Management and followup of complicated crown fractures in young patients treated with partial pulpotomy

Abstract

Two cases of young patients with traumatized permanent teeth having complicated crown fractures are reported. Endodontic management included partial pulpotomy by the Cvek technique; restorative management included resin restoration and reattachment of the teeth fragments. Treatments were considered successful in all cases according to the following criteria: absence of clinical symptoms, absence of X-ray signs of pathology, and presence of pulpal vitality 6 to 25 months after treatment.

Figure 1

(a) Initial clinical image of patient 4 h after trauma with complicated crown fracture in maxillary left central incisor, with ulcerated and exposed pulp, and enamel crown fracture in left lateral incisor. (b) Initial radiograph showing loss of dental structure, complete root development, closed apices, normal periodontal ligament, and absence of root or alveolar bone fractures. (c) Resin reconstruction and reattachment of tooth fragments after treatment. (d) Posttreatment radiograph showing indirect pulp capping with resin reconstruction in the maxillary left lateral incisor and pulpotomy with reattachment of the dental fragments in the left central incisor. (e-f) Clinical and radiographic examinations 6 months after trauma. Patient showed no periodontal or periapical pathology, nor pulpal signs or symptoms.

Figure 2

(a) Initial clinical image of patient 17 hours after trauma with complicated crown fracture in the maxillary left central incisor. (b) Initial radiograph showing loss of dental structure, complete root development, closed apices, and absence of root or alveolar bone fractures. (c) Resin reconstruction after treatment. (d) Posttreatment radiograph showing partial pulpotomy with resin reconstruction. (e-f) Clinical and radiographic images 25 months after treatment. Patient's teeth were found to be vital; no pain to percussion or palpation, with functional restorations.