Friday, October 23, 2009

Maxillary Canine Extraction Site Trauma Secondary to the Mandibular Canine Treated by Crown Reduction, Vital Pulpotomy and Pulp Therapy

This cat had a maxillary canine tooth extracted.  Upon recheck at the referring veterinary hospital the mandibular canine was causing a mucosal defect at the extraction site.  Options for therapy were crown reduction and vital pulpotomy followed by vital pulp therapy or extraction. 
The crown was reduced to the level of the incisors.  Several millimeters of pulp and dentin were removed with a small diamond bur.  Bleeding was minimal and controlled with a paper point.  Mineral trioxide aggregate was placed over the pulp followed by glass ionomer and composite as shown on radiographs.  The purple is the acid etchant applied prior to the composite.  The patient will be checked radiographically in a year to ensure success of the procedure.  The ulcer will heal within 10 days. 

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Thursday, October 22, 2009

Response to the Question Concerning the Dog with a Class III Malocclusion (Underbite) with Incisors Causing Lingual Floor Trauma

Hi Dr. Gonzalez,
     Glad to hear from you.  The approach to this case is one of selective extractions to eliminate the trauma caused by the maxillary incisors digging holes in the floor of the oral cavity.  The central 101, 201 and the intermediate 102, 202 incisors should be extracted.  Once complete extubate with caution and check to ensure that that lateral incisors are not hitting the canines.  If they are then extract those as well.  Keep up the good work.
Take care,
Brett

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Dog with a Class III Malocclusion (Underbite) with Incisors Causing Lingual Floor Trauma

Hi,

Thank you for signing me up on the blog. I been diagnosing dental disease daily and recommending treatments with true conviction. I even did a cat extraction!

I actually had an interesting case today and I was wondering if anything can be done with orthodontics to help him. Or whether he will need extractions.

Cody presented for his neuter today and on oral exam I noted:
1. Underbite
2. The left maxilla is longer than the right.
3. The left upper incisors are pressing on the lower gingiva and creating depressions.

(please see attached pictures)

Thank you,

Joanne Gonzalez
Town and Country Animal Hospital

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Tuesday, October 20, 2009

Puppy Tooth Trauma

Hi David,
     There appears to be a lucency surrounding the canine tooth apex.  The pulp chamber is large indicating the dentin formation has ceased indicating a dead tooth.  The incisor appears to have that same pulp cavity diameter but I can't tell for sure with the rads.  There is increased radiodnesity at the apical 1/3 of the canine and possibly the incisor that is likely abnormal dentin production initiated by the original insult.  Extraction of the canine and the incisor is indicated.  The discoloration indicates that there is pulp death.  Please let me know if you have any questions.
Brett

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Puppy Tooth Trauma

Dr. Beckman,
This is Sadie, a 6 year old JRT presented for OVH. An incompletely erupted crown of #204 was noticed. Also seen was discoloration of crown of #203. Lateral and lateral-oblique dental radiographs were taken after dental prophylaxis performed. The record indicates she may have suffered facial trauma (hit w/ golf ball) as puppy. Thanks! David Kane, dental tech @ Woodworth Animal Hospital (Waynesboro, VA)

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Friday, October 16, 2009

Tooth Resorption and Periodontal Disease in a Cat

The 4th premolar has type II resorption.  Crown amputation will resolve the inflammation around 408 and is indicated.  407 shows severe inflammation secondary to peridontal disease.  All teeth were treated with flouride to decrease sensistivity.  The patient will return next month for reevaluation.

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Periodontal Disease and Tooth Resorption in a Cat

Early extrusion and vestibular bone expansion is present.  An article published recently by John Lewis showed a correlation between extrusion tooth resorption in cats.

J Vet Dent. 2008 Jun;25(2):86-95. Links
Significant association between tooth extrusion and tooth resorption in domestic cats.Lewis JR, Okuda A, Shofer FS, Pachtinger G, Harvey CE, Reiter AM.
Matthew J. Ryan Veterinary Hospital of the University of Pennsylvania, Philadelphia, PA 19104-6010, USA. jrlewis@vet.upenn.edu
Abnormal extrusion of canine teeth is often noted in middle-aged and geriatric domestic cats. The same age group of cats also is commonly affected by tooth resorption (TR). This study explored the relationship between these two phenomena of unknown etiology. Using digital radiography, the distance between the alveolar margin (AM) and cementoenamel junction (CEJ), referred to as the AM-CEJ distance, was measured in clinically and radiographically healthy maxillary canine teeth of 24 TR-affected and 29 TR-free cats. The mean AM-CEJ distance of maxillary canine teeth of cats with and cats without TR was 2.68-mm and 2.22-mm, respectively. An analysis of covariance adjusting for age revealed a significant correlation (p = 0.02) between tooth extrusion and TR. Extrusion of the maxillary canine teeth became clinically apparent when an AM-CEJ distance of 2.5-mm or greater was evident in the absence of horizontal or vertical alveolar bone loss. Based on this criterion, 15 of 24 cats with TR (63.0 %) exhibited extrusion of maxillary canine teeth, compared to 9 of 29 cats without TR (31.0 %). Four extruded and five non-extruded maxillary canine teeth were evaluated histologically. Cementum of extruded teeth was significantly thicker compared to that of non-extruded teeth. Four of 4 canine teeth with extrusion (100 %) showed histological evidence of resorption, compared to 1 of 5 canine teeth without extrusion (20.0 %). These results suggest that tooth extrusion is linked to or may be caused by similar factors responsible for the development of TR.

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Periodontal Disease and Tooth Resorption

This 11 year old cat has gingival recession associated with 309.  Extraction is warranted to eliminate progression and discomfort.  A pain response is present under light general anesthesia.

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Tuesday, October 13, 2009

Severe Periodontal Disease in a Dog - Mandibular Incisors 6 Weeks Postop

Healing is complete.  The right canine has reestablished gingiva.  Food debris is accumulating on the right.  Owners cannot brush but will use a water additive and chlorhexidine gel.  A 3 month recheck is scheduled.  Depending on gross and radiographic findings 304 may require extraction.

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Severe Periodontal Disease in a Dog - Mandibular Incisors Post-op

Following root planing, dentinal bonding and debridement the mucosa was moved to oppose the right canine.  The left side was left to granulate and reepithelialize in hopes of saving at least the left canine tooth and possibly both.

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Severe Periodontal Disease in a Dog - Mandibular Incisors

Erosion of the gingiva and mucosa on the lingual floor in this 14 year old daschund secondary to periodonal disease.  This defect was packed with food, hair and debris.

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