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CASES - ENDODONTICS

MURAD AKHUNDOV

A NOVEL METHOD FOR FRAGMENT


REATTACHMENT AFTER POST PLACEMENT
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Fracture by trauma is one of the most common kind of dental injury in the permanent dentition
among children and teenagers.If the original tooth fragment is retained following fracture line, the
natural tooth structures can be reattached using adhesive protocols.
In this article we report one case of traumatized maxillary permanent central incisors, which were
treated with novel method of Fragment reattachment, preserving coronal integrity after post
placement.

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CASES OF THE WEEK

JAN 18 TO JAN 24
Adam Zawadka
Marc Kaloustian
Marino Sutedjo
Ivan Mirovic
A nineteen year old young woman presented to our attention reporting acute pain at the level of 2.1.
On oral examination the patient showed first of all a poor hygiene because pain prevented her from
brushing properly.
The trauma had caused the fracture of coronal part of three teeth, 1.1, 2.1 and 2.2. No elements

mobility has shown.Especially the 2.1 had a complicated fracture with pulp exposure and a palatal
second fragment still present.
On investigating the intraoral periapical radiograph did not appear signs of root fractures and
elements 1.1 and 2.2 responded positively to the pulp thermal testing that was performed on the labial
surface.
Instead, the left central incisor, which had been treated by another dentist with a partial pulpotomy
immediately after trauma, presented acute pain to percussion.

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We decided to treat this case performing the following operative plan:

ANNIKA KORVO
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Tooth 1.1: direct restoration with composite (fragment not available)


Tooth 2.1: Root canal treatment,fragments reattachment and fiber post.
Tooth 2.2: direct restoration with composite (fragment not available)
Especially for 2.1 element we have planned an innovative operative technique which will be described
in this article.

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All fragments were removed,cleaned and stored properly in saline water at 4 degrees.
2)All elements were isolated with rubber dam positioning clamp on 2.1 under fracture line exposing all
sound enamel.
3) Root canal treatment was performed granted al least 4 mm of apical guttapercha seal.
Shaping: Step back technique,Proglider and Protaper next X1.X2,X3,X4 (Dentsply Maileffer).
Irrigation: Chlor Xtra 6% , EDTA 17%. Obturation:AH plus as sealer and Warm Guttapercha
condensation.
4) Fragments were treated with conventional 3 steps adhesive technique and joined together
polymerizing a thin line of flow composite placed in the between.

Walter Devoto
Dr. Walter Devoto Born in
Chiavari on 29/03/1965
graduated in Dentistry in 1991
at Genova University.

5) For a better holder of the crown and to avoid any separation during luting technique a small
amount of composite was positioned on palatal side, above fracture line, with a K file holder merged
inside.

Angelo Putignano
M.D. degree and D.D.S. post
graduate certificate from
University of Ancona-Italy.

6) Root canal was cleaned and prepared with a largo bur number 3. At this point fiber post length
was tested cutting the post head till that crown fragment fitted perfectly with post and tooths
margins at same time. After that post was treated with silane,adhesive and bonded by the head
inside fragment pulp chamber with composite,without polymerizing and without doing any hole in
the crown.

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Pio Bertani
Pio Bertani is a full member of
the prestigious association...

7)Root canal was prepared with 3 steps adhesive technique and adhesive was mixed with activator
for a chemical setting. We selected a dual cure composite and we positioned it with a micro cannula
starting from the bottom avoiding in this way any void.

Fabio Gorni
Fabio Gorni is an active
member of the Italian Society
of Endodontics and the Italian
Academy...

8) Fragments with post were positioned removing all composite excess before polymerization. The k
file holder was removed and afterwards,
finishing and polishing steps were performed.
Elements 1.1 and 2.2 were restored with composite during the same session.

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Gaetano Paolone
My passion is aesthetic
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Born in Savona in 1961
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15 DAYS RECALL

worked in his own


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Vincenzo Musella
Vincenzo Musella
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Giuseppe Marchetti
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Simone Grandini
Chair of Endodontics and
Restorative Dentistry,
University of Siena, Italy.

Giovanna Orsini
Giovanna Orsini is a well
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Paulo Monteiro
My passion for esthetic
dentistry began when I
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Louis Hardan
Head of Restorative and
Esthetic department in
Saint-Joseph University
in...

Patrizia Lucchi
Patrizia Lucchi Graduated
in Dentistry cum Laude in
1995 at the University of
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Anna Salat
Dr Anna Salat graduated
with a degree in dentistry
from the International
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Giulio Pavolucci
After graduation magna
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Marcos Vargas
Dr. Marcos Vargas
attended Cayetano
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Stefan Koubi
Dr. Koubi graduated from
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Engin Taviloglu
Dr. Taviloglu graduated
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5 YEARS RECALL
1) An endo-aesthetic management of crown dilaceration in a permanent mandibular central incisor
Abhijit D Wankhade, Ramesh Kumar Pandey, Rajeev Kumar Singh, Milind V Naphade
BMJ Case Rep. 2013; 2013: bcr2012007956. Published online 2013 February 14. doi: 10.1136/bcr-2012007956
2 )Treatment imprudence leading to missed tooth fragment
Pranamee Barua, Seema Chaudhary, Harsimran Kaur, Rachappa Mallikarjuna
BMJ Case Rep. 2013; 2013: bcr2013009154. Published online 2013 April 20. doi: 10.1136/bcr-2013-009154
3) The Treatment of Anterior Dental Trauma
Dan Brllmann, Ralf K Schulze, Bernd dHoedt
Dtsch Arztebl Int. 2011 August; 108(34-35): 565570. Published online 2011 August 29. doi:
10.3238/arztebl.2011.0565
4)Post-traumatic impaction of maxillary incisors: diagnosis and treatment
Valeria Paoloni, Chiara Pavoni, Manuela Mucedero, Patrizio Bollero, Giuseppina Lagan, Paola Cozza
Ann Stomatol (Roma) 2013 Apr-Jun; 4(2): 174183. Published online 2013 June 25.
5)Dental fragment embedded in the lower lip after facial trauma: Brief review literature and report
of a case
Dorina Lauritano, Massimo Petruzzi, Gerardo Sacco, Guglielmo Campus, Francesco Carinci, Lucio
Milillo
Dent Res J (Isfahan) 2012 December; 9(Suppl 2): S237S241. doi: 10.4103/1735-3327.109769
6)Tooth fragment reattachment technique on a pluri traumatized tooth
Giuseppe Lo Giudice, Frank Lipari, Angelo Lizio, Gabriel Cervino, Marco Cicci
J Conserv Dent. 2012 Jan-Mar; 15(1): 8083. doi: 10.4103/0972-0707.92613
7)Management and Followup of Complicated Crown Fractures in Young Patients Treated with Partial
Pulpotomy
Francisco Ojeda-Gutierrez, Brenda Martinez-Marquez, Soraya Arteaga-Larios, M. Socorro RuizRodriguez, Amaury Pozos-Guillen
Case Rep Dent. 2013; 2013: 597563. Published online 2013 June 20. doi: 10.1155/2013/597563
8)Reattachment of Fractured Tooth Fragment with Fiber Post: A Case Series with 1-Year Followup
C. M. Sapna, R. Priya, N. B. Sreedevi, Rakesh R. Rajan, Renjith Kumar
Case Rep Dent. 2014; 2014: 376267. Published online 2014 November 3. doi: 10.1155/2014/376267

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Caroline Werkhoven
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Author of book edited by
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Dan Lazar
Dan Lazar, graduated from
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Murad Akhundov
Dr. Murad Akhundov
graduated from the
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Baku...

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Janos Grosz
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