36 Complicated crown fracture of an immature tooth
The dog came back from a run bleeding from the mouth. The owners took the dog to their regular veterinarian, who identified a complicated crown fracture of 404. The dog was given analgesics and referred to us. The dog was seen by us the day after the injury occurred.
ORAL EXAMINATION – CONSCIOUS
He was a boisterous but non-aggressive dog, who allowed conscious examination of the face and a quick view of the oral cavity.
Occlusion was normal and there was a mild generalized gingivitis. The tip of the crown of 404 was fractured and the pulp was exposed.
ORAL EXAMINATION – UNDER GENERAL ANAESTHETIC
A thorough oral and dental examination, including investigating periodontal parameters, was performed. All findings were noted on the dental record sheet.
In summary, examination under general anaesthesia identified the following:
The radiographs confirmed that both 304 and 404 were immature teeth, as expected in a 7-month-old dog.
ORAL PROBLEM LIST
A partial pulpectomy and direct pulp capping procedure is indicated for recent tooth crown fractures with pulp exposure in immature teeth. An immature tooth has a thin dentine wall and an open apex, allowing a good blood supply to the pulp. Treatment is aimed at maintaining a viable pulp, as this is needed for continued root development.
To optimize success, a partial pulpectomy and direct pulp capping procedure needs to be performed as quickly as possible after the injury. Referral needs to be arranged on an emergency basis.
Once root development is complete, i.e. the apex has closed and sufficient dentine has been deposited, conventional endodontic therapy (pulpectomy and root filling) should be performed.