Esthetics and Super Glue: A Case Report

ESTHETICS AND SUPER GLUE: A CASE REPORTCLINICALSheldon Winkler, DDSRobert Wood, DMDAnne M. Facchiano, DMDJonathan F. Bergloff, BAKEY WORDSEstheticsSuper glueCase historyCyanoacrylateSheldon Winkler, DDS, is professor ofRestorative Dentistry at Temple UniversitySchool of Dentistry, 3223 North Broad Street,Philadelphia, PA 19140-5096. He formerlyserved as professor and chairman of theDepartment of Prosthodontics at TempleUniversity. Correspondence should be addressedto Dr Winkler at swinkdent@aol.com.Robert Wood, DMD, is assistant professor ofRestorative Dentistry and assistant director ofthe Removable Prosthodontic Clinic at TempleUniversity School of Dentistry, Philadelphia,PA 19140.Anne M. Facchiano, DMD, is clinicalassistant professor of Restorative Dentistry,Temple University School of Dentistry,Philadelphia, PA 19140.Jonathan F. Bergloff, BA, is a senior dentalstudent at Temple University School ofDentistry, Philadelphia, PA 19140.286 Vol. XXIX/No. Six/2003This article describes how a man attempted to repair damage to his maxillaryteeth with super glue. Such action is discouraged, however, because of possibleadverse reactions in the hard and soft tissues.INTRODUCTIONntemporary dentistry revolvesaround esthetics.The dental profession todayis not without its shareof esthetic procedures,though such proceduresare meager when compared with thearsenal at the disposal of our medicalcolleagues.Under the influence of the mediaand a variety of other factors, patientstoday are concerned not only withtheir general health, but also with theiresthetic appearance. The desire to presenta favorable appearance to others,and to associate with people who effecta reciprocating pleasing reaction, isconstant and life long. The most outwardreaction is effected by the face,because the face is unmistakably us.1Everyone wants to look younger,and people will go to all extremes inour society to improve their appearance.2 Today, vast improvements in instrumentation,restorative materials,and knowledge of color has made itpossible for the dental profession toconsistently provide patients with lifelikeprostheses that are virtually undetectable.SUPER GLUESuper glue has been available on themass market as a general adhesivesince the late 1950s. It has experiencedextraordinary claims regarding itsstrength and versatility. It has beensaid that a 1-square-inch bond can holdmore than a ton. Super glue is availableunder many trade names, in manyforms (ie, stick, liquid, gel), and from anumber of major and minor manufacturers.Super glue is claimed to have theability to bond porous, nonporous, andflexible surfaces, including glass, porcelain,fabric, metal, leather, wood, rubber,and a variety of resins. It can bepurchased in super markets, in stationarystores, in convenience stores, andover the Internet. Its dangers are wellknown and appear on the packaging.Newer applications of super glue includewound closure instead of suturesand the detection of latent fingerprintsin criminal investigations.Super glue was evaluated forwound closure early in its history.However, the degradation of methylcyanoacrylate into cyanoacrylate andformaldehyde could inflame the involvedtissues before healing occurred.In the early 1960s, the formulation waschanged to butyl cyanoacrylate forpossible medical use, creating a lesstoxic product. The new compositionwas evaluated during the Vietnam con-flict for control of bleeding until surgerycould be performed. In 1998, theFood and Drug Administration approvedthe use of Dermabond (ClosureMedical Corporation, Raleigh, NC) asFIGURES 1-3. FIGURE 1. Facial view of 52-year-old Caucasian male patient. FIGURE 2. Maxillary left tooth crowns have been bonded withsuper glue to embedded roots. FIGURE 3. Periapical radiographs of maxillary super-glue bonded teeth.an alternative to the suturing of smallwounds.The major ingredient of super glueis cyanoacrylate, a methacrylate resinthat cures almost instantly. The catalystis hydroxyl ions in water, which ispresent in trace amounts on the surfaceof virtually any object one wishes tobond. The cyanoacrylate molecules beginto link on contact with water, andthe chains form a durable plastic mesh.The glue thickens and hardens untilmovement of the molecular chainsceases.A case history is presented of a patientwho attached fractured naturaltooth crowns to their embedded rootsin his mouth with super glue.CASE HISTORYA 52-year-old Caucasian man presentedfor treatment at Temple UniversitySchool of Dentistry in June 2003 (Figure1). In September of the previousyear, he was an umpire at a baseballgame. He was making a call behindhome plate when a player rapidly approached,and the incoming throw hitthe plate, bounced off, and struck thepatient violently in the mouth. Surprisingly,the patient stated that he hadvery little discomfort after the traumaticincident.Several of the patient's maxillaryteeth (upper left central, lateral, cuspid,and first premolar) were fractured bythe blow, and the crowns started to''fall out'' during the following weeks.The patient used hydrogen peroxiderinses and stored the fractured crownsin a peroxide solution.The patient did not have any dentalinsurance at the time of the accident.In order to improve his appearanceand try to function somewhat until hewas able to obtain adequate coverage,he decided to use super glue to reattachhis fractured crowns to the embeddedroots the following month.The crowns and roots were driedSheldon Winkler et alwith a blow dryer, and a small amountof super glue was placed on each toothand the corresponding root. The patientthen pushed the tooth onto itsroot and repeated the procedure withthe remaining crowns. The crownswere attached one at a time to theirroots and the adjacent newly insertedcrowns.After insertion of the 4 lost crowns,a large quantity of super glue remainedand adhered to the palate butseparated ''after a few hours.'' The patientthen removed the assembly and''shaped it with a file.'' He then replacedthe assembly intraorally and superglued it to the upper right centralincisor and the left second premolar,which served as abutments for the replacednatural tooth crowns (Figures2-6).The patient claimed he removedthe assembly every 4 to 6 weeks,cleaned it, reshaped it with a file, andreconnected it to the abutment teeth.Journal of Oral Implantology 287SUPER GLUE AND ESTHETICSFIGURES 4-6. FIGURE 4. Facial view of upper and lower teeth in occlusion. FIGURE 5. Close-up view of upper left central, lateral, cuspid,and first premolar crowns reattached to their embedded roots with super glue. FIGURE 6. Extensive palatal coverage of super glue as aresult of crown reattachment.Initially the patient used a liquid formof super glue but then changed to a gel,which he said ''worked better.''The patient said he had little or nodiscomfort after performing the procedureon himself. Clinically, he presentedwith severely inflamed gingivaltissues surrounding the assembly,which was very large and overextended.Future appointments were madefor the patient, which he did not keepfor financial reasons.DISCUSSIONThe problem of adjusting to tooth lossin our modern society is becoming extremelydifficult because of the highvalues placed on youth, beauty, and virility.2 We are a youth-oriented andage-fearing culture, with a passion to288 Vol. XXIX/No. Six/2003be esthetically pleasing to ourselvesand others. The case history presentedis an example of a patient going to anextreme to improve his appearance.The patient's claims of experiencingvery little discomfort after the traumaticepisode and placement of the assemblycan probably be attributed tononvital pulps in the fractured teeth.As for the use of methyl cyanoacrylateto create the assembly, a significant in-flammatory response probably did notoccur because there was no openwound and the super glue was appliedto hard tooth structures.One of the authors (S.W.) has witnessedanother male patient recoverhis 5 freshly extracted teeth from atrash can and appear at his next visitwith the teeth ingeniously attached tohis removable partial denture withREFERENCESdental floss through a series of smallholes drilled into the resin base.Achieving esthetics takes time, experience,an eye for beauty, and patientinput. For a patient who is determinedto self-improve his or her appearance,the dental profession should expect theimpossible, inconceivable, or improbable,often combined with ingenuity.Patients must be warned not to attemptself-treatment for esthetics withself-fabricated prostheses. Severe adverseand irreversible hard and soft tissuereactions may occur.1. Pound E. Dentures and facial esthetics.Dent Survey. 1962;38(10):35-43.2. Winkler S. Essentials of CompleteDenture Prosthodontics. 2nd ed. St Louis,Mo: Mosby-Year Book; 1988.