For which patient(s) should root canal treatment be…
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.
Three patients present with different luxation injuries, all with mature permanent teeth (closed apices) that do not respond to cold testing at follow-up: Patient A: Subluxation at 3-month follow-up. Patient B: Lateral luxation at 2-week follow-up. Patient C: Intrusion at 2-week follow-up. For which patient(s) should root canal treatment be initiated now?
- A. All three — negative cold test at any follow-up confirms necrosis requiring RCT
- B. None — negative sensibility tests should never be used to initiate RCT
- C. Patient C (intrusion) only — lateral luxation and subluxation should continue monitoring
- D. Patient B (lateral luxation) and Patient C (intrusion) — but NOT Patient A (subluxation)
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The endodontic timing decision depends on injury severity and root development: Subluxation (Patient A): do NOT start RCT based solely on negative sensibility. Monitor — the false negative response can persist for months while the pulp heals. The injury is a PDL stretch, not a severe disruption of the apical blood supply. Lateral luxation (Patient B): start RCT at ~2 weeks in mature teeth. The pulp will likely become necrotic because the apex was displaced into fractured bone, severely disrupting the blood supply. Intrusion (Patient C): start RCT at 2 weeks or as soon as the tooth's position allows. The pulp almost always becomes necrotic in mature intruded teeth. The principle: the more severe the disruption to the apical blood supply, the less likely the pulp will survive in a mature tooth, and the more proactive the endodontic approach should be. SOURCE — IADT Guidelines 2020, Fractures and Luxations, Tables 10, 12, 13
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