External Apical Root Resorption Research Articles

Root resorption in clear aligner treatment detected by CBCT: a Systematic review and Meta-analysis

ObjectiveThe aim of this study was to evaluate the amount of external apical root resorption in patients who had undergone orthodontic treatment with clear aligners evaluated using cone beam computed tomography. MethodsStudies that evaluated external apical root resorption before and after comprehensive orthodontic treatment with clear aligners were assessed by performing an electronic search from 5 databases comprising PubMed, SCOPUS, EBSCO, Cochrane Library, and LILACS and manual searches in the relevant journals and the reference lists of the included studies. Database search, elimination of duplicate studies, and data extraction were performed independently by 2 authors. The quality of the included studies was assessed using the Risk of Bias in Non-randomised Studies-of Interventions and the Cochrane Collaboration's Risk of Bias Tool. Studies that reported the tooth length or volume were used for quantitative analyses. ResultsNine studies were included in the meta-analysis. The overall root length after clear aligner treatment was significantly decreased compared with the pre-treatment length using cone beam computed tomography (mean differences = −0.56 mm, 95% confidence interval [−0.73, −0.38], P < .00001). However, only the maxillary central incisors, maxillary lateral incisors, and mandibular central incisors had significant reduction in root length. The meta-analysis from 3 studies also indicated that the root volume of the upper incisors also significantly decreased (mean differences = −13.34 mm3, 95% confidence interval [−16.57, −10.10], P < .00001). ConclusionsCurrent evidence suggests that clear aligners can cause minimal root resorption. The highest amount of root resorption was observed in the maxillary central incisors.

Efficacy of maxillary molar intrusion and quantification of related external apical root resorption - A comparison of two approaches.

This retrospective single-centre study aimed to compare the efficacy of maxillary second molar intrusion with two different approaches, miniscrew-assisted molar intrusion and traditional segmental archwire intrusion, and to compare orthodontically induced external apical root resorption (OIERR) during intrusion between two groups via cone beam computed tomography (CBCT). A total of 40 adult patients (33.6 ± 10.3 years old) with supraerupted maxillary second molars due to the loss of antagonistic teeth were recruited, with 20 patients in each group. A segmental archwire with adjacent teeth as an anchorage was used in the control group, and 60-100 g of intrusive force was applied by using miniscrews in the experimental group to intrude the overerupted molars. Full-volume CBCT was performed before and after intrusion, and the amount of intrusion and extent of OIERR of the overerupted molars were compared between the two groups. Supraerupted maxillary second molars could be successfully intruded in an average of 5 months. There was more intrusive movement of the buccal and palatal cusps in the mininscrew group than that in the segmental archwire group (P < .05). The intrusive amount of palatal cusp was 3.67 ± 1.13 mm in the miniscrew group and 2.38 ± 0.74 mm in the segmental archwire group. More palatal OIERR was observed in the miniscrew group (30.3 ± 11.6 mm3) than in the segmental archwire group (21.0 ± 8.66 mm3) (P = .0063). There was no significant difference in OIERR between the two groups for mesial and distal buccal roots (P > .05). Miniscrews help effectively with supraerupted maxillary second molar intrusion, especially for palatal cusps. There was more OIERR in the palatal root when using miniscrews compared to the segmental archwire approach.

Evaluation of the use of a clinical practice guideline for external apical root resorption among orthodontists

BackgroundExternal apical root resorption (EARR) is a frequently observed adverse event in patients undergoing fixed appliance therapy. Assessing the patients’ risk during treatment is important, as certain factors are assumed to be associated with an increased likelihood of occurrence. However, their predictive value remains limited, making evidence-based clinical decision-making challenging for orthodontists. To address this issue, the Dutch Association of Orthodontists (NvVO) developed a clinical practice guideline (CPG) for EARR in accordance with the AGREE II instrument (Appraisal of Guidelines for Research and Evaluation II) in 2018. The aim of this study is to get insight into the actual utilization and the practical implementation of the guideline among orthodontists. The hypothesis to be tested was that after its introduction, clinical practice for EARR has changed towards the recommendations in the CPG.ObjectiveTo investigate the use of the 2018 clinical practice guidelines for EARR among orthodontists 3 years after its introduction.MethodsA questionnaire using a 7-point Likert scale was developed concerning four domains of EARR described in the guideline. The questionnaire was piloted, finalised, and then distributed digitally among Dutch orthodontists. REDCap was used for data collection, starting with an invitation email in June 2021, followed by two reminders. Effect was tested by the Mann–Whitney U test, and the influence of demographic variables was analysed.ResultsQuestionnaires were sent out to all 275 and completed by 133 (response rate 48%); N = 59 females and N = 73 males were included; 81% had their training in the Netherlands, 89% had ≥ 6 years of work experience, and 89% worked in private orthodontic practice. One hundred thirty orthodontists (98.5%) reported changes in clinical practice. The biggest positive change in clinical behaviour regarding EARR occurred if EARR was diagnosed during treatment. Sex, clinical experience, country of specialist training, and working environment of the respondents did not affect clinical practices regarding EARR.ConclusionsThis questionnaire demonstrated that, 3 years after introduction of the guideline, orthodontists improved their self-reported clinical practices to a more standardised management of root resorption. None of the demographic predictors had a significant effect on the results.

Mandibular molar protraction: A comparison between fixed functional appliances and temporary anchorage devices.

This study aimed to compare the efficiency of temporary anchorage devices (TADs) and fixed functional appliances (FFAs) for mandibular molar protraction. Orthodontic records of 1050 consecutively treated patients with molar protraction were screened. Thirty-six records (22 females and 14 males; mean age, 17.4 years) were divided into two groups: TAD (21 subjects with 25 edentulous spaces) and FFA (15 subjects with 24 edentulous spaces). The primary outcome measure was the efficiency of protraction [magnitude and time required for protraction (rate) and anchor loss (AL)]. The secondary outcomes involved measuring the type of tooth movement (TOTM), external apical root resorption (EARR), alveolar bone height change (ABHC), alveolar bone width change (ABWC) and appliance failure. The rate of tooth movement was significantly higher for FFAs (0.83 ± 0.35 mm/month) versus TADs (0.49 ± 0.2 mm/month) (P = .005). Total treatment duration was less for FFAs (34.78 ± 8.1 months) versus TADs (47.72 ± 13.94 months) (P = .002). TOTM was similar for both (P = .909). EARR was 1.42 ± 1.38 mm for TAD and 1.25 ± 0.88 mm for FFA (P = .81). ABHC increased in the FFA group (1.01 ± 3.62 mm) and decreased for the TAD group (0.68 ± 1.66 mm). ABWC increased for both TAD (1.81 ± 1.73 mm) and FFA (1.75 ± 1.35 mm). The failure rate was 50% for FFAs and 33% for TADs. Both systems provided translation of lower molars with comparable anchorage control. However, FFAs were more efficient than TADs for lower molar protraction.

Micro-Osteoperforations Accelerate Tooth Movement without Exacerbating the Progression of Root Resorption in Rats.

A recent study reported that micro-osteoperforations (MOPs) accelerated tooth movement by activating alveolar bone remodeling. However, very little is known about the relationship between MOPs and external apical root resorption during orthodontic treatment. In this study, in order to investigate the mechanism through which MOPs accelerate tooth movement without exacerbating the progression of root resorption, we measured the volume of the resorbed root, and performed the terminal deoxynucleotidyl transferase (TdT)-mediated dUTP-biotin nick-end labeling (TUNEL) method on exposed MOPs during experimental tooth movements in rats. Male Wistar rats (11 weeks old) were divided into three groups: 10 g orthodontic force (optimal force) applied to the maxillary first molar (optimal force: OF group), 50 g orthodontic force application (heavy force: HF group), and 10 g force application plus three small perforations of the cortical plate (OF + MOPs group). On days 1, 4, 7, 10, and 14 after force application, the tooth movement and root volume were investigated by micro-computed tomography. Furthermore, the number of apoptotic cells in the pressured sides of the periodontal ligament (PDL) and surrounding hard tissues were determined by TUNEL staining. The OF + MOPs group exhibited a 1.8-fold increase in tooth movement on days 7, 10, and 14 compared with the OF group. On days 14, the HF group had a higher volume of root loss than the OF and OF + MOPs groups. On the same day, the number of TUNEL-positive cells in the HF group increased at the root (cementum) site whereas that in the OF group increased at the alveolar bone site. Furthermore, the number of TUNEL-positive cells in the OF + MOPs group increased at the alveolar bone site compared with the OF group. These results suggest that MOPs accelerate orthodontic tooth movement without exacerbating the progression of root resorption.

Diagnostic Accuracy of Cone Beam Computed Tomography and Periapical Radiography for Detecting Apical Root Resorption in Retention Phase of Orthodontic Patients: A Cross-Sectional Study.

Objectives: This clinical study aimed to evaluate and compare the diagnostic accuracy of intraoral periapical radiography (PR) and cone beam computed tomography (CBCT) in detecting external apical root resorption (EARR) in orthodontic patients during the retention phase. Methods: The research involved 41 Caucasian patients who had undergone comprehensive orthodontic treatment, with a total of 328 teeth analyzed. The Kappa values for inter- and intra-examiner agreement were high for both PR and CBCT, indicating a robust level of agreement among examiners. The study used a four-point scale for classifying EARR. Results: This study showed comparable accuracy, sensitivity, and specificity between PR and CBCT when using the most stringent criterion of "Definitely present". The data suggested that CBCT outperformed PR when using a less stringent criterion ("Definitely present" or "Probably present"), particularly for maxillary incisors. However, overall diagnostic performance, as measured by the area under the ROC curve, showed only a slight advantage for CBCT over PR. Areas under the ROC curve range between 0.85 and 0.90 for PR and between 0.89 and 0.92 for CBCT. According to DeLong's test, there is no evidence to conclude that the area under the ROC curve is different for PR and CBCT. Conclusions: Both PR and CBCT are accurate diagnostic tools for identifying EARR, with PR being deemed more suitable for routine clinical use due to its cost-effectiveness and lower radiation exposure. The findings emphasize the importance of considering the risk-benefit ratio when deciding on imaging modalities for monitoring EARR in orthodontic patients.

The Correlation between the Bone Morphotype and Density and Root Apical Resorption of the Anterior Teeth Due to Orthodontic Forces

The potential side effects of modern orthodontic treatment and its unfavorable impact on dentition and hard tissues have been extensively discussed in professional literature for decades. The presence of uncontrolled forces can result in pulp necrosis, radicular reabsorption, and/or loss of alveolar bone. Dehiscence and fenestration are more commonly found in anterior than posterior teeth, where only the periodontal ligament and the mucosa protect the dental root.&#x0D; Most studies investigating the effect of periodontal phenotype over gingival recession in orthodontic patients have primarily focused on examining the soft tissues. However, due to the vulnerability of thin alveolar bone, the previous evaluation of orthodontic candidate patients may also include the analysis of hard tissues. Bone density plays an important role in facilitating orthodontic tooth movement, such that reductions in bone density can significantly increase movement velocity. These types of localized density changes can affect the rate of orthodontic tooth movement and may also influence the risk of unwanted outcomes, such as the occurrence of dental external apical root resorption.&#x0D; According to the literature, the links of root resorption with the bone morphotype and the density are relevant in clinical dentistry but have not been studied in detail. However, the existing data is not yet conclusive.

Root Resorption during Orthodontic Treatment with Clear Aligners vs. Fixed Appliances—A Systematic Review

The external apical root resorption that occurs during orthodontic treatment was the focus of this study, using either fixed appliances (FA) or clear aligners (CA). Using the Boolean keywords “APICAL ROOT RESORPTION” and “CLEAR ALIGNERS”, the study searched PubMed, Scopus, and Web of Science, with a restriction to English-language publications. A total of 50 publications were found by the computerized search, but after eliminating duplicates, completing reviews, and determining eligibility, only 9 papers could be used in the study. In conclusion, apical root resorption (ARR) is a frequent consequence of orthodontic tooth movement that mainly affects the lower incisors, which may compromise the success of the procedure and the health of the patient’s teeth. Several variables, including the type of tooth, have an impact on the severity of ARR.

Evaluation of Apical Root Resorption during Alignment Phase of Fixed Orthodontic Treatment: A Prospective Study

Purpose: External apical root resorption (EARR) is a permanent shortening of the root apex, often detected through radiographic imaging, characterized by the loss of the protective outer layer.To evaluate the apical root resorption during alignment phase of fixed orthodontic treatment Method: Prospective Study was conducted in the Department of Orthodontic, Nishtar Institute of Dentistry, and Multan from 6th October 2020 to 5th April 2021. The study included a 110 patients aged between 18 and 25 years. The evaluation of External Apical Root Resorption (EARR) was conducted prior to and following the therapy. In order to carry out this assessment, a group of 110 patients underwent periapical radiographs utilizing the paralleling approach. The radiographs were taken at the beginning of the treatment and then again at the conclusion of a three-month research period. Afterwards, the length from the incisal edge to the apex of all incisors was carefully measured using a vernier caliper. The difference in root length, measured in millimeters, between the pre-treatment (T0) and post-treatment (T1) stages was measured and expressed as a percentage of the initial root length.

Assessment of external apical root resorption following En-masse and two steps retraction in maxillary protrusion cases: A randomized controlled clinical trial

Assessment of external apical root resorption following En-masse and two steps retraction in maxillary protrusion cases: A randomized controlled clinical trial

External apical root resorption in African American orthodontic patients.

External apical root resorption (EARR) is a side effect of orthodontic treatment that results in root shortening. However, this condition has yet to be evaluated in African Americans. The aim of this study was to determine the EARR prevalence within this ethnicity and investigate how patient and treatment-related factors contribute to root resorption. The records of 336 African Americans treated at the University of Alabama at Birmingham School of Dentistry Department of Orthodontics were retrospectively analyzed with Dolphin Imaging software. Pre-treatment and post-treatment panoramic radiographs were used to measure EARR. Resorption was recorded when final roots were at least 2 mm shorter after orthodontic treatment. Additionally, moderate and severe EARR was reported when 20% and 50% or more of the root structure was lost for any of the four maxillary incisors, respectively. The Pearson chi-square test was used to evaluate the associations of individual patient and treatment-related factors with EARR. The prevalence of root resorption with 2 mm or greater of root structure loss was 51.8%. The prevalence of ≥ 20% EARR was 29.8%. Only one patient displayed severe resorption (0.3%). The associations between the patient-specific and treatment-specific variables and EARR were not statistically significant (P > .05). More than half of the African American patients exhibit at least 2 mm of root resorption with orthodontic treatment. However, in this ethnicity, patient-related factors such as age, gender, dental malocclusion, and skeletal classifications, as well as treatment-related factors do not indicate a significant correlation with the risk of developing EARR.

Effects of premolar extraction and orthodontic treatment in adolescents - a retrospective cephalometric study

Objectives To evaluate the cephalometric effects of premolar extraction on skeletal and dental parameters, and on the soft tissues, in patients subsequently treated with fixed appliances. Prevalence and severity of external apical root resorption due to premolar extraction were also examined. Materials and methods The dental records of 79 patients treated with fixed appliances were retrieved (groups: extraction, n = 19; non-extraction, n = 60). Pre- and post-treatment statuses of skeletal, dentoalveolar, and soft tissue variables were analyzed on lateral cephalograms to determine change. Periapical radiographs of the maxillary incisors were assessed for external apical root resorption using the Levander & Malmgren index. The t-test, Mann-Whitney U test, chi-squared test, and Kruskal-Wallis test were used to analyze the data. Significance was set at p < .05. Results Changes in the protrusion and proclination of the incisors and in lip position were significantly different between the groups. Prevalence of external apical root resorption in the two groups was similar. Conclusions Our findings suggest that extraction therapy affects dentoalveolar traits but not jaw position, nor the risk of root resorption, in patients treated with fixed appliances

Role of vitamin D for orthodontic tooth movement, external apical root resorption, and bone biomarker expression and remodeling: A systematic review.

: This systematic review aimed to evaluate the correlation between vitamin D levels and the rate of tooth movement, external apical root resorption, bone biomarker expression, and bone remodeling. : Three databases (PubMed, Scopus, and Web of Science) were systematically searched from inception until 14th March 2023 to identify studies investigating the correlation between orthodontic tooth movement and vitamin D in animals and humans. The quality assessment was made in accordance with the Joanna Briggs Institute Critical Appraisal Checklist. : Overall, 519 records were identified, and 19 were selected for the qualitative synthesis. Eleven studies investigated the effect of local administration (injections in the periodontal ligament, to the gingiva distal to the teeth, or submucosae palatal area) and systemic administration (oral supplementation) of vitamin D on tooth movement, external apical root movement, pro-inflammatory cytokines, and bone remodeling factors. The remaining eight studies investigated the correlation between serum vitamin D levels and salivary vitamin D levels on bone turnover markers and tooth movement. : The findings of this systematic review support that vitamin D3 local injections might increase the rate of tooth movement via the receptor activator of the nuclear factor-kB/osteoprotegerin axis. However, the non-uniform study designs and the different protocols and outcome methods make it challenging to draw reliable conclusions.

[Relationship between orthodontic treatment and root resorption].

As one of the common complications of orthodontic treatment, external apical root resorption (EARR) often occurs during orthodontic treatment. This paper systematically elaborates the degree classification of EARR and the biological mechanism of root resorption in orthodontic treatment. At the same time, orthodontic root resorption is caused by a variety of factors. They are not only affected by genetic and environmental factors, but also by great individual differences. This paper summarizes the factors influencing the root resorption of orthodontic teeth and the prognosis of root resorption. This paper also provides some suggestions for the prevention and treatment of root resorption in the process of orthodontics, in order to provide guidance and help for the clinical work of orthodontists.

Factors that may increase the risk of external apical root resorption during orthodontic treatment : Retrospective clinical investigation.

To determine the correlation between external apical root resorption and malocclusion-related variables in patients treated with fixed orthodontic appliances. In all, 103patients aged 12-15years and treated with edge-wise appliances either without extractions or with four premolar extractions were included in this retrospective cohort study. External apical root resorption was assessed in the pre- and posttreatment panoramic radiographs of these patients for incisors, canines, premolars, and first molars. Atotal of 2332 teeth were evaluated in 206 panoramic radiographs obtained from 103patients. The gender of the patients, duration of orthodontic treatments, presence of premolar extractions, Angle classification, overbite, overjet and amount of crowding were assessed. Wilcoxon signed-rank test, Mann-WhitneyUtest, and Kruskal-Wallis test were used for statistical analysis of the data. Statistically significant (p < 0.001) root resorption occurred in all examined teeth during orthodontic treatment. The degree of root resorption observed in the premolars was significantly greater in premolar extraction cases than in nonextraction cases. Statistically significant negative correlations were found between the degree of root resorption of the maxillary lateral teeth and between the maxillary first premolar teeth and the amount of maxillary crowding. The orthodontic treatment protocols and the amount of tooth movements achieved were shown to be dependent on the severity of dental malocclusions and they have an influence on the amount of external apical root resorption that occurs during the course of orthodontic treatment.

Assessment of changes in maxillary dentoalveolar complex following retraction and intrusion of maxillary anterior teeth in mixed Indian population

The biology of tooth movement implies to selective resorption and deposition of the alveolar bone during orthodontic tooth movement. The controversy about "tooth movement through bone" and "tooth movement with bone” is still not settled. The cortices of the alveolar bone are considered boundaries of the alveolar complex that limit the orthodontic tooth movement. The present study evaluated the change in these limits of maxillary dentoalveolar complex post-retraction and intrusion of maxillary anterior teeth.: CBCT data of 15 subjects was assessed to primarily measure the changes in thickness, area and volume of anterior maxillary alveolar bone following retraction &amp; intrusion. As a secondary objective, tooth length was also assessed to ascertain external apical root resorption, post-retraction and intrusion of maxillary anterior teeth. A statistically significant reduction in alveolar bone thickness, mean area and volume on the palatal side was evident and also reduction in tooth length of maxillary central and lateral incisor was observed post retraction and intrusion of maxillary anterior teeth (P-value&amp;#60;0.05). It is essential to evaluate the alveolar housing prior to considering retraction and intrusion of anterior teeth in order to plan appropriate biomechanics and treatment protocol which would minimize iatrogenic side effects and yield a stable treatment outcome.

Alveolar bone loss and root resorption in mesialized second molars in mandibular first molar extraction cases as compared to contralateral non-extraction side in young adults: A retrospective cross-sectional study

The alveolar bone loss (ABL) and external apical root resorption (EARR) depict the safety of mesialization of mandibular second molars into the extraction space of mandibular first molars. The aim of this study was to evaluate the ABL and EARR after closure of mandibular first molar extraction space by mesialization of second molar on extraction side (ES) as compared to the contralateral non-extraction side (NES). A retrospective cross-sectional study was carried out using the pre and posttreatment orthodontic records of young adults with complete set of permanent dentitions treated with extraction of unilateral mandibular first molar and non-extraction treatment on the contralateral side. All patients underwent mini-implant supported mesialization of second molar on ES. The ABL and EARR of second molar on ES and contralateral NES were measured on digital orthopantomograms. The ABL and EARR of second molars on ES and contralateral NES were compared using independent sample t-test. A total of 36 subjects (14 males and 22 females) were included in the study. The mean treatment duration for molar mesialization was 28.75±8.05months. The mean crown and root movements of mandibular second molar on ES were 10.94±1.25mm and 9.04mm±1.14mm, as compared to 0.91±1.01mm and 0.77±0.83mm on contralateral NES, respectively. The mean ABL and EARR at mandibular second molar were found to be significantly greater on the ES than the contralateral NES (P<0.001 and<0.05, respectively). A total of seven patients (19.4%) experienced ABL≥1mm on ES as compared to none in the contralateral NES. EARR of>2mm of at least one root was found in seven patients (19.4%) in ES as compared to four (11%) in contralateral NES. There was small but statistically significant difference in the ABL and EARR of mesialized mandibular second molar at first molar ES as compared to the contralateral NES. For majority of patients this difference was small but few isolated cases experienced severe ABL and EARR.

Corrective orthodontic treatment of high Frankfort mandibular plane angle with maxillary expansion and four premolar extractions with presence of external apical root resorption during treatment

This case report describes the orthodontic treatment performed on a 10-year-old female patient in mixed dentition stage who presented with maxillary constriction that was associated with Angle Class III malocclusion, severe crowding, and high mandibular plane angle. She had the main complaint of an unaesthetic smile. The rapid maxillary expansion approach was chosen, followed by four first premolars extraction with fixed appliance. Two mandibular miniscrews were used for anchorage control and 0.018 × 0.025-in beta titanium advance archwire were used to increase labial tipping of the maxillary incisors. After 3 years, favorable results were achieved for the occlusion, dental aesthetics, and facial profile. External apical root resorption was noted in the maxillary incisors. The patient's self-esteem improved. Treatment results were stable after 1-year follow-up.

Development of a tooth movement model of root resorption during intrusive orthodontic treatment.

There is a high risk of external apical root resorption (EARR) following the application of intrusive orthodontic forces to the apical root. However, there is a lack of suitable animal models to study this phenomenon in depth. This study compared the usability of three different types of loops, namely, vertical helical loop, box loop, and L loop, for preparing a rat model of orthodontic tooth movement with invasive forces. Results showed a significant downward movement in the first molar of the rat after L loop placement for 14 days. Three-dimensional reconstructed images showed root resorption and length shortening on the apical root and decreased bone volume and trabecular thickness in the alveolar bone under compression. Histological staining revealed odontoclasts on the root resorption fossa. This study showed that orthodontic tooth movement using the L loop provides an effective experimental animal model of EARR.

Orthodontically induced external apical root resorption considerations of root-filled teeth vs vital pulp teeth: a systematic review and meta-analysis

IntroductionThe purpose of this systematic review was to research the difference between root-filled teeth (RFT) and vital pulp teeth (VPT) in orthodontically induced external apical root resorption (EARR) and to offer suggestions for clinicians on therapeutic sequence and timing when considering combined treatment of endodontic and orthodontic.Materials and methodsAn electronic search of published studies was conducted before November 2022 in PubMed, Web of Science and other databases. Eligibility criteria were based on the Population, Intervention, Comparison, Outcome, and Study design (PICOS) framework. RevMan 5.3 software was used for statistical analysis. Single-factor meta-regression analysis was used to explore the sources of literature heterogeneity, and a random effects model was used for analysis.ResultsThis meta-analysis comprised 8 studies with 10 sets of data. As there was significant heterogeneity among the studies, we employed a random effects model. The funnel plot of the random effects model exhibited a symmetrical distribution, indicating no publication bias among the included studies. The EARR rate of RFT was significantly lower than that of VPT.ConclusionsIn the context of concurrent endodontic and orthodontic treatment, priority should be given to endodontic therapy, as it serves as the foundation for subsequent orthodontic procedures. The optimal timing for orthodontic tooth movement post-root canal therapy is contingent upon factors such as the extent of periapical lesion resolution and the degree of dental trauma sustained. A comprehensive clinical assessment is essential in guiding the selection of the most suitable approach for achieving optimal treatment outcomes.