What is the correct initial management for each patient?
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 intrusion injuries to upper central incisors: Patient A: 8-year-old, permanent tooth 11 with open apex (immature), intruded 5 mm. Patient B: 25-year-old, permanent tooth 11 with closed apex (mature), intruded 5 mm. Patient C: 3-year-old, primary tooth 51, intruded 5 mm, apex displaced labially. What is the correct initial management for each patient?
- A. All three: surgical repositioning — 5 mm intrusion requires active intervention regardless of tooth type or maturity
- B. Patient A and C: allow re-eruption. Patient B: extract — mature intruded teeth beyond 3 mm have poor prognosis
- C. Patient A: allow re-eruption. Patient B: surgical or orthodontic repositioning. Patient C: allow spontaneous repositioning
- D. Patient A: orthodontic repositioning. Patient B: allow re-eruption for 8 weeks. Patient C: extract to protect permanent successor
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Intrusion management varies dramatically by tooth type and maturity: Immature permanent teeth (Patient A): allow re-eruption WITHOUT intervention for ALL degrees of intrusion. The tooth retains eruption force. If no movement by 4 weeks, initiate orthodontic repositioning. Mature permanent teeth (Patient B): depth-dependent approach. At 5 mm (3-7 mm range), reposition surgically (preferably) or orthodontically. Below 3 mm: observe. Above 7 mm: surgical only. Primary teeth (Patient C): allow spontaneous repositioning REGARDLESS of displacement direction or degree. Usually within 6 months, can take up to 1 year. The logic: immature teeth have eruption force. Mature teeth don't. Primary teeth heal conservatively and active intervention risks damaging the permanent successor. SOURCE — IADT Guidelines 2020, Fractures and Luxations Table 13; Primary Dentition Table 11
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