ADC Practice Question — Traumatic Dental Injuries — Permanent Teeth

What is the recommended initial management?

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. The tooth has incomplete root formation (open apex) and is intruded 6 mm. What is the recommended initial management?

A. Reposition surgically — at 6 mm, the degree of intrusion is too severe for observation
B. Reposition orthodontically over 4 weeks — at this stage when the tissue conditions are most favourable for intervention
C. Allow re-eruption without intervention, regardless of the degree of intrusion
D. Extract the tooth to protect the developing permanent tooth germ

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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

For teeth with INCOMPLETE root formation (immature teeth): allow re-eruption without intervention for ALL intruded teeth, independent of the degree of intrusion. If no re-eruption occurs within 4 weeks, initiate orthodontic repositioning. This is a fundamentally different approach from mature teeth, where depth thresholds determine the method. The reason: immature teeth retain eruption force — the tooth is still actively trying to erupt, so it has a biological mechanism to push itself back. Mature teeth have no eruption force, so they depend on passive PDL healing or active intervention. 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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