Direct Restorations: Class IV composite.
Reattaching tooth fragment
Before and after: click to magnify
Slide show: Class IV composite. Reattaching tooth fragment.
This slide show demonstrates reattachment of a tooth fragment. The fragment will usually be dehydrated, and appear very white before rebonding, but this whiteness normally disappears quickly after it has been placed and contacts saliva.
Some authorities suggest placing the fragment in saline first so it can rehydrate the fracture line, which will be slower to rehydrate naturally as it is covered once in position.
An option is to drill a channel along the fracture line, using a round diamond bur once it is reattached and filling the gutter with some composite to reduce the refraction effects of the enamel/composite/enamel sandwich at the fracture.
This can be placed in slight excess (i.e. a small convexity) so that it can be polished as and when it stains (as composites do) without touching the fracture line. This can be done immediately, or - more conservatively - in the future if a "dark line" aesthetic problem appears.
Here's a picture of this tooth 2 years post-repair: the join was un-noticeable with normal viewing.
Click the image to magnify it.
How reliable are vitality tests following trauma?
How long can it take before a negative vitality test can be considered reliable?
What are the possible long-term consequences of trauma as in this case?