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Dental trauma in children can cause long-term functional, esthetic, and psychological consequences, especially when maxillary central incisors are affected. This case report describes an 11-year-old male, three years after a bull attack, presenting with severe mesiolabial rotation of tooth 11 and soft tissue entrapment between 11 and 12. The condition compromised the esthetics, oral hygiene, and self-esteem of the patient. Management involved slow maxillary expansion with a jackscrew supported by a transpalatal arch, derotation with a 2×4 appliance, and supracrestal fiberotomy to prevent relapse. Soft tissue corrections included vestibuloplasty and frenectomy with revision, as there was high gingival attachment of the frenum. Retention was maintained using a bonded palatal retainer from 12 to 22. At the 10-month follow-up of the retention phase, the patient demonstrated stable alignment, improved esthetics, healthy soft tissues, and enhanced psychological well-being. This successful outcome underscores the effectiveness of a multidisciplinary phased approach in managing complex pediatric dental trauma.

Tooth rotation, traumatic dental injury, 2×4 appliance.