Endodontic treatment of teeth with uncomplicated
crown fractures is usually unnecessary unless pulp
necrosis and infection develop subsequent to the injury.
With minor injuries, treatment can be restricted to
smoothing of rough edges and review. As prognosis is
related to time before treatment, dentine-covering
procedures should be urgently instituted as soon as
possible for fractures involving the dentine, particularly
for deep and angular fractures, and when there has
been an associated luxation injury. This typically
involves re-attachment of the fractured segment or
restoration of lost tooth structure with composite resin.
As reactions to pulp sensibility testing procedures are
often lowered immediately after injury, sensibility
testing of teeth with uncomplicated crown fractures
can, in general, be delayed for a short time after injury,
particularly in the presence of haemorrhage and
associated soft tissue injuries, or where sensitivity to
thermal stimulation or to touching the exposed surface
clearly indicates that the pulp is responsive. Reversal of
negative sensibility testing results can occur,
particularly in immature teeth and in teeth with open
apices. If pulp problems are to arise, they will generally
occur within the first six months after injury. In view of
the fact that the pulps in traumatized teeth can become
necrotic and infected even a number of years
subsequent to injury, routine sensibility testing at six to
eight weeks and then at yearly intervals should be
included in the treatment regime.
Sensibility testing
and assessment of adjacent teeth should also be
routinely undertaken at regular intervals.