Complicated crown-root fracture
The healthy tooth is composed of two major parts: the supra-gingival portion that extends above the gingiva and is grossly visible, termed the crown, and the sub-gingival portion that extends beneath the gingiva, termed the root. A central cavity is located within the tooth, termed the pulp canal (located in the root segment) and pulp chamber (located in the crown segment). The pulp, which consists of nerves, blood vessels and connective tissues, is located within the pulp canal and chamber. It provides nutrition and sensation to the tooth. The pulp is surrounded and therefore protected by two hard layers. An inner layer composed of dentine, which is found in both the crown and root, and an outer layer of enamel and cementum. The crown is covered in enamel. The root has an outer covering of cementum. The point where the crown and root meet is termed the cemento-enamel junction. A CCRF is one which removes enamel and dentine from the crown, cementum and dentine from the root and does expose the pulp. As such the dentinal tubules and the pulp canal are exposed leading to pulpitis and pain. Treatment is aimed at removing rough edges, decreasing pulpitis, preventing periapical abscessation or treating it and restoring normal anatomy where possible and practical. Where the fracture is less than 48 hours duration, direct pulp capping is preferred, whereas older pulp exposes require root canal treatment or extraction.