Endodontics · patient case question
How is the fracture of tooth #8 classified?
Patient case: Trauma to the maxillary central incisors in a young adult
Patient: Male, 21 years old
Chief Complaint: “I hit my mouth on the edge of the pool and broke my front teeth.”
Background: Injury occurred four hours ago. No loss of consciousness, no nausea. Tetanus status current. Healthy, no medications.
Vital Signs: BP 126/78 mmHg · HR 88 bpm · T 98.4°F
Findings: Tooth #8: fracture through ENAMEL, DENTINE and with a visible PULP EXPOSURE of approximately 1 mm, bleeding, and exquisitely sensitive. Tooth #9: fracture through enamel and dentine only, NO pulp exposure. Separately, #8 is also INTRUDED approximately 3 mm into its socket. Radiographs show no root fracture and mature apices on both teeth.
Show answer and explanation
Correct answer: A. Complicated crown fracture
- A. CORRECT. In the current IADT and WHO nomenclature, a crown fracture is COMPLICATED when the PULP IS EXPOSED and UNCOMPLICATED when it is not. Tooth #8 has a visible, bleeding pulp exposure, so it is a COMPLICATED CROWN FRACTURE. The word 'complicated' refers to pulpal involvement and nothing else — not to the size of the fragment, not to how difficult the restoration will be.
- B. A root fracture is confined to the root and is visible radiographically as a lucent line across it. The radiographs explicitly exclude this.
- C. Uncomplicated describes tooth #9 — enamel and dentine with no exposure. That is what makes the pair in this case a useful teaching contrast.
- D. A crown-root fracture extends from the crown BELOW the cementoenamel junction into the root, usually obliquely, and typically involves the palatal aspect. Neither tooth is described this way.
Note: What this item adds is the CURRENT terminology, which is what recent examinations use. Map the two: Ellis I = enamel only, an uncomplicated crown fracture; Ellis II = enamel and dentine, still uncomplicated; Ellis III = pulp exposed, a COMPLICATED crown fracture; Ellis IV = the tooth is non-vital. Management of #8 here: with a mature apex, a small exposure and treatment within 24 hours, PARTIAL PULPOTOMY (Cvek) with calcium hydroxide or MTA has an excellent prognosis and preserves vitality — root canal treatment is not the automatic answer.