Delayed endodontic management of traumatically exposed immature maxillary anterior teeth: a case series

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™, both hydraulic calcium silicate cements, have demonstrated favorable biological responses in VPT. Aim: To evaluate clinical and radiographic outcomes of full pulpotomy using MTA and Biodentine™ in immature permanent teeth with complicated crown fractures and delayed treatment intervals of up to 10 days. Methods: This case series included eight immature maxillary central incisors in seven patients, aged 8.5–9.5 years, presenting with complicated crown fractures. Full pulpotomy was performed using either MTA or Biodentine™ 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. Results: At 18–24 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. Conclusion: Full pulpotomy using MTA or Biodentine™ 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.