ADC Practice Question — Traumatic Dental Injuries — Permanent Teeth

should root canal treatment be started for this…

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. When should root canal treatment be started for this intruded mature tooth?

A. At the emergency visit, before any repositioning attempt
B. At 2 weeks or as soon as the position of the tooth allows
C. Only if signs of infection-related resorption develop at follow-up
D. After 3 months, once the tooth has been stable in its repositioned location

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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: B

In teeth with complete root formation, the pulp almost always becomes necrotic after intrusion. Root canal treatment should be started at 2 weeks or as soon as the position of the tooth allows, using a corticosteroid-antibiotic or calcium hydroxide as an intra-canal medication. The purpose is to prevent the development of inflammatory (infection-related) external resorption — which is very rapid in young patients. Contrast this with immature teeth: for those, you monitor and only intervene if necrosis and resorption actually develop, because revascularisation may occur through the wide open apex. SOURCE — IADT Guidelines 2020, Fractures and Luxations, Table 13

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

Remy's study tip — Check the patient’s medical history first — anticoagulants, bisphosphonates, immunosuppression change management.

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?

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