Maxillary Incisor Fragment Reattachment Protocols: Influence on Tooth Fracture Resistance and Strength of Bonding to...

Objectives: Trauma to maxillary incisors is frequent, and requires timely, conservative management for optimal prognosis. This in vitro study evaluated the fracture resistance (FR) and orthodontic bracket bond strength (BS) of incisors following incisal fragment reattachment using various restorative techniques. Materials and Methods: Two independent tests-FR testing (Newtons) and BS testing (megapascals)-were conducted. Eighty intact human maxillary central incisors (n = 40/test), standardized in size and shape using a digital caliper (Mitutoyo, ±0.01 mm), were embedded in acrylic resin and numbered. An uncomplicated crown fracture was induced in 64 teeth (n = 32/test), and the teeth were randomly assigned (simple randomization using Excel's RAND function) to five groups (n = 8/group/test): (1) intact teeth (negative control, NC); (2) nanohybrid composite buildup using Filtek Z250 and Single Bond 2 (positive control, CB); (3) fragment reattachment using flowable composite (Filtek Supreme, FL); (4) reattachment with a palatal veneer using a nanohybrid composite (PV); and (5) reattachment reinforced with a polyethylene fiber band (Ribbond Inc., RB). In BS testing groups, stainless steel orthodontic brackets (PINNACLE) were bonded using Transbond XT, centered over the fracture line. Light curing was performed using an LED unit (Mini LED Standard, Acteon, 1250 mW/cm², 20 s/bond, 40 s/composite, 2 mm curing tip distance). Specimens were stored in distilled water at room temperature for 24 h before reattachment. FR and BS were evaluated using a universal testing machine (Instron) until failure. Failure modes were analyzed, and data were statistically evaluated using one-way ANOVA, Tukey's post hoc test, and Pearson's correlation analysis. Results: Significant differences were observed among groups for both FR and BS (p < 0.05). The NC group exhibited the highest FR (514.4 N) and BS (17.6 MPa). The RB group recorded the second-highest FR (324.6), followed by the PV (234.6), CB (224.9), and FL (203.7) groups. The CB group demonstrated the second-best BS (16.6), followed by the RB (15.2), FL (13.4), and PV (6.5) groups. FR and BS were negatively correlated. Mixed failures predominated in the reattachment groups, except for the PV group, which showed mainly adhesive failures. In BS testing, mixed failures dominated in the NC and CB groups, while adhesive failures predominated in the PV and FL groups. Conclusions: Ribbond reinforcement improves the mechanical performance of reattached incisal fragments, and composite buildup may provide more reliable bracket bonding than fragment reattachment. Clinical Relevance: In cases where biomimetic, minimally invasive reattachment is indicated, Ribbond fiber reinforcement appears to offer a reliable restorative solution.