ADC Practice Question — Traumatic Dental Injuries — Permanent Teeth

How does this change the endodontic approach compared to a mature tooth?

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.

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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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: D

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

Source: IADT Guidelines 2020 — Fractures and Luxations, Table 12

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Exam preparation FAQ

Should I memorise guidelines word-for-word for Traumatic Dental Injuries — Permanent Teeth?

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

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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How does this change the endodontic approach compared to a mature tooth?

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