American Board of Pediatric Dentistry (ABPD) Oral Boards Practice Exam

The situation relies on the high likelihood of the tooth to realign itself when the intrusion is mild in an immature tooth. With open growth centers and a pliable periodontal ligament, a tooth intruded less than about 7 millimeters often re-erupts on its own if we give it time. That’s why the best initial plan is to watch and wait for spontaneous re-eruption over roughly six weeks, using careful clinical and radiographic follow-up.

If spontaneous eruption occurs, you continue to monitor until the tooth stabilizes in its proper position, avoiding unnecessary intervention that could disrupt the developing root or surrounding tissues. If there is no eruption after about six weeks, then deliberate repositioning can be considered—either orthodontically or surgically—depending on the case and timeline.

Extraction is not favored here because removing an immature tooth deprives the patient of a developing root and alters occlusion and arch length, which we want to preserve whenever possible. Surgical repositioning alone is more invasive and carries risks to the immature root and periodontal structures, without first leveraging the tooth’s natural healing potential. Orthodontic repositioning without allowing for spontaneous eruption misses the chance to use the tooth’s inherent capacity to re-erupt, though it may be indicated if spontaneous eruption does not occur.