracture resistance of reattached incisal frag-ments using different materials and techniques. Dent Traumatol 2011;27:15-8.
16Murchison DF, Burke FJ, Worthington RB. Incisal edge reattachment: Indications for use and clinical technique. Br Dent J 1999;186:614-9.
17Maia EA, Baratieri LN, de Andrada MA, Monteiro S Jr, de Araújo EM Jr. Tooth fragment reattachment: Fundamentals of the technique and two case reports. Quintessence Int 2003;34:99-107.
18Krastl G, Filippi A, Zitzmann NU, Walter C, Weiger R. Current aspects of restoring traumatically fractured teeth. Eur J Esthet Dent 2011;6:124-41.