Endodontics · single question
Same case (complex crown fracture with pulp involvement). What is the pulpal diagnosis?
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Correct answer: C. Pulpal necrosis
The tooth does not respond to thermal testing following trauma with pulp exposure. In the context of trauma, a tooth with a complex fracture (pulp exposed) that does not respond to cold testing has PULPAL NECROSIS — the trauma has disrupted the blood supply and/or the pulp is exposed and necrotic. While it could be asymptomatic necrosis, trauma cases that test negative to thermal are classified as pulpal necrosis.
- A. INCORRECT. Reversible pulpitis would show a normal or slightly exaggerated response to cold with rapid return to baseline — not a negative thermal response.
- B. INCORRECT. While 'asymptomatic pulpal necrosis' is technically a diagnosis, in the context of an acute trauma case, the diagnosis is simply 'pulpal necrosis.' The distinction between symptomatic and asymptomatic refers to whether there is symptomatic apical periodontitis — the pulp diagnosis itself is necrosis.
- C. CORRECT. Pulpal necrosis is diagnosed when the tooth does not respond to thermal testing (cold/heat). Following trauma with complex fracture (pulp exposed), negative thermal response = PULPAL NECROSIS.