ADC Practice Question — Replantation Protocols — Closed & Open Apex

3-month follow-up, the tooth shows normal mobility, no…

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 9-year-old with penicillin allergy (anaphylaxis) has an avulsed upper left central incisor with an open apex. The tooth was dry for 15 minutes, then stored in milk for 40 minutes. Radiographs reveal a buccal alveolar wall fracture. The dentist replants the tooth and plans the complete management protocol. At 3-month follow-up, the tooth shows normal mobility, no percussion sensitivity, and the radiograph reveals the root canal appears narrower than baseline with continued root development. What is the correct interpretation AND next step?

A. Favourable — pulp canal obliteration indicates revascularization is occurring; continue monitoring without endodontic intervention
B. Unfavourable — canal narrowing indicates internal resorption requiring immediate root canal treatment to prevent perforation
C. Uncertain — canal narrowing could be artefact; repeat radiographs in 1 week from a different angle to confirm
D. Favourable — but prophylactic root canal treatment should be started now while access is still possible before full obliteration

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Sources cited

Therapeutic Guidelines v4 Odell's 3rd & 4th Ed IADT 2020 Code of Conduct CMS (Evans) Infection Control + more

Show the answer and cited explanation

Correct answer: A

Integration: (1) Open apex + canal narrowing + continued root development = successful revascularization. (2) Pulp canal obliteration is the EXPECTED healing mechanism (Sec 11.2.2). (3) No RCT unless necrosis develops (Sec 3.2.2). (4) Normal percussion + mobility = favourable outcome criteria. SOURCE — Fouad AF et al. IADT Avulsion Guidelines, Dent Traumatol 2020;36:331-342, Sections 3.2.2, 11.2.2

Source: Fouad AF et al. IADT Avulsion Guidelines, Dent Traumatol 2020;36:331-342, Sections 3.2.2 & 11.2.2

Remy's study tip — Trauma questions hinge on: tooth maturity (open vs closed apex), time out of mouth, storage medium, and fracture type.

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Extract key clinical data from the stem before reading options. There are usually 3–4 critical variables that determine the correct answer.

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3-month follow-up, the tooth shows normal mobility, no…

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