Maintaining pulp vitality of the immature permanent tooth is of paramount importance. Approaches to achieving this aim depend on age of the tooth, the cause of the pulpal insult (carious or traumatic) or whether revascularization must be attempted. Approaches will be discussed and presented based on a biological approach that can be adapted as technologies develop in the future. The avulsed tooth is an interesting traumatic injury in that it can be regarded as a very minor injury when emergency treatment is carried out in a timely and correct fashion. One the other hand this injury can be catastrophic if conditions are not ideal. The presentation will discuss the latest approaches to ensure maximal success even if conditions are not ideal when the patient presents to the dental office.