A Critical Narrative Review of Tooth Fragment Reattachment After Traumatic Crown and Crown-Root Fractures

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Traumatic crown fractures of permanent anterior teeth are common in children and young adults, and the availability of an intact tooth fragment creates a distinctive restorative opportunity: preservation of the patient's own enamel, dentine, morphology and surface texture rather than reconstruction with an artificial substitute. This critical narrative review integrates biological, adhesive, biomechanical and clinical evidence on tooth-fragment reattachment, with particular emphasis on where laboratory findings do and do not translate into durable clinical outcomes. Literature was selected through live searches of accessible scholarly sources, supplemented by citation chasing and verification of bibliographic metadata and Digital Object Identifiers. The evidence indicates that fragment reattachment is a highly conservative option when the fragment is retrievable, structurally usable and accurately repositionable, and when the fracture margins can be isolated. Hydration of a dehydrated fragment is consistently supported by laboratory evidence, although optimal storage media and rehydration duration remain uncertain. Preparation designs such as chamfers, overcontouring and internal grooves often increase immediate fracture resistance relative to simple reattachment, but added preparation sacrifices tissue and may shift failure towards less repairable tooth-substrate fracture. Clinical evidence is substantially weaker than the laboratory literature. Retrospective cohorts and a recent meta-analysis suggest that fragment loss is a meaningful long-term risk and that direct composite restoration may show greater restorative survival in some settings, while other cohorts report similar outcomes. Crown-root fractures can remain functional for years after adhesive reattachment, but periodontal compromise and repeated restorative or endodontic intervention are common. The most defensible strategy is therefore risk-calibrated rather than technique-driven: preserve pulp vitality where possible, maintain fragment hydration, secure isolation, minimise unnecessary preparation, assess occlusal loading and associated luxation injury, and plan surveillance and repairability from the outset. Better prospective comparative studies with standardised outcomes are needed before any single reinforcement protocol can be considered superior.

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