Surgical management of avulsed immature permanent incisor with alveolar bone loss and ridge preservation in a pediatric trauma patient

Objective: Dental trauma includes injuries to the teeth and their supporting tissues, most often caused by direct impact such as traffic accidents. It commonly affects both primary and permanent dentition, especially the maxillary central and lateral incisors. Injuries may involve the crown, root, or both, while supporting tissue injuries include concussion, subluxation, luxation, and avulsion. Treatment depends on the type, location, and severity of the trauma.

Materials & Methods: An 8-year-old child presented one hour after trauma with avulsion of teeth #21, #62, and #63, along with loss of the buccal alveolar plate. Radiography showed hypodontia of tooth #22. Immediate reimplantation of tooth #21 and wire–composite splinting was performed. Endodontic
treatment with MTA-based bio-ceramic cement was performed due to the open apex. By bone grafting and resorbable membrane placement under the coronally advanced flap, we preserved the alveolar ridge, followed by laser-assisted vestibuloplasty. Orthodontic disarticulation and controlled sagittal repositioning of tooth #11 were carried out for correction of the reversed overjet and traumatic occlusion previously present, which had caused visible gingival recession of tooth #41. Follow-up was performed every 30 days, with re-obturation of tooth #21 after three months, radiographically confirmed.

Results: At the one-year follow-up, successful repositioning of tooth #11 into normal occlusion was achieved, while tooth #21 showed complete apical closure and stable integration within the preserved alveolar bone. Clinical and radiographic evaluation confirmed favorable functional and esthetic outcome, with no signs of mobility, root resorption, or other pathological complications.

Conclusion: Early multidisciplinary management including immediate reimplantation, combined with endodontic, surgical, and orthodontic treatment, allowed successful stabilization of the traumatized area, preservation of the alveolar ridge, and prevention of further complications. Careful follow-up remains crucial for long-term prognosis and growth-related outcome.