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Case Report

Management of Tooth Fractures Using Fiber Post and Fragment

Reattachment: Report of Two Cases
Rajesh Gopal, Lalkrishna Raveendran, Sonia P. Pathrose1, Benin Paulaian

Department of Conservative Reattachment of the tooth fragment is an ultraconservative technique for managing

Abstract
Dentistry and Endodontics,
Rajas Dental College,
coronal tooth fractures when the tooth fragment is available, and there is minimal
Tirunelveli, Tamil Nadu, violation of the biological width. The advances in adhesive dentistry have
1
Department of Conservative allowed dentists to use the patient’s own fragment to restore the fractured tooth
Dentistry and Endodontics, which provides fast and esthetically pleasing results. This article reports fragment
Al‑Azhar Dental College, reattachment technique and presents two clinical cases of complicated crown
Idukki, Kerala, India fracture.
Keywords: Crown fracture, fiber post, reattachment, restoration, trauma

Introduction history was unremarkable. No mobility of the injured tooth

was recorded and there was no apparent trauma to the
R estoring endodontically treated teeth with
complicated crown or crown‑root fracture is a major
challenge for dental practitioners because it requires a
soft tissues in the extraoral and intraoral examination. On
hard tissue examination, Ellis Class  III fracture was seen
in the coronal portion of tooth No.  22, which extended
comprehensive and accurate diagnosis and treatment
from cervical 3rd  of crown on labial aspect to 2  mm
plan.[1] The traditional treatments of complicated
subgingivally on the lingual aspect. The fractured fragment
crown fractures are the use of definitive crown after
was loosely attached to the tooth [Figure 1a to h].
crown lengthening or orthodontic or surgical extrusion,
extraction followed by implant or fixed partial denture, A periapical radiograph showed that the root formation
and post and core‑supported restorations.[2] If the was complete, with no extrusion. The patient expressed
crown fragment is retrieved at the time of injury, its the desire to maintain the tooth and restore it due to
reattachment provides several advantages over the other the lower cost compared to an indirect restoration.
forms of restorations such as exact restoration of the A  detailed explanation about the treatment plan was
crown form, surface morphology, color, and minimal given to the patient, which included root canal treatment
violation of biologic width.[3,4] However, successful and reattachment with fiber post. The treatment plan
reattachment was determined by factors such as the site was accepted by the patient. Local anesthetic was
administered and the segment was removed with
of fracture, size of fractured remnants, periodontal status,
minimal force and recovered and stored in normal saline
pulpal involvement, maturity of the root formation,
to prevent discoloration and dehydration. Following a
biological width invasion, occlusion, material used for
detailed examination, the adaptation of the fragment
reattachment, use of post, and prognosis.[5] Purpose
was checked. The working length was determined
of this article is to report 2  cases of successful crown
with an electronic apex locator  (Root ZX, J.  Morita
reattachment with 2‑year follow‑up. Corp., Japan) and confirmed with radiography. The
Case report 1 gates glidden drills  (Mani Inc., Japan) were used for
A 23‑year‑old male patient presented to the Department Address for correspondence: Dr. Rajesh Gopal,
of Conservative Dentistry and Endodontics, Mar Baselios Department of Conservative Dentistry and Endodontics,
Dental College, Kothamangalam, after sustaining a Rajas Dental College, Kavalkinaru,
Thirunelveli, Tamil Nadu, India.
complicated crown fracture to his maxillary left lateral E‑mail: [email protected]
incisor due to fall on the ground. The patient’s medical
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How to cite this article: Gopal R, Raveendran L, Pathrose SP,

DOI: 10.4103/jpbs.JPBS_111_17 Paulaian B. Management of tooth fractures using fiber post and fragment
reattachment: Report of two cases. J Pharm Bioall Sci 2017;9:S295-8.

© 2017 Journal of Pharmacy and Bioallied Sciences | Published by Wolters Kluwer - Medknow S295
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Gopal, et al.: Tooth fracture reattachment

a b c d

e f g h
Figure  1:  (a) Preoperative view,  (b) preoperative radiograph,  (c) fracture segment removed,  (d) sectional obturation,  (e) fractured segment, (f)
reattachment of fractured segment, (g) suturing of soft tissue, (h) review after 2 year

coronal enlargement of the root canal. The root canal Case report 2
was enlarged to ISO size 60 at working length. About A 19‑year‑old male patient reported to the Department
3% sodium hypochlorite was used as irrigant during of Conservative Dentistry, Mar Baselios Dental College,
the preparation. The root canal was dried with paper following trauma to maxillary left central incisor due to
points (Spident, Hand Rolled, Korea) and obturated a motorcycle accident. On intraoral examination, Ellis
using endodontic sealer (Sealapex, Kerr, USA) and Class III fracture was seen on the crown portion of tooth
laterally condensed with Gutta‑percha  (Spident, Hand No.  22, which extended from cervical 3rd  of crown on
Rolled, Korea). The root canal orifice was sealed with the labial side to 2 mm subgingivally on the lingual
a temporary restoration. The day after completion of aspect. The fractured segment of the tooth was removed
the endodontic treatment, gingival flap was raised as the atraumatically and stored in normal saline. Single
fracture line was below the gingival level on the lingual visit root canal treatment was done. Gingival flap was
aspect. raised as the fracture line was below subgingival level
on the lingual aspect. As mentioned earlier, the fracture
The root canal was prepared for the postplacement crown fragment was reattached with remaining tooth
by removing the gutta‑percha from the coronal portion by suitable fiber post with the help of dual core
two third of the canal with peso reamers. The fiber composite. At the end, flap was repositioned and sutured
post  (FIBRAPOST PD, Switzerland) was tried in the and postoperative instructions were given to the patient.
canal and adjusted to the desired length. Space was also The patient was recalled for regular review up to 1  year
prepared in the pulp chamber of the fractured crown [Figure 2a to g].
fragment for receiving the coronal portion of the post
and also the core. The alignment of the coronal fragment Discussion
was verified with the post in place. The root canal was Complicated coronal fractures of permanent incisors
then etched with 37% orthophosphoric acid, rinsed, blot represent 11%–15% of all trauma to incisors, of these
dried with paper points, and bonding agent  (PRIME 96% involve maxillary central incisors.[6] Conventionally
and BOND NT, DENTSPLY)) was applied. The post custom cast post and core followed by metal ceramic
was then luted in the canal using dual‑cured resin crown was the treatment of choice for these types of
luting cement (RelyX, 3M, USA). The inner portion of complicated crown fractures. When compared to this,
the coronal fragment was similarly etched and bonded tooth fragment reattachment is a more conservative,
to the tooth using flowable composite resin  (Esthet‑X affordable, and less time‑consuming treatment option
Flow, DENTSPLY) after proper shade matching. At the with favorable advantages such as original color
end, flap was repositioned, sutured, and occlusion was match, preservation of contour, contacts, and incisal
checked, and postoperative instructions were given to translucency.[7,8] Moreover, there has been a clearly
the patient. Clinical and radiographic examinations were observable transition from the use of metal alloy
carried out after 1 month, 3 months, 6 months, 1 year, posts toward the use of fiber‑reinforced resin‑based
and 2 years, and the tooth responded favorably. composite  (FRC) posts, especially with teeth in the

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Gopal, et al.: Tooth fracture reattachment

a b c d

e f g
Figure 2: (a) Preoperative view, (b) preoperative radiograph, (c) fracture segment removed, (d) obturation, (e) fractured segment, (f) reattachment of
fractured segment, (g) review after 2 years

esthetic zone such as maxillary incisors. FRC posts Conclusion

have a dentin‑like modulus that allows a more even These case reports demonstrated the importance of
distribution of occlusal stresses in the root dentin,[9] establishing a multidisciplinary approach for a successful
which have led to fewer and less severe in vitro root management of complex crown fracture and its possible
fracture failures. FRC post needs less dentin removal sequelae. After almost 2 years of follow‑up, the attached
as it uses the undercuts and surface irregularities to coronal fragments are in position with good esthetics as
increase the surface area for bonding, thus minimizes the well as clinical and radiographic signs of periodontal
possibility of tooth fracture.[10] In addition, using glass health and root integrity, thus indicating treatment
fiber post with composite core and adhesive materials success.
can create a monoblock, a multilayered structure with no Declaration of patient consent
inherent weak interlayer interfaces, which reinforces the
The authors certify that they have obtained all appropriate
tooth structure.[11]
patient consent forms. In the form the patient(s) has/have
In the above‑mentioned cases, a dual cure resin cement given his/her/their consent for his/her/their images and
RelyX  3M which is a self‑etching and self‑adhesive other clinical information to be reported in the journal.
system was used for the reattachment of the fragments. The patients understand that their names and initials will
This dual cure resin cement has a good bond strength, not be published and due efforts will be made to conceal
ensures complete curing and reduces microleakage. The their identity, but anonymity cannot be guaranteed.
coronal fragment was bonded to the remaining tooth Financial support and sponsorship
using flowable composite resin Esthet‑X Flow that offers Nil.
excellent color stability, minimizes the inclusion of air
Conflicts of interest
voids, and helps in achieving higher bond strengths of
the fractured segments. There are no conflicts of interest.

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