Advanced Endodontic Therapy

The furcation is the anatomic area where the roots divide on a multirooted tooth. Periodontal disease causing alveolar bone loss can lead to furcation lesions of various stages. Once furcation involvement has occurred, the area can be more difficult to clean or treat due to the complex anatomy and morphology of furcations. Teeth with short root trunks, longer tooth roots, and roots with wide furcation entrance areas/degrees of separation and wide root divergence are considered better candidates for long term maintenance. Dog teeth possess many of these advantageous anatomic features compared to human teeth. Treatment options for teeth with furcation lesions include: closed debridement, open debridement, furcation plasty, tunneling, partial tooth or root resection, root separation (hemisection or trisection), regenerative therapies, or exodontia. There are many factors to consider in determining treatment options. The favorable and unfavorable characteristics for maintenance of teeth with furcation lesions are summarized. Home care and ongoing professional care are important aspects of periodontal disease control for any patient. Studies of systemic and local antibiotic therapies in human patients have not demonstrated reduction of furcation stages, and probiotic effects at furcation sites have not been specifically examined. Human review studies show that most molar teeth once deemed “hopeless” due to stage 3 furcation lesions can be maintained for at least 5 to 15 years with supportive periodontal therapy. Similar long term studies in dogs are needed to improve the evidence-based management of canine patients with furcation lesions.

Section: Partial Tooth Resection Root Resection Hemisection and Trise...mentioning

confidence: 99%

Section: Partial Tooth Resection Root Resection Hemisection and Trise...mentioning

confidence: 99%

Diagnosis and Management of Furcation Lesions in Dogs – A Review

Zacher

Marretta

2022

“…At the time of eruption of the permanent tooth, only about 50% of the expected tooth root length has formed. 17 Depending on the tooth, the root apices have been found to close in dogs between 7 and 10 months of age. 18,19 In cats, root apices have been found to close between 7 and 11 months of age.…”

Section: Assessment Of Tooth Injuriesmentioning

confidence: 99%

“…Published timing for vital pulp therapy treatment following pulp exposure has varied widely, from a few hours to 3 weeks. 17,21,27,33,41 Older retrospective veterinary studies from 2001 found greater success when vital pulp therapy was performed sooner after pulp exposure. 27,41 However, a 2014 review of 190 vital pulp therapies in dogs found no significant correlation between time of pulp exposure to treatment and success of treatment, 33 with time since exposure ranging from 3 to 250 h (median 24 h).…”

Section: Complicated Crown Fractures In Vital Teeth—partial Pulpotomy With Direct Pulp Cap/vital Pulp Therapymentioning

confidence: 99%

“…A recent, major veterinary dentistry reference text has also mentioned the possibility of using a lavage of bleach for hemostasis, stating that it has no adverse effect on pulpal healing, even if refreshed and left in contact with the pulp for 10-15 min. 17 Saline induces the mildest pulp response and is used in most studies; NaOCl induces increased inflammatory response in the pulp but provides enhanced hemorrhage control. 48 “The bleach causes chemical amputation of the blood coagulum; removes damaged pulp cells, dentin chips, and other debris; and provides hemorrhage control with minimal damage to the “normal” pulp tissue underneath.” 28 NaOCl “is not only antimicrobial but appears to have no adverse effects on pulpal healing, odontoblastic cell formation, or dentinal bridging.” 8 A recent in vitro study examining the response of stem cells of the apical papilla to NaOCl in various concentrations found the best cell survival and differentiation in the populations irrigated with 1.5% NaOCl.…”

Section: Pulp Flushing/blotting Solutionsmentioning

confidence: 99%

See 1 more Smart Citation

Decision-Making and Management of Immature Permanent Teeth with Crown Fractures in Small Animals—A Review

Zacher

Marretta

2021

Immature permanent teeth with crown fractures present a unique challenge in human and animal patients. Immature permanent teeth have not yet developed completely, often presenting with thin dentin walls, incomplete apical formation, and increased crown-to-root ratios. Loss of pulp function at this stage has devastating long-term implications for these teeth. Ideally, attempts should be made to preserve pulp vitality in immature permanent teeth to allow for continued dental development. The range of treatment options for vital teeth includes odontoplasty with bonding and sealing +/− restoration, indirect pulp capping, and direct pulp capping/vital pulp therapy. These treatments have long been established in human and veterinary medicine, and cases have been reported in dogs and cats. Apexification using calcium hydroxide is a well-established treatment for nonvital immature teeth. The advent of mineral trioxide aggregate and other bioceramic materials for use in vital pulp therapy and apexification has reduced treatment sessions and improved outcomes. Recent developments in the field of regenerative endodontic therapy further expand treatment options and provide the possibility for continued development of a formerly nonvital tooth. Selecting the appropriate treatment based on the severity of tooth fracture and status of pulp vitality can avoid a lifetime of poor structure and function for the affected tooth. This article provides multiple step-by-step protocols for the management of immature permanent teeth with crown fractures in small animals.

Success of Occlusal Aperture Access for Endodontic Therapy of Canine Teeth in Dogs

Morris¹,

Hale²

2022

The objective of this study was to determine the success of the natural crowns of endodontically treated canine teeth in pet dogs, instrumented and obturated using rotary driven non-taper nickel titanium files, through an occlusal access preparation, without the placement of a prosthetic cast metal crown. A search of medical records at a private veterinary dental referral practice was conducted to identify pet dogs having had endodontic treatment of one or more canine teeth over an eleven-year period (2007-2018). Follow up, performed by the same veterinary dental specialist, included a complete oral health assessment under general anesthesia and included intraoral radiography thereby allowing close visual examination of the crown and restoration as well as assessing endodontic success. Time to follow up was between two and nine years after treatment with a mean of 4.5 years. Analysis revealed that 29/29 (100%) of the treated crowns maintained their stability and did not require extraction. 5/29 (17.2%) of the treated teeth had an enamel fracture requiring additional treatment to the crown after the initial treatment; 1/29 (3.4%) had additional abrasion but did not require treatment and 23/29 (79.3%) were found to have sustained no additional damage. This study supports endodontic treatment without the placement of a prosthetic crown in canine teeth in pet dogs when an occlusal access site is used as described in this paper. Further study is required on the increased risk of fracture of the remaining unaltered canine teeth.