ADC Practice Question — Traumatic Dental Injuries — Permanent Teeth

What is the recommended repositioning approach?

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.

A 22-year-old man was assaulted and sustained an intrusion injury to tooth 11. The tooth has been pushed into the alveolar bone. It is immobile and gives a high metallic (ankylotic) sound on percussion. It does not respond to cold testing. A periapical radiograph shows complete root formation with a closed apex. The cemento-enamel junction of tooth 11 is positioned more apically than the adjacent uninjured teeth. The degree of intrusion is estimated at approximately 5 mm. The tooth has complete root formation and is intruded approximately 5 mm. What is the recommended repositioning approach?

A. Reposition surgically (preferably) or orthodontically
B. Allow re-eruption without intervention and reassess at 8 weeks
C. Extract the tooth — intrusion beyond 3 mm in mature teeth has a hopeless prognosis
D. Reposition surgically only — orthodontic repositioning is contraindicated at this depth

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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

For mature teeth (complete root formation), the IADT guidelines use three depth thresholds: • Less than 3 mm: allow re-eruption without intervention. If no re-eruption within 8 weeks, reposition surgically and splint for 4 weeks. Alternatively, reposition orthodontically before ankylosis develops. • 3-7 mm: reposition surgically (preferably) or orthodontically. • Beyond 7 mm: reposition surgically only. At 5 mm, this tooth falls in the 3-7 mm category. Surgical repositioning is preferred because it's faster and avoids the risk of ankylosis developing during prolonged orthodontic movement, but orthodontic repositioning remains an acceptable alternative. SOURCE — IADT Guidelines 2020, Fractures and Luxations, Table 13

Source: IADT Guidelines 2020 — Fractures and Luxations, Table 13

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