The fragment reattachment technique, commonly referred to as the Collage technique in Latin American dentistry, represents a minimally invasive and biomimetic approach for the management of uncomplicated and complicated crown fractures.
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PDF 🔽 Guidelines for the management of traumatic dental injuries in the primary dentition ... We share an article that does not offer different recommendations for the diagnosis and treatment of traumatic injuries in the primary dentition.This technique prioritizes preservation of natural tooth structure, optimal esthetics, and functional recovery by adhesively reattaching the patient’s own tooth fragment. In English-speaking countries, this procedure is well documented under terms such as tooth fragment reattachment and adhesive fragment reattachment, particularly in dental traumatology and pediatric dentistry.
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✅ Introduction
Dental trauma frequently results in crown fractures affecting anterior teeth, especially in children and young adults. Traditional restorative approaches often involve composite resin build-ups or indirect restorations. However, contemporary dentistry emphasizes conservative, tissue-preserving strategies.
The fragment reattachment technique aligns with these principles by utilizing the fractured tooth fragment as the definitive restorative material, ensuring superior esthetic integration and biomechanical compatibility.
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The success of this technique relies on several core concepts:
▪️ Biomimetic restoration, maintaining natural enamel and dentin architecture
▪️ Adhesive dentistry principles, ensuring durable bonding
▪️ Minimal intervention, avoiding unnecessary tooth reduction
▪️ Optical continuity, preserving natural translucency and surface texture
The reattachment of the original fragment provides unmatched esthetic outcomes compared to synthetic restorative materials.
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The fragment reattachment technique is indicated in cases of:
▪️ Uncomplicated crown fractures (enamel–dentin)
▪️ Complicated crown fractures with pulp exposure (combined with vital pulp therapy)
▪️ Traumatic injuries where the fragment is intact and retrievable
▪️ Patients seeking highly conservative treatment options
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1. Fragment Preservation
Immediately after trauma, the fragment should be stored in saline solution, milk, or distilled water to prevent dehydration.
2. Clinical and Radiographic Assessment
Evaluate fracture pattern, pulp involvement, periodontal status, and occlusion using periapical radiographs.
3. Isolation
Achieve strict rubber dam isolation to ensure moisture control and adhesive success.
4. Fragment and Tooth Preparation
▪️ Clean both surfaces with pumice
▪️ Perform minimal beveling if indicated to increase bonding surface
▪️ Avoid excessive preparation to maintain structural integrity
5. Adhesive Protocol
▪️ Etch enamel and dentin using phosphoric acid
▪️ Apply adhesive system following manufacturer instructions
▪️ Use light-cured resin cement or flowable composite
6. Fragment Reattachment
Position the fragment accurately, remove excess material, and light cure thoroughly from multiple angles.
7. Finishing and Polishing
Refine margins, adjust occlusion, and polish to restore natural morphology and gloss.
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Clinical studies demonstrate that fragment reattachment offers favorable long-term outcomes when compared to direct composite restorations. Advantages include reduced chair time, superior esthetics, and preservation of tooth vitality. However, success is technique-sensitive and depends on adhesive quality, fragment condition, and occlusal control.
In English-language literature, this approach is consistently framed within conservative and biomimetic dentistry paradigms, reinforcing its validity and widespread clinical acceptance.
✍️ Conclusion
The fragment reattachment technique is a scientifically supported, conservative solution for managing crown fractures following dental trauma. Recognized globally under different terminology, it remains a gold-standard option when fragment integrity and clinical conditions permit.
🎯 Recommendations
▪️ Always prioritize fragment preservation at the trauma site
▪️ Employ strict adhesive protocols and rubber dam isolation
▪️ Combine with vital pulp therapy when indicated
▪️ Educate patients on post-operative care and trauma prevention
📚 References
✔ Andreasen, J. O., Andreasen, F. M., & Andersson, L. (2018). Textbook and color atlas of traumatic injuries to the teeth (5th ed.). Wiley Blackwell.
✔ Macedo, G. V., Diaz, P. I., De O. Fernandes, C. A., & Ritter, A. V. (2008). Reattachment of anterior teeth fragments: A conservative approach. Journal of Esthetic and Restorative Dentistry, 20(1), 5–20. https://doi.org/10.1111/j.1708-8240.2008.00134.x
✔ Reis, A., Francci, C., Loguercio, A. D., Carrilho, M. R., & Rodrigues Filho, L. E. (2004). Re-attachment of anterior fractured teeth: fracture strength using different techniques. Operative Dentistry, 29(5), 528–533.
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