Survival analysis of adhesive reattachments in permanent teeth with crown fractures after dental trauma

Abstract

Background/Aim When patients have saved tooth fragments in case of crown fractures, reattachment is considered as the treatment of choice. With respect to the need to provide clinical outcome data regarding adhesively reattached fragments, the aim of this practice‐based clinical study was to evaluate the survival of reattached fragments after crown fractures in permanent teeth. Materials and Methods Records from patients treated at Ludwig‐Maximilians‐University between 2004 and 2017 were analyzed to collect clinical and radiographic data regarding the management of fractured teeth that were treated with an adhesive reattachment. The study population consisted of 109 patients comprising 135 reattached fragments divided into uncomplicated (N = 84/135) and complicated (N = 51/135) crown fractures. The Kaplan‐Meier Survival estimator was used to estimate the survival probability of primary reattachments after uncomplicated and complicated crown fractures. Results Overall, 77.4% (N = 65/84) and 66.6% (N = 34/51) of the primarily applied reattachments in uncomplicated fractured teeth and complicated fractured teeth, respectively, survived over the period of observation. The survival rate for adhesive reattachment in all teeth was 84.4% (N = 114/135) after 608.2 days (±983.1 days). The data further suggest that in the case of a detachment, repeated reattachment might be a valuable restoration strategy. Conclusions Adhesive reattachment is a good first‐choice treatment option in cases of crown fractures when the fractured fragment has been saved.

Conservative Treatment of Complicated Crown Fracture and Crown-Root Fracture of Young Permanent Incisor—A Case Report with 24-Month Follow-Up

“…Although various reattachment techniques have been described to achieve a larger adhesive surface, simple fragment reattachment with an intermediate material is the preferred procedure [ 11 ]. The success rate of adhesive reattachment in crown fractures has risen since the development of modern adhesive systems, from 55% [ 23 ] to 84–93% in 2-years follow-up [ 9 , 10 ]. The influence of vital pulp therapy on the success rate is questionable, and the results of clinical studies are contradictory [ 9 , 10 ].…”

“…The success rate of adhesive reattachment in crown fractures has risen since the development of modern adhesive systems, from 55% [ 23 ] to 84–93% in 2-years follow-up [ 9 , 10 ]. The influence of vital pulp therapy on the success rate is questionable, and the results of clinical studies are contradictory [ 9 , 10 ]. The success rate of adhesive reattachment in crown-root fractures was reported to be as high as 56.4% in a 9.5-year horizon [ 12 ].…”

“…Unfortunately, there are no scientific data on the occurrence of pulp necrosis after vital pulp therapy and adhesive fragment reattachment. The overall incidence of pulp necrosis after complicated crown fracture is influenced by the occurrence of concomitant luxation injury, the presence of immature root development, and the absence of a response to sensitivity tests immediately after trauma [ 9 , 24 , 25 ]. Generally, it is suggested to proceed with vital pulp therapy in immature permanent teeth after dental traumatic injury with exposed pulp [ 15 , 16 ], except for intrusion or avulsion [ 26 ].…”

“…In the case of fragment detachment, the decision making is much more complicated. The first possibility is to proceed with repeated adhesive fragment reattachment, which is a viable treatment option [ 9 ]. If it is not possible to perform repeated reattachment, root canal treatment and prosthodontic restoration would be the gold-standard treatment.…”

“…Thus far, long-term studies investigating the clinical outcomes of fragment reattachment in complicated crown-root fractures are lacking. There is growing evidence that adhesive fragment reattachment is a suitable long-term solution after complicated or uncomplicated crown fracture [ 9 , 10 , 11 ], or crown-root fracture in general [ 12 ].…”