PRIMARY AND EMERGENCY MANAGEMENT OF DENTAL AND FACIAL TRAUMA: OUTCOMES OF EARLY RESTORATIVE INTERVENTIONS IN MAXILLOFACIAL INJURIES; A SYSTEMATIC REVIEW

Abstract Background: Dental and facial trauma present to emergency services and require rapid decisions on stabilization, timing of definitive repair, and restorative strategies. Delays may increase infection risk, worsen functional outcomes, and complicate reduction due to edema or early fibrosis. Objective: To synthesize evidence on the outcomes of early (primary, emergency) restorative or definitive interventions for dental and maxillofacial injuries, focusing on timing-dependent outcomes and early restorative approaches. Methods: A PRISMA-informed systematic review was conducted using PubMed Central full-text articles. We included original clinical studies evaluating timing or early restorative strategies for mandibular, midface, orbital, nasal, and dental trauma (fixation timing, early reduction windows, replantation timing, fragment reattachment strategies). Outcomes included complications (infection, malunion, nonunion, reoperation), function (occlusion, ocular motility, diplopia), symmetry, accuracy measures, and restorative retention. Results: Ten original studies met inclusion criteria (prospective audits, retrospective cohorts, and clinical cohort studies). In mandibular fractures, shorter time-to-surgery was associated with reduced infection risk in some cohorts, while large multicenter data suggested comparable complication rates with semi-elective pathways when patients were selected appropriately. For zygomaticomaxillary complex (ZMC) fractures, surgery within a defined early window was associated with improved intraoperative symmetry measures. In orbital injuries, most symptoms improved early, and only a subset required surgery after short-term observation. In dental trauma, extra-alveolar time strongly influenced survival of replanted teeth, and early fragment reattachment strategies achieved acceptable short-term and longer-term retention in selected cases. Conclusion: In injury types, evidence supports structured emergency pathways that prioritize early stabilization and timely definitive care, particularly within practical early windows, while allowing selected semi-elective approaches without compromising outcomes in low-risk mandibular fractures. Dental restorative outcomes are strongly time-sensitive for avulsions and are favorable for fragment reattachment when protocols and case selection are appropriate.