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

Introduction history was unremarkable. No mobility of the injured tooth

R estoring endodontically treated teeth with
complicated crown or crown‑root fracture is a major
challenge for dental practitioners because it requires a
comprehensive and accurate diagnosis and treatment
plan.[1] The traditional treatments of complicated
crown fractures are the use of definitive crown after
crown lengthening or orthodontic or surgical extrusion,
extraction followed by implant or fixed partial denture,
and post and core‑supported restorations.[2] If the
crown fragment is retrieved at the time of injury, its
reattachment provides several advantages over the other
forms of restorations such as exact restoration of the
crown form, surface morphology, color, and minimal
violation of biologic width.[3,4] However, successful
reattachment was determined by factors such as the site
of fracture, size of fractured remnants, periodontal status,
pulpal involvement, maturity of the root formation,
biological width invasion, occlusion, material used for
reattachment, use of post, and prognosis.[5] Purpose
of this article is to report 2  cases of successful crown
reattachment with 2‑year follow‑up.
Case report 1
A 23‑year‑old male patient presented to the Department
of Conservative Dentistry and Endodontics, Mar Baselios
Dental College, Kothamangalam, after sustaining a
complicated crown fracture to his maxillary left lateral
incisor due to fall on the ground. The patient’s medical
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was recorded and there was no apparent trauma to the
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
from cervical 3rd  of crown on labial aspect to 2  mm
subgingivally on the lingual aspect. The fractured fragment
was loosely attached to the tooth [Figure 1a to h].
A periapical radiograph showed that the root formation
was complete, with no extrusion. The patient expressed
the desire to maintain the tooth and restore it due to
the lower cost compared to an indirect restoration.
A  detailed explanation about the treatment plan was
given to the patient, which included root canal treatment
and reattachment with fiber post. The treatment plan
was accepted by the patient. Local anesthetic was
administered and the segment was removed with
minimal force and recovered and stored in normal saline
to prevent discoloration and dehydration. Following a
detailed examination, the adaptation of the fragment
was checked. The working length was determined
with an electronic apex locator  (Root ZX, J.  Morita
Corp., Japan) and confirmed with radiography. The
gates glidden drills  (Mani Inc., Japan) were used for
Address for correspondence: Dr. Rajesh Gopal,
Department of Conservative Dentistry and Endodontics,
Rajas Dental College, Kavalkinaru,
Thirunelveli, Tamil Nadu, India.
E‑mail: rajeshgopalv@gmail.com
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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
was enlarged to ISO size 60 at working length. About
3% sodium hypochlorite was used as irrigant during
the preparation. The root canal was dried with paper
points (Spident, Hand Rolled, Korea) and obturated
using endodontic sealer (Sealapex, Kerr, USA) and
laterally condensed with Gutta‑percha  (Spident, Hand
Rolled, Korea). The root canal orifice was sealed with
a temporary restoration. The day after completion of
the endodontic treatment, gingival flap was raised as the
fracture line was below the gingival level on the lingual
aspect.
The root canal was prepared for the postplacement
by removing the gutta‑percha from the coronal
two third of the canal with peso reamers. The fiber
post  (FIBRAPOST PD, Switzerland) was tried in the
canal and adjusted to the desired length. Space was also
prepared in the pulp chamber of the fractured crown
fragment for receiving the coronal portion of the post
and also the core. The alignment of the coronal fragment
was verified with the post in place. The root canal was
then etched with 37% orthophosphoric acid, rinsed, blot
dried with paper points, and bonding agent  (PRIME
and BOND NT, DENTSPLY)) was applied. The post
was then luted in the canal using dual‑cured resin
luting cement (RelyX, 3M, USA). The inner portion of
the coronal fragment was similarly etched and bonded
to the tooth using flowable composite resin  (Esthet‑X
Flow, DENTSPLY) after proper shade matching. At the
end, flap was repositioned, sutured, and occlusion was
checked, and postoperative instructions were given to
the patient. Clinical and radiographic examinations were
carried out after 1 month, 3 months, 6 months, 1 year,
and 2 years, and the tooth responded favorably.
Case report 2
A 19‑year‑old male patient reported to the Department
of Conservative Dentistry, Mar Baselios Dental College,
following trauma to maxillary left central incisor due to
a motorcycle accident. On intraoral examination, Ellis
Class III fracture was seen on the crown portion of tooth
No.  22, which extended from cervical 3rd  of crown on
the labial side to 2 mm subgingivally on the lingual
aspect. The fractured segment of the tooth was removed
atraumatically and stored in normal saline. Single
visit root canal treatment was done. Gingival flap was
raised as the fracture line was below subgingival level
on the lingual aspect. As mentioned earlier, the fracture
crown fragment was reattached with remaining tooth
portion by suitable fiber post with the help of dual core
composite. At the end, flap was repositioned and sutured
and postoperative instructions were given to the patient.
The patient was recalled for regular review up to 1  year
[Figure 2a to g].
Discussion
Complicated coronal fractures of permanent incisors
represent 11%–15% of all trauma to incisors, of these
96% involve maxillary central incisors.[6] Conventionally
custom cast post and core followed by metal ceramic
crown was the treatment of choice for these types of
complicated crown fractures. When compared to this,
tooth fragment reattachment is a more conservative,
affordable, and less time‑consuming treatment option
with favorable advantages such as original color
match, preservation of contour, contacts, and incisal
translucency.[7,8] Moreover, there has been a clearly
observable transition from the use of metal alloy
posts toward the use of fiber‑reinforced resin‑based
composite  (FRC) posts, especially with teeth in the

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Gopal, et al.: Tooth fracture reattachment
a b
e f
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
have a dentin‑like modulus that allows a more even
distribution of occlusal stresses in the root dentin,[9]
which have led to fewer and less severe in vitro root
fracture failures. FRC post needs less dentin removal
as it uses the undercuts and surface irregularities to
increase the surface area for bonding, thus minimizes the
possibility of tooth fracture.[10] In addition, using glass
fiber post with composite core and adhesive materials
can create a monoblock, a multilayered structure with no
inherent weak interlayer interfaces, which reinforces the
tooth structure.[11]
In the above‑mentioned cases, a dual cure resin cement
RelyX  3M which is a self‑etching and self‑adhesive
system was used for the reattachment of the fragments.
This dual cure resin cement has a good bond strength,
ensures complete curing and reduces microleakage. The
coronal fragment was bonded to the remaining tooth
using flowable composite resin Esthet‑X Flow that offers
excellent color stability, minimizes the inclusion of air
voids, and helps in achieving higher bond strengths of
the fractured segments.
The fracture line was below the gingival level in the
mentioned cases; the gingival flap was raised to obtain
access to the fractured site for bonding fractured
component. As the biological width was only minimally
invaded and the restorative margin could be placed at
or above the level of the cementoenamel junction, the
bone recontouring through crown lengthening would
not be indicated in the present cases. The literature
suggested that whenever biologic width is invaded,
surgery should be performed with minimum osteotomy
and osteoplasty.[12]
Journal of Pharmacy and Bioallied Sciences  ¦  Volume 9  ¦  Supplement 1  ¦  November 2017
c d
g
Conclusion
These case reports demonstrated the importance of
establishing a multidisciplinary approach for a successful
management of complex crown fracture and its possible
sequelae. After almost 2 years of follow‑up, the attached
coronal fragments are in position with good esthetics as
well as clinical and radiographic signs of periodontal
health and root integrity, thus indicating treatment
success.
Declaration of patient consent
The authors certify that they have obtained all appropriate
patient consent forms. In the form the patient(s) has/have
given his/her/their consent for his/her/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
Nil.
Conflicts of interest
There are no conflicts of interest.
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