ADC Practice Question — Replantation Protocols — Closed & Open Apex

What is the correct interpretation and action for Tooth K?

Dental trauma questions test protocol-level decisions — splint type, duration, follow-up timing — where one wrong detail means a wrong answer. This high-difficulty vignette tests your ability to work through clinical details and arrive at the correct management.

A 15-year-old has two replanted incisors: Tooth J (closed apex, Group 2, replanted 30 minutes ago) and Tooth K (open apex, Group 1, replanted at scene). The dentist plans the endodontic strategy for both teeth. At 3-month follow-up, Tooth K (open apex) shows a sinus tract, periapical radiolucency, and no root development since replantation. The 2-week RCT for Tooth J was completed successfully. What is the correct interpretation and action for Tooth K?

A. Revascularization has failed — options now include root canal treatment, apexification, or pulp revitalization/revascularization procedures
B. This is expected healing — sinus tracts are normal in the first 6 months after open apex replantation
C. Continue monitoring for 6 more months — revascularization can still occur despite these signs
D. Extract Tooth K immediately — necrotic open apex teeth cannot be treated endodontically

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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: A

Integration: (1) Sinus tract + radiolucency + no root development = failed revascularization with necrotic infected pulp. (2) Three treatment options available (Sec 10). (3) Rapid resorption risk in children = urgent action needed. (4) Contrast with Tooth J's completed RCT — different timelines, different outcomes. SOURCE — Fouad AF et al. IADT Avulsion Guidelines, Dent Traumatol 2020;36:331-342, Sections 3.2.1, 10

Source: Fouad AF et al. IADT Avulsion Guidelines, Dent Traumatol 2020;36:331-342, Sections 3.2.1 & 10

Remy's study tip — Trauma questions hinge on: tooth maturity (open vs closed apex), time out of mouth, storage medium, and fracture type.

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Build competence across all topics. The exam tests application of guidelines to clinical scenarios, not memorisation.

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Extract key clinical data from the stem before reading options. There are usually 3–4 critical variables that determine the correct answer.

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