Dental Traumatology 2008; 24: e76–e80; doi: 10.1111/j.1600-9657.2008.00698.

Combined technique with glass-fibre-

reinforced composite post and original
fragment in restoration of traumatized anterior
teeth – a case report
CASE REPORT
Ceyhan Altun, Gunseli Guven Abstract – Dentoalveolar trauma is frequently encountered by dental practitio-
Department of Pediatric Dentistry, Central of ners. In some instances, saving a child’s traumatized permanent teeth can create
Dental Sciences, Gulhane Medical Academy, difficulties for the child, the parents and the dentist. Reattachment of a crown
Ankara, Turkey fragment is a conservative treatment that should be considered for crown
fractures of anterior teeth. This case describes the clinical reattachment of an
original tooth fragment. A 10-year-old male presented at the Department of
Pediatric Dentistry with a complex crown fracture of the left maxillary central
incisor 1 day after the trauma occurred. Following endodontic Ò
treatment, a
glass-fibre-reinforced composite root canal post (FRC Postec ; Ivoclar Vivadent
AG, Schaan, Liechtenstein) was inserted to increase retention and distribute
stress along the root. The dental restoration was completed
Ò
using the original
Correspondence to: Ceyhan Altun DDS, fragment and a dual-cured resin composite (Variolink II; Ivoclar Vivadent
PhD, Assistant Professor, Department of AG). Clinical and radiographic examinations at 1-year recall showed the glass-
Pediatric Dentistry, Centre of Dental fibre-reinforced composite root canal post and restoration to be in place,
Sciences, Gulhane Medical Academy, Etlik/ indicating the success of the treatment in maintaining the fractured tooth. Thus,
Ankara, Turkey 06018
Tel.: +90 312 304 6045 we conclude that reattachment of a tooth fragment using a dual-cured resin
Fax: +90 312 304 6020 composite and a glass-fibre-reinforced composite root canal post is an
e-mail : [email protected] alternative method for the rehabilitation of fractured teeth that offers satisfac-
Accepted 28 February, 2008 tory aesthetic and functional outcomes.

Injuries to primary and permanent dentition are among fractures of anterior teeth. This technique may be used
the most common types of trauma to occur in the for uncomplicated coronal fractures in which
maxillofacial region (1, 2). Traumatic tooth injuries in the fracture margin is located coronal to the gingival
children are most frequently the result of an accidental level, with visual and physical access to all fracture
fall, although they may also occur as a result of a traffic surfaces (8). In order to avoid dehydration and
accident, impact sports or play (3, 4). Because of their discolouration, the detached fragment should be recov-
exposed position in the dental arch, maxillary incisors ered immediately after the trauma and placed in a
are the teeth most commonly involved in dental trauma, preserving medium. Some authors suggest using phys-
and in most cases, damage occurs to the crown (5, 6). iological saline solution at 37°C (9), whereas others
Following maxillary incisors, traumatic injuries occur consider water or saliva to be adequate storage media
most frequently in upper and lower lateral incisors and for fragment preservation, possibly in a closed con-
the upper canines; however, the rate of traumatic injury tainer (10).
is significantly higher for maxillary incisors than for Traumatized anterior teeth require quick functional
other teeth (7). and aesthetic repair. Composite materials are commonly
Traumatic injury that involves a permanent tooth can used for aesthetic restorations in clinical practice (11);
sometimes create a difficult situation for the child, the however, these materials have poor mechanical resis-
parents and the dentist, who may opt for treatment that tance. Different approaches for strengthening composite
aims to save the original traumatized tooth. Recent materials have included reinforcing their resinous matrix
improvements in the aesthetics of restorative materials with fibres (12) or using glass-fibre posts consisting of
have enabled excellent results in the restoration of glass-interlaced filaments. The use of fibre-reinforced
damaged teeth with minimal sacrifice of any additional materials in restorative dentistry has met with increasing
tooth structure. acceptance over time (13).
The immediate reattachment of a dental fragment Technological developments have led to improve-
should be considered in treating patients with crown ments in the composition, aesthetics, radiopacity and

e76 Ó 2008 The Authors. Journal compilation Ó 2008 Blackwell Munksgaard

 Combined technique to restoration of traumatized teeth e77

shape of glass-fibre posts (14–17). Manufacturers have

recently begun to produce radiopaque posts. Modifica-
tions have also been made to post configuration, with the
aim of achieving better adaptation to root canal shape.
The translucent glass-fibre post has a modulus of
elasticity similar to that of dentine and offers adequate
mechanical properties (16, 18). Although, light can be
transmitted through the translucent glass-fibre post, it is
possible to use a bonding procedure that combines an
acid-etching technique with a light-cured adhesive system
and dual-cured resin cement (17). Moreover, it is possible
to light-cure the cement and bonding system in only one
step, thus simplifying and shortening the clinical proce-
dure (19).
In the case reported here – a complex crown fracture
requiring endodontic treatment – the use of fibres aimed
to create a central support stump in order to restore
dental morphology and avoid the difficulties, including
possible failure, encountered when other adhesive tech- Fig. 1. Clinical appearance of central incisors with crown
niques have been used to reattach an original fragment. fracture.

Case Report
A healthy, 10-year-old boy was referred to the pediatric
dentistry clinic with the chief complaint of trauma to the
permanent maxillary left central incisor. According to his
parents, the child had experienced two traumatic injuries.
The first occurred at age 9 when he fell while playing at
school, resulting in pain and bleeding around the gingiva
of both maxillary central incisors and a fracture of the
maxillary right central incisor. However, the patient was
not brought for treatment at this time. The second
traumatic injury occurred as a result of falling while
playing soccer and affected the maxillary left central
incisor. A fractured tooth segment was recovered at the
site of the injury and placed in milk.
One day after this second traumatic incident, the
patient was referred to our clinic. The patient was
conscious, and there was no evidence of head or neck
trauma. Extra-oral examination revealed no significant
abnormalities, and intra-oral examination revealed nei-
ther lacerations nor evidence of alveolar bone fracture.
Both maxillary central incisors were fractured, but the
teeth presented with normal mobility. Clinical examina-
tion showed a Class II fracture of the maxillary right
central incisor and a Class III fracture of the maxillary
left central incisor (Fig. 1) (9).
The maxillary left central incisor pulp chamber was
exposed, and the necrotic parts of the pulp chamber were
excavated. A confirmatory vitality test carried out using
a Periflux 4001 Master Laser Doppler Flowmetry (Peri- Fig. 2. The radiograph of the maxillary central incisors.
med, Stockholm, Sweden) revealed no response, and it
was concluded that the pulp of both teeth had become
necrotic as a result of previous trauma. A radiograph Indústria e Comércia Ltd, Guarulhos, SP, Brazil) and
indicated complete root formation and a closed apex and gutta-percha using the vertical condensation technique.
did not show any other fracture or injury on the adjacent The gutta-percha was then partially removed, leaving the
tooth (Fig. 2). A treatment plan was decided upon that apical 4 mm of the filling to maintain a good seal (20,
comprised immediate endodontic treatment of both 21), and a glass-fibre-reinforced composite root canal
maxillary central incisors and reattachment of the post (FRC PostecÒ; Ivoclar Vivadent AG, Schaan,
fractured left maxillary central incisor crown fragment. Liechtenstein) was placed in the canal. A hole was
Following cleaning, the root canals were filled with a drilled in the centre of the original crown fragment
calcium hydroxide-based sealer (Sealapex; Sybron/Kerr, (Fig. 3), and both the intact coronal portion of the tooth

Ó 2008 The Authors. Journal compilation Ó 2008 Blackwell Munksgaard

e78 Altun & Guven

Fig. 3. Clinical appearance of glass-fibre post and original

fragment: (a) Labial view, (b) Palatal view.

and the original crown fragment were etched with 37%

phosphoric acid gel for 20 s, rinsed for 20 s and dried
with a gentle stream of air. An adhesive (ExciteÒ DSC;
Ivoclar Vivadent AG), a dual-curing luting system
(Variolink II; Ivoclar Vivadent AG) and a glass-fibre-
reinforced composite root canal post (FRC PostecÒ)
were sequentially applied according to the manufac-
turer’s instructions. Endodontic treatment was com-
pleted in 1 week, during that time the original crown Fig. 5. The radiograph of the maxillary central incisors after
fragment was preserved in a sterile saline solution. the restoration.
Following this, the original fragment was accurately
placed and photopolymerized for 40 s. The maxillary
right central incisor was then restored using a composite 1 year post-treatment, clinical and radiographic exami-
resin (Tetric Ceram; Ivoclar Vivadent AG) (Fig. 4). nation (Fig. 6) revealed a stable reattachment of the
Clinical and radiographic follow-up examinations crown fragment with no colour change.
confirmed the effectiveness of the combined restoration
technique using the glass-fibre-reinforced composite root Discussion
canal post and the original crown fragment (Fig. 5).
Follow-up examinations conducted at 3, 6, 9 and It is beneficial to quickly restore the function and the
12 months revealed no pathological signs (i.e. mobility, aesthetics of a fractured tooth. The reattachment of a
percussion, colour change, ankylosis, internal and/or fractured crown fragment may be the most conservative
external resorption) in either of the restored teeth. At and desirable treatment of choice for anterior teeth,
providing an instant return to the natural appearance
upon reattachment of the original tooth fragment.
Successful reattachment is highly dependent upon the
rapid retrieval of the fragment (22), which should be
preserved in physiological solution, sterile saline or
water to prevent any change in colour due to dehydra-
tion (9, 10). In this case, the crown fragment was stored
in a sterile saline solution during the treatment period,
and no discolouration was observed during post-treat-
ment follow-up examinations. Simonsen (23) reported
that rehydration of a dehydrated fragment may occur
within several months. During a 1-year follow-up,
Toshihiro & Rintaro (22) observed that a reattached
crown fragment could return to its original colour and
translucency after 1 month without further adverse
changes.
Cavalleri & Zerman (24) reported that the long-term
prognosis for reattached crown fragments appears to
Fig. 4. Intraoral view of the patient after the restoration of the be better than for composite resin restorations. An-
permanent maxillary central incisors. dreasen et al. (25) indicated that the reattachment of a

Ó 2008 The Authors. Journal compilation Ó 2008 Blackwell Munksgaard

 Combined technique to restoration of traumatized teeth e79

requires little chair time and minimum patient compli-

ance. No complications were experienced during the
18-month follow-up. However, before this type of
combined restoration can be advocated as a routine
procedure in crown fractures, longer follow-up periods
and more patients are required to substantiate the
efficacy of the technique.

Conclusion
The combined use of a glass-fibre-reinforced composite
root canal post and an original crown fragment is a
simple and efficient procedure for the treatment of
traumatized anterior teeth that appears to offer excellent
aesthetic and functional results.

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Ó 2008 The Authors. Journal compilation Ó 2008 Blackwell Munksgaard