Journal of Mahatma Gandhi University of Medical Sciences and Technology
Volume 7 | Issue 3 | Year 2022

Reattachment of Maxillary Central Incisor Using Laser Crown Lengthening and Prefabricated Fiber Post: A Case Report on Preserving the Natural

Avneet Kaur1, Harshit Srivastava2, Deepak Raisingani3, Ashwini B Prasad4, Prachi Mital5, Deeksha Khurana6

1–6Department of Conservative Dentistry and Endodontics, Mahatma Gandhi Dental College and Hospital, Jaipur, Rajasthan, India

Corresponding Author: Avneet Kaur, Department of Conservative Dentistry and Endodontics, Mahatma Gandhi Dental College and Hospital, Jaipur, Rajasthan, India, Phone: +91 9079494046, e-mail:

Received on: 15 February 2023; Accepted on: 13 March 2023; Published on: 16 September 2023


Aim: To reattach the Fractured Maxillary Central Incisor using a laser crown lengthening procedure and a fiber post.

Background: Anterior crown fractures are a frequent type of traumatic dental injuries that mostly affect the maxillary incisors, and their aftereffects can make it difficult to create and carry out an effective treatment strategy. Reattaching the fractured component itself is one of the therapeutic techniques. Fragment reattachment is a minimally invasive and reasonably priced treatment technique that can quickly restore form and function in crown-root instances. Due to its simplicity, natural esthetics, and long-lasting beauty due to the preservation of the original morphology, color, and surface texture, it ought to be the first option and a viable alternative to conventional procedures.

Case description: A 25-year-old male patient came to the Department of Conservative Dentistry and Endodontics with fractured segment. Patient was given local anesthesia, the fractured segment was removed and placed in normal saline. Straight line access was prepared and sectional obturation was done. Then, laser crown lengthening was done to expose the fractured margin, post space was prepared, and bevelling was done on remaining tooth structure. Finally, prefabricated fiber post and the tooth fragment were luted with dualcure resin cement.

Conclusion: An easy and effective method for treating fractured anterior teeth is tooth fragment reattachment following crown lengthening using the original tooth fragment and a fiber-reinforced post. It seems to provide the best possible functional and esthetic results.

Clinical significance: If the fractured segment is available, then reattachment seems to be a conservative and viable option.

How to cite this article: Kaur A, Srivastava H, Raisingani D, et al. Reattachment of Maxillary Central Incisor using Laser Crown Lengthening and Prefabricated Fiber Post: A Case Report on Preserving the Natural. J Mahatma Gandhi Univ Med Sci Tech 2022;7(3):87–90.

Source of support: Nil

Conflict of interest: Dr Deepak Raisingani is associated as the Editorial Board member of this journal and this manuscript was subjected to this journal’s standard review procedures, with this peer review handled independently of this editorial board member and his research group.

Patient consent statement: The author(s) have obtained written informed consent from the patient for publication of the case report details and related images.

Keywords: Complicated crown fracture, Dental trauma, Fiber post, Tooth reattachment


In the dentistry profession, tooth fractures are frequently reported as emergencies. They can range in severity from a minor fracture of the enamel to a total tooth avulsion. The most frequent cause of tooth loss among these traumas is likely to be crown-root fractures. Treatment depends on the severity and location of the tooth fracture line, the accessibility of displaced tooth fragments, the kind of occlusion, and the prognosis.1,2

If the fragments are available, reported early, and in a clean, hydrated state, reattachment of the tooth fragment is the most biologically sound treatment for crown-root fractures.3 This method is an effective substitute for the usual procedure with little to no violation of biological width.4 It is a straightforward, cost-effective method of functional rehabilitation that can also produce good, long-lasting esthetics.5,2

Fiber-reinforced posts can be used for reattachment because of their adhesive and elastic qualities, which increase the retention of shattered crown segments and reduce the risk of root fracture.1 For the reattachment of tooth pieces, clinicians have used a variety of bevel designs, chamfers, dentinal and enamel grooves, and options of resin composite materials and procedures.6 An envelope flap can aid in achieving the appropriate isolation and visibility in cases of subgingival fractures.1 In this paper, a coronal tooth fracture is described that was effectively repaired with prefabricated fiber posts and laser crown lengthening.


The main complaint of a 25-year-old male patient who visited the department of conservative dentistry and endodontics was pain and movement in the area of the top front teeth. The patient described trauma that occurred 1 week prior as a result of a car accident. His medical history wasn’t relevant. There was no evidence of soft tissue injuries upon extra and intraoral inspection. Upon clinical examination, it was discovered that the maxillary left central incisor had an oblique crown fracture that started in the cervical third of the crown labially (Fig. 1) and extended subgingivally on the palatal side (Fig. 2). The depth of the probing was normal, and there was no concomitant soft tissue damage to the teeth. Regarding tooth number 21, a complex crown fracture diagnosis was made. Treatment by reattachment was described to the patient because the fracture fragment was partially attached to the gingiva in the oral cavity and showed no signs of dehydration. Consent was obtained.

Fig. 1: Preoperative view showing fractured tooth

Fig. 2: Preoperative radiograph

A local anesthetic was administered using 2% lidocaine and 1:80000 adrenaline. Forceps were used to remove the fractured fragment without causing any harm (Fig. 3). On removing the fragment, the subgingival extent of the fracture was confirmed (Fig. 4). To eliminate any pulpal tissue, the tooth fragment was thoroughly cleaned with 2% sodium hypochlorite. It was then kept in normal saline until reattachment to prevent discoloration and dehydration. Since the patient presented several days after the incident, it was unable to preserve the tooth’s vitality. Therefore, 21 received a single-visit root canal treatment.

Fig. 3: Removal of the fragment

Fig. 4: Buccal and palatal view

Using an endo access bur number two, an access cavity with straight-line access was prepared (Dentsply Maillefer, Switzerland). Using the Root ZX II Apex locator and a 10K file from Dentsply Maillefer in Switzerland, the working length was established before radiographic confirmation. Using a 15% ethylenediaminetetraacetic acid (Glyde, Dentsply Maillefer, Ballaigues, Switzerland) solution, cleaning and shaping were carried out using the ProTaper Universal rotary file system (Dentsply) up to F3 in a crown-down manner. Each instrument was irrigated with 2.5% sodium hypochlorite (Medilise Chemicals, Kannur, Kerala, India) and lots of saline. With the aid of paper tips, the root canal was dried, and sectional obturation was carried out using gutta-percha and AH Plus sealer (Dentsply).

In order to expose the fractured margin, crown lengthening using a laser (Biolase) was done because the fracture line was subgingivally on the palatal side. (Figs 5 and 6). Peso reamers #1 and #2 were used to prepare the postspace (Fig. 7). In the canal, fiber post #2 (Reforpost, Angelus) was tested and lengthened if required. The fragment’s shattered border, as well as the remaining tooth structure, were all beveled. Acid was used to etch and bind the prepared postspace. After that, the post was luted with dual-cure resin cement (Multilink, Ivoclar, Vivadent), with the coronal section of the cement extending 2 mm into the chamber (Fig. 8). Resin cement was used to reattach the tooth fragment. Occlusion was examined at the end, and the patient received postoperative instructions. A postoperative radiograph was obtained immediately (Figs 9 and 10). Aftera month, clinical and radiographic examinations showed that the crown fragments had been securely reattached.

Fig. 5: Bleeding points marked

Fig. 6: Laser crown lengthening performed

Fig. 7: Postspace prepared

Fig. 8: Fiber post placed with dualcure luting cement

Fig. 9: Postoperative radiograph

Fig. 10: Postoperative view after the fragment has been reattached


Due to its prevalence, negative effects on monetary output, and detrimental effects on quality of life, dental trauma (DT) is a serious public health issue. The incidence of DT, which primarily affects children and schoolchildren (8–11 years old), ranges from 7.4 to 58%. The maxillary incisors, both permanent and deciduous, are typically the teeth most frequently affected. The most frequent type of damage in the permanent dentition is an uncomplicated crown fracture, and success rates can vary depending on the severity of the trauma and its underlying causes.7,8

This case report’s reattachment procedure is simple because it uses a fairly conservative approach to restore function and esthetics. With the materials readily available today, predictable results can be achieved in terms of appearance. Case studies and clinical observations demonstrate that reattaching tooth pieces yields positive short and medium-term benefits.9

The predictable restoration of fractured teeth is now possible owing to recent advancements in restorative materials, implantation methods, preparatory designs, and adhesive protocols. Adhesive dentistry has made fragment reattachment easier and more dependable while also enabling dentists to use the patient’s own fragment to repair the damaged tooth.7

The best approach to restore the morphological, practical, and esthetic features of the dentition when the tooth fragment is intact is fragment reattachment. It will not only retain the natural teeth’s shape, contour, texture, color, and alignment, but it will also be a quick, affordable option that will boost the patient’s mood.10,11 According to Cavalleri and Zerman, reattached crown fragments appear to have a better long-term outlook than composite resin restorations.12

The pulp vitality and stage of root growth or resorption determine the type of treatment. Root canal treatment followed by reattachment of the fractured segment with fiber postreinforcement is a viable alternative in complex fractures. Postsystems are typically advised for fractures encompassing at least two-thirds of the crown. The tooth-colored fiber post was deemed to be the best option out of the large range of post systems available because of its esthetics, strong bonding between the post and cement, shorter chairside times, and the need for minimal tissue removal.13

For reattachment procedures, a wide range of intervention approaches are available. Some strategies for reattaching fragments use bonding without any kind of surface preparation on the surfaces of the surviving tooth or fragment. The name of this method is simple reattachment.13 Several reattachment methods have been proposed for reattaching a tooth fragment, including:

Reattachment success is influenced by a number of aspects, such as the amount of time since the trauma, the location and size of the fracture, pulpal involvement, the stage of root development, periodontal health, invasion of biological width, type of post, and reattachment material.16

Compared to metal posts, fiber-reinforced posts have a number of benefits. Their main advantages include being passive, tooth-colored, more flexible than metal posts, and having an elasticity modulus that is similar to dentin. Since resin cement makes use of surface irregularities to improve the surface area for adhesion, they only require minimal preparation. Reattaching the fractured piece of the crown using the fiber-reinforced resin post-bonded into the root canal improves retention. Due to the combination of elastic and adhesive properties, it boosts fracture resistance. As a result, tooth and post flex and move together, guaranteeing optimal stress distribution.16

According to Reis et al., the procedure of reattachment has a greater impact on the fracture strength of the reattached teeth than the reattachment materials themselves.15 As a result of dentin’s lower elastic modulus compared to metal posts, catastrophic root fractures are common. This causes root dentin to experience hazardous, nonhomogeneous stresses. On the other hand, fiber post better safeguards the integrity of the root. Root strain is similar to that on an intact tooth due to the dentin’s lower modulus of elasticity. In addition, glass fiber posts are esthetically pleasing, biocompatible, and do not discolor at the gingival margin.13

Natural tooth material eliminates issues with uneven wear of restorative materials, mismatched colors, and trouble reproducing shape and texture that is common with conventional restorative procedures.14

This case report showed how an intricate crown fracture was effectively managed cosmetically. The approach used to treat crown-root fractures, which involves gluing the broken pieces of the tooth together with fiber posts and resin, protects the healthy dental structure and restores lost tooth structure.2


An easy and effective method for treating fractured anterior teeth is tooth fragment reattachment following crown lengthening using the original tooth fragment and a fiber-reinforced post. It seems to provide the best possible functional and esthetic results.


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