{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,3]],"date-time":"2026-05-03T00:48:35Z","timestamp":1777769315496,"version":"3.51.4"},"reference-count":29,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,4,8]]},"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:p>Traumatic dental injuries are prevalent among children and adolescents, especially those between 6 and 12 years of age with varying degrees of severity. The complexities of their diagnosis, management and overall prognosis are compounded by their occurrence in combination. International Association of Dental Traumatology guidelines provide a systematic roadmap for the management of isolated dental trauma but the management of a combination of injuries is still left to clinicians\u2019 discretion. This case report illustrates the uncommon occurrence of multiple luxation injuries, including avulsion, in an early adolescent female child, concurrently with complicated tooth fractures of maxillary anterior teeth and its 5\u2009year sequelae. The multidisciplinary management of the traumatised teeth involved endodontic therapy and mesialisation of teeth, resulting in a successful aesthetic reconstruction. This report highlights the promising approach of orthodontic treatment combined with prosthetic and\/or endodontic therapy to manage combination injuries.<\/jats:p>","DOI":"10.1136\/bcr-2025-265874","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T16:15:38Z","timestamp":1777479338000},"page":"e265874","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Comprehensive interdisciplinary management of multiple combination injuries in permanent maxillary anterior teeth in an adolescent patient"],"prefix":"10.1136","volume":"19","author":[{"given":"Saraa","family":"Angel L","sequence":"first","affiliation":[{"name":"Division of Orthodontics and Dentofacial Deformities, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9566-4405","authenticated-orcid":false,"given":"Prabhat K","family":"Chaudhari","sequence":"additional","affiliation":[{"name":"Division of Orthodontics and Dentofacial Deformities, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6747-5110","authenticated-orcid":false,"given":"Nitesh","family":"Tewari","sequence":"additional","affiliation":[{"name":"Division of Paediatric and Preventive Dentistry, All India Institute of Medical Sciences New Delhi, New Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ritu","family":"Duggal","sequence":"additional","affiliation":[{"name":"Division of Orthodontics and Dentofacial Deformities, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,4,29]]},"reference":[{"key":"2026042909151420000_19.4.e265874.1","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1111\/edt.12389","article-title":"World traumatic dental injury prevalence and incidence, a meta-analysis-One billion living people have had traumatic dental injuries","volume":"34","author":"Petti","year":"2018","journal-title":"Dent Traumatol"},{"key":"2026042909151420000_19.4.e265874.2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-9657.2012.01133.x"},{"key":"2026042909151420000_19.4.e265874.3","doi-asserted-by":"publisher","DOI":"10.1111\/edt.12578"},{"key":"2026042909151420000_19.4.e265874.4","doi-asserted-by":"crossref","first-page":"2085","DOI":"10.1007\/s00784-021-04190-2","article-title":"Prevalence and patterns of traumatic dental injuries in primary teeth: a 3-year retrospective overview study in Vienna","volume":"26","author":"Lembacher","year":"2022","journal-title":"Clin Oral Investig"},{"key":"2026042909151420000_19.4.e265874.5","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1111\/j.1600-9657.2011.01102.x","article-title":"Combination injuries 1. The risk of pulp necrosis in permanent teeth with concussion injuries and concomitant crown fractures","volume":"28","author":"Lauridsen","year":"2012","journal-title":"Dent Traumatol"},{"key":"2026042909151420000_19.4.e265874.6","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1111\/j.1600-9657.2011.01101.x","article-title":"Combination injuries 2. The risk of pulp necrosis in permanent teeth with subluxation injuries and concomitant crown fractures","volume":"28","author":"Lauridsen","year":"2012","journal-title":"Dent Traumatol"},{"key":"2026042909151420000_19.4.e265874.7","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1111\/j.1600-9657.2011.01100.x","article-title":"Combination injuries 3. The risk of pulp necrosis in permanent teeth with extrusion or lateral luxation and concomitant crown fractures without pulp exposure","volume":"28","author":"Lauridsen","year":"2012","journal-title":"Dent Traumatol"},{"key":"2026042909151420000_19.4.e265874.8","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1111\/edt.12678","article-title":"A 5-year data report of traumatic dental injuries in children and adolescents from a major dental trauma center in Greece","volume":"37","author":"Agouropoulos","year":"2021","journal-title":"Dent Traumatol"},{"key":"2026042909151420000_19.4.e265874.9","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1111\/adj.12397","article-title":"Responses of the pulp, periradicular and soft tissues following trauma to the permanent teeth","volume":"61 Suppl 1","author":"Yu","year":"2016","journal-title":"Aust Dent J"},{"key":"2026042909151420000_19.4.e265874.10","doi-asserted-by":"crossref","first-page":"1484","DOI":"10.14219\/jada.archive.2008.0074","article-title":"Planning esthetic treatment after avulsion of maxillary incisors","volume":"139","author":"Zachrisson","year":"2008","journal-title":"J Am Dent Assoc"},{"key":"2026042909151420000_19.4.e265874.11","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1111\/ipd.12603","article-title":"Orthodontic treatment recommendation and expected adverse reactions in patients with a history of dental trauma: A survey among general dentists, paediatric dentists, and orthodontic specialists","volume":"30","author":"Van Gorp","year":"2020","journal-title":"Int J Paediatr Dent"},{"key":"2026042909151420000_19.4.e265874.12","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1111\/edt.12474","article-title":"Knowledge of orthodontic treatment approach of traumatized teeth by a group of Belgian general dentists, pediatric dentists, and orthodontists","volume":"35","author":"Van Gorp","year":"2019","journal-title":"Dent Traumatol"},{"key":"2026042909151420000_19.4.e265874.13","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1111\/j.1600-9657.1990.tb00426.x","article-title":"Tooth splinting: a review of the literature and consideration of the versatility of a wire\u2010composite splint","volume":"6","author":"Oikarinen","year":"1990","journal-title":"Dent Traumatol"},{"key":"2026042909151420000_19.4.e265874.14","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1111\/adj.12398","article-title":"Splinting of teeth following trauma: a review and a new splinting recommendation","volume":"61 Suppl 1","author":"Kahler","year":"2016","journal-title":"Aust Dent J"},{"key":"2026042909151420000_19.4.e265874.15","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1111\/j.1600-9657.1987.tb00611.x","article-title":"Occurrence of pulp canal obliteration after luxation injuries in the permanent dentition","volume":"3","author":"Andreasen","year":"1987","journal-title":"Dent Traumatol"},{"key":"2026042909151420000_19.4.e265874.16","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1177\/1465312520977498","article-title":"Guidelines for the orthodontic management of the traumatised tooth","volume":"48","author":"Sandler","year":"2021","journal-title":"J Orthod"},{"key":"2026042909151420000_19.4.e265874.17","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1111\/edt.12099","article-title":"Analysis of pulp prognosis in 603 permanent teeth with uncomplicated crown fracture with or without luxation","volume":"30","author":"Wang","year":"2014","journal-title":"Dent Traumatol"},{"key":"2026042909151420000_19.4.e265874.18","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1111\/adj.12400","article-title":"Prevention and management of external inflammatory resorption following trauma to teeth","volume":"61 Suppl 1","author":"Abbott","year":"2016","journal-title":"Aust Dent J"},{"key":"2026042909151420000_19.4.e265874.19","doi-asserted-by":"crossref","first-page":"542","DOI":"10.3390\/healthcare9050542","article-title":"Dental Trauma Management in a Young Teenager through Endodontics and Implantology: A Case Report","volume":"9","author":"Munoz-Sanchez","year":"2021","journal-title":"Healthcare (Basel)"},{"key":"2026042909151420000_19.4.e265874.20","article-title":"Management of Concomitant Intrusion and Complicated Crown-Root Fracture Injury of Maxillary Central Incisors in a Child","volume":"2023","author":"Haimed","year":"2023","journal-title":"Case Rep Dent"},{"key":"2026042909151420000_19.4.e265874.21","doi-asserted-by":"crossref","first-page":"169","DOI":"10.4103\/atr.atr_96_18","article-title":"Interdisciplinary sequential management of combination traumatic dental injuries","volume":"7","author":"Chaudhari","year":"2018","journal-title":"Arch Trauma Res"},{"key":"2026042909151420000_19.4.e265874.22","doi-asserted-by":"crossref","first-page":"S55","DOI":"10.1016\/j.ajodo.2005.11.007","article-title":"Managing the patient with missing or malformed maxillary central incisors","volume":"129","author":"Kokich","year":"2006","journal-title":"Am J Orthod Dentofacial Orthop"},{"key":"2026042909151420000_19.4.e265874.23","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1111\/j.1600-9657.2011.00975.x","article-title":"Multidisciplinary solution for an avulsed upper central incisor: case report","volume":"27","author":"Drummond","year":"2011","journal-title":"Dent Traumatol"},{"key":"2026042909151420000_19.4.e265874.24","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1902\/jop.1975.46.3.139","article-title":"Orthodontic vs. restorative treatment of the congenitally absent lateral incisor--long term periodontal and occlusal evaluation","volume":"46","author":"Nordquist","year":"1975","journal-title":"J Periodontol"},{"key":"2026042909151420000_19.4.e265874.25","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1111\/edt.12854","article-title":"Orthodontic management of traumatic dental injuries in Norway and orthodontists\u2019 perceptions of referral routines: A quality assurance survey","volume":"39","author":"Beyene","year":"2023","journal-title":"Dent Traumatol"},{"key":"2026042909151420000_19.4.e265874.26","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-4469.2004.00230.x"},{"key":"2026042909151420000_19.4.e265874.27","doi-asserted-by":"crossref","first-page":"e16","DOI":"10.1111\/j.1600-9657.2008.00579.x","article-title":"Multiple dentoalveolar traumatic injury: a case report (3 years follow up)","volume":"24","author":"Koyuturk","year":"2008","journal-title":"Dent Traumatol"},{"key":"2026042909151420000_19.4.e265874.28","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1034\/j.1600-9657.2000.016003138.x","article-title":"A multidisciplinary treatment approach to a complicated maxillary dental trauma: a case report","volume":"16","author":"Leroy","year":"2000","journal-title":"Dent Traumatol"},{"key":"2026042909151420000_19.4.e265874.29","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1111\/j.1600-9657.2004.00226.x","article-title":"Management of a complex dentoalveolar trauma with multiple avulsions: a case report","volume":"20","author":"Sheroan","year":"2004","journal-title":"Dent Traumatol"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-265874","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T16:15:41Z","timestamp":1777479341000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-265874"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":29,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4,29]]},"published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1136\/bcr-2025-265874"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-265874","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]}}}