Question: What is an Ellis Class II fracture and does it need urgent care?
Explanation: An Ellis Class II fracture extends through the enamel into the dentine, without exposing the pulp. The exposed dentine appears yellow and is sensitive to air, cold, and touch, because the open dentinal tubules communicate hydraulically with the pulp. Bacteria can also travel down these tubules, so the pulp is at risk if the fracture is left uncovered. Treatment involves sealing the exposed dentine, typically with glass ionomer or bonded composite, within 24 to 48 hours. Pulp vitality should be monitored for at least a year afterwards.
Related Questions:
How quickly does an Ellis Class II fracture need covering?
Ideally within 24 hours, and certainly within a few days. Exposed dentinal tubules allow bacterial ingress towards the pulp. The thinner the remaining dentine over the pulp, the more urgent the seal. Very deep fractures may need a calcium hydroxide or MTA liner beneath the restoration.
Why is exposed dentine so sensitive?
Dentine is riddled with microscopic fluid-filled tubules running from the pulp to the surface. Air, cold, and pressure move that fluid, deforming nerve endings at the pulpal end. This is the hydrodynamic theory of dentine sensitivity. Enamel has no tubules, which is why enamel-only chips do not hurt.
Can the pulp still die after an Ellis Class II fracture is fixed?
Yes, particularly if the fracture was deep or accompanied by a luxation injury. Pulp necrosis can present months later as discolouration or an abscess. This is why follow-up sensibility testing at six to eight weeks and one year is recommended.
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