tooth has incomplete root formation (open apex). How…
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An 8-year-old girl fell while climbing a tree. Tooth 11 is displaced labially. It is immobile and gives a high metallic sound on percussion. The tooth does not respond to cold testing. A periapical radiograph shows incomplete root formation with an open apex and a widened periodontal ligament space. The tooth has incomplete root formation (open apex). How does this change the endodontic approach compared to a mature tooth?
- A. Perform immediate apexification with MTA at the emergency visit — as this timing aligns with the optimal window for treatment effectiveness
- B. No difference — start RCT at 2 weeks regardless of root development
- C. Extract the tooth — immature teeth with lateral luxation have a poor prognosis
- D. Spontaneous revascularisation may occur — monitor and start RCT only if signs of necrosis and infection-related resorption develop
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This is the critical immature vs mature distinction for lateral luxation: • Immature teeth (open apex): spontaneous revascularisation may occur. RCT should only be started if the pulp becomes necrotic AND there are signs of inflammatory (infection-related) external resorption. The wide apical foramen allows blood vessel regrowth. • Mature teeth (closed apex): the pulp will likely become necrotic. Start RCT at ~2 weeks proactively. The reasoning: the apical foramen diameter determines whether new blood vessels can grow into the canal. In immature teeth, the foramen is wide enough to allow revascularisation. In mature teeth, the narrow foramen is a bottleneck that prevents it. SOURCE — IADT Guidelines 2020, Fractures and Luxations, Table 12
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