ADC Practice Question — Replantation Protocols — Closed & Open Apex

Should endodontic treatment be started immediately for this open-apex tooth despite the prolonged dry time?

Dental trauma questions test protocol-level decisions — splint type, duration, follow-up timing — where one wrong detail means a wrong answer. This exam-level vignette tests your ability to work through clinical details and arrive at the correct management.

An 8-year-old boy's open-apex upper central incisor was dry for 80 minutes before being found and placed in milk. The tooth has been replanted. The dentist considers starting root canal treatment immediately. Should endodontic treatment be started immediately for this open-apex tooth despite the prolonged dry time?

A. No — revascularization is still the goal; initiate RCT only if necrosis and infection are confirmed
B. Yes — after 80 minutes dry, PDL cells are dead and revascularization is impossible at any apex stage
C. Yes — infection-related resorption is so rapid in children that waiting would risk losing the tooth
D. No — but only because the tooth should be extracted rather than treated endodontically in this case

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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

IADT open apex >60min: 'Revascularization of the pulp space is the goal when replanting immature teeth. The risk of external infection-related resorption should be weighed against the chances of revascularization.' RCT should be initiated only when pulp necrosis and infection are identified. SOURCE — Fouad AF et al. IADT Avulsion Guidelines, Dent Traumatol 2020;36:331-342, Section 3.2.3, item 10

Source: Fouad AF et al. IADT Avulsion Guidelines, Dent Traumatol 2020;36:331-342, Section 3.2.3

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

Exam preparation FAQ

How are Replantation Protocols — Closed & Open Apex questions structured in the ADC written exam?

ADC Replantation Protocols — Closed & Open Apex questions present as clinical vignettes requiring management decisions. The correct answer is always traceable to a guideline source.

Should I memorise guidelines word-for-word for Replantation Protocols — Closed & Open Apex?

Focus on decision points — when the guideline says X vs Y. The exam tests application, not recitation.

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Should endodontic treatment be started immediately for this open-apex tooth despite the prolonged dry time?

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