[Murat KUTAY]

[size=x-large]Baboon with a hemifacial abscess
“Sage”is a 18 year old female baboon, with a body weight of approximately 12 kgs.

We performed a previous surgery on her about 7 months ago, due to a dental fistula located in the middle of the external corner of the eye and the comissura buccalis on the left side of the face, just along the zygomatic arch. The surgery consisted in the removal of the first molar tooth and fistulectomy.

Fig. 1
This time there was a very large hemifacial abscess on the opposite side of the face, the swelling involved the whole right side of the face and made very difficult the closure of the eye lid on the right side (Fig.1). There was a large area of the face covered with a crust that resulted after the spontaneous break of the abscess formation and elimination of the purulent discharge. After applying the premedication which consisted of Zoletil, here in a dosage of 0,3 ml, administered intramuscularly and induction with Propofol 35mg, intravenously continued with inhalation anesthesia using isofluran.
Fig. 2

The trajectory of the fistula lead itÂ’s way to the last molar tooth (3rd molar) as we can see in Fig.2 the probe pointing at the intraoral emergence point of the fistula. After local anesthesia (local nerve block) with articaine (Ubistezin forte) at the infraorbital foramen we proceeded to debridement of the external skin wound by removing the crusts and spraying with a propolis-iodine based antiseptic solution.

Fig. 3

After debridement a 2-3 mm size fistula skin opening was revealed as pointed with a black arrow in Fig.3.The intra-oral Xrays were performed using a size 4 occlusal film, a bisecting angle incidence and the dental X-ray Unit. After developing the film it became clear why “Sage” had a facial swelling.

Fig. 4

The red arrow in Fig.4 numbered with 1 shows the first causing tooth was the second premolar tooth that had a large periapical abscess visible on the film as a 1 cm diameter large lucency around the distal root of the tooth. The lucency although not so impressive was present as a 2 mm rim surrounding all 3 roots of the last molar tooth as pointed by the red arrow numbered with 2 in the same Fig.4. After corroborating the X-ray images with the clinical aspect we realized that we are dealing with a dual problem and that our fistula had in fact 2 braches, one leading to the 2nd premolar and the other leading itÂ’s way to the above mentioned 3rd molar.

Fig. 5

The conclusion was to extract both teeth. We extracted the molar by separating the tooth crown in 2 parts. Separation was performed with the high-speed turbine using a round steel burr. The premolar did not necessitate separation and the extraction did not pose any special technical difficulty. After extraction we had a moderate amount of bleeding which was controlled using Tabotamp (cellulose based resorbable hemostypticum, Ethicon) as we can see in Fig.5.

Fig. 6

The pathologically involved premolar was successfully extracted “in toto” (Fig.6). Both post-extractional alveoli were not sutured after extraction. However the 3 by 10 cm large skin wound needed protection after proper antisepsis and curettage. This protection was assured using a non-adherent dressing (Inadine, from Johnson and Johnson) which was fixated to the wound using several simple interrupted sutures using a 3.0 resorbable Vycril material. We used antibiotherapy (Cefazolin) for 10 days and a proper pain management control protocol. Now 3 days later we heard that “Sage” is eating again and is gaining weight after a period of considerable pain and almost total loss of appetite.

DDr. Camil Stoian PhD[/size]

[Murat KUTAY]

[size=x-large]Malocclusion in Rabbits
Due to the continually growing nature of rabbit incisors and molars is obvious that any disruption in the normal attrition (grinding/erosion of the occlusal surface of teeth) can lead to problems manifested with overgrowth.

The most common dental problem in rabbits and hares is malocclusion. Malocclusions are classified as atraumatic or traumatic.

Atraumatic malocclusion results from genetic malpositioning of teeth or due to dietary causes with insufficient attrition (Fig. 1 and Fig. 4). Traumatic malocclusions are the result of overgrowth of a tooth after the loss or frac¬ture of the opposing tooth. Loss of proper attrition may lead to the same symptoms and problems as in atraumatic malocclusion.

Fig. 1

The treatment of malocclusion is crown-height control to approximate the wear that would normally be experienced. Crown trimming and reduc¬tion must be done with a diamond bur or disc, on a regular basis. The treatment should be repeated every 4-8 weeks until normal occlusion is reestablished, or in some cases for the entire life of the animal.

A tongue depressor or wooden spatula must be held behind the incisors to protect the tongue and other soft tissues during odontoplasty (re-contouring the crown of the tooth to reinstate normal aspect and occlusion)

Fig. 2

The use of nail trimmers, tooth nippers, bone rongeurs, etc. should definitely be avoided, due to potential tooth fractures and fissures that could lead to infection. If a pulp is exposed by crown trimming it can be treated in the same way as a fractured tooth. A calcium hydroxide paste should be placed to cap the pulp (direct capping) to form a reparative dentinal bridge.

Fig. 3

The site should be closed with an intermediate temporary filling material to approximate the wear of the normal tooth Other materials such as amalgam are not indicated due to their resistance to attrition. Crown reduction of the opposing tooth is necessary until the damaged crown grows to a correct length.

The only treatment that results in a permanent correction of malocclusion is the extraction of the involved teeth. In order to correctly evaluate the condition, shape and direction of the root, an X-ray in an oblique latero-lateral incidence is indicated where possible before the extraction (Fig. 2). Special instruments are needed such as the Remeeus/Fahrenkrug or Crossley/Fahrenkrug tooth luxators (Fig. 6).

Fig. 4

Any attempts to extract the incisors without the proper instrumentation will definitely result in tooth crown or root fracture and lead to infections. In most cases incisor extraction is a quite challenging operation and its importance should not be minimized based on the perspective of low operation profit (the cost of this operation is not proportional with the time and effort spent).

The extracted teeth should be photographed as documentation (Fig. 3 and Fig. 5), and shown to the owner. They usually impress most animal owners with their incredible root length and sometimes curved shape. After the extraction, normal pain control and sometimes antibiotherapy (depending on the general condition of the animal and the complexity of extraction) might be instituted. Rabbits can chew actually much better than before the extraction using just their cheek teeth (premolars and molars).

Fig. 5

DDr. Stoian Camil, PhD, Dipl. EVDC

Fig. 6

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[Murat KUTAY]

[size=x-large]Complex Odontoma vs. included teeth in a Dog

Sammy, a 6 months old dog, mixed breed, male, not neutered, came to our dental station due to a severe malposition of the upper third incisor on the left side.

Fig. 1

After sedation using a combination of Domitor/Ketamine we could visually assess the clinical aspect (Fig.1, Fig.2).
Fig. 2

A size 4 occlusal X-ray film was used in a oblique incidence and after developing the film an interesting fact was discovered. A complex odontoma was present, consisting not only of the malpositioned (vestibulo-version) 3rd incisor but also the canine tooth, not fully developed and what appeared to be a root rest of the deciduos caninus, but difficult to assess on the X-rays (Fig.3, Fig.4).

Fig. 3

I was also difficult to tell the difference between the present formation whether it is an unerrupted/retained caninus, not fully developed due to the malposition of 3rd incisor and the presence of the milk tooth root rest or a complex odontoma. In any of the 2 cases, there was only one way to solve the problem, dental extraction of the teeth involved in the process.

Fig. 4

An open flap U shaped surgical extraction was performed, thus allowing full visualization of the impacted teeth (Fig.5). After extraction we could see a fully developed 3rd incisor, a canine tooth not fully developed and the root rest of the milk tooth (Fig.6).

Fig. 5

We sutured the flap with 4,0 Vicryl resorbable multifilament using a simple interrupted pattern after having properly reshaped the alveolar bone (Fig.7). Odontomas are mixed odontogenic tumors, since they are composed of both epithelial and mesenchymal dental hard tissues. The fully differentiated tissues are composed of enamel and dentine. Biologically, odontomas can be regarded as hamartomas rather than neoplasms.

Fig. 6

The owner reported one week later that the dog is doing well, feeding normally and happy as ever.

DDr. Stoian Camil, PhD, Dipl. EVDC

Fig. 7

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[Murat KUTAY]

[size=x-large]Intra-oral splinting in a maxillary fracture
Brica, a 3 years old female dog, Deutscher Jagdterrier came to our dental department for a complete and complicated maxillary fracture due to a massive trauma caused by the head being compressed by a wine – press.

Trauma resulted in a complete maxillary transverse fracture involving the hard palate and nasal bones starting from the distal root of the third premolar right side (107) to the mesial root of the fourth premolar left side (208) with a fracture line going around this premolar having incorporated a fragment of alveolar bone, this way the tooth was totally loose.

Fig.1

A full head X-ray was performed to be able to precisely assess the extent and direction of the fracture, in Fig.1 we see the latero-lateral incidence view of the fracture, with the obvious detachment of the fractured fragment and the formation of a step of about 0,5-1 cm between fractured areas.

In the second X-ray from Fig.2, we have a rostro-caudal incidence view of the skull where we can clearly see the loose fragment of alveolar bone together with the 108 premolar (upper part of photo).
Intra-operatively we could further see the fracture line (Fig.3) involving the palate, palatinal mucosa, nasal bones and both crowns of the 3rd premolars also fractured. We decided to use a combined parapulpar pin-surgical wire frame-acrylic intra-oral splinting for this case.

Fig.2

This way we can perfectly stabilize also the loose PM4 right side together with the loose alveolar bone fragment. After repositioning of the loose fractured fragments we started applying the parapulpar pins between 2 to 4 pins for each maxillary tooth with the exception of the upper incisors. First we had to use a small size round tungsten steel burr to make a small indentation for the pin drill supplied with the kit.

After drilling the proper diameter holes, we proceeded in manually inserting the pins using the specially adapted key also included in the kit. After all the pins where in place we started modeling the U shaped 0,8 mm surgical wire and adapting it perfectly to the maxilla.

Fig.3

After the wire was shaped and modeled the surface was roughened with a diamond burr in order to better stick to the acrylic material. We etched the surface of the enamelum of all maxillary teeth with 37% ortho-phosphoric acid for 45 seconds and after we rinsed it using the air/water spray.

Fig. 4

A light curing bonding liquid was applied, gently air dried and light cured. The final fixation phase of the fracture consisted in applying the 2 component non-exothermic acrylic material ( Protemp Garant®) using a special dispensing gun and incorporating in this mass the pins and the surgical wire. After polymerization of the acrylic we shaped and polished the surface using a flame shaped diamond burr to remove all anfractuous margins and irregularities and to prevent soft tissue trauma (Fig. 4).

Fig. 5

After the occlusion was checked and any eventual surplus material removed, we covered the acrylic mass with a lacquer to prevent chemical reaction with oral fluids and also to soften the surface of the acrylic mass in the mouth and improve acceptance of this device by the dog.

After 5 weeks in a new anesthesia session a control X-ray was performed (Fig.5) and due to very good healing results and a good callus formation we decided to remove the fixation device. We used round larger size burrs under water cooling fitted to a high-speed turbine and grooves where made in a chess table pattern (squares) thus facilitating the removal of bits (chipping off ) of material.

Fig. 6

The trajectory of the surgical wire was first liberated (Fig.6) and the wire removed. After complete removal of the entire material we started taking the parapulpar pins out (Fig.7) and, filled all this little holes that resulted with light curing composite. In the final stage all teeth where polished and appropriate pain management therapy instituted for the acute generalized gingivitis that we had as a result of these 5 weeks of foreign material (acrylic splint) presence in the oral cavity. The dog recovered soon after surgery and owners reported that he fed already that day with an increased appetite.

DDr. Stoian Camil, PhD, Dipl. EVDC

Fig. 7

[/size]

[Murat KUTAY]

[size=x-large]Complicated Canine Crown and Root Fracture in a chimpanzee
On 9th of January, 2007, a team of anesthetists and one dental surgeon proceeded for an interesting case to be operated in Gänserndorf Affenzentrum.

Fig. 1
Holophernes, 25 years old, male chimp, 50 kg body weight that had a complicated horizontal and vertical mandibular left caninus fracture (303 Tridan system) as a consequence of a fight with another male. The fracture comprised the entire crown of tooth to a subgingival level, with an open dental pulp that was spontaneously bleeding, and was very painful (Fig.1 and Fig.2).

Fig. 2
The operating team consisted of the anesthesia team: Drs. Attilio Rocchi and Korbinian Pieper (they actually look much better without the mask on), (Fig.3) that had the difficult task of anesthesia induction, intubation (Fig.4) and maintenance, pre and postoperative pain control and recovery.

Fig. 3
Dr. Werner Höllriegl was present as well, supervising the operation and offering valuable advice and expertise (Fig.5-right side of photo). Following an anesthesia premedication with Zoletil (3mg/kg, i.m.) and Fentanyl (1µg/kg, i.v.), induction with Propofol 1,5 mg/Kg, i.v. the maintenance was performed using Isofluran after endotracheal intubation, using a size 8 tube.

Fig. 4
The local anesthesia was performed using a mental nerve block with Bupivacaine. The operation consisted of an open combined vestibular and lingual flap surgical tooth extraction, completed with a circular alveolar bone removal.

Fig. 5
After removal of hypertrophic gingival tissue by means of a vestibular and lingual flap (Fig.6) the extent of the fracture could finally be assessed. We had a horizontal fracture combined with an incomplete vertical fracture involving the entire crown of tooth as well as a small portion of the root. Since the pulp was opened and was spontaneously bleeding we can realize the amount of pain our chimp Holophernes was going through, explaining his increased irritability, aggressiveness and decrease in appetite.

Fig. 6
We decided to apply a circular alveolar bone height reduction, due to the remarkable thickness of the alveolar bone (over 3 mm) housing a huge canine (10 cm long-crown plus root) having to cope with the large occlusal forces of the chimpanzee.

Fig. 7
After removal of about 1 cm of alveolar bone using a Mannessman portable electrical drill (30.000 RPM) and a large round steel burr under copious sterile saline irrigation (Fig.7), we could than begin to wiggle our way around the canine using a combination of 3 different size elevators.
Fig. 8
Finally the canine came out, but not without complications(Fig.. Although particular care, appropriate extraction force and sufficient time where applied, the tip of the root fractured and a portion of about 8 mm was still in the alveolus (Fig.9). The luck was that we could remove completely the root apex (in several fragments) using a root pick and small root elevators. The large size of the alveolus permitted full visual assessment thus not requiring a post-extractional X-ray.

Fig. 9
The caninus root had about 4 cm lenght and 1,5 cm in width(Fig.10). The flaps where sutured after haemostasis (with Tabotamp) using resorbable 3.0 Vicryl suture in a simple interrupted pattern (Fig. 11) closing a challenging full hour of operation.

Fig. 10

A forth generation cephalosporin antibiotherapy was advised post-operatively as well as appropriate pain control management. Our friend Holophernes is doing well 2 days post-operatively and can fight again with other males for supremacy over females, ensuring this way the future of veterinary dentistry and offering interesting post-traumatic cases. I would like to thank to all my colleagues and to my operating assistant Daria for the active involvement in this operation.

DDr. Stoian Camil, PhD

Fig. 11[/size]

[Murat KUTAY]

[size=x-large]Luxation eines Oberkiefereckzahnes bei einem 8 Jahre alten Rettungshund
Es kommt immer wieder vor, dass nach einem Unfall oder nach Hunderaufereien Zähne luxiert sind. Der Hund hat Schmerzen, da meist die Zahnalveole gebrochen ist.

Aus diesem Grund und wegen der sehr rasch einsetzenden Infektion und darauffolgenden Schädigung des Zahnhalteapparates ist eine rasche Erstbehandlung beim Tierarzt unumgänglich.

Fig. 1

Der lose Zahn kann dann durch speziell angefertigte Fixierungen von einem Zahnspezialisten gerettet werden. Der Zahnhalteapparat kann heilen, wenn er nicht zu sehr zerstört oder verschmutzt wurde und wenn der betroffene Bereich während des Heilungsprozesses vom Besitzer einer regelmäßigen Hygiene unterzogen wird.

Fig. 2
Meist ist die Versorgung der Zahnpulpa zerstört, und im Zuge der Behandlung muss eine Wurzelbehandlung bei der Entfernung der Fixierung durchgeführt werden (GRACIS 1999). Alternativ zur Wurzelbehandlung kann der Zahn in regelmäßigen Abständen von zuerst etwa 3-6 Monaten und dann 6-12 Monaten mittels intraoralem Zahnöntgen kontrolliert werden (TUTT 2002, ANDREASEN 1999).
Fig. 3

Fallpräsentation

“Timmy”, ein 8 Jahre alter Golden Retriever-Rüde kam von einem Rettungshundetraining direkt mit dem “Rettungsauto” am Samstagnachmittag in meine Praxis. Timmy hatte sich beim spielerischen Raufen mit einem Hund an der Leine so unglücklich an dieser Leine verhängt, dass der linke Oberkiefer-Eckzahn (204) nach lateral luxiert war. Der Zahn “blutete” und war etwa 1 cm nach lateral luxiert. Somit war auch die Zahnalveole frakturiert sowie die Gingiva über die mucogingivale Grenze hinaus offen.

Fig. 4

Therapie

Nach einem kurzen klinischen Check wurde Timmy mittels Venflon, Infusion, Antibiotika und Schmerzmedikament erstversorgt. In der sofort anschließenden Anästhesie wurden Zahnröntgen angefertigt, um das genaue Ausmaß der Alveolenverletzung und weitere Frakturen des Zahnes auszuschließen. Der Zahn zeigte keine weiteren Verletzungen und somit wurde mit der Versorgung der Luxation begonnen. Zuerst musste der Zahn reponiert werden, was wie meist im Oberkiefer nur mit Kraftanstrengung möglich war. Daraufhin wurde der Zahn mit einem 20G Draht am gegenüberliegenden Zahn fixiert.

Fig. 5

Der lose Draht wurde mittels Schmelzätztechnik und Bis-Acryl-Composite fixiert. Neben der Naht der Schleimhautwunde wurde zur weiteren Stabilisierung der Alveolenfraktur aus demselben Material eine Brücke zum naheligenden OK-P1 (205) gebaut um eine weitere intraorale Fixierung zu erreichen.

Nach 3 Tagen fand die erste Kurzkontrolle statt, wobei der Besitzer angewiesen wurde die Fixierung und die Umgebung weiter mittels Zähneputzen sauber zu halten. Nach dieser Kontrolle wurde aufgrund des guten Heilungsverlaufes auf weitere Antibiose und Schmerzmedikation verzichtet werden. Timmy konnte daraufhin wieder sein Training als Suchhund und das Fährtentraining aufnehmen. Spielen mit Dummies und harte Kauknochen waren aber tabu.

Fig. 6

Etwa 7 Wochen nach der Fixierung fand die nächste Kontrolle statt. Die Heilung wurde mittels intraoralem Zahnröntgen in einer Kurznarkose kontrolliert. Dabei wurde keine Veränderung am Apex des 204 und auch sonst eine normale Verheilung des Alveolenfraktur festgestellt.

Die Fixierung zum 205 wurde entfernt. Aufgrund des guten Heilungsverlaufes und der hervorragenden Besitzerkooperation wurde der weitere Behandlungsverlauf diskutiert. Der Besitzer von Timmy erklärte sich bereit weitere Dentalröntgen-Kontrollen auch in weiteren Kurznarkosen durchführen zu lassen. Somit konnte nach 2 Monaten die Fixierung ohne Wurzelbehandlung des 204 entfernt werden.

Fig. 7

Der Golden Retriever “Timmy” kann nun wieder voll trainiert werden und seiner Beschäftigung als Rettungshund nachgehen.

Dr. Gerhard Biberauer, Vet-Dental-Service, http://www.kleintier-ordination.com

Fig. 8[/size]

[Murat KUTAY]

[size=x-large]Periodontal splinting in a dog
Lisa is a 11 year old female spayed that has an advanced periodontal disease due to the presence of advanced periodontal disease, with increased mobility of the frontal superior incisor teeth. We decided to apply a periodontal splint.

Upper and lower incisors, in groups or as a single tooth, may require stabilization because of bone loss from periodontal disease, particularly in toy-breed dogs. This stabilization is performed in conjunction with periodontal treatment. Mobile teeth interfere with post-surgical healing, often making it impossible to ensure remission of the periodontal disease.

Fig. 1

Mobile teeth are stabilized by splinting or ligating the involved tooth or teeth to stable abutment teeth, provided there are no missing teeth in the incisor segment. This can be accomplished in two ways: with the use of dental acrylics or composite filling material alone or with dental acrylic/composite and interdental ligation. After periodontal therapy the mobile teeth are placed in proper arch alignment.

Method I. Dental acrylic is applied to the contact areas between teeth and over the labial and lingual surfaces, making sure to prevent subgingival seeping of the acrylic. The acrylic is best applied by dipping a camel’s hair brush into the liquid, then dipping the brush into a small reservoir of powder. This small amount of mixed acrylic is then carried to the contact area. This is repeated until sufficient material has been applied and allowed to cure.

Method II. The crowns and roots are thoroughly scaled and polished with a nonfluoride dental polish. The teeth are acid-etched (Fig. 1), and a band of transparent fiberglass material is glued to the equator area of the vestibular side of incisor teeth by using either a transparent light curing composite or alternatively by use of a cyanoacrylate glue. It is essential to leave sufficient space between the splint and the soft tissues to allow for proper oral hygiene. Finishing disks and burs are used to shape and smooth the surface of the teeth (Fig. 2 and 3).

After stabilization, the mouth is closed to check for occlusal contact. If the splinted teeth or tooth is found to strike the opposing incisors, the incisal edge of each affected tooth or maloccluding bulge of the splint is reduced and the bite rechecked until the occlusion is normal. Composite resins are somewhat more rigid than are acrylic splints; this may be a problem for the lower jaw because the symphysis is fibrous. The result is that a rigid splint joining the right and left lower incisors may break.

Dental splints, depending on the severity of the disease or bone loss, may be retained for a short period or for several years. Composite resins provide a more esthetic splint than does pink acrylic material; they will slowly wear down and require periodic reinforcement.

Fig. 3
[/size]

[Murat KUTAY]

[size=x-large]Severe Periodontal Disease and Post-extractional Oro-nasal Fistula
“Paco” a 13 year old Terrier dog, male castrated, has been operated as a consequence of severe periodontal disease, and we had no other choice but to perform a full-mouth extraction.

Fig. 1

Once again we can see the importance of prophylaxis in the prevention of oral and dental diseases. One of the most common disease in small animals, in particular in dogs is periodontal disease. A multifactorial disease where plaque, microflora, calculus, species, breed, genetics, general health, age, home dental care, chewing behavior, saliva , and local irritants are some of the most common factors that contribute to the apparition, onset and clinical form of periodontal disease.

Fig. 2

After our usual anesthesia protocol consisting of premedication, induction and maintenance with isofluran, we where able to asses the full clinical aspect of the dogÂ’s mouth. I guess that the photos (Fig.1-left side and Fig 2-right side) speak for themselves. Since all of the teeth with no exception had an increased mobility, a lot of calculus and plaque and as a consequence deep periodontal pockets filled with pus and debris. Considering his advanced age we were expecting a certain amount of geriatric periodontitis (periodontal ligament involution is normal after a certain age) but this was a real exception to the worse.

Fig. 3

We decided to extract all teeth, since not even one could be saved. The extraction did not pose any particular difficulty; however all the multirooted teeth were extracted by separating each root by means of high-speed turbine (300.000 rpm) and a round steel burr with a long shaft. The reason why we separated the roots was to avoid iatrogenic fracturing of the alveolar wall, and the mandible due to very deep infrabony pockets and alveolar bone resorption. The gruesome image of all teeth and their aspects is shown in Fig.3.

The risk of fracture is not the only complication that might occur due to advanced periodontal disease and deep infrabony pockets. Oro-nasal communication or fistula is another consequence of post-extractional complications . We had that happening to us after extracting both upper canini. We could see air bubbles coming in the mouth through the post extractional alveolus and blood coming through the respective nostril.

Fig. 4

We closed both oro-nasal communication by occluding the alveolus with a little piece of Tabotamp ® haemostatic material that has not only excellent haemostatic properties and is self resorbable but also offers an good occlusion material that facilitate the execution of the flap and the closure of the communication. The flap was designed by means of the Ellman radiosurgical unit (Fig.4). This excellent radiosurgery equipment can be used for many other procedure:

• Removal of hypertrophied tissue or scar tissue (epulis fissuratum, papillomatosis)

• Desensitization of hypersensitive dentin

• Gingivectomies, gingivoplasties

• Frenectomies

• Removal of soft tissues over impacted teeth to achieve tooth eruption

• Biopsies

• Incision and drainage of abscesses

• Periodontal flap surgery

• The unit is operating at 3.8MHz for smooth, bloodless cutting

Fig. 5

After preparing the flap by 2 releasing incisions (Fig.5) and having detached the palatal and vestibular mucosa with a periosteal elevator we proceeded in suturing the flap in a simple interrupted pattern with a Vycril 3.0 multifilament resorbable material (Fig.6).

The dog recovered well and although he has no teeth left in the mouth he manages to feed better than before with the deeply diseased teeth that only caused him pain.

DDr. Stoian Camil, PhD

Fig. 6[/size]

[Murat KUTAY]

[size=x-large]Bilateral eosinophilic granuloma in a Persian cat
A quite rare occurrence in the cat oral pathology is the eosinophilic granuloma complex, a pathologic entity that is three times more frequent in females than in males.

This makes even more rare this bilateral granuloma that appeared in an unusually young cat only 10 months old, not neutered male Persian cat named “Chicco”.

Fig.1

The tumoral formation was situated approximately in the area between the fourth premolar and first molar tooth on the buccal side of both mandibles (Fig.1). The growth on the right side of the mandible was almost twice larger (about 8 x 5 mm) than the one on the opposite side (Fig.2) and more irritated, edematous and congested from the continuous mechanical injury caused by the upper fourth premolar that was biting into it, thus leading to often bleeding episodes from the oral cavity.

Fig. 2

We decided to make an excisional biopsy, since the tumoral formation was well delimited and pediculated with a multilobular aspect. The premedication was performed using a combination of medetomidine, ketamine and methadone, the induction was done using propofol intravenously and maintenance with isofluran. The immediate post-operative analgesia was ensured using Buprenorphine.

Fig. 3

After the cat was anesthetized we began by shooting several X-rays using the dental unit Explor-X and classical retroalveolar films for both areas of the mandible involved in the tumoral process (Fig.3) using the parallel technique and a value of 0,28 s exposure time. After developing intra-operatively the X-ray films with our Periomat automatic developer we obtained normal images of both mandibles without any sign of bone involvement (Fig.4), thus reinforcing the decision to make an excisional biopsy.

Fig. 4

The surgery was performed using a looped bit and an Ellman radiosurgical unit, the tumor was removed with minimal bleeding the pedicle was well defined and removal easily performed (Fig.5). The lack o profuse bleeding together with the normal radiological images of the alveolar bone, tooth and periodontium led us to believe we are dealing with a benign process. The pathology proved that we were right and that it was a granulation tissue and not a neoplasm. The cat was released from our service the same day. A week later when we communicated the owner the diagnosis we found that the cat was doing well, no more oral bleeding episodes and regained the normal appetite and body weight.

Fig. 5[/size]

[Murat KUTAY]

[size=x-large]Lower lip avulsion
“Findling” is a 2 and a half months old female cat that was found on the street with the lower lip torn on the right side.

The lip avulsion started from the left canine tooth 304, and went all the way to the right side mandibular last molar (409) and the ventral border of the mandible (Fig.1).

Lower lip avulsion Fig. 1

As we can see from this figure the exposed tissue as a consequence of the avulsion is edematous, swelled and forming a crust on surface proving the injury was at least one day old. On top of everything we found another unusual thing, namely an ectopic second deciduous incisor which was lying between the second and third left side lower incisors with about 3 mm distance towards ventral (Fig.2).

After proper sedation with a combination of Domitor (80 mg/kg) and Ketamine (2.5 mg/kg), and local mental nerve block completed with a local infiltration with Ubistezin (articaine) we proceeded with the operation. Firstly we properly rinsed the area with an antiseptic solution containing propolis (obtained from bees and known to have a strong antiseptic effect), poviodine and iodine ether. After that we continued by debriding the edematous crusted tissue with the aid of a scalpel blade all the way to bleeding healthy tissue.

Lower lip avulsion Fig. 2

We also loosened using a periosteal decolator and the scalpel blade the lower lip which was contracted because of dehydration as a consequence of external exposure. We insured there are no necrotic areas left uncleaned and proceeded in suturing the lower lip. We used a combination of U shaped sutures with simple interrupted sutures using Vycril 4.0 resorbable multithreaded material and passed most of the sutures interdentally and behind canini. We also used simple monolayer sutures to re-appose the lip mucosa. The final view is self explanatory (Fig.3 and Fig.4).

Lower lip avulsion Fig. 3

We instituted a moderate pain control protocol using a single dose of injectable Rymadil (2mg/kg) administered subcutaneously and antibiotherapy with Clindamycin (11mg/kg) per os for 7 days. After 2 days the owner states that the cat feels and feeds happily.

DDr. Camil Stoian Phd., Mag. Helene Widmann

Lower lip avulsion Fig. 4[/size]

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