Endodontics | Traumatic Injuries | INBDE, ADAT

In this video, we talk about traumatic injuries ranging from horizontal root fracture to avulsion and how to treat them in a clinical setting. Thanks for watching!
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Ellis Classification Video:
➤ • Tooth Trauma- Ellis Cl...

[@mentaldental]

Quick correction! At 3:05, Ellis Class V should be avulsion, Class VI should be root fracture, and Class VII should be luxation. There have been modifications to the classification system through the years, but this is the one I would stick with.

[@nehapatel6978]

This is the latest classification Dr Ryan?

[@pamelazuniga]

Yes, I had noticed that too. If you allow me to complement that classification, it ends with two more categories, which are: Class VIII cervical crown fracture (complete) and Class IX primary dentition trauma. Thanks for your videos!

[@RamandeepKaur-tp5xg]

U r exceptionally amazing,,u have made things very easy to understand,,,I can see many of Ur videos continuously without a snap,,,,keep doing great work ,,, thanks a lot ,,god bless u immensely👍👍👍

[@EllyVKr]

Thank you very much, Dr. Ryan.

[@lifeofhope5100]

dr.ryann no words fr u 👏👏👏👏👏 u r such a treasure noone can simplify n concise the topics like this...thanks a ton doc...u r outstanding coach...🙏🙏🙏🙏

[@mentaldental]

You're most welcome! Happy to help 😊

[@DentalLyfe]

This is how endo should be taught! Thanks

[@enamelrod2826]

Thank you, doctor.

[@lifeline1702]

Finally another video.. Thanks !!

[@razan3742]

You’re awesome!! Thank you soooooooooooo much

[@carmelaazulado6236]

thank you, loved it !

[@user-hh1iw8jt8p]

Thank you dr please continue making educational videos:)

[@isha3611]

U r doing a great job.. its so helpful.. keep going 👌

[@dentalriver6]

Great video Ryan !!!

[@yallblessed9019]

Thanks 🙏 this saved my tooth literally

[@SD-ft1pe]

Thankyou .helped a lot

[@lora7677]

Thank you!

[@TheSANATmethod]

Thank you.

[@tenzinpassang2071]

Thanks doc 👍🏼

[@jarofhearts3961]

Thank u so much🌹

[@marguerite9029]

hello dr. Ryan! the ADA has made some modification in relation to the sequence of best to worst storage media for an avulsed tooth: 1-milk 2- HBSS 3-saliva 4-saline 5- water wonderful video as always, thank you for everything you do!

[@NEDMD]

Where did you see this?

[@habeebahmad6678]

you're right ADA has changed it recently

[@user-xx7ed7ti1z]

Thank you, I was scrolling the comments just to see if someone had pointed it out. The latest ADA recommendation is that milk is the best storage medium

[@nnnnnnnn-b8v]

You are the best.

[@jarofhearts3961]

Great thanks dr🌹🌹🌹

[@flawlessbutdysfunctional7787]

Thanks

[@Dr.melissa_seibert]

thank you so much for these awesome vidoes!

[@mentaldental]

So glad you like them! 😁

[@cutecathatesme336]

I saw greentea and propolis as excellent storage mediums in a research... Learned weird stuff to tell my patients haha. Thanks for the video!

[@RockSimmer-gal4God]

There’s deffo a lot to learn in this area.

[@sharifaalasmari5516]

Thanks🌹

[@salik674]

You r the best

[@ghadaalshamy9154]

thank u sooo mucg

[@markovuksanovic9981]

amazing , thank you

[@HomayunKahrij-xf9cb]

Amazing

[@tsegaseleshi9]

Hey great job keep it up! Did u cover vertical root fractures in another video I don’t see it in this one ?

[@brianmbayiwa8116]

Love it

[@cheaksokleng2627]

Thank so much for sharing. And how about coronal fracture with pulp necrosis in open apex, what should we do dr?

[@Fi5701]

Best video 📹👌

[@abdallahragab8409]

Thanx

[@loganharmon7807]

First of all, thanks for these videos! Has the Ellis classification changed since your last video? The other video on Ellis classifications you referenced is posted as somewhat different with class V being avulsion, class VI being root fracture with or without loss of crown structure, and class VII being displacement of tooth without fracture of crown or root. However, this video only has up to class VI and it has class V as luxation (not avulsion). Will you clarify which is correct for the NBDE?

[@NourhenBrahem]

Best way to diagnose vertical root fracture? a. Rx b. visual c. use the probe and look for pocket

[@abdullahabdessamad2766]

Hi Ryan Thank you very much for your videos! Truly amazing and 100% guaranteed info retention. Just wanted to clarify something if I may: Internal resorption happens only when the pulp is still vital (as the blood supply to the inflamed pulp brings in the clastic cells).

[@dramrokhier]

Hey Ryan thank you so much for these videos. Whats the name of the video where you talked about ellis classification?

[@mentaldental]

kzbin.info/www/bejne/nH-qaKyFhbyer6s

[@random_dentist_guy]

Thank you doctor for lecture! May Allah bless you

[@adrianazambrano8799]

Hey Ryan thanks again for your videos!!.. they are so helpfull.. I have a question.. the calcific metamorphosis will resolve with an internal bleaching or what would be the treatment?

[@mentaldental]

Usually, no treatment is necessary for calcific metamorphosis, but internal bleaching can be completed for esthetic improvement!

[@ammoula2974]

Hey Ryan, is the prognosis of the open apex tooth in case of avulsion better that closed apex? cause you are mentioning that if it's been over an hour of EADT, you need to consider implant?

[@mentaldental]

Good question. Generally open apex is better for dental trauma, but in the case of avulsion it actually makes the prognosis slightly worse. For the open apex example you mentioned as well as the closed apex example with >60 min EADT, ankylosis is to be expected and long term prognosis is guarded. But in addition, if the open apex tooth ankyloses, the tooth has to be planned for decoronation/extraction.

[@mo7eb720]

Dear dr. Ryan Hi , first thing first is my continuous appreciation ❤. (1)In cases of avulsion we use rigid or flexible splint? ‏‪ (2)And what about avulsive luxation how we deal with it

[@mrsNetty34]

Also is it best not to handle the root portion of the tooth

[@zedick1]

after a trauma, vitality test are not super effective. how would you know for sure if a tooth is necrotic?

[@hindi4521]

Lol you had a fair bit of traumatic dental experience as a child, you poor baby.. avulsion, painful class 3 correction. P.s.- thanks for your video ❤. Always helpful as usual.

[@mentaldental]

Haha yes I did! But that trauma is what led me to become a dentist, so there’s always a silver lining. Thank you so much for your support!

[@mariyajohnson6742]

Hi Dr. Ryann its was an awesome lecture video and i have a question... in case of avulsion open apex more than 60 min of EADT, if the tooth is reimplanted, the tooth has to be done rct or apexification procedure?

[@mariyajohnson6742]

Because it was written in the slide as rct

[@xmisshyx]

Hi Dr. Ryan! In your oral surgery videos, you advised to splint the tooth for 4 months if there was a fracture in the apical third- is that in the case that the tooth is non-vital, and thus if it is vital we splint for 2 weeks as you said in this video?

[@user-xx7ed7ti1z]

Usually 4 months is for alveolar bone fractures, was there an alveolar fracture in your example?

[@raulbetancourt467]

Thank you for this video ryan , I only have one question what would the ideal treatment for external resorption be? , I think it doesn't have any but I'm not completely sure.

[@mentaldental]

Good question. It depends on the size and location of the lesion. If it can be accessed non-surgically, MTA can be used to restore it. Most of the time though, there is no ideal treatment for the condition unfortunately.

[@raulbetancourt467]

@@mentaldental thankyou Ryan!

[@madihamajid7359]

first of all thankyou soo much ryan , secondly did you made this lecture from endodontics principles and practice book by Mahmood Torabinejaad??

[@mentaldental]

I did not, but that is an excellent textbook that we used in dental school!

[@nicksaveka5078]

how long should u wait b4 you assume the tooth is truly necrotic? (without waiting for rg evidence)

[@vinaynaik6905]

10 days later check vitality

[@tihanyrod5240]

Thanks Dr. I have a question... 18:55 why an open apex tooth EADT>60 may or no be reimplanted, but a closed apex one should be reimplanted? I think that it is the opposite. Am I wrong? Thanks

[@mentaldental]

Hi Tihany, thanks for the question. For avulsions specifically, a closed apex tooth has a guarded prognosis whereas an open apex tooth has a poor prognosis. In both cases the tooth should either be left out or cleaned, root canal treated, replanted, and splinted with the expectation that it will ankylose and likely need replacement down the road.

[@tihanyrod5240]

@@mentaldental thanks Dr. I really appreciate your help.

[@strawberrylala5529]

Can you use other persons saliva to store the tooth?

[@moeariss6249]

do we usually re-implant primary teeth? or only perminant teeth

[@mentaldental]

No, we typically do not re-implant primary teeth that have been avulsed.

[@moeariss6249]

@@mentaldental u the best

[@saadbordainy4376]

Thanks & so much appreciating,, what's EADT???

[@mentaldental]

EADT stands for extra-alveolar dry time, so how long an avulsed tooth is out of the mouth for.

[@saadbordainy4376]

@@mentaldental what about keeping avulsed tooth in 2.4% fluoride sol. acidulated at 5.5 PH for 5-20 mis before Replantation- inorder to decrease External resorption

[@hazhay.2699]

awesome thanks so much....for external resorption .. what can we do about it ?? whats ur opinion ??

[@mentaldental]

Hi there! Great question. Treating external resorption can be tricky and depends on the etiology of the problem. If there is pressure involved (cyst or tumor placing pressure on and damaging the cementoblastic layer) then the source of pressure should be removed. If there is sulcular infection, then periodontal treatment should be administered. If there is pulpal infection contributing to the resorption, then root canal therapy should be initiated to remove the necrotic infected tissue and associated bacteria. Hopefully that helps!

[@hazhay.2699]

Mental Dental great answer thanks alot .... then what about the lost tooth structure as a result of the resorption?? Do we only remove the cause ?? Is it enough as a treatment??? Or we have to open a flap and place a filling material like MTA or something else ?? And again thank u so much

[@mentaldental]

Depending on the severity (and if the tooth is restorable), it is my understanding you would do something like you are saying involving a biocompatible material like MTA or a conventional root canal treatment may suffice, again depending on severity of the resorption.

[@hazhay.2699]

Mental Dental aha thanks so much 🌸☺️

[@sheetu2203]

How can u inform wrong at 3.50..? Class 5 moves the Tooth out of socket (Avulsion:- you urself told the similarities between V AND V to remember). And class 6 is a Root Fracture. Plz correct me if i am wrong.

[@lizm2306]

what is PPTY?

[@mentaldental]

Pulpotomy!

[@nidhipatel69]

Hi Dr. Would it be odontoblasts or undifferentiated mesenchymal cells that produce the reparitive dentin in this yellow orange tooth scenrio?

[@mentaldental]

It would be secondary odontoblasts!

[@bebendonafonte-resumocript1293]

open apex more 60 min - plan for implant? i think is wrong, because you cant do implant in a young patient.!!

[@mentaldental]

The key here is *plan* for implant. You wouldn't place an implant in a young patient due to concerns about decreased bone quality and continued alveolar growth. You would want to wait until at least 18-20 years of age when the vast majority of vertical alveolar ridge development has completed.

[@DrManoj17]

Thanks

[@mentaldental]

Thank you for the Super Thanks! 🙏🏼😊