Pulp horns recede with age and from pulpal insults resulting from caries, restorations, and trauma. Because of the patient population we care for, many of the teeth we treat as endodontists, don’t have prominent pulp horns. Thus, for the vast majority of our patients, a simple incisal based approach is appropriate for canal management, conservation of tooth structure, and post reinforcement. However, one subset of our population is trauma. More often, trauma affects younger patients. As a result endodontic management of teeth with pulp horns may be necessary. In this case, the patient was injured playing soccer. The tooth began discoloring and lost sensibility to cold. If the pulp horns aren’t managed, and a conservative approach is used, it’s possible to leave debris and or voids in this area. It’s possible that such a process centered outcome may predispose the tooth to an aesthetic failure if the tooth discolors over time. This is particularly true during apexification procedures if MTA is used and MTA (regardless of whether grey or white is used) ends up in this void. Access along the long axis of the tooth leaves a sharp angle of dentin adjacent to the pulp horn. This transition leads to void formation during the restorative procedure. Adjusting the dentin here with an internal axial groove allows air to vent and restorative materials to proceed without jumping over the sharp transition leaving a void. In order to prepare such a vent, adjusting the enamel in the apical aspect of the access can facilitate the use of small burs and/or ultrasonics. In the more rare situation that a shovel shaped incisor presents with the need to manage pulp horns, the risks and benefits must be carefully weighed if contemplating a buccal approach as a larger more demanding composite restoration may be necessary if the pulp horns are to be managed.