Decision-Making and Management of Immature Permanent Teeth with Crown Fractures in Small Animals—A Review

Abstract

Immature permanent teeth with crown fractures present a unique challenge in human and animal patients. Immature permanent teeth have not yet developed completely, often presenting with thin dentin walls, incomplete apical formation, and increased crown-to-root ratios. Loss of pulp function at this stage has devastating long-term implications for these teeth. Ideally, attempts should be made to preserve pulp vitality in immature permanent teeth to allow for continued dental development. The range of treatment options for vital teeth includes odontoplasty with bonding and sealing +/− restoration, indirect pulp capping, and direct pulp capping/vital pulp therapy. These treatments have long been established in human and veterinary medicine, and cases have been reported in dogs and cats. Apexification using calcium hydroxide is a well-established treatment for nonvital immature teeth. The advent of mineral trioxide aggregate and other bioceramic materials for use in vital pulp therapy and apexification has reduced treatment sessions and improved outcomes. Recent developments in the field of regenerative endodontic therapy further expand treatment options and provide the possibility for continued development of a formerly nonvital tooth. Selecting the appropriate treatment based on the severity of tooth fracture and status of pulp vitality can avoid a lifetime of poor structure and function for the affected tooth. This article provides multiple step-by-step protocols for the management of immature permanent teeth with crown fractures in small animals.

Clinical, radiographic and histological findings of seven teeth from two California sea lions (Zalophus californianus) housed under professional care

“…In fact, vital pulpectomy was found to be highly successful in humans ( 30 ), especially as the radicular pulpal tissue in teeth with pulp polyps was shown to remain normal in longer periods after pulp exposure ( 31 ) and also observed in teeth in this report. Other endodontic treatment options (i.e., direct pulp capping, regenerative endodontics, and apexification), especially for immature permanent teeth, should also be considered ( 32 ). However, the possibility of endodontic failure and need for further treatments should be weighted in the treatment choice.…”

Periodontal Ligament Cells Are Involved in the Formation of Intracanal Cementum-Like Tissue After Regenerative Endodontic Procedures: A Mouse in situ Model

“…Apexification, which has conventionally been performed on immature teeth diagnosed with pulp necrosis and/or apical periodontitis, has various disadvantages such as a short root length and a thin root canal wall. A short root length makes a higher crown root ratio, and a thin root canal wall becomes fragile and prone to root fracture (4,40). Regenerative endodontic procedures (REPs) are performed to overcome those two problems.…”