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Complicated Crown and Crown/Root Fractures

Rationale for Management of Incisors with Incomplete Root Development and Vital Pulp

Continued root development in immature traumatised incisors depends upon pulp healing. If the pulp becomes non-vital, root development will cease. Incomplete root development will mean that there is insufficient amount of dentine and cementum, and also an inadequate crown : root ratio, leaving the root structure inherently weak and at risk of root fracture under masticatory forces. A wide root canal with an open apex also creates an endodontic challenge for the clinician. Therefore, all attempts must be made to carry out treatments to facilitate pulp healing which will allow normal and continued root development, thereby vastly improving the prognosis of the traumatised teeth (Fig. 30.1).

Figure 30.1 Proximal fracture on the upper right central incisor with an immature apex.

Management Options to Facilitate Pulp Healing

Pulp Capping

This should be considered in very few cases specifically for very small uncontaminated exposures that have presented almost immediately after the trauma to the dentist.

The following should be performed:

Follow-Up Care

Regular follow up should be performed to monitor:

• reaction of pulp to sensibility tests, both thermal and electric;
• colour change;
• continued root development;
• patient symptoms that might indicate the pulp is not healing.

Pulpotomy

Pulp capping is not preferred after trauma unless the exposure is very small, uncontaminated and the patient presents immediately after trauma.

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