Non-Vital Primary Incisor — ORE Part 1 MCQ

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EasyPaediatric DentistryNon-Vital Primary IncisorORE Part 1

A 6-year-old child presents with a discoloured upper primary incisor that has become non-vital following trauma 1 year ago. There is a chronic draining sinus tract buccally. What is the most appropriate treatment?

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Correct answer: D — Extract the primary incisor

Extraction is the most appropriate treatment. SDCEP guidance indicates that when root canals are necrotic, pulpectomy or extraction should be considered. In a traumatised primary incisor with a chronic sinus tract, extraction is preferred because: (1) ZOE pulpectomy in traumatised primary incisors has a 42% failure rate, significantly higher than non-traumatised teeth; (2) primary upper incisors exfoliate naturally by age 7–8 (short remaining lifespan at age 6); (3) primary incisors have no clear anatomical demarcation between coronal and radicular pulp, making successful pulp therapy less likely; (4) extraction definitively resolves the chronic suppurative pathology and is minimally invasive. Option E (pulpectomy) is technically possible but has high failure rates in this cohort. Option A (MTA pulp cap) is inappropriate for a frankly necrotic tooth. Option B (antibiotic alone) does not address the underlying pathology. Option C (crown without pulp therapy) ignores the necrotic pulp and persistent infection.

Reference: SDCEP: Prevention and Management of Dental Caries in Children. Guidance on pulpotomy for primary teeth. https://www.childcaries.sdcep.org.uk/guidance/dental-techniques/pulpotomy-for-primary-teeth/