A 4-year-old avulses a primary maxillary central incisor. The extraoral time has been under 60 minutes. What is the correct management?

Correct answer: A. Do not replant the tooth

• A. CORRECT. Avulsed PRIMARY teeth are NEVER replanted, regardless of how short the extraoral time has been. The permanent successor sits immediately palatal to and above the primary root apex. Replantation risks pushing infected or displaced tissue against the developing tooth germ, producing enamel hypoplasia, crown or root dilaceration, or arrested development. The risk to the successor far outweighs the temporary benefit.
• B. Apical maturity does not alter the rule — the risk is to the permanent successor, not to the primary tooth.
• C. Splinting presupposes replantation, which is contraindicated for primary teeth.
• D. Rigid splinting is inappropriate even for permanent avulsions, and replantation itself is contraindicated here.

Note: Reassure the parent, confirm the tooth is accounted for (consider a chest radiograph if aspiration is possible), and monitor space. A space maintainer is rarely needed for a single primary incisor, since anterior arch length is largely preserved.