For avulsion with closed apex and extraoral time greater than 60 minutes, which endodontic approach is indicated?

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Multiple Choice

For avulsion with closed apex and extraoral time greater than 60 minutes, which endodontic approach is indicated?

When a permanent tooth with a closed apex is avulsed and its extraoral time is over 60 minutes, the pulp will not recover and the periodontal ligament is likely nonviable. Replantation is still performed to preserve the alveolar bone and aesthetics, but the tooth will require endodontic management to prevent inflammatory (infection-related) root resorption. Because the pulp is necrotic, root canal therapy is indicated. Doing the root canal procedure outside the mouth (extraoral) to ensure thorough debridement is one valid approach, or, if continued intraoral access is preferred, debridement of the canal with placement of calcium hydroxide as an intracanal medicament can control infection and slow resorption until definitive root canal treatment is completed. Calcium hydroxide helps disinfect the canal and creates an alkaline environment that inhibits resorptive processes. In contrast, relying on splinting alone ignores the necrotic pulp and the high risk of resorption; no endodontic therapy would not address the infection risk. Immediate replantation with no endodontic planning also falls short because the necrotic pulp and contaminated canal space can drive resorption and failure. The key point is that endodontic treatment is essential after replantation in a closed-apex tooth with prolonged dry time to prevent resorption and preserve the tooth.

When a permanent tooth with a closed apex is avulsed and its extraoral time is over 60 minutes, the pulp will not recover and the periodontal ligament is likely nonviable. Replantation is still performed to preserve the alveolar bone and aesthetics, but the tooth will require endodontic management to prevent inflammatory (infection-related) root resorption. Because the pulp is necrotic, root canal therapy is indicated. Doing the root canal procedure outside the mouth (extraoral) to ensure thorough debridement is one valid approach, or, if continued intraoral access is preferred, debridement of the canal with placement of calcium hydroxide as an intracanal medicament can control infection and slow resorption until definitive root canal treatment is completed. Calcium hydroxide helps disinfect the canal and creates an alkaline environment that inhibits resorptive processes.

In contrast, relying on splinting alone ignores the necrotic pulp and the high risk of resorption; no endodontic therapy would not address the infection risk. Immediate replantation with no endodontic planning also falls short because the necrotic pulp and contaminated canal space can drive resorption and failure. The key point is that endodontic treatment is essential after replantation in a closed-apex tooth with prolonged dry time to prevent resorption and preserve the tooth.

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