Revascularisation — ORE Part 1 MCQ

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HardEndodonticsRevascularisationORE Part 1

A 9-year-old child presents with a previously traumatised maxillary permanent central incisor. The tooth is confirmed non-vital, has an incompletely formed root with a wide open apex, and shows a periapical radiolucency. Which is the most appropriate endodontic management?

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Correct answer: C — Create an MTA apical barrier, then obturate the root canal

**A is correct.** This is a non-vital immature permanent incisor with apical periodontitis: the open apex prevents predictable conventional gutta-percha obturation. European Academy of Paediatric Dentistry guidance supports an MTA apical barrier followed by root-canal obturation as the treatment of choice for this situation. Regenerative endodontic treatment is biologically appealing but, for traumatised immature incisors, the guideline judges the evidence to be extremely weak and reserves it for limited cases with an extremely poor prognosis using other methods. Conventional gutta-percha alone does not provide an adequate apical seal. Pulpotomy and direct pulp capping are vital-pulp procedures and are incompatible with confirmed pulp necrosis and a periapical radiolucency. The item is hard because it distinguishes an MTA apical plug from both vital pulp therapy and regenerative treatment.

Reference: European Academy of Paediatric Dentistry. Interventions for the endodontic management of non-vital traumatised immature permanent anterior teeth in children and adolescents: a systematic review of the evidence and guidelines of the European Academy of Paediatric Dentistry. 2017. https://pubmed.ncbi.nlm.nih.gov/28508244/