At what point should the decision about decoronation be made, and why can't an implant be placed now?
Dental trauma questions test protocol-level decisions — splint type, duration, follow-up timing — where one wrong detail means a wrong answer. This high-difficulty vignette tests your ability to work through clinical details and arrive at the correct management.
A 10-year-old had a closed-apex incisor replanted 2 years ago. The tooth is now confirmed ankylosed (metallic percussion, absent PDL space, beginning infra-position at 1.5mm). The orthodontist notes active facial growth. The parents ask about the full range of options and timing. The 1.5mm infra-position can currently be masked with composite buildup. At what point should the decision about decoronation be made, and why can't an implant be placed now?
- A. Decoronate now while infra-position is minimal; implant is contraindicated because titanium causes ankylosis in children
- B. Decoronate when infra-position becomes esthetically unacceptable and unrestorable; implant must wait until growth is completed because it would also infra-position
- C. Never decoronate — extract and place an immediate implant since modern implants are approved for children over age 8
- D. Decoronate at age 18 regardless of infra-position severity; implant at age 21 when bone maturation is confirmed by CBCT
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Integration: (1) Decoronation criterion: 'infra-occlusion deemed esthetically unacceptable AND cannot be corrected by simple restorative treatment' (Sec 12). (2) Implant: 'after growth is completed' because implants don't erupt with bone. (3) Currently maskable = not yet time for decoronation. SOURCE — Fouad AF et al. IADT Avulsion Guidelines, Dent Traumatol 2020;36:331-342, Section 12
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