For Tooth K (open apex), what is the endodontic plan?
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 15-year-old has two replanted incisors: Tooth J (closed apex, Group 2, replanted 30 minutes ago) and Tooth K (open apex, Group 1, replanted at scene). The dentist plans the endodontic strategy for both teeth. For Tooth J (closed apex), root canal treatment is initiated within 2 weeks with calcium hydroxide for up to 1 month. For Tooth K (open apex), what is the endodontic plan?
- A. Same as Tooth J — initiate RCT within 2 weeks with calcium hydroxide regardless of apex status
- B. Initiate RCT within 2 weeks but use MTA apical plug instead of calcium hydroxide for the open apex
- C. No endodontic treatment — monitor for revascularization; initiate treatment ONLY if necrosis and infection develop
- D. Place corticosteroid paste immediately in both teeth — open and closed apex follow the same medicament protocol
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Integration: (1) Closed apex = RCT within 2 weeks, always. (2) Open apex = revascularization goal, endodontics ONLY for necrosis/infection. (3) Different apex status in the SAME patient = two completely different endo pathways running in parallel. SOURCE — Fouad AF et al. IADT Avulsion Guidelines, Dent Traumatol 2020;36:331-342, Sections 3.1.2, 3.2.1, 10
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