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Complicated Crown-Root Fracture — NDEB AFK MCQ

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HardPaediatric DentistryComplicated Crown-Root FractureNDEB AFK

A child aged 8 presents after a bicycle accident with a complicated crown-root fracture of a maxillary permanent central incisor. The fracture extends subgingivally on the palatal aspect and involves the pulp. The apex is still open. What is the most appropriate initial management?

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Correct answer: E — Emergency pulpotomy with MTA, temporary stabilisation, and referral for definitive management including possible orthodontic extrusion or surgical crown lengthening

A complicated crown-root fracture with pulp exposure in a young permanent tooth with an open apex requires emergency pulp management (Cvek pulpotomy or full pulpotomy with MTA to maintain vitality and allow continued root development). The subgingival fracture margin will need subsequent management — options include orthodontic extrusion (forced eruption) to bring the fracture margin supragingivally, surgical crown lengthening, or intentional replantation. The treatment plan depends on the extent of the subgingival fracture and remaining root length.

Reference: IADT – Guidelines for Management of Traumatic Dental Injuries, 2020