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Complicated crown fractures of permanent teeth following dental trauma in children are a common presentation in the dental practice. The prognosis of these teeth largely depends on the emergency management provided by the dentist. Treatment options include direct pulp capping and partial pulpotomy. While both have been suggested as possible vital pulp therapies for the management of complicated crown fractures, there are no clear recommendations as to when each procedure is indicated to aid the clinician in decision making. This narrative review aims to provide evidence-based recommendations for the optimal management of complicated crown fractures in children. The factors affecting success rates of both direct pulp capping and partial pulpotomy are discussed and a step-by-step guide to carrying out a partial pulpotomy is presented.
CPD/Clinical Relevance: This article will assist clinicians in making an evidence-based decision for the optimal management of complicated crown fractures of permanent teeth in children.
Article
A complicated crown fracture is a fracture involving loss of tooth structure and exposure of the pulp (Figure 1a).1 The reported prevalence is 5–8% in the permanent dentition, and the maxillary central incisors are the most frequently affected.2,3 Approximately 25% of dental traumatic injuries to the permanent dentition occur before the age of 9 years, when the maxillary incisors have not yet fully formed.4 While apical closure of the maxillary permanent incisor is expected by the age of 10–11,5 the root walls may still be immature and thin.
Histological studies have shown that if exposed pulps are appropriately managed at the time of injury, they have the ability to heal.6 Dental practitioners should, therefore, always attempt to maintain the vitality of traumatized immature incisors to allow apexogenesis. Continued root formation will lead to a more favourable crown root ratio, decrease the risk of fracture, and facilitate future root canal treatment if required. Fully matured teeth with exposed pulps can also be preserved with vital pulp therapy if the pulp is healthy.7
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