A broken upper front tooth showing the pink of the pulp: Complicated Crown Fracture

Complicated Crown Fracture: Identifying and Managing Dental Pulp Exposure in Traumatic Injuries

A traumatic dental injury that exposes the dental pulp represents a significant clinical situation requiring prompt intervention. This clinical image shows a fractured upper front tooth (maxillary central incisor) with visible pulp exposure, indicated by the pink spot at the fracture site. Dental trauma of this nature is classified as a complicated crown fracture where the enamel and dentin have been compromised, and the vital pulp tissue has become exposed to the oral environment. This type of injury is especially common in children and adolescents, demanding immediate dental attention to prevent infection, manage pain, and preserve tooth vitality when possible.

Dental Pulp Exposure: Diagnosis and Clinical Significance

Pulp exposure occurs when dental trauma or extensive caries breaches the protective layers of the tooth. The distinctive pink appearance visible in the image represents living pulp tissue with its rich vascular supply.

• Immediate recognition of pulp exposure is critical, as the pulp contains nerves, blood vessels, and connective tissue essential for tooth vitality.
• When exposed, the pulp becomes vulnerable to bacterial invasion from the oral cavity, potentially leading to pulpal inflammation (pulpitis) and eventually necrosis.
• Clinical symptoms may include pain to thermal stimuli, sensitivity to pressure, or spontaneous pain depending on the extent of exposure and time elapsed since injury.
• Radiographic examination is essential to assess root development stage, which significantly influences treatment decisions and prognosis.
• The size and duration of pulp exposure directly impact treatment success rates, with smaller, freshly exposed pulps having more favorable outcomes.

Treatment Approaches for Pulp Exposure

The management of exposed dental pulp depends on several factors including the patient’s age, root development stage, time elapsed since injury, and extent of exposure.

• Vital pulp therapy options include direct pulp capping, partial pulpotomy (Cvek procedure), or complete pulpotomy, aimed at preserving pulp vitality and allowing continued root development in immature teeth.
• Direct pulp capping involves placing a biocompatible material (such as calcium hydroxide or mineral trioxide aggregate) directly over the small exposure, followed by a permanent restoration.
• Partial pulpotomy removes 2-3mm of the exposed pulp before placement of a biocompatible material, particularly effective for traumatic exposures in young permanent teeth.
• Complete pulpectomy or root canal therapy becomes necessary when the pulp is extensively damaged or when significant time has elapsed since exposure.
• The fractured tooth may require restoration with composite resin, a crown, or in severe cases, extraction followed by prosthetic replacement.
• Regular follow-up is essential to monitor pulp vitality, continued root development, and potential complications such as pulp canal obliteration or internal resorption.

Prompt recognition and appropriate management of dental pulp exposure are critical for favorable outcomes. The pink appearance of exposed pulp tissue serves as a clear diagnostic indicator requiring immediate dental intervention to maintain tooth vitality and function, particularly in developing dentition.

1. Traumatic Dental Injuries: Recognizing and Managing Pulp Exposure in Fractured Teeth
2. Pulp Exposure in Dental Trauma: Clinical Presentation and Treatment Options
3. Managing Complicated Crown Fractures: Interventions for Exposed Dental Pulp
4. Dental Pulp Exposure Following Trauma: Diagnosis and Therapeutic Approaches
5. Preserving Tooth Vitality After Traumatic Pulp Exposure: Clinical Guidelines