Manuscript Title –“Restoring Function and Aesthetics: A 2 Year Follow-up Case Report of Maxillary Central Incisor Fragment Reattachment.”ABSTRACTDental trauma is a significant public health concern due to its high prevalence, economic impact, and psychological consequences. Among traumatic dental injuries, uncomplicated crown fractures, particularly in the maxillary central incisors, are the most common. Tooth fragment reattachment is a minimally invasive, cost-effective technique that preserves natural tooth structure while restoring function and aesthetics. This case report presents the management of an oblique crown fracture in the maxillary left central incisor of a 62-year-old male patient who sustained trauma following a fall. The patient preserved the fractured segment in water before seeking treatment. Clinical and radiographic examinations confirmed irreversible pulpitis without root fractures. A single-visit root canal treatment was performed, followed by fragment reattachment reinforced with a glass fiber post to enhance retention and longevity. Adhesive protocols, including acid-etching, silanization, and dual-cure resin cement application, were meticulously followed to optimize bonding. The patient was monitored over a two-year follow-up period, demonstrating stable adhesion, occlusal harmony, and no signs of discoloration or secondary complications. Radiographic and clinical evaluations confirmed the long-term success of the procedure, with no evidence of periapical pathology or detachment. This case underscores the importance of immediate fragment preservation, precise adhesive protocols, and long-term monitoring in achieving a predictable outcome. With advancements in adhesive dentistry, tooth fragment reattachment remains a reliable and conservative approach for managing anterior crown fractures, providing an excellent alternative to more invasive prosthetic options while maintaining the integrity of natural tooth structure.KEYWORDS – tooth fracture, trauma, tooth fragment attachment, glass fiber post, paracore, preservation, root canal treatment, dental pulp test.INTRODUCTION: -Dental trauma is a prevalent public health concern due to its high occurrence, economic implications, and impact on quality of life. It primarily affects children, particularly those aged 8 to 11 years, with reported prevalence ranging from 7.4% to 58% (1, 2). The maxillary incisors, both primary and permanent, are the most frequently affected teeth (3). Among various types of dental injuries, uncomplicated crown fractures in permanent teeth are the most common, with success rates varying depending on the nature and circumstances of the trauma (4, 5, 6).Advancements in restorative materials, bonding techniques, tooth preparation, and adhesive protocols have significantly improved the predictability of restoring fractured teeth (7). The introduction of adhesive dentistry has simplified and enhanced the reliability of fragment reattachment, enabling clinicians to restore a fractured tooth using the patient’s own tooth fragment(8).Tooth fragment reattachment serves as a viable treatment option for dental fractures, provided the fragment is adequately preserved in physiological saline or saliva to prevent dehydration and discoloration(9). This technique offers favourable aesthetic and functional outcomes in both the short and medium term while also contributing to the patient’s psychological well-being(10).The advantages of fragment reattachment include enhanced enamel smoothness and hardness, maintained dentin translucency, preservation of the tooth’s original contours, retention of occlusal contacts, and colour stability, all while being a cost-effective approach(11).Despite the high success rates of tooth fragment reattachment documented in the literature, some clinicians opt for less conservative approaches, such as tooth extraction followed by implant-supported prosthetic rehabilitation. This preference may stem from a lack of familiarity with the procedure or concerns regarding potential failure(12, 13).This article presents the rehabilitation of a crown fracture in a maxillary central incisor utilizing the tooth fragment reattachment technique, reinforced with a glass fiber post to enhance retention. The case was monitored over a two-year follow-up period to assess long-term outcomes.CASE HISTORY-A 62-year-old male patient was referred to the Department of Conservative Dentistry and Endodontics in March 2023 following a fall from the stairs. Clinical and radiographic examinations identified an oblique crown fracture of the maxillary left central incisor (#21), affecting the enamel and dentin of the facial surface. The patient had preserved the fractured segment in water for one hour before presenting to the department. A periapical radiograph confirmed an intact periodontal ligament space, complete root formation, and the absence of root fractures. No facial injuries were observed.Pulp vitality was assessed using thermal testing with Endo Frost (Colete, Germany), which elicited lingering pain for approximately 10 minutes. An electrical pulp test revealed an early response compared to the adjacent tooth, indicating irreversible pulpitis. The patient’s medical history was non-contributory (Figure 1).TREATMENT -A single-visit root canal treatment was planned for tooth #21, followed by fragment reattachment reinforced with a fiber post. The treatment plan was explained to the patient with all the options explained. The patient opted for the root canal and fiber post with tooth fragment reattachment plan. After obtaining informed consent, local anesthesia (2% lidocaine with 1:80,000 epinephrine) was administered, and the tooth was isolated using a rubber dam. The fractured segment was cleaned with saline, disinfected with a 2% chlorhexidine solution, and stored in isotonic saline (Figure 2). Access cavity preparation was performed, and the working length was determined using an apex locator (Root ZX Mini, J. Morita, Japan) and confirmed radiographically. Biomechanical preparation was carried out with ProTaper Gold rotary files (Dentsply Sirona, USA) following the manufacturer’s protocol. The canal was irrigated with 5.25% sodium hypochlorite and 17% EDTA, followed by a final rinse with normal saline. Sectional obturation was completed using ProTaper Gold gutta-percha points (Dentsply Sirona, USA), with the apical 5 mm sealed using Bio-C Sealer (Angelus, Londrina, Brazil).An aesthetic fiber post (Size #1, Diameter 1.1 mm, Reforpost, Angelus, Londrina, Brazil) was selected. The post space was etched with 37% phosphoric acid for 15 seconds, followed by thorough rinsing with water. Excess moisture was removed using a cotton pellet and paper points. The post was silanized and air-dried before applying a non-rinse conditioner (ParaBond Non-Rinse Conditioner, Coltene Whaledent, USA). Excess conditioner was removed with a paper point, and a chemically cured adhesive system (ParaBond A and ParaBond B, Coltene Whaledent, USA) was applied with a scrubbing motion for 30 seconds and then air-thinned. The post was cemented using dual-cure resin cement (ParaCore, Coltene Whaledent, USA), extending 2 mm coronally into the chamber. A slot was created in the fractured crown to accommodate the extruding post (Figure 3). The fractured tooth fragment was then reattached using the same resin cement (Figure 4).CONCLUSION AND RESULTS -During periodic follow-ups, the endodontic treatment remained clinically acceptable. A 12-month follow-up conducted in March 2024 and a 24-month follow-up in March 2025 confirmed a stable and functionally satisfactory outcome through both clinical and radiographic evaluations (Figures 5 & 6).With advancements in dental materials and techniques, achieving predictable and aesthetically favourable outcomes is now more feasible. Tooth fragment reattachment remains a reliable and minimally invasive approach, effectively restoring both function and aesthetics while preserving the natural tooth structure.DISCUSSION –Crown fractures can result from various traumatic incidents, with existing literature identifying common causes such as falls during play, sports-related injuries, and direct facial trauma (13, 14). Taiwo and Jalo (15) reported that maxillary central incisors are the most frequently affected, accounting for approximately 67% of all dental injuries, followed by maxillary lateral incisors and mandibular incisors. Goenka et al. similarly emphasized this trend (16).In line with these observations, this case report presents a conservative approach to tooth fragment reattachment for a maxillary central incisor fracture. A glass fiber post was incorporated to enhance retention, offering an effective solution for restoring both aesthetics and function in traumatized teeth. While fragment reattachment is generally recommended when the fracture line is clinically accessible, this report demonstrates its feasibility even in complex cases involving biological width invasion and root involvement. The clinical success observed over a two-year follow-up reinforces findings from Durkan et al. (11) and Rajput et al. (13), underscoring the importance of long-term monitoring.Advancements in adhesive dentistry have significantly improved the efficacy of the reattachment technique, particularly with the development of acid-etching and dentin adhesive systems(12). Unlike metal posts, which exhibit increased rigidity and mechanical incompatibility with dentin—leading to a higher risk of root fractures—glass fiber posts provide superior stress distribution and minimize the likelihood of catastrophic failures(17). Their elastic properties closely resemble those of dentin, enhancing adhesive bonding and contributing to superior aesthetic outcomes. Given these advantages, a glass fiber post was selected for this case, considering the available tooth structure and the presence of enamel, which further optimizes adhesion(18).Tooth fragment reattachment remains the most conservative approach for managing anterior crown fractures, as it ensures precise adaptation of the fragment to the remaining tooth structure while maintaining stability and biocompatibility with the periodontium(16, 19). This technique preserves the tooth’s original contours and occlusal relationships while providing immediate functional and aesthetic rehabilitation, making it a preferred option for managing dental trauma (20)CLINICAL KEY MESSAGE -Tooth fragment reattachment is a conservative, cost-effective solution for anterior crown fractures. With proper fragment preservation, adhesive protocols, and fiber post reinforcement, it restores function and aesthetics predictably in a single sitting. 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