Oral Surgery · patient case question
Teeth #7 and #8 have frank pulp exposures with mature apices, and 5 hours have elapsed. What is the appropriate definitive management?
Patient case: Face-First Fall on Concrete
Patient: 34-year-old male
Chief Complaint: “I tripped and landed on my face on the sidewalk.”
Background: Healthy. No loss of consciousness, no nausea, no visual disturbance. Tetanus status current. Injury occurred approximately 5 hours ago.
Medications: None
Vital Signs: BP 128/78 mmHg · HR 84 bpm · RR 16 · T 98.4°F
Findings: Chin shows a broad, raw, superficially scraped area with punctate bleeding and embedded grit. The inner surface of the lower lip has a full-thickness tear with irregular edges. Teeth #7 and #8 are fractured with frank pulp exposure, tender to percussion, mature apices. Tooth #6 is intact, non-mobile, responds normally to cold, with no radiographic changes.
Show answer and explanation
Correct answer: C. Root canal treatment
- A. Incorrect. Direct pulp capping is reasonable for a small, fresh exposure treated within hours in a tooth with an immature apex, where preserving vitality supports continued root development. In a mature tooth exposed for 5 hours, its prognosis is poor. A partial pulpotomy would be the more defensible vital option in that window.
- B. Incorrect. Both teeth are restorable. Crown fracture with pulp exposure is not an indication for extraction when adequate tooth structure remains.
- C. Correct. With a mature apex, a frank exposure, and a delay of several hours, the pulp is contaminated well beyond the superficial layer. Root canal treatment provides the predictable outcome and permits definitive restoration of the fractured crowns.
- D. Incorrect. An exposed pulp left untreated will become necrotic and infected. Observation is not an option once the pulp is exposed to the oral environment.