Depending on the extent of the exposure, the circulatory status of the pulp, and the stage of root development, three treatment options may be considered:
- Pulp capping
- Partial pulp amputation (pulpotomy, ie, partial removal of pulp)
- Pulp extirpation (removal of entire pulp)
All three methods are highly technique sensitive and should be performed under uncompromised treatment situations where adequate moisture control and sterility can be maintained. Experience has shown that delayed treatment does not compromise the prognosis. Exposed pulp does not normally result in spontaneous pain but pain reaction can be elicited by mechanical stress (chewing), thermal stimulation (exposure to cold and heat), and chemical irritants (acid beverages). It may be tempting to cover the exposed pulp with cement, but experience has shown that this can lead to anaerobic bacteria accumulation under the filling, which is very harmful to the pulp. Therefore coverage with cement should not be performed.
There is a significant window of opportunity for the treatment of crown fractures with exposed pulp. Definitive treatment may be deferred within 1 week with negligible influence on the prognosis.