The Endo Fix
Collage of a dental trauma case: radiographs and clinical photos of two upper central incisors with complicated crown fractures treated with Cvek partial pulpotomies using Biodentine.

Crown Fracture Case: Two Immature Centrals, Cvek Pulpotomies with Biodentine

Daily Fix

Trauma was caused by a bike accident on this 12-year-old patient. Two upper centrals, both complicated crown fractures, both with incomplete root development. #8 came in with the piece; #9 did not. I did a Cvek partial pulpotomy on both with Biodentine.

Preop, then the pulpotomies. For #8 I used green OpalDam to provide a custom matrix before reattaching the fragment.

Preoperative periapical radiograph of the two upper central incisors with crown fractures
Preop.
Mirror view of the fracture surfaces of the two upper central incisors, white material over one and a pulp exposure in the other
Mirror view.
Mirror view under rubber dam of a fractured upper central incisor with white Biodentine placed over the pulp
Biodentine placed, mirror view.

Postop films the same day, and the teeth restored.

Postoperative periapical radiograph centered on the upper right central incisor, number 8, after the partial pulpotomy
Postop, #8.
Postoperative periapical radiograph centered on the upper left central incisor, number 9, after the partial pulpotomy and restoration
Postop, #9.
Front view of the restored upper central incisors, lips retracted
Restored.

Recalls at 18 months and 2.5 years. Both teeth are in braces now, and there is no staining.

Periapical radiograph of the two upper central incisors at the 18-month recall, with orthodontic brackets and arrows marking the area of interest in each tooth
18-month recall.
Periapical radiograph of the two upper central incisors at the 2.5-year recall, with orthodontic brackets
2.5-year recall.
Front view of the upper central incisors in orthodontic braces at recall, with no discoloration
Recall, in braces. No staining.

Takeaway

With or without the piece, an immature tooth with an exposure still gets my go-to, the Cvek partial pulpotomy. Both of these got it with Biodentine, and at 2.5 years there is no staining. The dentin bridge between the Biodentine and the pulp is evident at 18 months (blue arrows). Both teeth tested positively to cold. Some alveolar remodeling could be seen at 18 months which has not progressed in the following year.

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