Pediatric Dentistry · patient case question
Given the wide open apex, how should the pulp be managed after replantation?
Patient case: Avulsed Central Incisor on the Soccer Field
Patient: 8-year-old male
Chief Complaint: “His tooth got knocked out at soccer practice.”
Background: Healthy, immunizations current, no allergies. Tooth #8 was avulsed 35 minutes ago. The coach placed it directly into a container of Hank’s Balanced Salt Solution from the sideline kit. No loss of consciousness, no other injuries.
Medications: None
Vital Signs: BP 100/64 mmHg · HR 98 bpm · RR 20 · T 98.6°F
Findings: Empty socket at #8 with no alveolar fracture. The avulsed tooth is intact with a wide open apex and short root (approximately two-thirds formed). Adjacent teeth #7 and #9 are firm and respond within normal limits.
Show answer and explanation
Correct answer: A. Withhold root canal treatment and monitor closely for revascularization
- A. Correct. In an immature tooth, spontaneous revascularization of the pulp space is possible and is the goal, since it permits continued root development and thicker dentinal walls. Endodontic treatment is withheld and started only if pulp necrosis or infection-related resorption is later confirmed clinically or radiographically.
- B. Incorrect. Apexification presupposes a necrotic pulp. It is not performed prophylactically at the time of replantation.
- C. Incorrect. That protocol applies to a closed apex, where revascularization will not occur and treatment is begun before splint removal to prevent inflammatory resorption. Applying it here forfeits the chance of continued root maturation.
- D. Incorrect. Extraoral pulp extirpation prolongs extra-alveolar time and further damages the periodontal ligament. Replantation speed is the priority.
Note: Flagged — the source recorded “after 2 weeks.” That figure applies to a closed apex, where endodontic treatment is initiated before the splint comes off. This patient has an open apex, which reverses the recommendation. Watch closely: inflammatory root resorption progresses very rapidly in children, so short-interval recall is essential.
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