apex appears to be displaced labially (toward the…
Paediatric dentistry questions combine clinical management with age-appropriate considerations — LA dosing by weight, behaviour management. This exam-level vignette tests your ability to work through clinical details and arrive at the correct management.
A 2-year-old girl fell while learning to walk and intruded her upper right primary central incisor (tooth 51). The tooth has almost completely disappeared into the socket and can be palpated labially. A periapical radiograph shows the image of the tooth appears shorter (foreshortened) compared to the contralateral tooth, and the apical tip can be seen — indicating the apex has been displaced toward or through the labial bone plate. The apex appears to be displaced labially (toward the labial bone plate, away from the permanent successor). What is the recommended management?
- A. Reposition orthodontically using a fixed appliance — to reduce the risk of infection spreading to adjacent structures
- B. Extract the tooth immediately to prevent damage to the permanent successor
- C. Allow the tooth to spontaneously reposition itself, irrespective of the direction of displacement
- D. Surgically reposition the tooth and splint for 4 weeks — as the more aggressive approach provides better long-term outcomes
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The tooth should be allowed to spontaneously reposition itself, IRRESPECTIVE of the direction of displacement. This is one of the most important updates in the 2020 IADT guidelines for primary teeth. Previous guidelines recommended extraction if the root was displaced toward the permanent tooth germ. This is no longer advised for three reasons: 1. Evidence shows spontaneous re-eruption occurs for intruded primary teeth 2. The extraction itself may inflict further damage on the tooth germ 3. There is no evidence that immediate extraction minimises damage to the permanent successor Spontaneous improvement usually occurs within 6 months, but can take up to 1 year. SOURCE — IADT Guidelines 2020, Injuries in Primary Dentition, Table 11 and Section 1.8
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