An avulsion injury is a challenge to manage and there are many treatment options to consider to obtain the best prognosis depending on the avulsion scenario. In 2001, Lee et al published decision analysis paradigms for the management of avulsed permanent teeth to provide busy clinicians with user-friendly, referenced-based flowcharts to facilitate the best possible outcomes for managing these teeth in children and adolescents. The flowchart was updated in 2007 by McIntyre et al. The purpose of this paper is to update the 2001 and 2007 flowcharts and decision analyses with current concepts, recent literature-based findings, new treatment philosophies, and expert consensus from the 2008 AAPD Dental Trauma Symposium.