Complicated Crown Fracture

A complicated crown fracture is defined as an enamel/dentin fracture with pulp exposure. Clinical and radiographic examination reveals a loss of tooth structure with pulpal involvement. As with the non-complicated tooth fracture, the injured lips, tongue and gingival should be examined for tooth fragments and debris. Radiographic examination consists of periapical and occlusal radiographs of the injured teeth and of the injured soft tissues to rule out foreign body contamination. Pulp sensibility testing is not indicated initially since pulpal involvement is confirmed by sight. Subsequent monitoring is recommended. Treatment objectives are to maintain pulp vitality and restore normal esthetics and function. The type of treatment rendered is dependent on pulp vitality and the stage of root development or resorption.
Primary teeth: If the root is in the process of resorbing, the suggested treatment is extraction. If the pulp tissue is vital, a pulpotomy is performed. Pulp capping is not a recommended procedure for primary teeth. If the pulp is non vital and the root structure is intact, a pulpectomy is performed. Follow up treatment consists of a clinical examination after one week and a radiographic examination at six to eight weeks and one year intervals.
Permanent teeth: Pulpal treatment is dependent upon the time elapsed since injury, size of the exposure and root development.