Multidisciplinary treatment of an avulsed central incisor.

A 16-year-old female presented with the chief concern of esthetic deficiency caused by a missing tooth (Fig. 1A). She had lost her maxillary right central incisor in a cycling accident nine years previously. The tooth, which had been avulsed during the accident, was reimplanted and subjected to endodontic therapy several days later, but was lost again in a second traumatic avulsion after a few months. The pa tient was not treated for trauma at that time and had not undergone further dental examination or treatment of the incisal area before initial consultation at our clinic. Intraoral examination re vealed, in addition to the absent tooth, a full Class II malocclusion on the right and partial Class II malocclusion on the left. Even light pressure on the apical zone at the site of the missing tooth caused severe pain. X-rays showed a well-delineated zone of radio pacity in this area, indicating the presence of a foreign body (Fig. 1B).