Success of Occlusal Aperture Access for Endodontic Therapy of Canine Teeth in Dogs.

The objective of this study was to determine the success of the natural crowns of endodontically treated canine teeth in pet dogs, instrumented and obturated using rotary driven non-taper nickel titanium files, through an occlusal access preparation, without the placement of a prosthetic cast metal crown. A search of medical records at a private veterinary dental referral practice was conducted to identify pet dogs having had endodontic treatment of one or more canine teeth over an eleven-year period (2007-2018). Follow up, performed by the same veterinary dental specialist, included a complete oral health assessment under general anesthesia and included intraoral radiography thereby allowing close visual examination of the crown and restoration as well as assessing endodontic success. Time to follow up was between two and nine years after treatment with a mean of 4.5 years. Analysis revealed that 29/29 (100%) of the treated crowns maintained their stability and did not require extraction. 5/29 (17.2%) of the treated teeth had an enamel fracture requiring additional treatment to the crown after the initial treatment; 1/29 (3.4%) had additional abrasion but did not require treatment and 23/29 (79.3%) were found to have sustained no additional damage. This study supports endodontic treatment without the placement of a prosthetic crown in canine teeth in pet dogs when an occlusal access site is used as described in this paper. Further study is required on the increased risk of fracture of the remaining unaltered canine teeth.

Success of Feather Margin Preparation for Full Metal Prosthodontic Crowns in the Canine Teeth in 84 Pet and Working Dogs (2005-2017).

Medical and dental records of Veterinary Dental Specialties and Oral Surgery were searched to identify dogs that received full metal prosthodontic crowns on canine teeth, using a feather or knife edge preparation between 2005 and 2017. A total of 160 teeth in 84 dogs were included in the study. Current follow-up by telephone, electronic mail, or electronic messaging was conducted, in addition to thorough record review for in-person recheck examinations. Treatment was considered successful if the prosthodontic crown was in place and no further or additional injury to the tooth had occurred at the time of reexamination, owner contact, or patient death. Tooth fracture apical to the prosthodontic crown occurred in 2 (1.25%) cases, bond failure between the tooth and the cement or the cement and the crown occurred in a single case (0.625%), and one metal crown required replacement after 3 years due to wear (0.625%), for an overall failure rate of 2.5%. These results suggest that feather preparation of the margin is at least as, if not more, successful as the more commonly accepted and performed chamfer margin, and thus is a successful, practical and durable option for prosthodontic crown treatment in dog canine teeth.

Decision-Making and Management of Immature Permanent Teeth with Crown Fractures in Small Animals-A Review.

Immature permanent teeth with crown fractures present a unique challenge in human and animal patients. Immature permanent teeth have not yet developed completely, often presenting with thin dentin walls, incomplete apical formation, and increased crown-to-root ratios. Loss of pulp function at this stage has devastating long-term implications for these teeth. Ideally, attempts should be made to preserve pulp vitality in immature permanent teeth to allow for continued dental development. The range of treatment options for vital teeth includes odontoplasty with bonding and sealing +/- restoration, indirect pulp capping, and direct pulp capping/vital pulp therapy. These treatments have long been established in human and veterinary medicine, and cases have been reported in dogs and cats. Apexification using calcium hydroxide is a well-established treatment for nonvital immature teeth. The advent of mineral trioxide aggregate and other bioceramic materials for use in vital pulp therapy and apexification has reduced treatment sessions and improved outcomes. Recent developments in the field of regenerative endodontic therapy further expand treatment options and provide the possibility for continued development of a formerly nonvital tooth. Selecting the appropriate treatment based on the severity of tooth fracture and status of pulp vitality can avoid a lifetime of poor structure and function for the affected tooth. This article provides multiple step-by-step protocols for the management of immature permanent teeth with crown fractures in small animals.

Orthodontic Treatment for Linguoversion of Mandibular Canine Teeth Using Crown Extensions.

This step-by-step article describes the process to apply and remove crown extensions for the treatment of linguoversion of the mandibular canine teeth. The process offered in this article provides a guideline for practitioners to become more comfortable with using crown extensions to treat a common malocclusion seen in companion animals.

The Incidence of Radiographic Lesions of Endodontic Origin Associated With Uncomplicated Crown Fractures of the Maxillary Fourth Premolar in Canine Patients.

Fractured maxillary fourth premolar teeth are commonly diagnosed in canine patients. These fractures are subdivided into uncomplicated and complicated, depending on absence or presence of pulp exposure, respectively. Pulp injury associated with fractures can lead to pulpitis, pulp necrosis, and "lesions of endodontic origin" (LEO) on intraoral radiographs. The incidence of LEO associated with uncomplicated crown fractures (UCFs) of the maxillary fourth premolar in canine patients is currently unknown. We hypothesized that a significant number of UCFs of the maxillary fourth premolar would have LEO evident on intraoral radiographs. The purpose of this article was to identify this incidence and to illustrate the importance of radiographing these teeth. This was a retrospective study of 111 UCFs and 500 nonfractured (control) maxillary fourth premolars in domestic canine patients. The frequency of LEO was 24.3% (27/111) in the UCF population and 0% (0/500) in the control population (P < .0001). These findings are important because UCFs are sometimes ignored or considered insignificant, when in fact a large proportion of them have LEO, indicating periapical pathology. These results suggest that all UCFs be radiographed, even if there are no other abnormalities noted on clinical oral examination.

Assessment of Temporary Crown Extensions to Correct Linguoverted Mandibular Canine Teeth in 72 Client-Owned Dogs (2012-2016).

A search of the medical and dental records at Evidensia Lørenskog Dyreklinikk, in Lørenskog, Norway, was conducted to identify dogs that received temporary crown extensions (TCEs) to correct linguoverted mandibular canine (LMC) teeth over a 54-month investigation period (2012-2016). Criteria for inclusion into the study were the presence of complete medical and dental records, pre- and postoperative clinical photographs and intraoral radiographs of the affected canine teeth, adequate information pertaining to the procedures performed, and at least 1 follow-up >3 months after appliance removal. Seventy-two dogs with LMC teeth were treated with TCE. Thirty-nine breeds were represented in this study. Mean age at the time of appliance installation was 6.4 (range, 4.7-13.4 months [median, 5.9 months] months). Fifty-three (73.6%) dogs presented with class I malocclusion, 14 (19.5%) dogs with class II malocclusion, and 5 (6.9%) dogs with class III malocclusion. Twenty-five (34.7%) dogs were considered to have mild, 32 (44.4%) dogs to have moderate, and 15 (20.8%) dogs to have severe mandibular canine malocclusion. The TCE was combined with other treatment modalities (active orthodontics, extraction of nonstrategic teeth, gingivectomy, and inclined bite plane and ball therapy) to correct mandibular canine tooth malocclusions in 19 (26.4%) dogs. Fractured or detached crown extensions were seen in 9 (12.5%) dogs. Soft tissue ulceration or inflammation was seen in 7 (9.7%) dogs. The mandibular canine teeth occlusion resolved completely with self-retaining, functional, nontraumatic occlusion in 56 (77.8%) dogs. Fifteen dogs (20.8%) resolved with functional, nontraumatic occlusion, but the mandibular canine teeth were too short to be perfectly self-retained, thus left with 1- to 2-mm crown extensions for permanent retention. In 1 (1.4%) dog, both mandibular canine teeth relapsed almost back to original position. The results show that TCE is a viable treatment option to correct LMC teeth in young dogs.

A Review of Dental Cements.

This review provides an in-depth comparison of advantages and disadvantages of different types of dental cements as they are used for cementing base metal alloy crowns in dogs.

Cementation of Full Coverage Metal Crowns in Dogs.

This step-by-step article describes the technique for cementation of a full metal prosthodontic crown on the maxillary fourth premolar tooth of a dog using a common resin-based cement.

Assessment of 68 Prosthodontic Crowns in 41 Pet and Working Dogs (2000-2012).

A search of the medical and dental records at the Matthew J. Ryan Veterinary Hospital of the University of Pennsylvania was conducted to identify dogs that received full or partial prosthodontic crowns over a 13-year period (2000-2012). Forty-one dogs with a total of 68 prosthodontic crowns were identified. Further criteria for acceptance into the study included presence of complete medical records containing adequate information pertaining to the procedures performed, and current follow-up either by telephone, electronic mail, or via in-person examination. Treatment was considered to be successful when the prosthodontic crown was in place and there was no further structural injury to the tooth upon making contact with the client or at the time of death of the dog confirmed by the client. The mean number of days the prosthodontic crowns remained in place without further injury to the tooth was 1,598 (range, 161-4, 464 days [median, 1,414 days], standard deviation 1,093 days). Bond failure between the cement and the tooth or the cement and the prosthodontic crown occurred in 3 cases (4.4%). Fracture of the prosthodontically treated tooth occurred in an additional 7 cases (10.3%). Treatment was classified as successful in 58 cases (85.3%). The results suggest that prosthodontic crown therapy is a successful, practical, and durable treatment option for protection of previously injured teeth in pet and working dogs.

Effect of preparation surface area on the clinical outcome of full veneer crowns in dogs.

Crown therapy is commonly used in veterinary medicine to provide support to teeth which have previously fractured, received root canal therapy, have significant wear, or experienced other detrimental removal of tooth substance. As with several aspects of veterinary medicine, many of the recommendations or guidelines for crown therapy originate from human dentistry, which are then transferred to veterinary patients. Due to the significant difference in the anatomy of teeth and function of the oral cavity between humans and dogs, these guidelines need to be studied to determine the appropriateness of their use in veterinary patients. This article evaluates the relationship between surface area of the preparation and clinical outcome of full veneer crown therapy of the canine tooth in dogs. Although there appeared to be a positive relationship between preparations with greater surface area and successful clinical outcome, it was not found to be statistically significant.

Crown preparation design: an evidence-based review.

Evidence-based clinical guidelines for full metal crown preparation design are seldom encountered in the veterinary literature. The veterinary literature regarding prosthodontic treatment in companion animals is sparse and consists primarily of case reports and expert opinion based primarily on clinical experience. The goal of this manuscript is to present concepts of evidence-based practice, review common recommendations on crown preparation design from the veterinary literature, and to provide an assessment of the evidence for or against those recommendations.

Achievable convergence angle and the effect of preparation design on the clinical outcome of full veneer crowns in dogs.

It is widely accepted that the convergence angle of a full veneer crown preparation should be as close to parallel as possible to attain adequate retention/resistance. The shape of the dog's canine tooth limits the veterinary dentists' ability to achieve the recommended convergence angle. However, the clinically achievable convergence angle of the canine tooth in dogs has not been evaluated. In addition, the convergence angle and other physical properties of a preparation, such as height and base diameter, have been shown to affect the retention/resistance of full veneer crowns, in vitro. This effect has not been evaluated clinically in the dog. Physical properties of 32 stone dies from full veneer crowns of canine teeth were studied to evaluate the clinically achievable convergence angle and the potential effect physical properties of the preparation had on the clinical outcome of the restoration. The clinically achievable convergence angle was much higher than the current recommendation. There was an association, albeit not statistically significant, between physical properties of a preparation (convergence angle, height, base diameter) and the clinical outcome of the restoration.

Crown restoration of the endodontically treated tooth: literature review.

The reviewed literature supports full crown restoration in all endodontically treated teeth other than incisors in humans [corrected] In general terms, a crown is a cemented, extra-coronal restoration that covers the entire outer surface of the clinical crown. Prosthodontic treatment, and particularly crown restoration in veterinary patients has been the subject of general informational articles and veterinary dental texts. These publications have discussed techniques for crown preparation, fabrication, and cementation as well as the general principles of prosthodontic treatment. The purpose of this review is to present available information on this topic in an organized manner which will help veterinary dentists to use an evidence-based approach when deciding on a type of final restoration for their endodontic patients.

[Adhesively cemented full-cast metal crowns on traumatized canine teeth in working dogs]. / Resultaten van adhesief gecementeerde metalen kronen op getrau- matiseerde hoektanden bij werkhonden.

In this retrospective study, 58 metal crowns were placed in 35 guard dogs with fractured or severely worn canines. All animals could resume their work after treatment. Only three metal crowns came off (5%) and two metal crowns were lost for unknown reasons. At a later stage, six canine teeth (100%) broke off underneath the crown during dog training. The success rate of this procedure in our clinic was therefore 81% (47/58). A significant correlation was found between the height of the tooth stump and the loss of the crown. Recommendations for further research were made.

Assessment of vital pulp therapy for nine complicated crown fractures and fifty-four crown reductions in dogs and cats.

Subjective owner assessment of the success of vital pulp therapy was performed for complicated crown fracture (n = 9) and crown reduction (n = 54) of canine teeth in dogs and cats. Our results documented that owners are not able to accurately determine the outcome of vital pulp therapy. Objective assessment of vital pulp therapy for teeth receiving crown reduction indicated maintenance of vitality in 28 of 28 (100%) teeth. Subjective and objective assessments of vital pulp therapy performed > 7-days following complicated crown fracture indicated 9 of 9 (100%) teeth were non-vital. A poor prognosis for maintenance of tooth vitality is warranted for vital pulp therapy of complicated crown fractures with prolonged pulp exposure regardless of the age of the patient. Whereas, an excellent prognosis can be provided for vital pulp therapy following crown reduction. Semiannual, postoperative oral and radiographic examinations are recommended for a minimum of 2-years to assess vitality in all teeth receiving vital pulp therapy.