Uncomplicated crown fracture with periapical complications

32 Uncomplicated crown fracture with periapical complications




INITIAL PRESENTATION


No presenting signs.



PATIENT DETAILS


A 9-year-old, neutered female, springer cross.



CASE HISTORY


This case was seen as a new client when I was in first opinion practice.


The owner was interested in oral care, and the dog had received an annual scale and polish since she was 2 years old (seven episodes of periodontal therapy under general anaesthesia). She was fed a dental diet and given daily dental hygiene chews. The owner reported that the dog was worried about having her face touched. The dog had previously allowed toothbrushing, but had not allowed it for the last year.



ORAL EXAMINATION – CONSCIOUS


The dog was aggressive when the head was approached and conscious oral examination was not possible.



ORAL EXAMINATION – UNDER GENERAL ANAESTHETIC


A thorough oral examination, including investigating periodontal parameters, was performed and all findings were entered on the dental record sheet.


In summary, examination under general anaesthesia identified the following:


1. Mild to moderate accumulation of dental deposits

2. Mild to moderate generalized gingivitis

3. Uncomplicated crown fracture (UCF) of 108 and 208 (Fig. 32.1)

4. Drainage tract at the mucogingival junction of mesial 208 (Fig. 32.1).

image

Figure 32.1 Lateral photograph of 208. The uncomplicated crown fracture involved the tip of the main cusp and can be seen in this view as a short main cusp. Note the draining tract at the mucogingival line mesial to 208.



FURTHER INVESTIGATIONS


Radiographs were taken of 108 and 208.



RADIOGRAPHIC FINDINGS


The diameter of the pulp system of 108 was wide and the apices of the roots were open, indicating that the injury occurred during tooth development in the first year of life. There was also periapical inflammation with bone destruction and external root resorption (see Fig. 32.2 for details of the radiographic findings for 108).


image

Figure 32.2 Radiograph of the right upper caudal mandible. Note the wide diameter of the pulp chamber and the distal root canal of 108, indicating pulp necrosis and cessation of dentine production. Periapical pathology is evident. There is a significant periapical destruction of the distal root of 108 and the apical segment is rough and uneven, indicating inflammatory external root resorption. A second view was taken to visualize the mesial roots, which were also found to have external root resorption and periapical bone destruction.


The diameter of the pulp system of 208 was narrow and the apices were closed, i.e. it was a mature tooth, as expected in a 9-year-old dog. There was periapical inflammation with bone destruction. The drainage tract was shown to originate from the mesiopalatal root (see Fig. 32.3a, b for details of the radiographic findings for 208).


image

Figure 32.3 Radiographs centring on 208.


(a) Tooth 208 is mature with closed apices and narrow root canals, as expected in a 9-year-old dog. Lucent areas surround all three roots, indicating periapical bone destruction as a result of pulp necrosis.

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Sep 3, 2016 | Posted by in SMALL ANIMAL | Comments Off on Uncomplicated crown fracture with periapical complications
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