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[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. 10A 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][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.1A 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.2This 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.3After 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. 4A 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. 5After 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. 6The 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]
[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. 1After 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. 4An 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. 5We 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. 6The 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[/size]
[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. 1The 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. 2The 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. 3The 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. 4Any 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. 5DDr. Stoian Camil, PhD, Dipl. EVDC
Fig. 6[/size]
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GEÇMİŞ OLSUN…
göreceğiz bakalım liverpool maçına dünyanın en iyi hakemi verilmiş…
bakalım sorun hakemlerdemi beşiktaştamı?
Veterinerlik Fakültesi yetkilileri, skandaldan Farmakoloji Bölümü’nden bir asistan veteriner hekimi sorumlu tuttu. Prof. Dr. A.B’nin taciz için kullandığı bekar evinin sahibinin de, aynı kadın asistan B.H. olduğu ortaya çıktı. Asistan B.H. de, taciz skandalının ardından sözleşmesi yenilenmeyerek okuldan uzaklaştırıldı.
ARKADAŞLAR İZNİNİZ OLURSA BU HABERİ KALDIRALIM…
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Özdemir: Rüşveti Bakanlığa Bildirdim
Haber: Özdemir: Rüşveti Bakanlığa Bildirdim
Resmi büyütmek için tıklayınMavi Hat Operasyonu Kapsamında İhaleye Fesat Karıştırmak Suçundan Tutuksuz Yargılanmasına Karar Verilen İşadamı Nihat Özdemir, Savunmasında ‘Rüşvet Olayını Bakanlığa Bildirdiğini’ Açıkladı.
Mavi Hat operasyonu kapsamında ihaleye fesat karıştırmak suçundan tutuksuz yargılanmasına karar verilen işadamı Nihat Özdemir, savunmasında “Rüşvet olayını bakanlığa bildirdiğini” açıkladı. İşadamı İbrahim Selçuk ile herhangi bir rüşvet anlaşması yapmadığını söyleyen Özdemir, savunmasında işi alabilmeleri için kendilerinden rüşvet istendiğini söyledi.
MAVİ Hat Operasyonu kapsamında BOTAŞ’ın ihalelerine fesat karıştırdığı iddiasıyla gözaltına alınan ve tutuksuz yargılanmasına karar verilen Fenarbahçe 2. Başkanı ve Limak Holding Yönetim Kurulu Başkanı Nihat Özdemir, suçlamaları reddederken “Rüşvet olayını Bakanlığa bildirdim” dedi.
HAKİM ÖNÜNE ÇIKTI: KOM Daire Başkanlığı ve Ankara Emniyet Müdürlüğü Organize Suçlarla Mücadele Bürosu’nun, Botaş’taki yolsuzluklar üzerine yürüttüğü Mavi Hat Operasyonu’nunda geçtiğimiz perşembe günü gözaltına alınan 12 kişi, Cumhuriyet Savcısı Mehmet Tamöz tarafından sorgulandı. Zanlılar, dün sabah saatlerinde sağlık kontrolünden geçirilerek Ankara Adliyesi’ne getirildi. 12. Sulh Ceza Mahkemesi’ne sevk edilen 8 sanıktan 5’i hakkında tutuklama kararı verilirken, aralarında Nihat Özdemir’in de bulunduğu 3 sanık ise tutuksuz yargılanmak üzere serbest bırakıldı. Davada tutuklu sayısı 31’e yükselirken, Özdemir ve diğer sanıklar için yurt dışına çıkış yasağı konuldu. Sanıklar hakkında adli kontrol altında tutulma kararı da alındı.
POLİSE İFADE VERMEDİ: Özdemir, emniyette kaldığı yaklaşık 40 saat içinde, “Savcıya konuşurum” diyerek, “susma hakkını” kullandı. Özdemir, önceki akşam emniyete gelen Savcı Tamöz’e 5 saat ifade verdi. Özdemir, 80 sayfalık ifadesinde hakkındaki suçlamaları kabul etmedi. Özdemir’in, “Diğer müteahhitlerin yaptığı konuşmalarda ismimin neden kullanıldığı konusunda bilgim yok. Sanıyorum benim ismimi kullanarak ihaleleri almaya çalışıyorlardı. Yaptığım telefon görüşmeleri yasal olarak takip ettiğimiz ihalelerdir ve bu ihalalerde hiçbir illegal yol izlemedik” dediği öğrenildi.
SUÇLAMALARI REDDETTİ: Mahkemede verdiği ifadesinde sanayici olduğunu ve 10 bin YTL aylık geliri bulunduğunu belirten Özdemir, kendisini şöyle savundu: “Limak Şirketler Grubu’nun ortaklarındanım, Tuz gölü su hattı ihalesine ilişkin ihaleye Erko ve Alke inşaatla birlikte katıldık. İhaleye katılmamıza rağmen üçüncü durumdaydık. İlk iki firmanın önemli eksiklerinden dolayı iş bizim konsorsiyuma kaldı. İbrahim Selçuk ile yanındaki arkadaşlar, ben ve diğer konsorsiyumdan yer alan şirketlerle irtibata girdiler. İşi biz almamamıza rağmen bu işi alabilmemiz için öncelikle kendilerine rüşvet vermemiz gerektiğini ifade ettiler. Ben de durumdan haberdar olunca herhangi bir anlaşma yapmadığım gibi görüşmeyi reddettik. Hatta ben durumu bakanlık üst düzey yetkilerine açıkca ifade ettim. İhaleden çekilmek istediğimizi kendilerine bildirdim. İhale Dünya Bankası kriterlerine göre yapıldığından dolayı her 90 günde bir teklifimize devam edip etmediğimiz sorulmaktadır. Bu nedenle teminatımızın iadesi hususunda ihaleye fesat karıştırmamız söz konusu olamaz.”
TEKLİFİ KABUL ETMEDİM: Bu operasyonda adı geçen İbrahim Selçuk ile olan tanışıklığını ise Özdemir, şöyle anlattı: “İhaleden çekilmemizden dolayı teminatımız da şartname gereği serbest kalmıştır. Sezai Bacaksız benim ortağımdır. Ben İbrahim Selçuk’u ise bu ihale nedeniyle kendisinin bizi aramasıyla tanıdım. Kendisiyle herhangi bir rüşvet anlaşması yapmadım, rüşvet teklifini kabul etmediğim telefon görüşmelerinde de açıkça tesbit olunmuştur. Ayrıca tarafımıza ait Limak İnşaat’a İbrahim Selçuk gelerek yukarıda belirtiş olduğum rüşvet teklifinde bulunmuştur. Bu nedenle birkaç defa daha diğer aradaşlar görüşmüş olabilir. Ancak benimle bir defa görüştü.”
İki gece nezarette kaldı
TUZGÖLÜ Gaz Depolama İnşaatı ve Şahdeniz Boru Hattı ihaleleriyle ilgili sorgulanan Nihat Özdemir’in, teslim olmadan bir gün önce Ankara’da bulunan evine, organize polisinin arama yapmak amacıyla gittiği ortaya çıktı. Özdemir’in ailesinin, “Şu an yurtdışında bir gün sonra teslim olacak” demesi üzerine, polis tutanak tutarak durumu savcılığa bildirdi. Mavi Hat Operasyonu kapsamında halen 40 kişinin arandığı, gözaltıların önümüzdeki günlerde devam etmesi bekleniyor.
İLK GECE UYUYAMADI: Nezarette iki gece kalan Özdemir’e emniyetin anlaşmalı olduğu yemek firmasından, iki gün süreyle soğuk sandviç ve kek getirildi. Özdemir, nezarethaneyi kendisi gibi müteahhit olan ve savcının ifadesini aldıktan sonra serbest bıraktığı Metin K. ile paylaştı. Özdemir, ilk geceyi uyumadan geçirdi.
GÖRÜNTÜYE KARŞI ÇEVİK KORUMA: Duruşmanın görüldüğü mahkeme kapısı önünde bekleyen gazeteciler ise, polisin tepkisi ile karşılaştılar. Polis, koridorda beklemekte olan gazetecilerin adliyeden çıkmasını istedi. Gazeticilerin itirazı üzerine polisle gerginlik yaşandı. Bunun üzerine içeriye çevik kuvvet timi girdi. Çevik kuvvete mensup 50 kişilik polis timde, gaz atar tüfek ve göz yaşartıcı spreyler olduğu görüldü. Gazetecilerin etrafına etten duvar ören polis görüntü alınmasını engelledi.
daha sonra nihat özdemir serbest bırakıldı….