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[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. 1As 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. 2We 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][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.1The 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. 2We 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. 3After 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. 4The 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][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. 1Once 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. 2After 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. 3We 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. 4We 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. 5After 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][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. 1Mobile 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][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. 1Der 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. 4Therapie
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. 5Der 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. 6Etwa 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. 7Der 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]