Tooth fragment reattachment using cyanoacrylate tissue adhesive and flowable composite: An in vitro study

ABSTRACT Aim: Crown fractures in anterior teeth represent 18%–22% of dental hard tissue injuries. Immediate reattachment of the fragment using composite resin is the preferred treatment option. However, the reattached fragments are prone to fracture. The use of topical cyanoacrylate tissue adhesive has been reported for managing painful fractured molar teeth and maxillary incisors. Rural population of India does not have access to basic health care; hence, over-the-counter availability of cyanoacrylate may prove beneficial for reattaching the tooth fragment until a patient receives professional care. The present study aimed to evaluate and compare the methods of fractured fragment reattachment using isoamyl 2-cyanoacrylate tissue adhesive and flowable composite. Methods: Eighty intact human permanent maxillary central incisors were randomly divided into four groups ( n = 20). Except for the control Group D, other teeth were cut through the middle third of the crown horizontally. Fragments were reattached using flowable composite in Group A, cyanoacrylate tissue adhesive in Group B, and in Group C fragments were attached using cyanoacrylate tissue adhesive, and filling flowable composite circumferentially in chamfer placed along the fracture line. Fracture resistance was tested using a universal testing machine by applying load to each tooth perpendicular to the line of reattachment from labial to lingual direction. The force required to fracture the tooth was recorded in Newtons, and data were statistically analyzed. Results: The highest fracture resistance was exhibited by Group D, followed by Group A, Group C, and Group B, respectively. There was no statistically significant difference between Groups A and C. Conclusion: Composite remains most efficacious in reattaching fractured fragments to the tooth. However, the use of isoamyl 2-cyanoacrylate followed by composite restoration in chamfer offers comparable bonding. The experimental over-the-counter available isoamyl 2-cyanoacrylate may be useful for reattaching uncomplicated fractured teeth when emergency dental care is inaccessible, and needs to be clinically and esthetically evaluated by a professional. However, this in vitro experiment needs to be evaluated clinically for long-term bond strength and under various intraoral forces.