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Traumatic dental injury (TDI) is a globally prevalent condition, as evidenced by epidemiological studies. These studies reveal that approximately one-third of adults and one-fourth of school-aged children have experienced dental trauma. Notably, the active engagement of males in sports and games often results in a higher prevalence of severe tooth injuries compared to females.

The central incisors of the maxillary arch are the most commonly affected, accounting for 37% of cases, followed by mandibular central incisors (18%), mandibular teeth (12%), and other mandibular teeth (4%). TDI exhibits a peak incidence in primary teeth at 2 to 3 years of age, coinciding with the development of motor coordination. Luxation injuries, characterised by tooth displacement, account for a substantial portion (21%-81%) of all TDIs. Among TDIs, intrusion, the most severe form, affects 0.5% to 1.9% of all patients, and it carries the poorest prognosis due to extensive damage to the periodontal ligament and pulp fibres.

Lateral luxation represents another form of TDI involving damage to one of the root surfaces and shares similarities with intrusion injuries. To mitigate and prevent future injury-related consequences following TDI, prompt therapy is imperative, ideally within the first hour. Urgent interventions, such as repositioning and splinting, are essential for teeth with intrusion and/or lateral luxation damage. Endodontic treatment is undertaken after 2 weeks if pulpal damage is suspected to prevent progressive inflammatory resorption. The primary objectives encompass pain management, safeguarding the developing permanent tooth bud, and reducing the likelihood of sequelae in children with primary dentition. It is noteworthy that TDI therapy for deciduous teeth differs from that for permanent teeth due to the close proximity of the deciduous tooth’s root apex to its permanent successor. Inadequate care may inflict more harm on primary teeth than the trauma itself. Consequently, treatments aimed at halting the progression of TDI’s sequelae assume critical importance. Dentists should consider factors such as the degree of tooth displacement, dental mobility, root formation, and the child’s ability to manage an emergency, all in accordance with the International Association for Dental Traumatology (IATD) guidelines.

The most common complication arising from TDI is periapical lesions. Pulpectomy, an essential procedure, proves instrumental in restoring the health of teeth that might otherwise require extraction. This procedure not only halts the spread of infection but also reinstates the tooth to its proper position within the dental arch.

It is noteworthy that IATD strongly advocates splinting, despite limited research in this area and a lack of comprehensive prognosis assessments associated with splint use. It has been observed that splinting significantly improved prognosis in cases of root fractures, underscoring the favourable outcomes achievable through timely and conservative interventions.

In cases of luxation injuries, there exists the potential for disruption of the neurovascular supply to the pulp. This disruption arises from the crushing of periodontal fibres and constriction or compression of supply channels to the pulp, resulting in ischemia that may culminate in necrosis. The effectiveness of splinting was evident in the reported case, yielding positive results. As previously mentioned, the deciduous tooth exhibited no signs of pulp alteration or sensitivity to percussion at the 6-month follow-up, with the crown displaying no evidence of colour change.

Clinical Evaluation:

• The affected tooth exhibits tenderness upon touch or tapping and displays increased mobility without displacement.
• Bleeding from the gingival crevice may be observed.
• Initial sensibility testing may yield negative results, suggesting transient pulpal damage.
• Continuous monitoring of pulpal response is essential until a definitive pulpal diagnosis can be established.

Radiographic Findings:

• Radiographic abnormalities are typically not detected in these cases.

Treatment:

• 4 Weeks Post-Injury:
  • Clinical evaluation only
• In most instances, no active treatment is required. However, for patient comfort, a flexible splint may be applied to stabilise the tooth for a period of up to 2 weeks.

Follow-Up Schedule:

• 2 Weeks Post-Injury:
  • Clinical evaluation
  • Radiographic assessment
• 6-8 Weeks Post-Injury:
  • Clinical evaluation only
• 6 Months Post-Injury:
  • Clinical evaluation only
    • Pulp testing: Positive response
    • Note: False negatives may occur, particularly within the first 3 months.
  • 1 Year Post-Injury:
    • Clinical evaluation only)

Features Indicating Favourable Outcomes:

• Asymptomatic tooth.
• Positive response to pulp testing.
• False negatives are possible, especially within the first 3 months.
• Continuing root development in immature teeth.
• Intact lamina dura.

Features Indicating Unfavourable Outcomes:

• Symptomatic tooth.
• Negative response to pulp testing.
• False negatives may occur, particularly within the first 3 months.
• External inflammatory resorption.
• Lack of continuing root development in immature teeth, with signs of apical periodontitis.
• Indication for endodontic therapy appropriate for the stage of root development.