Clinical Outcomes of Fragment Reattachment and Direct Composite Restoration for Anterior Crown Fractures in Permanent Teeth: A Retrospective Cohort Study

Background/Aim In clinical practice, fragment reattachment and direct composite restoration are commonly used to restore fractured anterior teeth. However, the comparative studies about these two treatments in children and adolescents remain limited. This study aims to evaluate their clinical longevity in pediatric patients and identify risk factors associated with failure. Materials and Methods This study analyzed the clinical records of patients with anterior crown fractures treated by fragment reattachment or direct composite restoration from January 2021 to December 2022. Experienced pediatric dentists performed diagnoses and treatments in strict accordance with the latest International Association of Dental Traumatology guidelines. Restorative and biological survival rates were evaluated using Kaplan–Meier survival analysis, and potential prognostic factors were identified by Cox proportional hazards regression modeling. Results Overall, 439 patients (mean age, 8.8 ± 1.5 years; range, 6–14 years) with 500 teeth were included, with a mean follow‐up period of 31.1 ± 5.8 months. Fragment reattachment was performed on 63 teeth, while 437 teeth received direct composite restoration. The cumulative survival rates at 1 and 2 years were 76.2% and 71.4% for fragment reattachment, and 87.4% and 81.0% for direct composite restoration, respectively. The Log‐rank test revealed no statistically significant difference in survival rates between the two groups for either restorative or biological failure. The stratified multivariate analysis revealed that age (HR = 0.77, 95% CI: 0.66–0.90, p = 0.001) and fracture pattern (Class C: HR = 4.45, 95% CI: 1.87–10.58, p < 0.001 and Class c1: HR = 7.28, 95% CI: 1.79–29.53, p = 0.005) significantly influenced the survival rates of teeth treated by direct composite restoration. The rates of restorative and biological failure did not differ significantly between these two treatments for either uncomplicated or complicated crown fractures. A considerable proportion of failures occurred within the first 12 months after the initial treatment. Conclusion Both fragment reattachment and direct composite restoration demonstrated favorable clinical effects on the treatment of permanent anterior crown fractures in children and adolescents. Fragment reattachment was recommended as the primary treatment option for pediatric patients due to its clinical advantages in procedural simplicity, time efficiency, and aesthetic preservation. It can be concluded that younger age and teeth with Classes C and c1 fracture patterns significantly increase failure risks in direct composite restorations. Close follow‐up is highly recommended during the first 12 months post‐treatment.