ADC Practice Question — Replantation Protocols — Closed & Open Apex

For Tooth K (open apex), what is the endodontic plan?

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. For Tooth J (closed apex), root canal treatment is initiated within 2 weeks with calcium hydroxide for up to 1 month. For Tooth K (open apex), what is the endodontic plan?

A. Same as Tooth J — initiate RCT within 2 weeks with calcium hydroxide regardless of apex status
B. Initiate RCT within 2 weeks but use MTA apical plug instead of calcium hydroxide for the open apex
C. No endodontic treatment — monitor for revascularization; initiate treatment ONLY if necrosis and infection develop
D. Place corticosteroid paste immediately in both teeth — open and closed apex follow the same medicament protocol

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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: C

Integration: (1) Closed apex = RCT within 2 weeks, always. (2) Open apex = revascularization goal, endodontics ONLY for necrosis/infection. (3) Different apex status in the SAME patient = two completely different endo pathways running in parallel. SOURCE — Fouad AF et al. IADT Avulsion Guidelines, Dent Traumatol 2020;36:331-342, Sections 3.1.2, 3.2.1, 10

Source: Fouad AF et al. IADT Avulsion Guidelines, Dent Traumatol 2020;36:331-342, Sections 3.1 & 3.2

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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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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For Tooth K (open apex), what is the endodontic plan?

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