The most important initial step in managing an avulsed permanent tooth is immediate reimplantation or, if not possible, storing the tooth in an appropriate medium like milk or saline to preserve periodontal ligament cell viability. This approach maximizes the chances of successful reattachment and reduces the risk of complications such as ankylosis or root resorption. Prompt dental referral is crucial for proper assessment and stabilization. Avoiding delays or inappropriate handling improves long-term prognosis of the tooth.

Reference: *Andreasen and Andreasen, Traumatic Dental Injuries, 3rd Edition.*