When evaluating a patient with a fractured lingual cusp of a mandibular premolar, what is the most critical assessment?

When a cusp fractures, the proximity of the fracture to the pulp must be determined immediately. Pulp vitality testing (cold test, EPT) assesses whether the pulp is vital, which determines whether direct restoration, indirect pulp capping, or root canal treatment is needed. A fracture extending close to or through the pulp chamber requires different management than a superficial enamel-dentin fracture. While restorability and percussion are also important assessments, pulp status is the first and most critical determination after a cusp fracture.