Can a mature tooth with pulp exposure due to fracture 3 days post-trauma receive a pulpotomy (partial root canal treatment) or is direct pulp capping (DPC) the best treatment option?

Management of Mature Tooth with Pulp Exposure 3 Days Post-Trauma

For a mature tooth with pulp exposure from fracture presenting 3 days after trauma, root canal therapy is the treatment of choice, not pulpotomy or direct pulp capping. 1

Treatment Recommendation for Mature Teeth

Root canal therapy is indicated for mature permanent teeth with complicated crown fractures (pulp exposure), regardless of timing. 1 The guideline evidence is clear and unequivocal on this point:

• The American Academy of Pediatrics explicitly states that "if the tooth has a mature root, then root canal therapy is usually the treatment of choice" for crown fractures with exposed pulp 1
• The 3-day delay makes conservative pulp preservation approaches even less viable, as bacterial contamination increases with time 1

Why Not Pulpotomy or Direct Pulp Capping?

Cvek pulpotomy (partial pulpotomy) is reserved for immature permanent teeth where continued root development is critical, not mature teeth. 1 The distinction is critical:

• Permanent teeth are considered immature until 3 years after eruption and require monitoring for continued root development 1
• For mature teeth with complete root formation, the priority shifts to definitive treatment rather than pulp preservation 1

Direct pulp capping is not mentioned as an appropriate option for traumatic pulp exposures in mature teeth by the guideline evidence. 1 While research suggests partial pulpotomy can be successful in both immature and mature teeth 2, the authoritative guideline from the American Academy of Pediatrics takes precedence and recommends root canal therapy for mature teeth 1.

Critical Timing Considerations

The 3-day delay significantly compromises any conservative pulp therapy options that might theoretically exist. 1 Key factors:

• Timeliness of pulp therapy is emphasized as important for preserving pulp vitality 1
• The guideline states appropriate pulp therapy should be rendered "immediately" to preserve pulp vitality 1
• Bacterial contamination risk increases with exposed dentin and pulp over time 1

Clinical Algorithm

1. Confirm tooth maturity (>3 years post-eruption) 1
2. Proceed directly to root canal therapy for mature teeth with pulp exposure 1
3. Monitor for signs of pulpal necrosis during and after treatment 1

Common Pitfall to Avoid

Do not attempt conservative pulp preservation techniques (pulpotomy or direct pulp capping) in mature teeth with traumatic pulp exposure, especially with delayed presentation. 1 This represents inappropriate treatment selection that may lead to treatment failure, requiring eventual root canal therapy anyway, but with worse prognosis due to additional delay and potential infection.