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PEDIATRICS

SEQUELAE TO DENTAL TRAUMA:

RE-ATTACHMENT OF FRAGMENTS

OVER 12 YEARS

Rajesh Ahal and Ritu Ahal

INTRODUCTION and Delayed (after the first day). They classified these depending on
Dental trauma to the anterior teeth has been researched in-depth for the consequences of the treatment delay on the pulp and periodontal
many decades. Still, the treatment outcome is variable and depends on ligament tissues post-trauma.
multiple factors. The type of treatment to be rendered post-trauma depends on
In many countries, the treatment for traumatized teeth is still various factors like the biological tissues involved, the time elapsed
neglected. It is considered that as long as the traumatized tooth is before treatment, and the possible response of the tooth’s biological
asymptomatic, it is fine—but in reality, it is not healthy internally, and tissues. The outcome can be highly variable, making post-trauma
in the majority of cases, the patient seeks dental care very late. management highly challenging and, most of the times, unpredictable.
Today, there are numerous classifications available for trauma However, reattachment of the fractured component still offers more
to the anterior teeth. Ellis & Davey’s classification is still the most advantages over conventional full-coverage prosthetic options.
widely accepted, as it is the simplest to apply clinically. Andreasen The advent of lithium disilicate crown materials give us the option
et al. also categorized the treatment periods after traumatic injuries of offering biomimetic reconstructive solutions once the facial growth
into Acute (within a few hours), Sub-acute (within the first 24 hours), is complete and the occlusion has finally settled.

TECHNIQUES FOR RE-ATTACHING FRACTURED TOOTH FRAGMENTS

1. Simple Conservative Re-Attachment groove is created within the labial enamel of both the
This technique involves reattaching the tooth fragment tooth and the fragment, without touching the outer
en masse without altering the fractured fragment or the enamel surfaces (cavosurfaces). Some authors later
remaining tooth structure. It allows the original tooth modified this to extend circumferentially around both the
form, contour, colour, surface texture, translucence, fragment and the tooth.
occlusal alignment, and function to be maintained. This Disadvantages: Loss of accurate fit of the fragment due
method is akin to a jigsaw puzzle. Retaining more natural to preparation done prior to reattachment.
tooth structure allows the use of the inherent strength 4. Internal Dentine Groove
of the natural tooth. The advent of newer flowable
nano-cluster composites has led to better outcomes A 1mm wide x 1mm deep groove is prepared in the
compared to earlier flowable composites. dentine of both the fragment and the tooth. The inherent
strength of the reattached fragment increases due to
2. Enamel Bevel the larger surface area for adhesion.
This technique involves preparing a 45° bevel Disadvantages: Discoloration of the exposed composite
circumferentially on the enamel of both the fractured in the oral cavity. However, it is now known that bonding
tooth fragment and the tooth. Proposed by Simonsen in strength is higher in enamel compared to dentine, and
1979, it helps create a better bond. the evolution of finer techniques using composites
Disadvantages: Loss of precise placement due reduces discoloration over time.
to preparation done prior to reattachment and 5. External Chamfer
discoloration of the composite band over time. This
method was rejected by Simonsen himself upon the This technique was introduced to overcome the
introduction of the internal groove method. challenge of loss of fit due to pre-attachment
preparation techniques. It increases the surface
3. V-shaped Internal Enamel Groove area of re-attachment. The chamfer is created after
Introduced by Simonsen in 1982, a V-shaped notched reattachment of the fragment, with some authors later

34 Dental Practice I March-April 2025 I Vol 21 No 2