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OMFS-0140TraumaintermediateAnterior 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.
§References
- International Association of Dental Traumatology Guidelines, 2020.
§Similar cases
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