{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:03:37Z","timestamp":1785888217156,"version":"3.56.0"},"reference-count":38,"publisher":"MJS Publishing, Medical Journals Sweden AB","license":[{"start":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T00:00:00Z","timestamp":1772064000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BIiD"],"abstract":"<jats:p>Background: Traumatic dental injuries are a leading cause of pulpal exposure in immature permanent anterior teeth. Vital pulp therapy (VPT), particularly pulpotomy, has become the preferred treatment modality in such cases as it maintains pulp function, supports physiologic dentin deposition, and promotes long-term tooth retention. However, treatment delays may compromise clinical outcomes due to bacterial contamination and progressive pulpal inflammation. Mineral trioxide aggregate (MTA) and Biodentine\u2122, both hydraulic calcium silicate cements, have demonstrated favorable biological responses in VPT.\nAim: To evaluate clinical and radiographic outcomes of full pulpotomy using MTA and Biodentine\u2122 in immature permanent teeth with complicated crown fractures and delayed treatment intervals of up to 10 days.\nMethods: This case series included eight immature maxillary central incisors in seven patients, aged 8.5\u20139.5 years, presenting with complicated crown fractures. Full pulpotomy was performed using either MTA or Biodentine\u2122 following standardized clinical protocols, and teeth were restored in the same visit, with fragment reattachment performed when feasible. Clinical and radiographic follow-up was conducted at 1 week and at 1, 3, 6, 12, 18, and 24 months.\nResults: At 18\u201324 months, all treated teeth remained vital, demonstrated resolution of symptoms, and showed continued physiologic root development consistent with successful apexogenesis. A radiographic dentinal bridge was observed in three teeth. No cases exhibited pathological changes such as periapical radiolucency, swelling, or restoration failure, except for one case with crown discoloration.\u00a0\nConclusion: Full pulpotomy using MTA or Biodentine\u2122 may represent a promising treatment option for traumatically exposed immature permanent teeth, even when initiated up to 10 days after injury; however, these findings should be interpreted cautiously in view of the limited sample size and follow-up duration.<\/jats:p>","DOI":"10.2340\/biid.v13.45434","type":"journal-article","created":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T13:02:12Z","timestamp":1772110932000},"page":"81-87","source":"Crossref","is-referenced-by-count":1,"title":["Delayed endodontic management of traumatically exposed immature maxillary anterior teeth: a case series"],"prefix":"10.2340","volume":"13","author":[{"given":"Vignesh","family":"Ravi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruchi","family":"Singhal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madhur","family":"Sharma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ritu","family":"Namdev","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1183","published-online":{"date-parts":[[2026,2,26]]},"reference":[{"key":"142827","doi-asserted-by":"crossref","unstructured":"Marin\u010d\u00e1k D, Dole\u017eel V, P\u0159ibyl M, Voborn\u00e1 I, Marek I, \u0160ed\u00fd J, et al. Conservative Treatment of Complicated Crown Fracture and Crown-Root Fracture of Young Permanent Incisor\u2014A Case Report with 24-Month Follow-Up. Children. 2021; 8(9):725. https:\/\/doi.org\/10.3390\/children8090725","DOI":"10.3390\/children8090725"},{"key":"142828","doi-asserted-by":"crossref","unstructured":"Ojeda-Gutierrez F, Martinez-Marquez B, Arteaga-Larios S, Ruiz-Rodriguez MS, Pozos-Guillen A. Management and followup of complicated crown fractures in young patients treated with partial pulpotomy. Case Rep Dent. 2013;2013:597563. https:\/\/doi.org\/10.1155\/2013\/597563","DOI":"10.1155\/2013\/597563"},{"key":"142829","doi-asserted-by":"crossref","unstructured":"Haikal L, Ferraz Dos Santos B, Vu DD, Braniste M, Dabbagh B. Biodentine\u2122 pulpotomies on permanent traumatized teeth with complicated crown fractures. J Endod. 2020;46(9):1204\u20139. https:\/\/doi.org\/10.1016\/j.joen.2020.06.003","DOI":"10.1016\/j.joen.2020.06.003"},{"key":"142830","doi-asserted-by":"crossref","unstructured":"Koyuncuoglu G, Gorken FN, Ikikarakayali G, Zorlu S, Erdem AP, Sepet E, et al. Management of open apices in thirteen traumatized permanent incisors using mineral trioxide aggregate: case series. Pediatr Dent J. 2013;23:51\u201356. https:\/\/doi.org\/10.1016\/j.pdj.2013.03.007","DOI":"10.1016\/j.pdj.2013.03.007"},{"key":"142831","doi-asserted-by":"crossref","unstructured":"Abuelniel GM, Duggal MS, Kabel N. A comparison of MTA and Biodentine\u2122 as medicaments for pulpotomy in traumatized anterior immature permanent teeth: a randomized clinical trial. Dent Traumatol. 2020;36(4):400\u201310. https:\/\/doi.org\/10.1111\/edt.12553","DOI":"10.1111\/edt.12553"},{"key":"142832","doi-asserted-by":"crossref","unstructured":"Donnelly A, Foschi F, McCabe P, Duncan HF. Pulpotomy for treatment of complicated crown fractures in permanent teeth: a systematic review. Int Endod J. 2022;55(4):290\u2013311. https:\/\/doi.org\/10.1111\/iej.13690","DOI":"10.1111\/iej.13690"},{"key":"142833","doi-asserted-by":"crossref","unstructured":"Matoug-Elwerfelli M, ElSheshtawy AS, Duggal M, Tong HJ, Nazzal H. Vital pulp treatment for traumatized permanent teeth: a systematic review. Int Endod J. 2022;55(6):613\u201329. https:\/\/doi.org\/10.1111\/iej.13741","DOI":"10.1111\/iej.13741"},{"key":"142834","doi-asserted-by":"crossref","unstructured":"Klingberg G, Broberg AG. Dental fear\/anxiety and dental behaviour management problems in children and adolescents: a review of prevalence and concomitant psychological factors. Int J Paediatr Dent. 2007;17(6):391\u2013406. https:\/\/doi.org\/10.1111\/j.1365-263X.2007.00872.x","DOI":"10.1111\/j.1365-263X.2007.00872.x"},{"key":"142835","unstructured":"American Academy of Pediatric Dentistry. Behavior guidance for the pediatric dental patient. The Reference Manual of Pediatric Dentistry. Chicago, IL: American Academy of Pediatric Dentistry; 2025:379-99"},{"key":"142836","unstructured":"Kahler B, Rossi-Fedele G. A review of tooth fracture strength in immature teeth treated endodontically with mineral trioxide aggregate. Int Endod J. 2016;49(3):255\u201366."},{"key":"142837","doi-asserted-by":"crossref","unstructured":"Forghani M, Parisay I, Maghsoudlou A. Apexogenesis and revascularization treatment procedures for two traumatized immature permanent maxillary incisors: a case report. Restor Dent Endod. 2013;38:178\u201381. https:\/\/doi.org\/10.5395\/rde.2013.38.3.178","DOI":"10.5395\/rde.2013.38.3.178"},{"key":"142838","doi-asserted-by":"crossref","unstructured":"Mej\u00e0re I, Cvek M. Partial pulpotomy in young permanent teeth with deep carious lesions. Endod Dent Traumatol. 1993;9(6):238\u201342. https:\/\/doi.org\/10.1111\/j.1600-9657.1993.tb00279.x","DOI":"10.1111\/j.1600-9657.1993.tb00279.x"},{"key":"142839","doi-asserted-by":"crossref","unstructured":"Bourguignon C, Cohenca N, Lauridsen E, Flores MT, O'Connell AC, Day PF, et al.International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and luxations. Dent Traumatol. 2020 Aug;36(4):314-330. https:\/\/doi.org\/10.1111\/edt.12578.","DOI":"10.1111\/edt.12578"},{"key":"142840","doi-asserted-by":"crossref","unstructured":"Wolters WJ, Duncan HF, Tomson PL, Karim IE, McKenna G, Dorri M, et al. Minimally invasive endodontics: a new diagnostic system for assessing pulpitis and subsequent treatment needs. Int Endod J. 2017;50(9):825\u20139. https:\/\/doi.org\/10.1111\/iej.12793","DOI":"10.1111\/iej.12793"},{"key":"142841","doi-asserted-by":"crossref","unstructured":"Camilleri J. Hydration characteristics of Biodentine and Theracal used as pulp capping materials. Dent Mater. 2014;30(7):709\u201315. https:\/\/doi.org\/10.1016\/j.dental.2014.03.012","DOI":"10.1016\/j.dental.2014.03.012"},{"key":"142842","doi-asserted-by":"crossref","unstructured":"Surekha GL, Vinay C, Baliga S, Uloopi KS, RojaRamya KS, Penmatsa C. Effect of preconditioning the fractured coronal fragments with remineralizing agents on fracture resistance of re-attached teeth. J Indian Soc Pedod Prev Dent. 2021;39(4):384\u20137. https:\/\/doi.org\/10.4103\/jisppd.jisppd_376_21","DOI":"10.4103\/jisppd.jisppd_376_21"},{"key":"142843","doi-asserted-by":"crossref","unstructured":"Jalannavar P, Tavargeri A. Influence of storage media and duration of fragment in the media on the bond strength of the reattached tooth fragment. 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Int Endod J. 2018;51(8):829\u201346. https:\/\/doi.org\/10.1111\/iej.12906","DOI":"10.1111\/iej.12906"},{"key":"142847","doi-asserted-by":"crossref","unstructured":"Fatima S, Alam S, Kumar A, Andrabi SMUN, Rehman A. Minimal intervention treatment of crown-root fracture in a mature permanent tooth by MTA pulpotomy and fragment reattachment: a case report. Aust Endod J. 2021;47(2):365\u201371. https:\/\/doi.org\/10.1111\/aej.12477","DOI":"10.1111\/aej.12477"},{"key":"142848","doi-asserted-by":"crossref","unstructured":"Krastl G, Weiger R, Filippi A, Van Waes H, Ebeleseder K, Ree M, et al. Endodontic management of traumatized permanent teeth: a comprehensive review. Int Endod J. 2021;54(8):1221\u201345. https:\/\/doi.org\/10.1111\/iej.13508","DOI":"10.1111\/iej.13508"},{"key":"142849","doi-asserted-by":"crossref","unstructured":"Andreasen JO, Andreasen FM, Andersson L. Textbook and color atlas of traumatic injuries to the teeth. 5th ed. 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Clinical and radiographic assessment of direct pulp capping and pulpotomy in young permanent teeth. Pediatr Dent. 1982;4(3):240\u20134."},{"key":"142854","doi-asserted-by":"crossref","unstructured":"Gelbier MJ, Winter GB. Traumatised incisors treated by vital pulpotomy: a retrospective study. Br Dent J. 1988;164(10):319\u201323. https:\/\/doi.org\/10.1038\/sj.bdj.4806440","DOI":"10.1038\/sj.bdj.4806440"},{"key":"142855","doi-asserted-by":"crossref","unstructured":"Hecova H, Tzigkounakis V, Merglova V, Netolicky J. A retrospective study of 889 injured permanent teeth. Dent Traumatol. 2010;26(6):466\u201375. https:\/\/doi.org\/10.1111\/j.1600-9657.2010.00924.x","DOI":"10.1111\/j.1600-9657.2010.00924.x"},{"key":"142856","doi-asserted-by":"crossref","unstructured":"de Blanco LP. Treatment of crown fractures with pulp exposure. 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