Management of an Oblique Cervical Root Fracture in an Immature Maxillary Central Incisor: A Case Report

Traumatic dental injuries in immature permanent teeth present significant diagnostic and therapeutic challenges, particularly when associated with root fractures. A 7-year-old boy presented with trauma to the anterior maxilla after a fall on the pavement. Right central incisor (#11), previously unerupted due to premature extraction of the primary predecessor, erupted rapidly within 2 weeks post-trauma, likely facilitated by dental trauma. Initial radiographic examination revealed an immature root with an open apex (Cvek Stage 1) and an oblique root fracture extending from the cervical region toward the middle-apical third. No other clinical signs were present. The patient remained asymptomatic throughout the observation period, reporting no pain or discomfort at any time. Cone beam computed tomography (CBCT) obtained 3 months later confirmed the root fracture and demonstrated dentin bridge formation, isolating the coronal pulp associated with the root fracture from the unaffected pulp. A sinus tract developed 6 months post-trauma, but definitive treatment was delayed because of insufficient clinical crown for access. A month later, sufficient eruption allowed access cavity preparation. Under high magnification, a thick, continuous tertiary dentin bridge was observed overlying the pulp, with a localized pulpal exposure at the junction with the distal dentinal wall; bleeding confirmed pulpal vitality. The coronal pulp space above the bridge was gently irrigated with 1% NaOCl and 17% EDTA without mechanical instrumentation and subsequently sealed with a calcium silicate-based cement up to 2 mm below the cementoenamel junction. Clinical and radiographic follow-up for up to 2 years showed continued root development, dentin bridge formation, canal narrowing, and absence of symptoms. Conservative vital pulp therapy may be a viable treatment option in selected cases of root fractures in immature permanent teeth when pulp vitality is preserved.