Complex Dentoalveolar Trauma in a Growing Patient: Management of Avulsion and Alveolar Fracture.

Traumatic dental injuries (TDIs) involving both tooth avulsion and alveolar fracture present significant clinical challenges, particularly in growing patients, where long-term restorative planning must accommodate ongoing craniofacial development. This report describes the multidisciplinary management of an 11-year-old boy who sustained avulsion of tooth #21 and an associated alveolar fracture following a sports-related injury. Clinical and cone-beam computed tomography evaluations revealed an alveolar segment fracture extending from teeth #12 to #21. The displaced segment was manually repositioned and stabilized using a flexible composite and wire splint. Subsequent loss of pulpal vitality in teeth #11 and #12 was managed by root canal treatment with interim calcium hydroxide therapy. Given the patient's incomplete skeletal growth, a minimally invasive Maryland bridge was selected to replace the missing tooth #21. Clinical and radiographic follow-up at 6 and 12 months demonstrated normal healing of the alveolar bone and periodontal structures, with no evidence of root resorption or ankylosis. Successful management of complex dentoalveolar trauma in growing patients requires early diagnosis, appropriate splinting, endodontic intervention when indicated, and growth-conscious prosthetic rehabilitation. Long-term follow-up is essential to monitor healing and plan future definitive treatment.