Saving a tooth by endodontic treatment
(18.10.2004) Bodo is a 2,5 years young American Staffordshire Terrier, neutered male dog. Due to a trauma, he fractured his left upper caninus.
After 3 months he started having pain during feeding. When he came to our clinic, during the visual inspection we could see a vestibular fistula that expressed a little drop of pus, just above the gum line of the left caninus (or 204 in Triadan nomenclature), please see Fig. 1.
We performed a X-ray using 2 projections: parallel and bisecting angle. After developing of the size 4 occlusal films we could see two distinct areas of translucency just mesial and distal to the root of the tooth and not apically as we would normally expect. Please see Fig. 2. This also explains the location of the fistula.
The therapeutical decision was to save the tooth, since together with the fourth premolars upper and lower molars, the canine teeth are the most important teeth in carnivores. Saving the tooth was done by means of endodontic therapy.
After creating a secondary access opening to facilitate entering with the files (Nerve broaches, Haedstrom files, etc) all the way to the apex of the tooth. This secondary opening is not necessary in human endodontics but in carnivores due to the angulation of the root is impossible to reach the apex without this accessory opening, Fig. 3.
After the necrotic pulp was extirpated with the nerve broaches (tire-nerves) we performed the mechanical cleaning and enlargement of the root canal by a combination of manual filing (using Kerr and Haedstrom files) and ultrasound filing (using an adapted file for the regular descaler unit). A thorough flushing with sodium hypochlorite and peroxide alternately followed this procedure. Drying of the canal was performed using veterinary size paper cones and air spray. We used a 2 component endodontic cement applicable with a special syringe (RSA RoekoSeal Automix) and gutta-percha cones, Fig. 4
The intermediate filling consisted of a light curing glass-ionomer cement (GC Fuji II LC), after which a light curing A3 shade composite (LC Hybrid DS) was used for the accessory opening restoration and non-gamma amalgam for the fracture site of crown, see Fig. 5
A control X-ray showed a very good quality closure of the tooth pulp and root canal, Fig. 6.
Bodo was recommended not to feed only soft food for 2 days , antibiotherapy (clindamycin for 7 days) to prevent possible bacterial infections, and to return for control in 6 weeks. At that time, an X-ray should be performed to control the status of the caninus.
DDr. Camil Stoian PhD, Mag. Helene Widmann