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Post-Trauma Pulp Necrosis Management — ORE Part 1 MCQ

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ModerateEndodonticsPost-Trauma Pulp Necrosis ManagementORE Part 1

A 10-year-old child attends 6 months after subluxation of an upper central incisor. The crown has become progressively grey. The tooth gives no response to sensibility testing and a periapical radiograph shows a developing periapical radiolucency. The root apex is open. Which is the most appropriate diagnosis and management?

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Correct answer: E — Pulp necrosis with apical periodontitis — disinfect the canal and provide apexification or a regenerative procedure

The combination of progressive grey discolouration, absent sensibility response and a developing periapical radiolucency after trauma supports pulp necrosis with apical periodontitis. A negative sensibility test alone would not justify treatment in an immature traumatised tooth, because neural recovery and revascularisation may be delayed; however, the radiographic lesion and discolouration make observation inappropriate here. Because the apex is open, canal disinfection must be followed by apexification/apical barrier treatment or, where suitable, a regenerative endodontic procedure. Pulp canal obliteration is usually associated with a perfused pulp and is not treated endodontically without signs of necrosis. Ankylosis/replacement resorption requires characteristic clinical and radiographic findings, not present here. A purely transient post-traumatic pulpal response would not explain a progressively developing periapical lesion.

Reference: Royal College of Surgeons of England, Faculty of Dental Surgery. Management and root canal treatment of non-vital immature permanent incisor teeth, 1997, sections "Diagnosis of non-vital immature permanent incisor tooth" and "Aim of root canal treatment of non-vital immature permanent incisor teeth". https://www.rcseng.ac.uk/-/media/files/rcs/fds/publications/pd2.pdf?la=en