Treatment of Crown Fractures With Pulp Exposure in Primary Incisors

Resident’s Name: Jessica Wilson
Program: Lutheran Medical Center - Providence

Article title: Treatment of Crown Fractures With Pulp Exposure in Primary Incisors

Author(s): Kupietzky, Holan.

Journal: Pediatric Dentistry

Year. Volume (number). Page #’s: 2003. 25(3). 241-247.

Major topic: Treatment of Crown Fractures

Overview of method of research: Clinical Review/Case Study

Purpose:
1. Present indications and contraindications for each type of treatment for complicated crown fractures in primary incisors.
2. Highlight advantages of partial pulpotomy (Cvek Pulpotomy) technique in certain scenarios.

Findings:
1. Partial Pulpotomy (PP)
a. Indications:
-Small, noncarious exposure occurring <14>14 days prior or extensive pulpal inflammation.

2. Cervical Pulpotomy
a. Indications:
-After considering PP, pulpal inflammation not extending past coronal portion with good hemostasis.
b. Technique:
- Formocresol: acute inflammation is fixed into chronic inflammation, roots do not continue to develop and teeth theoretically remain asymptomatic.
- Calcium Hydroxide (CH): teeth remain vital. Authors conclude that may be acceptable for mechanical exposures, but positive correlation between degree of inflammation and CH failure.
-If using CH for pulpotomy, absolute hemostasis is critical to prevent internal root resorption.
c. Contraindications:
-Infection or inflammation beyond coronal pulp with inability to achieve hemostasis as well as any PA pathology.

3. Pulpectomy
a. Indications:
-Trauma producing chronic inflammation or necrosis of radicular pulp and goal is to maintain esthetics and function.
b. Technique:
-Zinc Oxide Eugenol: not ideal due to resistance to resorption.
-Iodoform Paste: produce good results. Resorbable and producing antibacterial effects.
- CH: another possible option
c. Contraindications:
-Nonrestorable crown due to loss of tooth structure, extensive root resorption or PA infections extending to the permanent tooth bud.
-Parental concern about esthetics due to the high frequency of color change to yellow or brown.

4. Extraction:
-Considered as a last resort . Space maintenance generally not an issue after primary canine eruption. Discuss possibility of delayed or premature eruption of succedaneums dentition as well as possible effect on function, speech and appearance.

Key points/Summary:
1. PP technique may be used in immature or mature tooth, maintains tooth vitality, and provides esthetic result.
2. Additional studies on PP needed.

Assessment of Article: Clear & concise, but still need additional resources for an all inclusive review.