OMFS-0140Maxillofacial traumaTraumaintermediateAnterior maxilla

Avulsed maxillary central incisor in a schoolchild

9-year-old male

Draft — educational study aid, pending faculty review.

§Chief complaint

Front tooth knocked out playing football 40 minutes ago

§Medical & dental history

01Healthy; tetanus immunisation up to date
02Tooth transported in milk by the school nurse
03No previous trauma to the region

§Clinical examination

0111 avulsed; socket clot present, alveolar walls intact
0221 grade I mobile, tender to percussion, no displacement
03Lacerated upper lip with no embedded fragments
04No signs of head injury; GCS 15

§Figures

Verified clinical, radiology and histopathology images not yet available

§Differential diagnosis

Avulsion of an immature permanent incisorTooth out of socket, transported in milk

Intrusive luxationTooth appears shortened, metallic percussion note

Alveolar fractureSegment mobility involving several teeth

Root fractureTooth mobile with radiographic fracture line

§Final diagnosis

Avulsion of tooth 11 with an open apex, extra-oral dry time under 15 minutes, stored in milk

Management is decided by the stage of root development and the extra-oral dry time. An open apex with short dry time offers a genuine chance of revascularisation, so replantation without immediate endodontics is correct.

§Investigations

01Periapical radiographs of 11 socket and 21 to exclude root/alveolar fracture and retained fragments
02Soft tissue radiograph of the lip if any fragment is unaccounted for
03Check tetanus status

§Treatment plan

01Immediate replantation after gentle rinsing in saline — do not scrub the root surface
02Flexible splint for 2 weeks
03Systemic antibiotics (amoxicillin or doxycycline by age), chlorhexidine rinses, soft diet
04Monitor for revascularisation; endodontics only if pulp necrosis develops

§Surgical procedure

01Socket irrigated, clot removed gently, tooth replanted digitally
02Flexible composite-wire splint 11 to 13 and 21 to 23 for 14 days
03Lip laceration cleaned and sutured

§Follow-up & outcome

01Splint removed at 14 days; tooth firm
02Pulp sensibility returned at 3 months with continued root development
03Reviewed at 1, 3, 6 and 12 months for ankylosis and replacement resorption

§Clinical pearls / learning points

01Milk, saline or the patient's own saliva are all acceptable storage media; water is the worst.
02Never scrub the root — periodontal ligament cells on the surface determine the outcome.
03Closed-apex avulsions need root canal treatment within 2 weeks; open-apex teeth may revascularise.

§ evidenceReferences & Evidence

Current Classification

WHO Classification of Tumours Online — Head and Neck

IARC / WHO · 2022

Continuously updated online edition of the WHO head and neck tumour classification.

View official source

Evidence summary

Highest level of evidence linked to this page: WHO / Official Classification.

L1 · Classification — 1
L6 · Textbook — 5

1 linked source was published from 2024 onwards. Where guidance is limited or contested, rely on the higher-level sources above rather than this summary. Educational use only — not a substitute for clinical judgement.

Content last reviewed

September 2026

Evidence last reviewed

September 2026

Next scheduled review

September 2027

Review status

EVIDENCE REVIEWED

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Last literature search: 7 September 2026

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Current Classification