A young patient suffers a complicated crown fracture with pulp exposure and an immature apex. What is the appropriate immediate vital pulp therapy and long-term plan?

• A. Do nothing
• B. Pulpotomy with stainless steel crown and monitor apex
• C. Root canal therapy immediately
• D. Extraction

Answer: (B)

In a young patient with a complicated crown fracture and an immature apex, the aim is to keep the tooth alive so the root can continue to develop (apexogenesis). The appropriate immediate vital pulp therapy is to perform a pulpotomy, removing the inflamed coronal pulp while preserving the radicular pulp, and restore with a durable barrier and coverage. Placing a stainless steel crown over the tooth protects the restored tooth during growth and function. After this, the long-term plan is to closely monitor the tooth radiographically for continued root formation and apex closure, ensuring vitality is maintained and the root matures. If vitality is preserved and apexogenesis proceeds, you avoid premature endodontic treatment; if the tooth later becomes non-vital or shows signs of pathology, endodontic therapy can be planned after apex formation is complete.

Why the other options aren’t suitable here: doing nothing ignores the pulp exposure and risks infection and loss of potential for continued root development; extracting the tooth eliminates a natural space maintainer and the developing tooth structure; performing root canal therapy immediately in an immature tooth would arrest root development and weaken the tooth walls, making future prognosis poorer.