ADC Practice Question — Traumatic Dental Injuries — Permanent Teeth

What is the next step?

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 7-year-old girl fell off playground equipment and intruded her upper left central incisor (tooth 21) approximately 6 mm into the alveolar bone. The tooth is immobile and gives a metallic sound on percussion. A periapical radiograph shows an open apex with incomplete root formation. The periodontal ligament space is not visible apically. At 4 weeks, there is no sign of re-eruption. What is the next step?

A. Reposition surgically and splint for 4 weeks
B. Continue to observe for another 4 weeks — re-eruption can take up to 3 months
C. Initiate orthodontic repositioning
D. Extract the tooth — failure to re-erupt by 4 weeks indicates ankylosis

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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

If no re-eruption occurs within 4 weeks for an immature tooth, initiate orthodontic repositioning. This is a time-bound decision point: 4 weeks of observation, then active orthodontic intervention if no progress. The management pathway for intruded immature teeth: 1. Allow spontaneous re-eruption (regardless of intrusion depth) 2. If no movement by 4 weeks → orthodontic repositioning 3. Monitor pulp — revascularisation may occur. If pulp becomes necrotic with signs of resorption → start RCT using endodontic procedures suitable for immature teeth 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.

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