ADC Practice Question — Traumatic Dental Injuries — Permanent Teeth

How does root development stage change the pulp…

OMS questions focus on surgical decision-making with medical comorbidities that change the surgical plan. This exam-level vignette tests your ability to work through clinical details and arrive at the correct management.

Two patients present with complicated crown-root fractures (involving enamel, dentin, cementum, and pulp) of upper central incisors. Patient A is a 9-year-old with an open apex (incomplete root formation). Patient B is a 30-year-old with a closed apex (complete root formation). Both have mobile coronal fragments. How does root development stage change the pulp management for complicated crown-root fractures?

A. Both: partial pulpotomy is the preferred treatment regardless of maturity
B. Immature: preserve the pulp with partial pulpotomy. Mature: removal of the pulp is usually indicated
C. Immature: extract the tooth. Mature: root canal treatment and restoration
D. Both: root canal treatment is required regardless of root development — to ensure complete resolution and prevent secondary complications

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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: B

For complicated crown-root fractures, root development stage determines pulp management: Immature teeth (incomplete root formation): it is advantageous to preserve the pulp by performing a partial pulpotomy. Rubber dam isolation is challenging but should be attempted. Non-setting calcium hydroxide or calcium silicate cements are suitable materials. Mature teeth (complete root formation): removal of the pulp is usually indicated, followed by root canal treatment and restoration. Note this is different from complicated crown fractures (without root involvement), where partial pulpotomy is preferred in BOTH immature AND mature teeth. The crown-root fracture pattern changes the recommendation for mature teeth because the subgingival fracture extension makes pulp preservation more challenging. SOURCE — IADT Guidelines 2020, Fractures and Luxations, Table 6

Source: IADT Guidelines 2020 — Fractures and Luxations, Table 6

Remy's study tip — Check the patient’s medical history first — anticoagulants, bisphosphonates, immunosuppression change management.

Exam preparation FAQ

How are Traumatic Dental Injuries — Permanent Teeth questions structured in the ADC written exam?

ADC Traumatic Dental Injuries — Permanent Teeth questions present as clinical vignettes requiring management decisions. The correct answer is always traceable to a guideline source.

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

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