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The risk of bonded fragment loss in crown-fractured anterior teeth managed by fragment reattachment: a systematic review and meta-analysis

Evidence-Based Dentistry (2024)Cite this article

Subjects

Abstract

Purpose

To identify the factors affecting the risk of bonded fragment loss in crown-fractured anterior teeth managed by fragment reattachment.

Methods

The study protocol followed the best practices of evidence-based medicine and was registered in PROSPERO. A comprehensive literature search was performed electronically in six databases (PubMed, Embase, SCOPUS, Web-of-Science, Lilacs, and Cochrane) on 18-09-2023. It was saved in EndNote-online and duplicates were removed. Selection of articles was performed in two stages, followed by data-extraction, risk of bias assessment, data-analysis, and meta-analysis. The quality of evidence for the outcomes was assessed by the GRADE-approach.

Results

The study included six articles that had similar selection protocols with variations in duration from trauma to treatment and the observation period. Only one study employed pre-attachment fragment preparation and three performed post-attachment reinforcements. Overall loss of fragment was 20% (95%CI–13,30%). When the risk ratio for loss of restoration or fragment was compared, it was found to be 2.21 (95%CI–1.52,3.21) in uncomplicated crown fractures, 2.54 (95%CI–1.35,4.79) in complicated crown fractures. The risk of bias was found to be low in two and moderate in four studies. Grade of evidence for all the outcomes was very low.

Conclusion

Fragment loss was lowest in uncomplicated crown fractures where reinforcement had been performed, and highest when bonding was done in complicated crown fractures without reinforcement. The risk of fragment loss was higher than the loss of composite restorations.

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Author information

Authors and Affiliations

  1. Division of Pediatric & Preventive Dentistry, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India

    Nitesh Tewari & Morankar Rahul

  2. Department of Pediatric Dentistry, Faculty of Dentistry, Hacettepe University, Ankara, Turkey

    Zafer Cehreli

  3. Centre of Community Medicine, All India Institute of Medical Sciences, New Delhi, India

    Partha Haldar

  4. Department of Pediatric Dentistry, ZA Ahmed Dental College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India

    Mohammad Atif

  5. Department of Restorative Dentistry, Kings College London, London, UK

    Aws Alani

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  1. Nitesh Tewari
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  5. Aws Alani
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  6. Morankar Rahul
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Contributions

The idea was conceptualized by NT and ZC. The team comprising all the co-authors designed the protocol and the methods of the study. The extraction of data was conducted by NT and MA. The steps of analysis were conducted by NT, MR, MA, AA, ZC, and PH. The initial draft of the manuscript was prepared by NT, ZC. It was revised by all the authors.

Corresponding author

Correspondence to Nitesh Tewari.

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Tewari, N., Cehreli, Z., Haldar, P. et al. The risk of bonded fragment loss in crown-fractured anterior teeth managed by fragment reattachment: a systematic review and meta-analysis. Evid Based Dent (2024). https://doi.org/10.1038/s41432-024-01003-9

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  • DOI: https://doi.org/10.1038/s41432-024-01003-9

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