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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 15  |  Issue : 3  |  Page : 353-357

Evaluation of the bond strength of reattached incisal fragments using different techniques: An In vitro study


1 Department of Conservative Dentistry and Endodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi(M), Wardha, Maharashtra, India
2 College of Dentistry, Jazan University, Jazaan, Saudi Arabia

Date of Submission14-Apr-2019
Date of Decision30-Apr-2020
Date of Acceptance30-May-2020
Date of Web Publication1-Feb-2021

Correspondence Address:
Dr. Ankita Rajurkar
Shivaji Chowk, Near Santoshi Mata Mandir Road, Wardha - 442 001, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_71_19

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  Abstract 


Aim: The aim of this study is to compare the bond strength of fractured teeth reattached using four different techniques, i.e., simple reattachment, overcontour, internal dentinal groove, and enamel bevelling using nanohybrid resin composite. Materials and Methods: A total of eighty extracted permanent maxillary central incisor teeth was used in this study. Sample was uniformly divided into four groups, i.e., (n = 20). Group I: Fracture teeth reattached with a simple technique. Group II: Fracture teeth reattached with overcontouring technique. Group III: Fracture teeth reattached with the internal dentinal groove technique. Group IV: Fracture teeth reattached with enamel bevelling technique. After the fracture teeth reattachment, the specimens were mounted on a custom-made fixture and were kept in saline till the specimens were subjected to the bond strength testing. The universal testing machine was used for the determination of bond strength. One-way ANOVA test was used to analyze the data and post hoc test was used for comparing (testing) three or more means (groups or variables) for statistical significance. SPSS 17.0 version was the software used in this analysis, and the level of significance was set at P = 0.002. Results: Highest bond strength was seen with Group II (reattached with overcontour technique) (9.04 ± 4.94) followed by Group III (inter-dentinal groove technique) group (8.04 ± 2.48), then Group IV (enamel bevelling technique) (5.87 ± 3.77), and least bond strength was with Group I (simple reattachment) (5.17 ± 1.59). Conclusion: Overcontour fracture reattachment technique displayed significantly higher bond strength as compared to simple reattachment, internal dentinal groove, and enamel bevelling techniques.

Keywords: Enamel bevelling, fracture reattachment, internal dentinal groove, nanohybrid composite resin, overcontour, simple reattachment, uncomplicated coronal fracture


How to cite this article:
Rajurkar A, Chandak M, Nikhade P, Patel A, Taheri A, Bhongade S. Evaluation of the bond strength of reattached incisal fragments using different techniques: An In vitro study. J Datta Meghe Inst Med Sci Univ 2020;15:353-7

How to cite this URL:
Rajurkar A, Chandak M, Nikhade P, Patel A, Taheri A, Bhongade S. Evaluation of the bond strength of reattached incisal fragments using different techniques: An In vitro study. J Datta Meghe Inst Med Sci Univ [serial online] 2020 [cited 2021 Feb 25];15:353-7. Available from: http://www.journaldmims.com/text.asp?2020/15/3/353/308575




  Introduction Top


A smile is one of the most defining features of many individual's life. It can diminish stress, make you more attractive and also includes the functional aspect of teeth-like mastication and the presence or absence of pain and hypersensitivity.

Dental traumatic injuries have a severe impact on the social and psychological well-being of a person. The etiology of traumatic dental injuries includes variable factors such as oral factors (e.g., overjet), environmental factors (e.g., material deprivation), and human behavior (e.g., risk-taking), which can be further separated into unintentional and intentional traumatic dental injuries. Domestic violence (child, spouse, or elder abuse) is an example of an intentional injury, while accident during sporting events are usually considered unintentional injuries.[1],[2]

Three percent to 39% of all the dental injuries occur in sports-related activities. 20% to 25% of all the dental injuries are fight and assaults related.[3] The injuries due to fall or collision are generally characterized by a high frequency of coronal fracture, which frequently occurs in school-going children, commonly during normal activities such as playing. Dental injuries have a greater predilection during the school years, around 59% of falls occurred in indoor activities, and 41% in out-of-door activities. Automobile is causative in 10.8% of cases of traumatic dental injuries and bicycle/motorcycle accidents are causative in 12%. With the advent of mandatory seat belt usage, many of these injuries may be prevented, or at least minimized. Oral traumas make up to 5% of all injured parts of the body of all ages while in the age group of 0–6 years it comprises about 17%.[4]

Coronal fracture of enamel and dentin, without pulp involvement, is the most common type of dental injury.[5] In the permanent dentition, among all the tooth injuries, crown fracture comprises about 26%–76% root fractures occur in about 0.5%–7% of all injuries.[6]

Different treatment modalities have been developed for restoration of fractured tooth structure, such as resin or ceramic crowns, orthodontic bands, resin composite restorations with and without pin, veneers, and laminates.[7] Considering the pros and cons of different treatment options for uncomplicated crown fractures, fragment reattachment is one of the chosen treatment modality used currently.

There are different techniques used for reattachment of the fractured tooth-like simple reattachment different bevel designs, enamel bevelling, V-shaped internal enamel groove, internal dentinal groove, external chamfer, over-contour, etc.Among these, simple reattachment technique, overcontour, internal dentinal groove, and enamel bevelling techniques are commonly used techniques for fracture reattachment in recent clinical practice.

This in vitro study was carried out with the aim to compare the bond strength of fractured teeth reattached using four different techniques, i.e., simple reattachment, overcontour, internal dentinal groove, and enamel bevelling using nanohybrid resin composite.


  Materials and Methods Top


Eighty extracted permanent maxillary central incisor teeth were used for the present study. Immediately after extraction, the teeth's were washed under running tap water, cleaned of any attached tissue, and were stored in distilled water until further use, following the OSHA guidelines. Teeth were sectioned at the mesial-incisal proximal edge 3 mm from the incisal edge in labiolingual direction with handpiece in low speed (<15000 rpm). The remnant and fragments were matched and stored at room temperature in distilled water for no longer than 48 h. Eighty permanent anterior teeth were uniformly divided into four groups, i.e., (n = 20) [Figure 1].
Figure 1: Fracture teeth reattachment with simple technique (a), overcontour (b), internal dentinal groove (c), and enamel bevelling technique (d)

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Group I: Fracture teeth reattachment with simple technique

In this sectioned fragment of teeth directly reattached without any additional preparation.

The sectioned fragment was reattached using one-step adhesive and nanohybrid resin composite.

Group II: Fracture teeth reattachment with over-contouring technique

In this group, the tooth was prepared 2.5 mm coronally and apically from the fracture line at a depth of 0.3 mm, on the buccal surface using straight fissure carbide bur. The areas were then treated with one step adhesive and nanohybrid resin composite.

Group III: Fracture teeth reattachment with internal dentinal groove

In this technique, a 1 mm deep and wide groove was placed within the fragment and remaining tooth by means of round carbide bur, then the tooth was restored with one step adhesive and nanohybrid resin composite.

Group IV: Fracture teeth reattachment with enamel bevelling

This technique was performed only on the lingual surface with 45° angulation using carbide bur. The sectioned fragment was reattached using one-step adhesive and nanohybrid resin composite.

After the fracture teeth reattachment, the specimens were mounted on custom-made fixture and it was kept in saline till the specimen was subjected to the bond strength testing to prevent it from dehydration that might alter the microhardness of the teeth. The universal testing machine was used for the determination of bond strength. The specimens were mounted on custom-made fixture. Knife-edge chisel, which was 0.5 mm in cross-section was used to deliver the fore so that contact was achieved 2 mm from the incisal edge. The crosshead speed of 1 mm/min shearing load was applied. The force was noted, and bond strength was calculated and recorded in kilogram-force unit (Kgf).

Ethical clearance

The Institutional Ethics Committee of DMIMSDU has approved the Research work proposed to be carried out at Sharad Pawar Dental College, Sawangi(M), Wardha. Date: 1st Jan 2017 with Reference no DMIMS(DU)/IEC/2017/1.


  Results Top


The data so obtained were subjected to statistical analysis. Group comparison was performed using one-way ANOVA and post hoc test to analyze the mean bond strength among various fracture tooth reattachment techniques. P < 0.05 was used to determine significance.

[Table 1] and [Table 2] show that Group I had minimum bond strength amongst all groups, and the difference was statistically highly significant with Group II and Group III and P = 0.002 (P < 0.05). Group I also showed lower bond strength comparable to Group IV, but the difference was not statistically significant.
Table 1: Comparison of mean bond strength in all the four groups by one-way ANOVA

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Table 2: Inter-group comparison of bond strength by Post-hoc test

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Group II showed maximum bond strength as compared to Group I, III, and IV and the difference was statistically significant with Group I and Group IV with P = 0.002 (P < 0.05), whereas the difference between Group II and Group III was not statistically significant.

Table 1 shows that highest bond strength in the overcontour group (9.04 ± 4.94) followed by the inter dentinal group (8.04 ± 2.48), enamel bevelling (5.87 ± 3.77), and the least was in simple reattachment (5.17 ± 1.59) All these differences were statistically significant (P < 0.05).

[Graph 1] showed that the over-contour fracture reattachment technique showed the highest bond strength (9.04 Kgf) and the simple reattachment group showed the lowest bond strength (5.17 Kgf) among all the four groups.




  Discussion Top


Traumatic dental injury is one of the factors that affect the healthy individual smile. Epidemiological investigations stated that the incidence of fractured teeth varies greatly depending on the population under study with regard to age, sex, and the fracture classification system utilized. Gutz in 1971 reported a significant high frequency of coronal fracture, around 20.24% of all fractures.[8] Zadik et al. in 1972 reported one of the largest studies to date, he examined 10,903 patients and found 8.7% prevalence of fractured anterior teeth.[9]

Fracture reattachment offers conservative, aesthetic, cost-effective, and less time-consuming treatment modality as compared to composite restoration or full coverage restorations.[10]

Recent advances in the material sciences and nanotechnology have led to the development of superior nano-composite materials. These are modified composite resins in which the basic organic matrix has been reinforced with nanofillers. The use of nano-composite resins allows for a better nano-bonding interface between the tooth structure and the restorative material resulting in a more stable and natural interface. Nanocomposites possess a much larger volume of the nanometric filler particles in the resin matrix, resulting in improved physical, chemical, and biological properties.[11]

In dentistry, Tennery in 1978 was the first to report the fractured segment reattachment using the acid-etching technique in five patients.[12] Four out of his five patients were considered successful, while one patient had reported with additional trauma due to which it was not possible to reattach the fragments.

In the present study, the over-contour reattachment technique showed the highest bond strength in comparison to all other techniques, whereas the simple reattachment technique showed the least bond strength among all.

The results of the present study are in accordance with Reis et al. in 2001,[13] Pusman et al. 2010[14] and Srilatha et al. 2012,[15] Kumar and Maria 2013,[16] Abdulkhayum et al. 2014.[17]

Reis et al. in 2001 stated that a simple reattachment with no further preparation of the fragment or tooth could restore only 37.1% of the intact tooth's fracture resistance and with an over-contour, it restore 97.2% of the intact tooth's fracture resistance.[13]

The tooth fragment reattachment with overcontour technique more fracture strength recovery obtained as compared to simple reattachment technique because in simple reattachment technique there is no enlargement of adhesion area.

The overcontour fracture reattachment is attributed to the enlargement of adhesion area provided by tooth preparation around the fracture site. The greater extension of material on the surface, better force distribution over a large enamel area. When simple reattachment technique was compared with inter dentinal groove technique, it showed lower bond strength comparable to inter dentinal groove, which was statistically significant.

Reis et al. in 2001 stated that the inter dentinal groove restored 90.5% of the intact tooth's fracture resistance.[13]

The results of the present study are in accordance with Pusman et al. 2010,[14] Srilatha et al. 2012,[15] Kumar and Maria 2013,[16] Abdulkhayum et al. 2014,[17] Agrawal et al. 2017,[18] Beltagy in 2018.[19]

The internal dentinal groove had the highest fracture resistance. The internal dentinal groove provides more fracture strength and the highest esthetic durability. It is liable that the greater adhesion area and permeability of internal resin bar, which acts as an opponent to the compression load applied on the buccal surface could be responsible for the superior results obtained in this reattachment technique.

When simple reattachment technique was compared to enamel bevelling technique, it showed lower bond strength comparable to enamel bevelling technique, but no statistically significant difference was found between simple reattachment and enamel bevelling.

These results of the present study are in accordance with Jeffrey et al. 1986.[20]

Jeffrey et al. in 1986 found no statistically significant difference in shear bond strength in tooth fragment, which was reattached using a bevel and when reattached without preparing either the fragment or the tooth.[20]

In the present study, when the over-contour technique was compared to the inter dentinal groove technique it showed higher bond strength comparable to the inter dentinal groove technique, but there was no statistically significant.

This result of the present study is in accordance with Loguercio et al. 2004.[21]

When the overcontouring technique was compared to the enamel bevelling technique, it showed higher bond strength, which is statistically significant comparable to the enamel bevelling technique. The overcontour technique provides more surface area for adhesion. The greater extension of material on the adhesion surface provides better force distribution over a large enamel surface.

When inter dentinal groove technique was compared to enamel bevelling technique, it showed higher bond strength comparable to enamel bevelling technique. The internal dentinal groove technique of fracture reattachment shows more fracture resistance due to the internal dentinal groove that may provide more fracture strength and greater adhesion area.

This is an in vitro study; therefore, it is possible that the inferences from the study might not co-relate completely with a similar situation clinically, which needs to be evaluated.[22],[23],[24],[25],[26],[27]


  Conclusion Top


The management of uncomplicated coronal fracture with fracture reattachment techniques offers several advantages over earlier techniques which include; the patient's tooth appears more natural than any composite restoration, the translucency of the natural tooth will be restored and also the incisal edge will wear in unison with the adjacent teeth. When directly compared with the simple reattachment, internal dentinal groove, and enamel bevelling technique; the overcontour fracture reattachment technique displayed significantly higher bond strength as compared to other fracture reattachment techniques.

Recommendation

The information gained from this study fracture tooth reattachment with over-contour technique is recommended for the management of uncomplicated coronal fracture teeth.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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