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

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. 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. 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. 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.