A nine-year-old boy presented to the Department of Pediatric and Preventive Dentistry with a chief complaint of dental fractures. The patient had an Ellis III fracture in the maxillary left central incisor (tooth #21) and an Ellis II fracture in the maxillary right central incisor (tooth #11) due to a traumatic injury sustained while playing football (Figure 2). The parents promptly brought the child to the department, approximately six hours after the incident occurred. The patient did not experience any spontaneous pain at the time of presentation.
During the intraoral examination, pulp exposure was observed in the maxillary left central incisor (tooth #21) with mild pain upon percussion. No periodontal pockets were detected, and the affected teeth showed class I mobility. Pulp vitality testing revealed a positive response to cold stimulation. The extent of pulp exposure in tooth #21 was measured to be approximately 2-3 mm. The radiographic examination did not reveal any root fractures or periradicular radiolucency in the regions of teeth #11 and #21, but it did confirm an enamel-dentin fracture in the maxillary right central incisor (tooth #11; Figure 3). According to Cvek's classification, both incisors were determined to be at stage 3 of root development; with two-thirds of root length present (Figures 1 and 3).
Oral prophylaxis was performed, and the sandwich technique followed by composite buildup was carried out for tooth #11 (Figure 4). For tooth #21, the treatment plan involved a partial pulpotomy procedure, which was explained to the patient and parents. Local anesthesia (LA) was administered through the infiltration of 2% lidocaine HCl with 1 : 100,000 epinephrine (LA). Using a sterile high-speed diamond bur and water irrigation to prevent thermal damage, approximately 2-3 mm of visibly inflamed pulp and adjacent dentin were removed from tooth #21. The access cavity was then rinsed with normal saline, and the coronal pulp tissue was removed until adequate hemostasis was achieved. A moistened sterile cotton pellet was placed over the remaining pulp for 5 minutes. White MTA powder (ProRoot MTA, DENTSPLY, Tulsa, OK, USA) mixed with distilled water was applied to the exposed pulp without pressure. A moistened cotton pellet was gently placed over the MTA to facilitate its setting. After 10 minutes, the MTA was covered with glass ionomer restorative cement (GC Gold Label II, GC Fuji II Tokyo, Japan), and the patient was discharged (Figures 4 and 5). During the two-week follow-up, the patient remained asymptomatic, with no pain, periodontal pockets, mobility, or sensitivity upon cold testing. The glass ionomer restoration was partially replaced with a direct bonded composite restoration (Figure 6). Clinical and radiographic evaluations were performed at one month, three months, six months, and one-year post-treatment, with no symptoms observed. Radiographs showed increased root lengths, accelerated apical closure, complete root growth, increased thickness of the root wall, and the formation of a calcified bridge above the vital pulp (Figure 7). The periodontal ligament space appeared normal in thickness, and the continuity of the lamina dura was observed. No radiolucent lesions were detected during the six-month follow-up or in subsequent examinations conducted over one to two years (Figure 8).