A 2–year retrospective cohort study of pulp-related outcomes of permanent anterior teeth with uncomplicated crown fractures

BACKGROUND: Uncomplicated crown fractures (UCFs) are the most common form of traumatic dental injury in permanent dentition. However, studies on long-term pulp outcome in South Asian populations are limited. This study aimed to analyse pulp survival of permanent anterior teeth with uncomplicated crown fractures in a Sri Lankan population. METHODS: A retrospective cohort study was conducted following STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines. Records of 257 teeth with uncomplicated crown fractures in patients attending a tertiary dental care centre in Sri Lanka between 2018 and 2023 were used. Pulp status was assessed using clinical and radiographic criteria over a 24-month period and categorised as pulp survival, pulp necrosis, or pulp canal obliteration. Cox regression, the log-rank test, and Kaplan-Meier survival analysis were employed to identify predictors of pulp necrosis. RESULTS: At 24 months, pulp survival was observed in 92.6% of teeth, pulp necrosis in 4.7% of teeth, and pulp canal obliteration in 2.7%. Teeth with enamel-only fractures had 100% pulp survival within this sample, whereas enamel-dentine fractures showed reduced survival. Tooth substance loss greater than 40% significantly increased the risk of pulp necrosis (Hazard Ratio (HR) = 5.00, 95% CI: 2.17-11.54, p < 0.001). Teeth with concomitant luxation injuries were also significantly associated with reduced pulp survival (p = 0.007). Treatment delay and stage of root development were not significant predictors. CONCLUSIONS: UCFs generally demonstrate favourable pulp survival. However, concurrent luxation injuries and extensive tooth substance loss were associated with increased risk of pulp necrosis. Adherence to trauma management protocols and long-term monitoring are essential for optimal outcomes and for early detection of complications.