Crown fractures involving enamel and dentin without pulp exposure are called uncomplicated crown fractures.They may include incisal-proximal corners, incisal edges or lingual “chisel”-type fractures in anterior teeth, and, frequently, cusps in posterior teeth.
Crown fractures that expose dentinal tubules may potentially lead to contamination and inflammation of the pulp. The outcome may be either formation of irritational dentin or pulp necrosis. Which outcome occurs depends on a number of factors:
- proximity of the fracture to the pulp, surface area of dentin exposed,
- age of the patient (pulp recession and size of dentinal tubules), concomitant injury to the pulp’s blood supply,
- length of time between trauma and treatment,
- and possibly the type of initial treatment performed.
The diagnosis of crown fracture without pulp involvement is made by clinical examination with a mirror and an explorer. In addition, it is also important to determine the status of the pulp and periradicular tissues by the usual examination procedures.
- The primary goal of treatment in teeth with crown fractures is to protect the pulp by sealing the dentinal tubules.The most effective method is by direct application of dentin bonding agents and bonded restorations.
- Placement of unsightly stainless steel or temporary acrylic crowns is now a thing of the past for enamel/dentin fractures.
- If the fractured crown fragment is available, it is often advantageous to use it to restore the tooth by reattachment technique.
As with most traumatic injuries, patients with crown fractures need to be reevaluated periodically to determine pulpal status.
Traumatized teeth can develop pulp necrosis sometime after the initial injury, and if necrosis occurs, endodontic therapy is indicated.