From Conventional Reattachment to Intentional Replantation: A Conservative Approach to Complicated Anterior Tooth Fractures.

Traumatic fractures of anterior teeth may result in substantial loss of coronal tooth structure and present complex restorative and endodontic challenges. Reattachment of the original tooth fragment is a conservative treatment option when the fragment is available, intact, and adequately adapted to the remaining tooth structure. This case series describes three anterior tooth fractures managed using tooth-fragment reattachment with progressively more complex treatment approaches. Case 1 involved a horizontal fracture of the gingival third of a maxillary central incisor and was treated with root canal treatment, fibre-post reinforcement and fragment reattachment. Case 2 involved a maxillary lateral incisor with a fracture extending approximately 2 mm subgingivally and was managed with root canal treatment, fibre-post support, surgical access and fragment reattachment. Case 3 involved a fracture extending to the junction of the cervical and middle thirds of the root. Intentional replantation was undertaken to facilitate extraoral endodontic and restorative management, followed by fibre-post-supported fragment reattachment and Mineral Trioxide Aggregate (MTA) placement at the fracture site. All the cases demonstrated satisfactory outcomes during the documented follow-up period of six months. These cases demonstrate how treatment strategies for fractured anterior teeth can be individualised according to fracture location, extent, accessibility, fragment condition and patient preferences.