Myths and misconceptions in veterinary dentistry

Diagnosis and Management of Furcation Lesions in Dogs - A Review

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.

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

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.

The Cat Mandible (II): Manipulation of the Jaw, with a New Prosthesis Proposal, to Avoid Iatrogenic Complications

Simple Summary

The small size of the feline mandible makes its manipulation difficult when fixing dislocations of the temporomandibular joint or mandibular fractures. In both cases, non-invasive techniques should be considered first. When not possible, fracture repair with internal fixation using bone plates would be the best option. Simple jaw fractures should be repaired first, and caudal to rostral. In addition, a ventral approach makes the bone fragments exposure and its manipulation easier. However, the cat mandible has little space to safely place the bone plate screws without damaging the tooth roots and/or the mandibular blood and nervous supply. As a consequence, we propose a conceptual model of a mandibular prosthesis that would provide biomechanical stabilization, avoiding any unintended (iatrogenic) damage to those structures. The improvement of imaging techniques and a patient-specific prosthesis made of full biocompatible material are part of the future trends to improve patients’ recovery.

Abstract

The cat mandible is relatively small, and its manipulation implies the use of fixing methods and different repair techniques according to its small size to keep its biomechanical functionality intact. Attempts to fix dislocations of the temporomandibular joint should be primarily performed by non-invasive techniques (repositioning the bones and immobilisation), although when this is not possible, a surgical method should be used. Regarding mandibular fractures, these are usually concurrent with other traumatic injuries that, if serious, should be treated first. A non-invasive approach should also first be considered to fix mandibular fractures. When this is impractical, internal rigid fixation methods, such as osteosynthesis plates, should be used. However, it should be taken into account that in the cat mandible, dental roots and the mandibular canal structures occupy most of the volume of the mandibular body, a fact that makes it challenging to apply a plate with fixed screw positions without invading dental roots or neurovascular structures. Therefore, we propose a new prosthesis design that will provide acceptable rigid biomechanical stabilisation, but avoid dental root and neurovascular damage, when fixing simple mandibular body fractures. Future trends will include the use of better diagnostic imaging techniques, a patient-specific prosthesis design and the use of more biocompatible materials to minimise the patient’s recovery period and suffering.

Evaluation of a Hydrophilic Gingival Dental Sealant in Beagle Dogs

A liquid solution, gingival sealant containing polymers that form a barrier film upon application was evaluated in dogs. It is a non-toxic, low viscosity, hydrophilic barrier sealant that dries in approximately 10 to 15-seconds after subgingival application. It was designed as a preventative to be applied immediately following a professional oral hygiene procedure in order to block plaque and calculus formation in the sulcus and aid in the prevention of periodontal disease in companion animals. Additionally, the polymer was designed to promote an aerobic environment in the sulcus by oxygen and water transport through engineered pores within the polymer. A 30-day split-mouth, blinded study in two groups of 15 beagle dogs was used. Plaque was significantly (p < 0.05) reduced on the side receiving the sealant by 30.0 % and 50.5 % (average = 40.3 %) in groups 1 and 2, respectively. Calculus was significantly (p < 0.05) reduced on the side receiving the sealant by 27.2 % and 20.0 % (average = 23.6 %) in groups 1 and 2, respectively. Gingival inflammation was monitored to assess product safety. Sides receiving sealant showed no statistically significant differences in gingival index score. No adverse events were observed in the study. This study demonstrates that this gingival sealant can be used as another valuable tool for aiding in the prevention of periodontal disease in dogs.

Evaluation of a dental model for training veterinary students

Periodontal disease has deleterious effects on an animal's health and potentially serious implications for its welfare. Consequently, veterinarians frequently perform routine periodontal treatment in small-animal practice. One would therefore assume that small-animal dentistry would constitute a core component of a veterinary curriculum. However, most practitioners received little or no formal training in dentistry during their veterinary degrees, and the amount of instruction students currently receive is variable, often with limited opportunities to practice. At the Royal Veterinary College, a prototype dental model was developed to address the lack of practical training; it was made using ceramic tiles, silicone sealant, and grout to emulate teeth, gingiva, and calculus, respectively. A study was conducted with third-year veterinary students to compare the outcomes of learning to perform a professional dental cleaning using a model (group A) or a video (group B). Performance was assessed using an objective structured clinical examination. Students in group A scored significantly better than those in group B (p<.001). All students also completed a questionnaire evaluating attitudes toward the use of a dental model in learning dentistry-related skills. All students identified a model as a potentially valuable learning tool to supplement existing teaching methods and facilitate the acquisition of small-animal dentistry skills. The dental model has the potential to equip students with useful, practical skills in a safe and risk-free environment.