Tooth fragment reattachment techniques-A systematic review.

BACKGROUND/AIM: Several strategies have been developed for tooth fragment reattachment following fracture. Although many techniques have been reported, there is no consensus on which one has the best results in terms of the bond strength between the fragment and the dentin over time. The aim of this study was to assess the currently reported tooth fragment reattachment techniques for fractured crowns of anterior teeth. MATERIALS AND METHODS: The PubMed, LILACS, Web of Science, Cochrane, and Scopus databases were searched in October 2016, and the search was updated in February 2017. A search of the gray literature was performed in Google Scholar and OpenGrey. Reference lists of eligible studies were cross-checked to identify additional studies; gray literature and ongoing trials were investigated. Two authors assessed studies to determine inclusion and undertook data extraction. Case reports/series of three or more cases, cross-sectional studies, cohort studies, and in vivo clinical trials in all languages were included. RESULTS: Five articles remained after screening. These studies predominantly reported on fragment reattachment with composite resin and resin cement. There was little consistency among the studies in regard to the technique used for tooth fragment reattachment and length of the follow-up period. CONCLUSIONS: According to the evidence found in the studies included in this review, simple tooth fragment reattachment was the preferred reattachment technique. An increase in the bond strength between tooth fragment and dentin was observed when an intermediate material was used. Further investigation is needed, using standard follow-up periods and larger samples.

Effect of dehydration and rehydration intervals on fracture resistance of reattached tooth fragments using a multimode adhesive.

BACKGROUND/AIMS: The tooth fragment bonding technique, frequently used to restore traumatized teeth, may be affected by dehydration/rehydration periods. The aim of this study was to evaluate the effects of different dry and wet storage intervals on multimode adhesive bonding between reattached fragments and teeth. MATERIALS AND METHODS: Eighty-four bovine incisors were fractured and randomized into groups (n=12). After teeth fracturing, each specimen was assigned to one of the following groups: G0: control group (sound tooth); GA1 and GA2: 1-h dehydration and a 15-min or 24-hours rewetting period, respectively; GB1 and GB2: 24-hours dehydration and a 15-minutes or 24-hours rewetting period, respectively; and GC: 1-hour (GC1) or 24-hours (GC2) dehydration period only. Tooth fragments were then reattached using a multimode adhesive in a self-mode technique with a flowable resin composite. The fracture resistance was evaluated in a universal testing machine under a compressive load (1 mm/min-1 ). Data were submitted to two-way analysis of variance and post hoc Tukey test (5%). RESULTS: No significant interaction between dehydration and rehydration intervals was observed (P>.05). Only the step of rehydration significantly affected the reattachment strength when compared to the groups submitted only to dehydration, regardless of the interval (15 minutes or 24 hours). CONCLUSION: Rehydrating a tooth fragment for 15 minutes before bonding with a multimode adhesive maintained sufficient moisture to increase reattachment strength.

Critical appraisal: adhesive-composite incompatibility, part I.

Apart from some questions related to the repairability of resin composite restorations, dentists have always assumed that methacrylate-based resins are compatible with each other. For example, there is no clinically relevant problem in using a microfilled composite to laminate a Class IV restoration made with a hybrid composite, even if they are not of the same brand or manufacturer. In the context of adhesive systems, we have always believed that resin composites, regardless of their type or composition, bond well to all types of bonding agents. However, unexpected debonding of self-cured, core buildup composites that had been bonded with single-bottle adhesive systems was reported about 5 years ago. Subsequent studies demonstrated that there were, indeed, compatibility problems between simplified adhesive systems and self- or dual-cured resin composites. Apparently, when such combinations are used, reduced bond strengths and subsequent failures at the resin-adhesive interface can occur because of adverse reactions between the acidic resin monomers, an integral part of the simplified adhesive systems, and the chemicals involved in the polymerization mechanism of the self- or dual-cured composites, particularly the basic tertiary amines. At least one research group has expanded the information on this issue by further investigating the mechanisms involved in this phenomenon. This group demonstrated that not only adverse chemical reactions but also the permeability of such simplified systems contribute to the compromised bonding. This issue has profound clinical implications in view of the wide use of self- and dual-cured composites as core buildup materials and in the bonding of indirect restorations and endodontic posts. Some of the most representative studies of this group are described in this Critical Appraisal. Part II will appear in the next issue of the Journal.

Adhesive-composite incompatibility, part II.

Apart from some questions related to the repairability of resin composite restorations, dentists have always assumed that methacrylate-based resins are compatible with each other. For example, there is no clinically relevant problem in using a microfilled composite to laminate a Class IV restoration made with a hybrid composite, even if they are not of the same brand or manufacturer. In the context of adhesive systems, we have always believed that resin composites, regardless of their type or composition, bond well to all types of bonding agents. However, unexpected debonding of self-cured, core buildup composites that had been bonded with single-bottle adhesive systems was reported about 5 years ago. Subsequent studies demonstrated that there were, indeed, compatibility problems between simplified adhesive systems and self- or dual-cured resin composites. Apparently, when such combinations are used, reduced bond strengths and subsequent failures at the resin-adhesive interface can occur because of adverse reactions between the acidic resin monomers, an integral part of the simplified adhesive systems, and the chemicals involved in the polymerization mechanism of the self- or dual-cured composites, particularly the basic tertiary amines.