Operative dentistry aje qualtrough, jd satterthwaite la morrow, pa brunton

Pulp sensibility testing
Pulp testing following traumatic injuries can be unreliable. These 
procedures require cooperation and a relaxed patient in order to
avoid false responses. Pulp sensibility testing, however, is important
at the time of injury for establishing a point of reference for evaluating
pulpal status at later follow-up examinations. It is essential to review
traumatised teeth clinically and radiographically before instituting
endodontic therapy.
Radiographs
These are important for initial diagnosis and later comparisons. Films
must be dry, and radiographs should also be available of the con-
tralateral teeth. It is essential to look for root development, fractures,
widening of the periodontal membrane space, size of the pulp, 
proximity of the pulp to any fracture, damage to adjacent teeth, 
coincidental pathology and foreign bodies.
Treatment options
Chipped enamel
The degree of damage depends on energy dissipation. Infractions
usually require no treatment. The trauma may have affected the peri-
apical tissues and there is the possibility that the pulp will become
non-vital. Pulp sensibility tests should be performed 3-monthly for 
1 year and radiographs 6-monthly for at least three recalls.
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Fracture into dentine
As dentine is exposed, there are two priorities – to protect the exposed
dentine and prevent possible migration of a tooth that has lost contact
with its neighbours. This may be done with a directly bonded restora-
tion or fragment.
Fracture exposing pulp
A complicated crown fracture implies exposure of the pulp to the oral
environment. Healing is not spontaneous and untreated exposures
lead to total pulp necrosis. The aim of pulp capping or pulpotomy
treatment is to preserve a vital pulp, which is biologically walled off
by a continuous hard tissue barrier. The maturity of the tooth is most
significant. It is agreed that the exposed pulp should be maintained in
young teeth with incomplete root formation and removed in mature
teeth when constriction of the apical foramen allows adequate obtura-
tion of the root canal.