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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 9  |  Issue : 4  |  Page : 233-236

Comparison of the effect of various storage media on the fracture resistance of the reattached incisor tooth fragments: An in vitro study


1 Department of Pedodontics and Preventive Dentistry, Bharati Vidyapeeth Dental College, Navi Mumbai, Maharashtra, India
2 Department of Pedodontics and Preventive Dentistry, Bharati Vidyapeeth Dental College and Hospital, Navi Mumbai, Maharashtra, India

Date of Web Publication1-Dec-2017

Correspondence Address:
Swati Jagannath Kale
A-Wing, 704, Giriraj Horizon, Sector - 20, Kharghar, Navi Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJDS.IJDS_70_17

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  Abstract 

Background: Fragment reattachment is a conservative and a valid alternative compared to direct composite. Aim: The aim of this study is to assess and compare effect of storage medium on the fracture resistance of the reattached tooth fragments stored in dry conditions for 1, 6, and 24 h, in milk for 1, 6, and 24 h, and in saline for 1, 6, and 24 h. Materials and Methods: A total of 72 freshly extracted human permanent maxillary central incisors were fractured intentionally using a low-speed diamond disk along, and saline was used as a coolant. The fractured fragments were stored in dry conditions, milk, and saline. The fragments were then reattached to respective apical parts and subjected to thermocycling, followed by fracture resistance test using universal testing machine at the speed of 1 mm/min and were recorded in newtons (N). Results: It was observed that fracture resistance of 43.846 ± 11.363 N was required for fragment stored in dry storage media at 24 h, for milk, fracture resistance of 97.363 ± 47.739 N was observed at 24 h, and for fragments stored in normal saline, it was 162.856 ± 93.932 N at 24 h. Conclusion: In the present study, the highest fracture resistance was observed for fragments stored in saline for 24 h, followed by milk for 24 h and then dry storage. The fragments stored in milk exhibited higher fracture resistance than the fragments stored in a dry environment. Therefore, milk can be considered as an interim storage media as it maintains hydration of fragment.

Keywords: Dry conditions, fractured fragments, milk, saline


How to cite this article:
Hegde RJ, Kale SJ. Comparison of the effect of various storage media on the fracture resistance of the reattached incisor tooth fragments: An in vitro study. Indian J Dent Sci 2017;9:233-6

How to cite this URL:
Hegde RJ, Kale SJ. Comparison of the effect of various storage media on the fracture resistance of the reattached incisor tooth fragments: An in vitro study. Indian J Dent Sci [serial online] 2017 [cited 2017 Dec 11];9:233-6. Available from: http://www.ijds.in/text.asp?2017/9/4/233/219628


  Introduction Top


Trauma to the anterior teeth is common among children and adolescents.[1] The traditional conservative treatment of crown fractures has been restoration with composite resin and dental bonding system. With the development of adhesive dentistry, came the concept of “fragment reattachment.”[2] If the crown fragment is retrieved at the time of injury, its reattachment provides several advantages over other forms of restoration.[3] The numerous benefits of this technique with regard to both patient and dentist have made it a treatment of choice, especially in children.[2] The successful reattachment of the crown fragment is dependent upon the crown fragment retrieval at the time of injury.[3] Some researchers also explain less chairside time needed for reattachment rather than composite resin construction.[4] The detached fragment should be immediately recovered after the trauma and rapidly placed in a preserving medium to avoid dehydration and discoloration.[5] No studies have yet been reported on the types of storage media, for example, saliva, water, milk, or normal saline in which parents should store the fractured parts before referring to the dentist like as in case of avulsion.[6] The present study was, therefore, carried out with the aim to evaluate the effect of various storage media on the fracture resistance of reattached incisor tooth fragments at different time intervals.


  Materials and Methods Top


A total of 72 permanent human maxillary central incisors, extracted for periodontal reasons, were selected. Each tooth was cleaned by ultrasonic scaler tips. Teeth were disinfected using 0.2% thymol and then stored in distilled water until the experimentation.[7]

The intentional fracture was done by sectioning the tooth 3 mm away from the incisal edge of the tooth using a low-speed diamond disk perpendicular to the long axis using saline as a coolant, followed by storage of the fractured fragments separately marked with appropriate storage medium (dry environment, milk, and saline) for the time intervals of 1, 6, and 24 h.

Following groups were made:

  • Group A: The fractured fragments stored in dry environment


    • Subgroups A1, A2, and A3 fragments stored for 1, 6, and 24 h, respectively


  • Group B: The fractured fragments stored in milk


    • Subgroups B1, B2, and B3 fragments stored for 1, 6, and 24 h, respectively


  • Group C: The fractured fragment stored in normal saline


    • Subgroups C1, C2, and C3 fragments stored for 1, 6, and 24 h, respectively.


Fragments were reattached by means of simple reattachment technique without any additional preparation.[2] Before reattachment, the fragment was removed from respective storage media, rinsed with distilled water for 10 s, and dried with paper towel. Both the surfaces of the tooth fragment were etched using 37% phosphoric acid (3M ESPE scotchbond) for 15 s and then rinsed with distilled water for 10 s, followed by air drying for 5 s. Two coats of bonding agent (3M ESPE Adper Single) were applied, and then, the surfaces were dried for 5 s using an air syringe to allow solvent evaporation. The bonding agent was light cured for 20 s in the fractured fragment and 20 s in the tooth remnant. The flowable composite (3M Filtek) of matching shade was applied on the fractured surface of fragment, and tooth remnant was reattached. The fragments were approximated together and light cured for 10 s on mesial, distal, buccal, and lingual sides each. The samples were then mounted on acrylic blocks. This was followed by 100 cycles of thermocycling at 5°C–55°C with dwell time of 15 s and transfer time of 10 s. All samples were then subjected to fracture resistance test using universal testing machine at the speed of 1 mm/min. The data were presented using descriptive statistics such as mean and standard deviation. The further statistical analysis was performed using statistical tests such as repeated measure ANOVA and one-way ANOVA. The level of significance was set at 5%. All P < 0.05 were treated as significant.


  Results Top


It was observed that a minimum fracture resistance of 43.846 ± 11.363 N was required for fragments stored in dry condition at 24 h and highest fracture resistance of 162.856 ± 93.932 N was observed for fragments stored in saline at 24 h [Table 1]. [Table 2] shows multiple comparisons using least significant difference (LSD) test at 1 h; the result indicates no statistically significant difference between milk and dry medium (P = 0.209) and milk and saline medium (P = 0.069). However, a statistically significant difference was observed between dry and saline group (P = 0.004). [Table 3] shows multiple comparisons using LSD test at 6 h; the result indicates no significant difference between milk and dry environment (P = 0.193) and milk and saline medium (P = 0.245). However, a statistically significant difference was observed between dry and saline group (P = 0.019). [Table 4] shows multiple comparisons using LSD test at 24 h; the result indicates no statistically significant difference between milk and dry environment (P = 0.095). A significant difference was observed between dry and saline (P = 0.001) and milk and saline medium (P = 0.044).
Table 1: Mean fracture resistance for different storage media at various time intervals

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Table 2: Multiple comparisons of various storage media at 1 h

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Table 3: Multiple comparisons of various storage media at 6 h

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Table 4: Multiple comparisons of various storage media at 24 h

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  Discussion Top


Fragment reattachment can be considered a biologically viable option which not just meets the current expectations but is minimally invasive as well.[8]

According to a study by Farik et al., it was observed that additional drying of fractured fragment beyond 1 h decreases the fracture resistance significantly, thus emphasizing the importance of keeping the fragment moist.[9] Some authors believe reattachment with hydration or without dehydrating of the surfaces with storage medium and without any additional preparation restores approximately 50% of the fracture strength of the original tooth.[7] Hydration maintains the vitality and original esthetic appearance of the tooth.[10] The authors have explained that etched, rinsed, but not dried dentin has a surface of partly demineralized hydroxyapatite covered with uncollapsed collagen fibers. On this surface, dentin bonding agents will penetrate through collagen and fill the space in the partly demineralized hydroxyapatite and create a bond by mechanical interlocking upon polymerization. If the etched and rinsed surface is dried to a certain extent, the collagen fibers will collapse and prevent the bonding agent penetrating to the partly demineralized zone. This results in relatively low bond strength and therefore may have important consequences for the reattachment procedure for fragments.[7]

As the aim of the present study was to investigate the effect of storage media for hydration on fracture resistance, no other retentive methods such as enamel bevel, chamfer preparation, or retentive grooves were used.

In the present study, the teeth were sectioned in a standardized manner using a low = speed diamond disk which is in accordance with Prabhakar et al.[3],[8] It has been suggested that fracturing the tooth in vitro will produce uneven fracture line and resultant fragments of unequal dimensions. The amount of material used for reattachment will vary leading to inconclusive results.[8]

Literature lacks evidence of the use of normal saline for the time intervals of 1 and 6 h, so in the present study, normal saline was chosen as one of the storage media for hydration of the fractured tooth fragments before reattachment.

Milk was chosen as it is easily available and has better physiologic properties, including pH and osmolality.[11] In our study, milk was used as one of the storage media for hydration to test the effect on fracture resistance after hydration of tooth fragment for the time intervals of 1, 6, and 24 h. Dry environment was also tested for 1, 6, and 24 h in the present study, to test the effect on the fracture resistance of the reattached tooth fragment to simulate the clinical scenario in which patient might report immediately or after some time or the next day.

Results observed after the reattached teeth fragments were subjected to universal testing machine at the speed of 1 mm/min that, as the drying time was increased from 1, 6, and 24 h, fracture resistance of fragments decreased (P < 0.001), showing the brittle behavior of tooh leading to weakness in reattached bond. making the tooth fragment reattached bond weak demonstrating the brittle behavior of human tooth on dehydration. A study by Shirani et al. tested effect of dehydration of fractured fragment for various time intervals suggesting rewetting or hydration by distilled water as storage media. In our study, the fracture resistance of the samples stored for 24 h in normal saline (P < 0.001) was higher when compared with those stored in milk. This can be due to the amount of water content in milk, which is less than saline.[2]

In the present study, the tooth fragments were kept in the medium for 24 h. According to David Ditto l et al., if the storage time was more than 48 h, even the samples stored in milk could have obtained similar fracture resistance as stored in saline.[2] Shirani et al. concluded preservation of the fractured tooth fragment in egg white or hypertonic solution results in a higher strength of the bond between the restoration and the tooth as compared to storage in water or dried conditions.[12] Various phosphoric acid concentrations have also been used by different authors like 35% by Shirani et al. and 50% phosphoric acid for 60 s by Dean. et al.[1],[7] Authors also have used in their study different bonding agent such as All-Bond 2, Scotchbond MP, and Gluma.[13],[14]

The direction of load application for fracturing the reattached teeth simulated a clinical scenario wherein a tooth reattached using fragment reattachment encounters the second episode of trauma. One potential drawback of this study was the amount of load which was applied using a universal testing machine at the crosshead speed of 1 mm/min, which did not simulate a natural traumatic scenario.[8],[13]


  Conclusion Top


However, it is evident that the use of storage media for the hydration of the fractured tooth fragment does improve its fracture resistance significantly. In the present study, normal saline offers highest fracture resistance for 24 h. Milk offers fracture resistance higher than dry storage media but less than normal saline, so milk can be considered as interim storage media till patient report dental office. However, more research is required to establish a protocol for storage media for hydration thereby increasing bond strength of fractured teeth fragments.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Dean JA, Avery DR, Swartz ML. Attachment of anterior tooth fragments. Pediatr Dent 1986;8:139-43.  Back to cited text no. 1
[PUBMED]    
2.
Sharmin DD, Thomas E. Evaluation of the effect of storage medium on fragment reattachment. Dent Traumatol 2013;29:99-102.  Back to cited text no. 2
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Toshihiro K, Rintaro T. Rehydration of crown fragment 1 year after reattachment: A case report. Dent Traumatol 2005;21:297-300.  Back to cited text no. 3
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4.
Arhun N, Ungor M. Re-attachment of a fractured tooth: A case report. Dent Traumatol 2007;23:322-6.  Back to cited text no. 4
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Rappelli G, Massaccesi C, Putignano A. Clinical procedures for the immediate reattachment of a tooth fragment. Dent Traumatol 2002;18:281-4.  Back to cited text no. 5
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6.
Shirani F, Malekipour MR, Tahririan D, Sakhaei Manesh V. Effect of storage environment on the bond strength of reattachment of crown fragments to fractured teeth. J Conserv Dent 2011;14:269-72.  Back to cited text no. 6
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7.
Shirani F, Malekipour MR, Sakhaei Manesh V, Aghaei F. Hydration and dehydration periods of crown fragments prior to reattachment. Oper Dent 2012;37:501-8.  Back to cited text no. 7
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8.
Prabhakar AR, Yavugal CM, Limaye SN, Nadig B. Effect of storage media on fracture resistance of reattached tooth fragments using G-aneial Universal Flo. J Conserv Dent 2016;19:250-3.  Back to cited text no. 8
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9.
Farik B, Munksgaard EC, Andreasen JO, Kreiborg S. Drying and rewetting anterior crown fragments prior to bonding. Endod Dent Traumatol 1999;15:113-6.  Back to cited text no. 9
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Capp CI, Roda MI, Tamaki R, Castanho GM, Camargo MA, de Cara AA. Reattachment of rehydrated dental fragment using two techniques. Dent Traumatol 2009;25:95-9.  Back to cited text no. 10
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11.
Bazmi BA, Singh AK, Kar S, Mubtasum H. Storage media for avulsed tooth - A review. Indian J Multidiscip Dent 2013;3:741-4.  Back to cited text no. 11
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12.
Shirani F, Sakhaei Manesh V, Malekipour MR. Preservation of coronal tooth fragments prior to reattachment. Aust Dent J 2013;58:321-5.  Back to cited text no. 12
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13.
Andreasen FM, Steinhardt U, Bille M, Munksgaard EC. Bonding of enamel-dentin crown fragments after crown fracture. An experimental study using bonding agents. Endod Dent Traumatol 1993;9:111-4.  Back to cited text no. 13
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Farik B, Munksgard EC, Kreigborg S, Andreasen JO. Adhesive bonding of fragmented anterior teeth. Endod Dent Traumatol 1998;14:119-23.  Back to cited text no. 14
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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