Trauma/case report
Use of 2-Octyl Cyanoacrylate for the Repair of a Fractured Molar Tooth

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Odontalgia in association with an acutely fractured tooth is a frequent reason for emergency department presentation. We describe the case of a patient who presented with a painful fractured molar tooth and was treated with topical application of 2-octyl cyanoacrylate tissue adhesive, resulting in prompt relief of her discomfort and a good temporary functional and cosmetic outcome. This product may prove useful in treating similar dental emergencies when access to emergency dental care is unavailable.

Introduction

Fractured teeth and the associated odontalgia are a common complaint encountered by emergency physicians who practice amid patient populations that include large numbers of adolescents and young adults. Tooth fractures can occur in a variety of clinical circumstances, including athletic injuries, blunt facial or intraoral trauma, or simply chewing or biting hard foods with teeth affected by dental caries. In the current emergency department (ED) environment of on-call specialist shortages and the chronic lack of insurance coverage experienced by a substantial percentage of ED patients, rapid access to urgent dental care is frequently unavailable. Emergency dental care is also unavailable in a variety of austere environments, including wilderness expeditions, military operations, and humanitarian relief efforts.

The dental literature is replete with examples of the use of cyanoacrylates. These compounds have been used to seal the remaining dentin of endodontically treated teeth because they were found to control microleakage of oral fluid at the tooth-filling interface. Cyanoacrylate also has applications in periodontics, such as desensitizing teeth, and is used by oral surgeons as a tissue adhesive for surgical procedures in the mouth. In preventive dentistry, cyanoacrylate was also the first material modified for use as a pit and fissure sealant to help prevent dental decay, especially on the occlusal surfaces.1

We present the case of a patient who presented to the ED in the middle of the night with a painful fractured molar tooth and was treated with the topical application of 2-octyl cyanoacrylate (2-OCA) tissue adhesive (Dermabond; Ethicon Products, Somerville, NJ) in an effort to provide immediate analgesia and temporary restoration of normal tooth architecture and function. This type of treatment has never been previously reported in the medical literature.

Section snippets

Case report

A 40-year-old black woman presented to our ED at 2 am with a chief complaint of breaking her tooth. The patient stated that she had been eating a piece of hard candy approximately 1 hour before her presentation, felt a cracking sensation, and now experienced moderate to severe pain in her right jaw. Drinking cold liquids exacerbated her discomfort. She denied any bleeding and stated that the tooth still seemed intact in her mouth. The patient’s review of systems revealed otherwise negative

Discussion

Fractured teeth are difficult to repair in the ED. Usual treatment involves enamel bonding material or dental cement; these materials are somewhat costly and messy, have a limited shelf life, and frequently cannot be located when they are needed. In practice, the functional outcome of using such materials is marginal and can result in a subluxed or fractured tooth falling apart, which subsequently increases the risk of recurrent odontalgia and infection. Other materials that are classically

References (14)

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    Such specialist compounds are not always on stock in the emergency department and can be complex to manage secondarily by a dentist if not applied appropriately and sparingly in the dental context. A commodity that is readily available is a cyanoacrylate tissue adhesive, which has been indicated in the literature as effective in dental and more general maxillofacial procedures.7,17,18 This is not a new concept, although less regularly applied, with the use of a cyanoacrylate to secure avulsed teeth being described by Baker19 in 1987.

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    Given the flexibility and pliability of the metal nasal bridge, this was deemed an adequate substitute. Dermabond, a cyanoacrylate adhesive that has been previously reported for the management of intraoral emergencies, including tooth fractures6 and avulsions,7 showed adequate bonding strength and retention for this case. Few data exist regarding the long-term bonding ability of cyanoacrylate adhesive in intraoral applications, and as such the adhesive should be used only as a temporary solution.

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    Tissue adhesives have gained favor for their quick and painless closure of lacerations, thus reducing the need for a local anesthetic. In addition, Dermabond sloughs off the incision site in 5 to 10 days; therefore, unlike with nonabsorbable sutures, the patient is not required to return to the hospital [22]. Formation of suture sinuses due to infected suture material has also been reported with the use of absorbable [23] and nonabsorbable [24] sutures.

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    The drainage procedure must be done after securing a “bag” to the tumor and the bag should be extracorporeal. Dermabond and BioGlue were chosen as adhesives for several reasons [15-17]. Studies document the safety and efficacy of using Dermabond, not only as an adhesive barrier after surgery on the skin but also as a protective adhesive in dental emergencies that works immediately to keep tissue dry and impermeable to fluid. [10,16,17].

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The views expressed in this case study are those of the authors and do not reflect the official policy or position of the Department of Defense, the Department of the Army, or the United States Government.

Supervising editor: Steven M. Green, MD

Funding and support: Dr. Linklater owns 10 shares in Johnson & Johnson.

Available online February 21, 2006.

Reprints not available from the authors.

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