Delayed Reimplantation of Traumatically Avulsed Permanent Incisors After 18 Hours and 4 Days:A Report of Two Paediatric Cases and a Review of the Literature

Traumatic avulsion most commonly affects the maxillary permanent incisors, with a prevalence of 0.5–16%. Immediate reimplantation is the treatment of choice; however, in low- and middle-income countries (LMICs) such as Nigeria, delayed presentation and limited access to emergency dental care often necessitate delayed reimplantation. Objective: To report two cases of delayed reimplantation of traumatically avulsed permanent maxillary incisors, following delays of 18 hours and 4 days, respectively, in a resource-limited setting. Clinical Cases: A 9-year-old male and a 12-year-old female presented to the Paediatric Dentistry Clinic at the University of Benin Teaching Hospital following traumatic avulsion of the maxillary incisors. Clinical assessment revealed intact avulsed teeth and empty alveolar bone sockets without associated fractures. Extraoral endodontic treatment was performed, and the teeth were reimplanted after root apex treatment with acidulated phosphate fluoride. Stabilization was achieved using semi-rigid composite and wire splints for six weeks, and systemic antibiotics were administered. Follow-up at 3 months, 6 months and 1 year in both cases demonstrated stable teeth, healthy gingival tissues, satisfactory function, mild crown discoloration in case 1 and no evidence of mobility, with minimal root resorption. Conclusion: Even with prolonged extra-alveolar time, reimplantation of traumatically avulsed permanent teeth is a feasible and beneficial intervention in LMIC settings when the tooth is intact and the alveolar socket is accessible. Adherence to standard protocols can preserve aesthetics, function, and alveolar bone, highlighting the value of delayed reimplantation where immediate dental care is not available.